WI0400599_Application_20230518

North Carolina Department of Environmental Quality—Division of Water Resources
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Groundwater Remediation (15A NCAC 02C.02251
Do not use this form for UIC wells Permitted by Rule(ref. 15A NCAC 02C .0217)
Permit Number(to be completed by DWR for new projects): WI0400599
I. APPLICATION INFORMATION
1. Project is: []New [X] Modification [ ] Renewal without modification [] Renewal with modification
2. If this application is being submitted for Renewal and/or Modification to an existing permit,provide:
Existing permit numberWI0400599 Issued Date:NA(from pilot test notification) &Expiration
Date: NA(same as before)
For all Renewals, attach an updated site map and status report including monitoring results of all injection activities
to date.
For Renewal without modification only,fill out sections I&II only,sign the certification on the last page of this form,
and obtain the property owner's signature to indicate consent(f the applicant is not the owner).
II. WELL OWNER(S)/PERMIT APPLICANT(generally the responsible party)
1. Name(s): Illinois Tool Works, Inc. (ITW)
2. Signing Official's Name*: Mr. Andrew Dorn,PE Title: Sr. Environmental Engineer
* Signing Official must be in accordance with instructions in Part XII.
3. Mailing address of Permittee/Applicant: 155 Harlem Avenue
City: Glenview State: IL Zip: 60026
4. Telephone number: 224-661-8870 Email: adorn(iDitw.com
5. Status (choose one): Individual X Business/Org. Federal State County Municipality
III. PROPERTY OWNER(S) (if different than well owners)
1. Name(s): Associated Posters, Inc./Robert Arnold,President
2. Mailing address: 2737 West Mountain Street
City: Kernersville State: NC Zip: 27284
3. Telephone number: 336-723-1018 Email: robert(kassociatedposters.com
IV. PROJECT CONTACT—(generally the environmental/engineering consultant).
1. Name: Helen Corley,PG Title: Service Line Lead
2. Company: WSP Environment&Infrastructure,Inc.
3. Address: 2801 Yorkmont Road, Ste 100
4. City: Charlotte State: NC Zip: 28208
5. Telephone number: 704-357-8600 Email: helen.corley(&wsp.com
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V. FACILITY INFORMATION
1. Facility name: Former CCI National Fleet Supply Facility Phone No. (if available):
2. Physical address: 2744 West Mountain Street
City: Winston Salem County: Forsyth Zip: 27284
3. Geographic Coordinates: Latitude: 36.11341 Longitude: -80.16168
Reference Datum: Center of site parcel Accuracy:
Method of Collection(i.e.,Google Earth,GPS,etc.): Google Earth
4. Brief description of business: Former brake manufacturer,now vacant property
VI. INCIDENT DESCRIPTION
1. Source and date of contamination: The 2744 West Mountain,former CCI National Fleet Supply Facility,propegy was
formerlypied by an approximately 29,000 square foot manufacturing building constructed in the early 1960s. The
building was used as a brake manufacturingfty from initial construction until the early 2000s. A release from the
petroleum underground storage tank ank system at the adjacent One Stop property was discovered in the early 1990s,at which
time chlorinated solvents were detected in groundwater. Subsequent assessment activities indicated the presence of
chlorinated volatile organic compounds OCs)and 1,4-dioxane above their respective NC 2L Standards that stemmed
from the former CCI property.
2. List all contaminants present in soils or groundwater at the site(contaminants may be listed in groups, e.g.,gasoline,
diesel,jet fuel,fuel oil, chlorinated ethenes, chlorinated ethanes, metals,pesticides/herbicides, etc):
1,4-dioxane and chlorinated solvents (primarily trichloroeth, lam)
3. Has LNAPL or DNAPL ever been observed at the site(even if outside the injection zone)?
[ ] Yes If yes, list maximum measured separate phase thickness: feet
[X]No If no, list maximum concentration of total VOCs observed at site: 1,115 (MW-6,2002)—ppb
4. Agency managing the contamination incident:
[ ] UST Section [X] Superfund Section(including REC Program and DSCA
sites)
[ ] DWR Aquifer Protection Section [ ] Solid Waste Section
[ ] Hazardous Waste Section [] Other:
5. Incident manager's name: Thomas Moore Phone No.: 336-776-9678
6. Incident number or other incident mgmt. agency tracking number: IHSB NONCD0001720
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VII. PERMITS
List all applicable permits or construction approvals issued for the facility or incident:
1. Previous or other UIC permits issued by DWR(e.g.,NOIs) W10400567 from pilot testing_
2. Other Non-Discharge or NPDES permit issued by DWR:
3. County or DEH subsurface wastewater disposal permits:
4. Hazardous waste management or other environmental permits required by state or federal law:
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VIII. INJECTION SUMMARY
1. List all proposed injectants/additives.
NOTE: Only injectants approved by the epidemiology section of the NC Division of Public Health, Department of
Health and Human Services can be injected. Approved injectants can be found online at
hlt 2:Hdeq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/ground-water-approved-injectants. All other substances must be reviewed by the DHHS prior to use.
Contact the UIC Program for more info ifyou wish to get approval for a different additive. However,please note
it may take 3 months or longer. If no iniectants are to be used use N/A.
Injectant: Sodium Persulfate Total Amt.to be injected(gal)/event: —5480 ,gallons
Injectant: Sodium Hydroxide Total Amt. to be injected(gal)/event: —1725 gallons
Injectant: Iron Ethylenediaminetetraacetic acid[Fe(EDTA)] Total Amt. to be injected(gal)/event: —46 gallons
Injectant: Municipal Water Total Amt. to be injected(gal)/event: —15,749 gallons
Injectant: Total Amt. to be injected(gal)/event:
Total Amt.to be injected(gal/event): —23,000 gallons
No. of separate injection events: I Total Amt.to be injected(gal): 23,000
Source of Water(if applicable): Municipal fire hydrant along West Mountain Street
2. Estimated Injection rate per well: 2 GPM
3. Estimated Injection pressure: <20 pounds/square inch(PSI)
4. Temperature at point of injection: 75 (ambient temperature) OF
5. Injection will be via:
Existing well(s)-Total No.: 4 ;Well Type(DPT,Permanent, etc.): Permanent
Proposed well(s)-Total No.: 19 ;Well Type (DPT,Permanent, etc.): Permanent
6. NC Certified Well Drilling Contractor's Name(if known): Michael Tynan
NC Well Contractor Certification No.: 2725-A
7. Date to be constructed if proposed: May 22-June 6, 2023 (attach well construction records [GW-1 s] for
existing injection wells)
8. Screened interval/Injection interval of injection wells (IWs):
Screened depth from 30 to 45 feet below land surface(BLS)for 16 IWs and 45 to 60 feet BLS for 3 IWs
9. Well casing(leave blank if Geoprobeso): Below describes permanent injection well construction.
Type(PVC, stainless steel, other): PVC for 16 of 19 wells
Casing depth: 0—to-45 ft. BLS
Type(PVC, stainless steel, other): PVC for 3 of 19 wells
Casing depth: 0 to 60 ft. BLS
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10. Grout(leave blank if Geoprobes):
Type (cement,bentonite, other): bentonite for 16 of 19 wells
Grout depth: 22 to 27 ft. BLS
Type (cement,bentonite, other): cement/grout
Grout depth: 0 to 22 ft. BLS
Type (cement,bentonite, other): bentonite for 3 of 19 wells
Grout depth: 37 to_42 ft. BLS
Type (cement,bentonite, other): cement/grout
Grout depth: 0 to_37 ft. BLS
IX. ATTACHMENTS—provide the following information in separate attachments. The attachments should be clearly
identified and presented in the order below to expedite review of the permit application package.
1. INJECTION ZONE — Per 15A NCAC 02C .0225(fl(3), specify the horizontal and vertical portion of the subsurface
within which the proposed injection activity will take place and beyond which no violations of groundwater quality
standards shall result from the injection as determined by an approved monitoring plan. The determination shall be
based on the hydraulic properties of the specified zone. Provide any supporting documentation in a separate
attachment.
SEE ATTACHMENT 1
2. HYDROGEOLOGIC EVALUATION — Per 15A NCAC 02C .0225(fl(4), provide a hydrogeologic evaluation of the
injection zone that includes all of the following: SEE ATTACHMENT 1
(A) Regional and local geology and hydrology;
(B) Changes in lithology underlying the facility;
(C) Depth to bedrock;
(D) Depth to the mean seasonal high water table;
(E) Hydraulic conductivity,transmissivity,and storativity,of the injection zone based on tests of site-specific material,
including a description of the test(s)used to determine these parameters;
(F) Rate and direction of groundwater flow as determined by predictive calculations or computer modeling;
(G) Lithostratigraphic and hydrostratigraphic logs of any existing test and injection wells; and
(H) For systems re-injecting treated on-site contaminated groundwater only- evaluation of infiltration galleries or
injection wells.
3. INJECTANT INFORMATION—Per 15A NCAC 02C.0225(fl(6),provide information on each injectant as indicated
below:
SEE ATTACHMENT 1
(A) MSDS, concentration at the point of injection, and percentage if present in a mixture with other injectants;
(B) The source of fluids used to dilute,carry,or otherwise distribute the injectant throughout the injection zone. If any
well within the area of review of the injection facility is to be used as the fluid source,then the following information
shall be submitted: location/ID number, depth of source, formation, rock/sediment type, and a chemical analysis
of the water from the source well, including analyses for all contaminants suspected or historically recognized in
soil or groundwater on the site;
(C) A description of the rationale for selecting the injectants and concentrations proposed for injection, including an
explanation or calculations of how the proposed injectant volumes and concentrations were determined;
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(D) A description of the reactions between the injectants and the contaminants present including specific breakdown
products or intermediate compounds that may be formed by the injection;
