HomeMy WebLinkAboutWI0501096_Injection Event Record_20221101RECEIVED
NOV 012022
NC DEQ1Norlb
D Carolina Department of Environmental Quality — Division of Water Resources
Central Office INJECTION EVENT RECORD (IER)
Permit Number WI0501096
. Permit Information
Eaton
Permittee
Former Selma Facility
Facility Name
1100 East Preston Street. Selma, Johnston County.
NC 27576
Facility Address (include County)
2. Injection Contractor Information
Draper Aden Associates. a TRC company
Injection Contractor / Company Name
Street Address 114 Edinburgh South Drive
Cary
City
NC
State
27607
Zip Code
C919D 827-0864
Area code — Phone number
3. Well Information
Number of wells used for injection 5 injection wells
Well IDs IW-61A. 61B. 62A. 62B. 63A, 63B,
64A. 64B. 65A, 65B
Were any new wells installed during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
EOS Plus, Potable water
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration _ 100% EOS Plus product
If the injectant is diluted please indicate the source
dilution fluid. Chase water- Hydrant along East
Preston Street
Total Volume Injected (gal) 2.610
Volume Injected per well (gal) Approximately 260
5. Injection History
Injection date(s) October 10-12, 2022
Injection number (e.g. 3 of 5) 1 of 1
Is this the last injection at this site?
❑ Yes ® No
I DO HEREBY CERTIFY THAT ALL THE INFORMATION ON
THIS FORM IS CORRECT TO THE BEST OF MY KNOWLEDGE
AND THAT THE INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
10/13/2022
SIGNATURE OF INJECTION CONTRACTOR DATE
SEAN JARVAH
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 3-1-2016