(E) A summary of results if modeling or testing was performed to investigate the injectant's potential or susceptibility
for biological, chemical, or physical change in the subsurface; and
(F) An evaluation concerning the development of byproducts of the injection process, including increases in the
concentrations of naturally occurring substances. Such an evaluation shall include the identification of the specific
byproducts of the injection process, projected concentrations of byproducts, and areas of migration as determined
through modeling or other predictive calculations.
4. INJECTION PROCEDURE—Per 15A NCAC 02C.0225(fl(7),submit a table with a detailed description of the proposed
injection procedure that includes the following: SEE ATTACHMENT 1
(A) The proposed average and maximum daily rate and quantity of injectant;
(B) The average maximum injection pressure expressed in units of pounds per square inch(psi); and
(C) The total or estimated total volume to be injected.
5. FRACTURING PLAN(if applicable)—Per 15A NCAC 02C.0225(t)(9), submit a detailed description of the fracturing plan
that includes the following: NOT APPLICABLE
(A) Material Safety Data Sheets of fracturing media including information on any proppants used;
(B) a map of fracturing well locations relative to the known extent of groundwater contamination plus all buildings,
wells, septic systems,underground storage tanks, and underground utilities located within the Area of Review;
(C) a demonstration that buildings,wells, septic systems,underground storage tanks,and underground utilities will not
be adversely affected by the fracturing process;
(D) injection rate and volume;
(E) orientation of bedding planes,joints, and fracture sets of the fracture zone;
(F) performance monitoring plan for determining the fracture well radius of influence; and
(G) if conducted, the results of geophysical testing or pilot test of fracture behavior conducted in an uncontaminated
area of the site.
6. WELL CONSTRUCTION DETAILS — Per 15A NCAC 02C .0225(D(l0), submit the following information in tabular or
schematic form as appropriate for each item: SEE ATTACHMENT 1,FIGURE 1 AND TABLE 1
(A) number and depth of injection wells;
(B) number and depth of borings if using multi-level or"nested"well systems;
(C) indication whether the injection wells are existing or proposed;
(D) depth and type of casing;
(E) depth and type of screen material;
(F) depth and type of grout;
(G) indication whether the injection wells are permanent or temporary"direct push"points; and
(H) plans and specifications of the surface and subsurface construction details.
7. MONITORING PLAN—Per 15A NCAC 02C,0225(fl(11), submit a monitoring plan that includes the following:
SEE ATTACHMENT I,Table 1 and Table 2
(A) target contaminants plus secondary or intermediate contaminants that may result from the injection;
(B) other parameters that may serve to indicate the progress of the intended reactions;
(C) a list of existing and proposed monitoring wells to be used; and
(D) a sampling schedule to monitor the proposed injection.
Monitoring wells shall be of sufficient quantity and location to detect any movement of injection fluids, injection process byproducts, or
formation fluids outside the injection zone. The monitoring schedule shall be consistent with the proposed injection schedule,pace of
the anticipated reactions, and rate of transport of the injectants and contaminants.
8. WELL DATA TABULATION—Per 15A NCAC 02C.0225(f)(12,provide a tabulation of data on all existing or abandoned
wells within the area of review of the injection well(s) that penetrate the proposed injection zone, including monitoring
wells and wells proposed for use as injection wells. Such data shall include a description of each well's type, depth, and
record of construction or abandonment. SEE ATTACHMENT 1,TABLE 1
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9. MAPS AND CROSS-SECTIONS — Per 15A NCAC 02C .0225(f)(13), provide scaled, site-specific site plans or maps
depicting the location, orientation, and relationship of facility components including the following: SEE FIGURES
ATTACHED
(A) area map based on the most recent USGS 7.5' topographic map of the area, at a scale of 1:24,000 and showing the
location of the proposed injection site;
(B) topographic contour intervals showing all facility related structures, property boundaries, streams, springs, lakes,
ponds, and other surface drainage features;
(C) all existing or abandoned wells within the area of review of the wells listed in the well data tabulation that penetrate
the proposed injection zone;
(D) potentiometric surface map(s)that show the direction of groundwater movement, existing and proposed wells;
(E) contaminant plume map(s)with isoconcentration lines that show the horizontal extent of the contaminant plume in
soil and groundwater, and existing and proposed wells;
(F) cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical extent of
the contaminant plume in soil and groundwater,major changes in lithology, and existing and proposed wells; and
(G) any existing sources of potential or known groundwater contamination, including waste storage, treatment, or
disposal systems within the area of review of the injection well or well system.
X. UIC SYSTEMS RE-INJECTING TREATED ON-SITE CONTAMINATED GROUNDWATER ONLY
NOT APPLICABLE
1. FEES—Per 15A NCAC 02C .0225(m), submit/attach fees for new permits or modifications (refer to fee schedule
at hlt 2s://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/non-discharge-groundwater-remediation
2. SOILS EVALUATION-Per 15A NCAC 02C .0225(f)(2), for systems with proposed discharge within seven feet
of land surface and above the seasonal high water table, a soil evaluation of the disposal site shall be provided to the
Division by the applicant. If required by G.S. 89F, a soil scientist shall submit this evaluation. This evaluation shall be
presented in a report that includes the following information:
(A) Field description of soil profile. Based on examinations of excavation pits or auger borings, the following
parameters shall be described by individual horizons to a depth of seven feet below land surface or to bedrock:
thickness of the horizon; texture; color and other diagnostic features; structure; internal drainage; depth,thickness,
and type of restrictive horizons;pH;cation exchange capacity;and presence or absence of evidence of any seasonal
high water table. Applicants shall dig pits when necessary for evaluation of the soils at the site.
(B) Recommendations concerning annual and instantaneous loading rates of liquids, solids, other wastewater
constituents and amendments. Annual hydraulic loading rates shall be based on in-situ measurement of saturated
hydraulic conductivity in the most restrictive horizon.
3. ENGINEERING PLANNING DOCUMENTS —Per 15A NCAC 02C .0225(f)(8), the following documents shall
be provided to the Division by the applicant (Note: if required by G.S. 89C, a professional engineer shall prepare
these documents):
(A) engineering plans for the entire system, including treatment, storage, application, and disposal facilities and
equipment, except those previously permitted unless they are directly tied into the new units or are critical to the
understanding of the complete process;
(B) specifications describing materials to be used,methods of construction,and means for ensuring quality and integrity
of the entire groundwater remediation system;
(C) plans that include construction details of recovery, injection, and monitoring wells and infiltration galleries;
(D) operating plans that include:
(i) the operating schedule including any periodic shut-down times;
(ii) required maintenance activities for all structural and mechanical elements;
(iii) a list of all consumable and waste materials with their intended source and disposal locations;
(iv) restrictions on access to the site and equipment;
(v) provisions to ensure the quality of the treated effluent and hydraulic control of the system at all times when
any portion of the system ceases to function, such as standby power capability,complete system-off status,
or duplicity of system components; and
(E) Completed, signed, and sealed Professional Engineer's Certification for new permit applications(form attached).
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XII. CERTIFICATION (to be signed as required below or by that person's authorized agent*)
NCAC 15A 02C .0211(e)requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer
2. for a partnership or sole proprietorship: by a general partner or the proprietor,respectively
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer or
ranking publicly elected official
4. for all others: by the well owner.
*If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the applicant
that names and authorizes their agent.
"I hereby certify under penalty of law that I have personally examined and am familiar with the information
submitted in this document and all attachments therein, and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate, and
complete. I am aware that there are penalties, including the possibility of fines and imprisonment,for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection wells)
and all related appurtenances in accordance with the approved specifications and conditions of the Permit."
Typed or Printed Name and Title:
SEE NEXT PAGE
Signature: Date:
XIII. CONSENT OF PROPERTY OWNER(if the property is not owned by the permit applicant)
"Owner"means any person who holds the fee or other property rights in the well being constructed. A well is real
property and its construction on land shall be deemed to vest ownership in the land owner,in the absence of contrary
agreement in writing.
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(1 SA NCAC 02C.0200 ."
Typed or Printed Na d Ti Robert Arnold, President
Signature: Date: 5/10/23
Submit TWO hard copies of the completed application package with an electronic version in CD or USB Flash
Drive to:
DIVISION OF WATER RESOURCES—UIC PROGRAM
1636 MAIL SERVICE CENTER
RALEIGH,NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
Groundwater Remediation Application Rev. 2-17-2020 Page 8 of 9

XII. CERTIFICATION(to be signed as required below or by that person's authorized agent*)
NCAC 15A 02C .0211(e)requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer
2. for a partnership or sole proprietorship: by a general partner or the proprietor,respectively
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer or
ranking publicly elected official
4. for all others: by the well owner.
*If an authorized agent is signing on behalf of the applicant,then supply a letter signed by the applicant
that names and authorizes their agent.
"I hereby certify under penalty of law that I have personally examined and am familiar with the information
submitted in this document and all attachments therein, and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate, and
complete. I am aware that there are penalties, including the possibility of fines and imprisonment,for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well(s)
and all related appurtenances in accordance with the approved specifications and conditions of the Permit."
Typed or Printed Name and Title: AyV0&ate Dail Vt-tie X. Lr 4d-671Z
G'y`'�/• (�!t-CMG►
Signature: 117 Date:
,X
XIII. CONSENT OF PROPERTY OWNER(if the property is not owned by the permit applicant)
"Owner"means any person who holds the fee or other property rights in the well being constructed. A well is real
property and its construction on land shall be deemed to vest ownership in the land owner,in the absence of contrary
agreement in writing.
"As owner of the property on which the injection well(s)are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A NCAC 02C C.0200)."
Typed or Printed Name and Title:
Signature: Date:
Submit TWO hard copies of the completed application package with an electronic version in CD or USB Flash
Drive to:
DIVISION OF WATER RESOURCES—UIC PROGRAM
1636 MAIL SERVICE CENTER
RALEIGH,NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
Groundwater Remediation Application Rev.2-17-2020 Page 8 of 9

Professional Engineer's Certification(for new permit application for UIC systems reinjecting treated on-site
contaminated groundwater only): NOT APPLICABLE
Permit No.:
Typed or Printed Name of Professional Engineer:
License Number:
Name of Engineering Firm(if applicable):
Mailing Address:
City: State: Zip:
Office Number: ( ) Mobile Number: ( )
Email Address:
1, ,attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations. Although
certain portions of this submittal package may have been developed by other professionals,inclusion of these materials
under my signature and seal signifies that I have reviewed this material and have judged it to be consistent with the
proposed design.
North Carolina Professional Engineer's Seal, Signature, and Date:
Groundwater Remediation Application Rev. 2-17-2020 Page 9 of 9

ATTACHMENT 1
1. INJECTION ZONE
The injection zone consists of three sub-areas of the project area.One sub-area is on the source property.
Two sub-areas are downgradient off-Site. The larger area that includes the three sub-areas covers
approximately 1 acre.The horizontal extent of this larger area,from the furthest upgradient injection
well on-Site to the furthest downgradient injection well offsite,spans approximately 390 feet.Injection
well locations are included on Figure 1. The vertical extent of the injection zone will span from
approximately 25 to 60 feet below ground surface (bgs).
2. HYDROGEOLOGIC EVALUATION
The Site and vicinity are in the Milton Belt Unit of the Piedmont Physiographic province(Piedmont),
characterized by low rounded hills and long,rolling southwest to northeast trending ridges with incised
creek channels.The Site is positioned near the top of one of the described ridgelines with land sloping
down to the northwest and to the southeast from the former Site building.
The Site project area is mostly composed of natural soils derived from in-place weathering of the
underlying bedrock with some occurrence of fill,mostly near the former building pad,downgradient on
the Associated Posters'property and Norfolk Southern(NS) railroad (RR) raised bed.The natural soils
are called residuum,saprolite,and partially weathered rock(PWR).Figure 2 presents a lithologic
volumetric visualization built from drilling logs and topographic data.The Site parcel and NS RR are
labelled on the figure,while lithology is identified by color and the legend.
Residuum is the unconsolidated material typically found below the topsoil or fill and characteristically
contains very little physical remnants of the parent material.At the Site,the residuum(shown as mustard
yellow in Figure 2) is clayey to fine-grained sandy silt;red brown to tan in color.Saprolite is the
unconsolidated product of the weathered bedrock that usually retains some physical characteristics and
relict structures but is breakable in your hand.Relict structures,such as quartz veins decomposed into
medium to coarse grained gravel,were recently observed near the water table surface during Standard
Penetration Test(SPT) drilling downgradient on the Associated Posters'property.At the Site,the
saprolite,shown in light green,appears as fine-to coarse-grained sand with variable silt,and is brown,
tan to white-grey in color.The transitional zone PWR is categorized as highly weathered rock defined as
exhibiting SPT resistance greater than 100 blows per foot or estimated to be such when SPT is
unavailable.The PWR transition zone typically has a higher permeability compared to the overlying
unconsolidated soil and underlying fractured bedrock.PWR transition zones can range from being very
defined in highly foliated metamorphic rock to undefined in massive igneous rock with unconsolidated
1

ATTACHMENT 1
soil present between masses of rock(boulders).PWR at the Site,shown in darker green,was observed to
be light gray to brown,coarse sand with pieces of gray to black schist.
The underlying bedrock for the Site,shown in blue and generalized as metamorphosed granitic bedrock,
is mapped as interlayered biotite gneiss and schist containing small masses of granitic rock(USGS 1985).
Bedrock was intercepted at depths below ground surface ranging from 45 feet(MW-C11D)to 90 feet
(MW-2D) determined from drilling of the bedrock monitoring wells.Similarly,during recent drilling,
bedrock was intercepted at depths of 51 feet(2022-B1)to 62 feet(2022-B2 and 2022-B4).Gneiss as
either boulders or bedrock was observed along some portions of the unnamed tributary and within the
creek valley itself while fine to medium grained diorite,schist,and schistic gneiss were observed at the
base of recent SPT borings downgradient on the Associated Posters'property.
The unconsolidated soil structure and relict structures (i.e.,decomposed quartz veins and former
fractures) support the movement of groundwater.However,once the unconsolidated material thins and
PWR is more dominant,vertical migration is limited,and groundwater is directed to the surface beyond
the railroad.
The uppermost groundwater system within the Piedmont region is generally comprised of two
hydraulically connected parts.The shallow aquifer zone is situated in unconsolidated materials.The
deeper aquifer zone is in fractured bedrock,while the transition zone in the PWR connects the two.The
shallow unconsolidated aquifer contains and transports water through primary pore spaces in the soil
and between rock particles within the weathered natural soils described above.Typically ground water
recharge occurs seasonally over a period of several months or after heavy rainfall periods in uplands and
along slopes while discharge occurs in valleys.The bedrock aquifer has very limited pore spaces and,
therefore,water primarily flows through secondary porosity such as rock fractures.
A Site-wide groundwater gauging event was performed during the 12-month post-injection performance
monitoring event.Depth to groundwater in the shallow aquifer from the March 2022 monitoring event
ranged from 31.44 feet below top of casing(btoc) (MW-3)to 37.54 feet btoc(MW-C6) on the former CCI
Fleet Supply Site,with a depth range from 32.41 feet btoc(MW-11)to 3 7.3 5 feet btoc(MW-10)at the
One-Stop property.Depth to groundwater for the shallow aquifer wells monitored off-Site and
downgradient that had groundwater within the screened interval ranged from 18.18 feet btoc(MW-Cl1)
to 32.99 feet btoc(MW-6).As shown in the Figure 3 hydrographs,historical groundwater elevations
from April 2018 through March 2022 indicate a steady increase in groundwater elevations from April
2018 to April 2021,and then a slight decrease in groundwater elevations from April 2021 to March 2022.
Seasonal fluctuations generally indicate water level highs in the Spring months with a drop in Fall
months.Monitoring MW-C10 was dry during the September 2021 and March 2022 gauging events.The
2

ATTACHMENT 1
highest water level elevations are noted in the Site wells situated near the ridgeline and West Mountain
Street(MW-C7,MW-3,MW-2,MW-6)with lower elevation in the wells closer to the tributary(MW-7,
MW-C10,MW-11).
Water level elevations measured in bedrock wells over time are also charted in Figure 3.Depth to water
in the bedrock aquifer zone where three Type III wells (signified with a"D") are installed on-Site and
three off-Site,ranged from 20.91 feet btoc(MW-C11D)to 40.08 feet btoc(MW-C6D) during the March
2022 monitoring event.The groundwater elevation trends are not that dissimilar between the shallow
aquifer zone wells and those installed in bedrock.
The general direction of groundwater flow can be inferred from depth to water in the monitoring wells
installed at the Site and ground surface elevations.Based on the groundwater elevations obtained from
the monitoring wells,the shallow aquifer water table flow direction is generally to the north,northwest
and east off a southwest-northeast trending groundwater divide at the former Site building.A water table
map generated from groundwater data collected in March 2022 is provided as Figure 4.The water table
at the off-Site One Stop property is generally flat with a slight northeast groundwater flow direction.
Rising and falling head aquifer slug tests were performed on monitoring wells MW-2,MW-6,and MW-
C11 and deep monitoring wells MW-C8D,MW-C10D,and MW-C11D.Slug testing results showed the
shallow aquifer has a hydraulic conductivity of around two orders of magnitude higher than the bedrock
aquifer.Horizontal hydraulic gradient in the shallow aquifer zone was calculated to be 0.012 feet/foot
near the apparent source area(near MW-2),0.046 feet/foot in the downgradient portion of the plume
(between MW-6 and MW-C11)and 0.066 feet/foot in the southeastern portion of the Site(near MW-C6).
With an assumed effective porosity of 20 percent,the groundwater velocity in the shallow aquifer at the
Site ranges from 0.076 feet/day to 2.067 feet/day.
The bedrock aquifer zone potentiometric surface contour map,shown in Figure 5,demonstrates a
similar groundwater divide effect with perpendicular flow from the divide to the northwest and
southeast.Horizontal hydraulic gradient of the potentiometric surface in the bedrock aquifer zone was
calculated to be 0.036 feet/foot near the apparent source area (near MW-21)),0.152 feet/foot in the
downgradient portion of the plume(between MW-C81)and MW-C11D),and 0.038 feet/foot in the
southeastern portion of the Site.It can also be noted that the hydraulic gradient to the northwest may be
artificially increased due to the possibility that MW-C11D is screened in a different fracture zone than
other Type III wells.With an assumed effective porosity of 0.09 percent,the groundwater velocity in the
bedrock aquifer at the Site ranges from 3.704 feet/day to 9.476 feet/day.
The vertical gradient between the well pair within the plume area(MW-2/2D)was calculated to be 0.02
3

ATTACHMENT 1
feet/foot in the upward direction for March 2022.The vertical gradient between downgradient well pairs
MW-C6/C6D,MW-C7/C7D and MW-C11/C11D were calculated to be in the downward direction ranging
from 0.01 feet/foot to 0.05 feet/foot for the March 2022 sampling event.MW-C10 was dry in March 2022
and therefore a vertical gradient could not be calculated.A downward flow direction is typical for
Piedmont hydrogeology and expected for a recharge area such as a ridgeline,while an upward gradient is
common in a discharge area such as the unnamed tributary.
According to the USGS Report https:1/nubs.usgs.gov/wri/1997/4140/report.pdf) Groundwater Recharge
to and Storage in the Regolith-Fractured Crystalline Rock Aquifer System of Guilford County,North Carolina,
streamflow has two components;groundwater discharge and surface runoff from overland flow,and
under most conditions streams are discharge areas continually as long as groundwater elevation is above
stream bed elevation.In the area of the Site,due to climate uniformity and similar water-bearing
properties of lithology,topography is probably the greatest influence on the water table.Accordingly,in
stream valleys and areas adjacent to surface water the water table may be at or very near to the ground
surface.
3. INJECTANT INFORMATION
A. Into each of the 23 injection wells, 1,000 gallons of solution containing potable water,sodium
persulfate (2000 pounds),sodium hydroxide(625 pounds at 25%) and iron ethyl enediaminetetraacetic
acid(Fe(EDTA); 15 lbs pounds)will be injected. The sodium persulfate, [Fe(EDTA)],safety data sheets
(SDS)are attached. The total gallons of injectate are approximately 23,000 gallons.
B. Potable water will be obtained from a municipal hydrant(City of Winston Salem)located adjacent to
the Site.
C. The injectants,concentrations and volumes were chosen based on the pilot scale injection results and
the prior laboratory bench scale results.
D. In-situ chemical oxidation (ISCO)is a remediation strategy that has been applied to a wide range of
compounds,including the project target COCs (1,4-dioxane and TCE)to induce oxidation reactions that
chemically convert the COC to non-hazardous compounds.Sodium persulfate and sodium hydroxide
catalyzed by Fe(EDTA)will be blended into a solution with municipal water to create free radicals and
oxidize the target contaminants of concern. Pilot injection activities were completed in March 2021 by
injecting a solution of sodium hydroxide,sodium persulfate,FeEDTA,and municipal water in permanent
injection wells near MW-2 and MW-6.Based on the results of the 360-day performance monitoring
period,the pilot test injections indicate that ISCO using sodium persulfate with FeEDTA as a catalyst is
effective at treating the Site COCs.Collectively,the 1,4-dioxane and other VOC analytical results from the
pilot injection areas indicate a removal of these contaminants of concern.
4

ATTACHMENT 1
E/F. WSP will use performance monitoring data to evaluate the potential effects of the injection on
water quality.Metal concentrations in groundwater can be influenced by strong oxidants like sodium
persulfate and changes in pH induced by chemically oxidizing the target contaminants.Based on
performance monitoring results from the 2021 ISCO pilot test,total chromium and barium
concentrations were elevated above the NC 2L Standard in the immediate vicinity of the injection near
MW-2.In addition,total chromium concentrations remained above the NC 2L Standard at the end of the
performance monitoring near the injection.However,approximately 125 feet downgradient,near MW-6,
chromium and barium concentrations returned to below their respective NC 2L Standard by completion
of performance monitoring.During the full-scale injection,the presence of chromium(speciated as Cr III
and Cr VI) and barium will be evaluated during each performance monitoring event.It is anticipated that
the concentrations of chromium and barium,if altered,will likely return to baseline prior to discharge at
approximately 150 feet downgradient from the last line of injection points.Notable changes in pH were
not observed during the pilot test in the immediate vicinity of the injection near MW-6 and
downgradient,nevertheless,pH will be evaluated during performance monitoring.
During pilot testing,total iron concentrations,seemly composed of oxidized iron based on dissolved iron
concentrations,increased during performance monitoring,but returned to baseline downgradient.It is
possible that the oxidized iron could interfere with injection well performance when multiple injections
are performed over time.Therefore,well rehabilitation with mild acids may be necessary between
injections.
Since sodium persulfate will be injected,it is possible that sulfate concentrations will also increase above
its 2L Standard.However,the sulfate concentrations also decreased well below its 2L Standard
approximately 125 feet downgradient and is expected to do so prior to discharge.
4. INJECTION PROCEDURE
A. It is anticipated that an average of 1,000-gallons of solution will be injected in each of the 23 injection
wells (Total=23,000 gallons). During injection activities,the solution will be injected in each well at
approximately 2 to 4 gallons/minute.Multiple injection points will be utilized simultaneously to
reduce implementation timeframes if feasible.
B. The injection pressure will be monitored and is expected to be less than 20 pounds per square inch.
C. Total estimated volume to be injected is 23,000 gallons.
5

ATTACHMENT 1
S. FRACTURING PLAN
No fracturing is proposed for this injection scope of work.
6. WELL CONSTRUCTION DETAILS
Targeted plume injections will be performed in the following three areas of the Site: 1) near the source
area around MW-2; 2)near MW-6 where the highest concentrations of 1,4-dioxane have been exhibited;
and 3)further downgradient of MW-6 towards the leading edge of the groundwater plume(near MW-7,
MW-C11,and MW-C10).
The ISCO injection approach involves the use of two existing permanent injection wells near MW-2 and
MW-6(2 existing and 3 proposed permanent injection wells)and injection wells (16 proposed injection
wells) further downgradient near MW-7,MW-C10,and MW-C11 as shown on Figure 1.
The three new injection wells near MW-6 will be installed to a target depth of approximately 60 ft bgs
utilizing hollow stem auger techniques with an injection screen interval set from 45 to 60 ft bgs.Injection
wells further downgradient,near MW-7,MW-C10,and MWC-11,are proposed to be installed at 45 ft bgs,with
a screen interval of 30 to 45 It bgs.
See Table 1 for existing and proposed injection well construction details.
7. MONITORING PLAN
A. Groundwater monitoring will be conducted to monitor the concentrations of the target compounds,
1,4-dioxane and TCE.
B. During post injection sampling(performance monitoring) field parameters such as dissolved oxygen,
pH,specific conductance,oxidation/reduction potential,temperature,and turbidity as well as
geochemical parameters (Nitrate,sulfate,and RCRA metals)will be used to assess the progress of the
intended reactions within the subsurface.
C. See Table 2 for a list of existing and proposed monitoring wells used for performance monitoring.
D. See Table 3 for proposed sampling schedule.
8. WELL DATA TABULATION
The table below indicates the monitoring wells that are within the area of review that penetrate the
proposed injection zones.The construction details for existing and proposed injection wells that will be
used within the proposed injection zones are listed in the attached Table 1.
6

ATTACHMENT 1
Well Screen Top of Casing
Monitoring Date Installed Diameter Total Depth Interval Elevation
Well ID (inches) (Feet bgs) (feet bgs) (feet amsl)
On-Site Fleet Supply Monitoring Wells
MW-2 12 15 1997 2.0 40 25 -40 914.95
MW-21) 4 27 1997 2.0 104 94- 104 915.57
Off-Site Down gradient MonitoringWells
MW-6 2 3 1994 2.0 42 27-42 913.35
MW-7 2 2 1994 2.0 30 15-30 893.81
MW-C81) 1 19 2010 2.0 120 115- 120 898.40
MW-C9 6 2 2020 2.0 36 21-36 911.85
MW-C10 6 4 2020 2.0 23 8-23 898.58
MW-C10D 6 4 2020 2.0 88 78-88 898.57
MW-C11 6 4 2020 2.0 20 5-20 888.08
MW-C11D 6 5 2020 2.0 88 73-88 887.96
Proposed
Performance TBD 2.0 45 30-45 TBD
Well 1
Proposed
Performance TBD 2.0 45 30-45 TBD
Well 2
Bgs-below ground surface
AMSL-above mean sea level
TBD-to be determined
7

ATTACHMENT 1
9. MAPS AND CROSS-SECTIONS
A. Topographic map is attached(Figure 1).
B. A map showing the facility and surrounding water features (streams,tributaries,and lakes) is
attached(Figure 6).
C. A map depicting monitoring well locations within the areas of injection is attached(Figure 1).
D. Potentiometric maps are attached(Figures 4 and 5).
E. Isoconcentration map is attached(Figure 7).
F. Geological cross-sections are attached(Figures 2,8,and 9).
G. There are no known sources of groundwater contamination within the injection area.
8

Table 1: Injection Well Construction Information
Kernersville, North Carolina
Casing/
Monitoring Construction Screen Total Well Screened Screen
Well Grout Bentonite Sand
Date Diameter Depth Interval Length Interval Interval Interval
(mm/dd/yy) (inches) (ft-bgs) (ft-bgs) (feet) (ft-bgs) (ft-bgs) (ft-bgs)
Onsite Wells (near MW-2)
IW1-1 12/14/20 2.0 40 25-40 15.0 0-18 18-23 23-40
IW1-2 12/14/20 2.0 40 25-40 15.0 0-18 18-23 23-40
Downgradient(near MW-6)
IW2-1 01/14/21 2.0 41 26-41 15.0 0-20 20-23 23-41
IW2-2 01/14/21 2.0 41 26-41 15.0 0-20 20-23 23-41
IW2-3 Proposed 2.0 60 45-60 15.0 0-37 37-42 42-60
IW2-4 Proposed 2.0 60 45-60 15.0 0-37 37-42 42-60
IW2-5 Proposed 2.0 60 45-60 15.0 0-37 37-42 42-60
Downgradient(near MW-7&MW-C8D)
IW3-1 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-2 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-3 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-4 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-5 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-6 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-7 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-8 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-9 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-10 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-11 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-12 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-13 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-14 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-15 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
IW3-16 Proposed 2.0 45 30-45 15.0 0-22 22-27 27-45
Notes:
1.ft-bgs:feet below ground surface
2.#2 filter sand is proposed for screen material
3. Injection wells are made of PVC,with a 0.010 machine slot screen
4. Portland cement slurry used for grout
5. Injection wells will be housed in flush mount manholes

Table 2: Well Construction Data and March 2022 Groundwater Elevations
ITW/CCI Fleet Supply Company
Kernersville, North Carolina
Screen Interval Top of Casing Depth to Groundwater
Monitoring Well ID Date Installed (feet bgs) Elevation Groundwater Elevation
(feet amsl) (feet btoc) (feet amsl)
On-Site Fleet Supply Monitoring Wells
MW-1 12/15/1997 25 - 40 916.16 35.08 881.08
MW-2 12/15/1997 25 - 40 914.95 32.68 882.27
MW-2D 4/27/1997 94 - 104 915.57 31.87 883.70
MW-3 12/15/1997 25 - 40 914.26 31.44 882.82
MW-4 4/24/1998 29 - 44 918.57 35.09 883.48
MW-C6 1/20/2010 30 - 45 913.97 37.54 876.43
MW-C6D 1/20/2010 95 - 110 913.81 40.08 873.73
MW-C7 1/22/2010 30 - 45 915.92 32.92 883.00
MW-C7D 1/21/2010 135 - 140 915.83 34.15 881.68
Off-Site One Stop Property Monitoring Wells
MW-1 5/20/1993 25 - 35 918.15 33.81 884.34
MW-2 5/20/1993 25 - 35 917.00 32.44 884.56
MW-313 6/16/1993 30 - 45 917.99 33.58 884.41
MW-4 6/16/1993 30 - 45 919.39 36.99 882.40
MW-9 2/28/1994 30 - 45 917.80 33.93 883.87
MW-10 3/1/1994 34 - 49 919.79 37.35 882.44
MW-11 3/22/1994 32 - 47 916.85 32.41 884.44
Off-Site Downgradient Monitoring Wells
MW-5 6/16/1993 20 - 40 909.97 25.58 884.39
MW-6 2/3/1994 27 - 42 913.35 32.99 880.36
MW-7 2/2/1994 15 - 30 893.81 19.62 874.19
MW-C8D 1/19/2010 115 - 120 898.40 20.91 877.49
MW-C9 6/2/2020 21 - 36 911.85 32.59 879.26
MW-C10 6/4/2020 8 - 23 898.58 Dry Dry
MW-C10D 6/4/2020 78 - 88 898.57 32.87 865.70
MW-C11 6/4/2020 5 - 20 888.08 18.18 869.90
MW-Cl1 D 6/5/2020 73 - 88 887.96 21.35 866.61
Proposed Performance Well 1 TBD 30-45 TBD TBD TBD
Proposed Performance Well 2 TBD 30-45 TBD TBD TBD
Notes:
1. Depth to groundwater shown in feet below top of casing (toc), measured on 3/15/22
2. Screen Interval shown in feet below ground surface(bgs)
3. Elevations shown in feet above mean sea level (amsl)
4.TBD -to be determined

Table 3
Overview of Groundwater and Surface Water Monitoring Program Requirements
Kernserville, North Carolina
Monitoring Frequency Baseline Sampling Event First Monthly Event Second Monthly Event First Quarterly Event Second Quarterly Event Third Quarterly Event Fourth Quarterly Event
Estimated Sampling Date June 2023 September 2023 October 2023 November 2023 February 2024 May 2024 August 2024
w w > w v v w w w w w w w w
> c > c > c > c > c > c > c
J .v. m J °� m J .v. m J .°- m m J .°. 5 J °� Ix m
c c x c x kn c x � c c x � c
w m o_ u_ `2 w w 0 u_ `2 w m 0 u_ `w w w 0 u_ `w w m o_ u_ `w w w 0 u_ `w w m _ u `w
°1 E E E n, °1 E E o E n, °1 E E 0 E n, °1 E E o E w P' E E (5 E w P' E E o E w P' E E E w
w t0 Ul 2 12 N Ul 12 Ul Ul w W t0 Ul Ul w 2 N N
Sampling Location v r E v r E v r E v r E v r E v r E v r E
3 `i 3 `i 3 `i 3 `i 3 `i 3 `i 3 `i
-c w '`° -c v '`° -c '`° -c '`° -c '`° -c v '`° -c
v a v a v a . v a v a v a v a
V l7 V 0 V l7 V l'J V l7 V l'J V l7
° LL O ° LL O ° LL O ° LL O ° LL O ° LL O ° LL O
l7 > l7 > l7 > l7 > l7 > l7 > l7 >
Groundwater
On Site Wells
MW-1 X X X X X X X X X
MW-2 X X X X X X X X X X X X X X X X X X X X X X
MW-2D X X X X X X X X X X X X X X X X X X X X X X
MW-3 X X X X X X X X X X X X
MW-4 X X X X X X X X X X X X
MW-C6 X X X X X X X X X
MW-C6D X X X X X X X X X
MW-C7 X X X X X X X X X
MW-C7D X X X X X X X X X
Downgradient Associated Posters Property
MW-6 X X X X X X X X X X X X X X X X X X X X X X
MW-7 X X X X X X X X X X X X X X X X X X X X X X
MW-C8D X X X X X X X X X X X X X X X X X X X X X X
MW-C9 X X X X X X X X X X X X X X X X X X X
MW-C10 X X X X X X X X X X X X X X X X X X X X X X
MW-C10D X X X X X X X X X X X X X X X X X X X X X X
MW-C11 X X X X X X X X X X X X X X X X X X X X X X X X
MW-C11D X X X X X X X X X X X X X X X X X X X X X X X X
MW-C12 X X X X X X X X X
MW-C13 X X X X X X X X X X X X X X X X X X X X X X
MW-C14 X X X X X X X X X
MW-C15 X X X X X X X X X
PROPOSED PERFORMANCE WELL 1 X X X X X X X X X X X X X X X X X X X X X X X X X X X X
PROPOSED PERFORMANCE WELL 2 X X X X X X X X X X X X X X X X X X X X X X X X X X X X
Duplicate Sample X X X X X X X X X X X X X X
Off Site One Stop Property
MW-1 X X X X X X X
MW-2 X X X X X X X
MW-36 X X X X X X X
MW-4 X X X X X X X
MW-5 X X X X X X X
MW-9 X X X X X X X
MW-10 X X X X X X X X X X X X X
MW-11 X X X X X X X
Surface Water
SW1-2 X X X X X X X X X X
SW2-10 X X X X X X X X X X
SW1-3 X X X X X X X X X X
SW1-3A X X X X X X X X X X
Duplicate Sample X X X X X X X X X X
Notes:
1.X=parameter is required
2.--=parameter is not required
3.This schedule is based on an assumed August injection date.
4.Field parameters include dissolved oxygen,pH,oxidation/reduction potential,turbidity,temperature,and specific conductance.
S.Geochemcial parameters include nitrate as N and sulfate by EPA Method 300.0;and arsenic,barium,cadmium,chromium(speciated),iron(total and dissolved),selenium,and lead by EPA Method 6020 C.
6.VOCs=volatile organic compounds analyzed by EPA Method 8260
7.1,4-Dioxane analyzed by EPA Method 8270 Selective Ion Monitoring(SIM)
8.Duplicate samples will be taken from each media per sampling event.
9.Trip Blanks will be submitted for every cooler containing VOC samples for each sampling event.
10.The fourth quarterly sampling event will run concurrently with the annual site wide sampling event.
11.Performance wells will be sampled after the injection event on a monthly basis until the first quarter event.

MW-C"13 Legend°a Parcels
° JA Site Boundary
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2072-83 O � O (One Stop)
O. 5 Proposed Permanent
~ Mw•t • 20 , 62 y�' Injection Well Location
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• Injection Wells
�T ► • w_ 2022 Boring Location
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Groundwater Elevations Over Time
900
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MW-2
•,�• MW-2D
885 MW-3
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—0— MW-6
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825 - —0— MW-C8D
I Solid line One Stop Well —0— MW-C9
Dotted line=One Stop Well —0— MW-C10
Dashed line=Off-Site Downgradient Well —0— MW-C11
810 - —0-- MW-C11D
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MW-C10D��
Q Site Boundary
Associated Posters, Inc
♦ Property Boundary
_ MW-C11D MW"C9- I One Stop Property
' (879.26) � � Boundary
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Stop)
P7
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' (874.19) j Injection Well Location
15 a
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�.. ��� s1� Flow Direciton
(882.22)
r (880.36)�0 Elevation (feet)
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WSP USA WATER TABLE MAP (MARCH 15, 2022) 11/4/2022 NC State Plane(NAD83,feet)
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Environment& Infrastructure Inc. Note: This map is for A
ITW/CCI Fleet Supply I Company [1
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(865.7) MW-C10
866��
g67 �6q, Q Site Boundary
S69 � Associated Posters, Inc
A
g10 � Property Boundary
MW-C11D S��
' (866.61)� MW-C9 i � One Stop Property
~ 872 � ;, , Boundary
i, ; � 873 �► � � ,'• Monitoring Well Location
- MW-C11 MW-C8D 874 � l � Fleet Su I
` _ � 875 w � Monitoring Well Location
`� r , 876 (One Stop)
�.'� �,� � MW-7 g�7 �„�. j Injection Well Location
87g f,• _ Groundwater Contours
' �_ .y, � ' Interpreted Groundwater
P7
i.• ��.' 879 � Flow Direction
• Y (882.22) Groundwater
r. � Elevation (feet)
• 881 `
ag2
jlo
pit
MW-2D
• N --
MW-C6D
W-5 �W-10 , 1 :'• ;�.4 MW-4 (873.73)
0000
P .
. - �w-4 � _ "y✓ Feet
MW-3B MW-C7�� -
MW-C7D
MW-2 (881.68)
obNas
v
ouisville P VIRGINIA
` LIr KY v p
P Richmond
MW-11 Q o
� . Q Greens oro �
W-1 �.MW-9 xville8' � �
� o oRaleigh
E Charlote�, NORTH
Greenville \E C CAROLINA
Q
w• �� oAtlanta CAROLINA
Title: Date: Projection: Figure:
Environment& Infrastructure Inc.
" WSP USA 11/4/2022
DEEP WELLS POTENTIOMETRIC SURFACE NC State Plane(NAD83,feet)
Note: This map is for (MARCH 14, 2022)
2801 Yorkmont Road, Suite 100 reference only. ITW/CCI Fleet Supply Company Project No: File:
Charlotte, NC 28208 2744 West Mountain Street 3160-20-1043 P\6228 Environmental\jobs\not 6228\3160-20-1043 CCI 5
[phone] Kernersville\2018 to
Kernersville, North Carolina present\GIS\Updated_ProProject\Kernersville\Kernersville.aprx
Esri,HERE,Garmin,FAO,NOAA,USGS,EPA,NC OneMap,NC Center for Geographic Information and Analysis,NC 911 Board 2021 Drawn by:LIVID-Checked by:SLK-Date: 11/4/2022

Notes:
1.At the time of sampling in September 2021,B-5,SW2-10,SW2-9 and MW-C10
were dry and no sample was collected from this location.
2.SW2-12 was collected from creek running through middle of dry lake. Legend
3.SW1-1 was not collected due to soft dry lake bed.
4.Results are in micrograms per liter(pg/L).
5.BOLD concentrations exceeded the NC 2L or NC 2B Standard Parcels
6.J=Indicates compound was detected at a concentration
below the Reporting Limit(lowest calibration standard),detection is considered an '" Site Boundary
estimate
Associated Posters, Inc
i, Property Boundary
SW 1-4
<0.033 Q One Stop Property
♦ Boundary
0 1 Ponds/Lakes
.� ;� �'-•, v �r,,i Creeks
m r d` ,.', �• �' s'. Lowery Mill Creek(Water
Supply III (WS-111)and
k- r` 4 Critical Area)r
✓� ' �T4 '' h Monitoring Well Location
t � r,�,••v r ti (Fleet Supply)
Monitoring Well Location
(One Stop)
♦2.6 r-.A
♦ SW-10-Sept ��•�y� I - �,���, Temporary Monitoring Well
0.73 ♦ SW-11-Sept t ��� . v. Surface Water Monitoring
SW2-10♦ ♦2.6 SW 28Sept B 8 -v. w 4. ` ', «, Point
♦ SW-13-Sept <0.86 >, Surface Water Sample
SW-7-Aug/Sept � ., •�_ •'v� p
2.7/2.8 ♦ 2'a SW-9-Aug ' ,r ♦ Location
h B-5 SW-8-Aug/Sept ♦SW-14-Sept B 7 C�� < Injection Well Locaiton
I 2.9
SW-15-Sept Y tic Line of Cross Section
♦ 3.3 �'vT 1,4-Dioxane Concentration
: B-4 T SW-16-Sept ♦ SW-1-2 SW-5-Aug SW2-9 �O
' <0.86 3.4 Ar 3.5 <0.86 ♦ DSO >1 pg/L
B 3SW-17-Aug
4.1 SW-6-Aug >3 p9/L
SW2-11 0.86 SW-4-Au >30 pg/L
:0.033 <0.86 < ♦ <0.86 g
SW-18-Aug a
3.9 ♦ >100 pg/L
G�y� B-2 SW:1-Ju9 <086 5�
� SW-2-Aug SW-1-Aug/Sept O -,�
'7 75.4,\ MW-C8D MW-9 `•S �i'• t• -.. .':(/�; 0 200 400
' -, MW-C11D h26:2 �<0.86 ,, ��'•
Feet
Y
♦ Q MW-5 2.1 � �M O�B6D
' MW-3B MW-a <o.as SW2-14
OL-D GREENSBORO RD .�,.;•• � MW-2�� <0.66 MW-C]D ♦ awsville � :'IR;IIII�.
Richmond I�
ty, T I MW_1 SW2-13 Q o
SW1-1 r. ♦ Q Greans oro
♦ J� w f. xv illy u� o O R aleigh
harl011Qe, NORTH
4 CAROLINA
v R Gtacrtville v
_ /��� •� . ( �� ��D�S�p21 oAllanta CAROLINA
i
Title: Date: Projection: Figure:
" WSP USA 11/4/2022
AUGUST AND SEPTEMBER 2021 SURFACE WATER AND NC State Plane(NAD83,feet)
Environment& Infrastructure Inc. Note: This map is for GROUNDWATER 1,4-DIOXANE ISOCONCENTRATION MAP
2801 Yorkmont Road, Suite 100 reference only. ITW/CCI Fleet Supply Company Project No: File:
Charlotte, NC 28208 2744 West Mountain Street P:\6228 Environmental\jobs\not 6228\3160-20-1043 CCI 6
3160-20-1043 Kernersville\2018 to
[phone] Kernersville, North Carolina
present\G I S\U pd ated_Pro P roject\Ke me rsvi I le\Kern ersvi I I e.a prx
Esri,HERE,Garmin,FAO,NOAA,USGS,EPA,NC OneMap,NC Center for Geographic Information and Analysis,NC 911 Board 2021 Drawn by:LIVID-Checked by:SLK-Date: 11/4/2022

M W-C 13
Legend
Parcels
MW-C15 Site Boundary
Associated Posters, Inc
Property Boundary
One Stop Property
C Boundary
f Mw-clop P � Monitoring Well Location
(Fleet Supply)
Monitoring Well Location
g� (One Stop)
MW-C11D MW-C9 2022 Monitoring Well
MW-C11 �
8�0 0 (Fleet Supply)
87g12 0 Proposed Permanent
a�a MW-CSD Injection Well Location
a�a MW OO Proposed Performance Well
a�5 • Injection Wells
a�6
Zone of Influence
aai OO
�Iwz-z• MW' 1,4-Dioxane Concentration
a7a >1 pg/L
�W2-1 MW-6 •�
s19 >3 pg/L
>30 pg/L
sao R >100 pg/L
MW-21) -�t
1 MW 2 IWt-1
8ez Iw S2 N
MW-5, MW-1� MW-4 -
4$/ r
MW� 0 37.5 75
•, v MW-E7
MW-3B MW-C7D
Feet
MW-11 X OWas
MW-1 MW-9 G
KY n
P FI�niond
Q o
�Zh Q Greenl
5� ll Raleigh
Charlotte NORTH
o 0
J
`Greenville E C CAROLINA
oAtlanta ? SOUTH
CAROLINA
c �
Title: PROPOSED INJECTION MAP Date: Projection: Figure:
" WSP USA AND 1,4-DIOXANE 5/18/2023 NC State Plane(NAD83,feet)
Environment& Infrastructure Inc. Note: This map is for
2801 Yorkmont Road, Suite 100 ITW/CCI Fleet Supply Company
reference only. Project No: File:
Charlotte, NC 28208 2744 West Mountain Street 3160-20-1043 H:\6228Environmental\jobs\not6228\3160-20-1043CCI 7(704)357-8600 Kernersville North Carolina Kernersville\2018to
, present\GIS\Updated_ProProject\Kernersville\Kernersville.aprx
NC Center for Geographic Information&Analysis,Esri,HERE,Garmin,FAO,NOAA,USGS,EPA 2021 Drawn by:LIVID-Checked by:SLK-Date:5/18/2023

.
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1,4-Dioxane Material
Legend CSM CROSS SECTION A-A'
ITW/CCI FLEET SUPPLY COMPANY
iw* 2744 WEST MOUNTAIN STREET
Area of Influence 0 Representative transect injection well KERNERSVILLE, NORTH CAROLINA
PREPARED BY: LIVID CHECKED BY: HI PROJECT NUMBER:3160201043 FIGURE NUMBER: 8
Date: 5/12/2022 Date: 5/12/20 22
Document Path: P:\6228 Environmental\jobs\not 6228\3160-20-1043 CCI Kernersville\2018 to present\GIS\3160-08-0075 Fleet Su pp ly\MXD\CorrectMXDs\2022\EVS Fig u re_Tem plate.mxd

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CSM 1,4 -DIOXANE PLUME CROSS SECTION A-A'
ITW/CCI FLEET SUPPLY COMPANY
2744 WEST MOUNTAIN STREET
KERNERSVILLE, NORTH CAROLINA
PREPARED BY: LMM CHECKED BY: HPC PROJECT NUMBER:3160201043 FIGURE NUMBER: 9
Date:5/12/2022 Date: 5/12/2022
Document Path:P:\6228 Environmental\jobs\not 6228\3160-20-1043 CCI Kernersville\2018 to present\GIS\3160-08-0075 Fleet Supply\MXD\CorrectMXDs\2022\EVS Fig ure_Tem plate.mxd

WELL CONSTRUCTION RECORD IGW-11 For Internal Use Only:
1.Well Contractor Information:
KENNY SARGENT 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 4226
et. rt.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a 6c Ie
GEOLOGIC EXPLORATION, INC FROM TO DIAMETER I THICKNESS MATERIAL
in.
Company Name
16.INNER CASING OR TUBING eotbermal closed-loop)
2.Well Construction Permit#' FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well constructionpermits(ie. UIC, County,State, Variance, etc.) 0,0 ft. 25.0 ft. 2.0 In' SCH 40 R%C
3.Well Use(check well use): ft. ft. In'
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE TICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 25.0 ft. 40.0 It. 2.0 in. .010 SCH40 PIC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft.
❑lndustriaWornmercial ❑Residential Water Supply(shared) IS.GROUT
❑Irrl ation ❑Wells> 100,000 GPO FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ff. 18.0 ft' PORTLAND BENTOWTE SLURRY
❑Monitoring ❑Recovery
Injection Well:
et. rt.
❑Aquifer Recharge WGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery El Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 23.0 ff• 40.0 ff• 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary
❑Geothermal (Heating/Cooling Return ❑Other(explain under#21 Remarks FROM TO DESCRIPTION color,hardness,soit/rock tvPe eraio size,etc.
0.0 ff• 1.0 ff• CONCRETE/GRAVEL
4.Date Well(s)Completed: 12/14/20 Well ID# IW-1-1 10 ft 290 ff• BROWN SILTY SANDY CLAY
Sa.Well Location: 29.0 ff' 40.0 tt' BROWN SANDY SILT
CCI FLEET SUPPLY
Facility/Owner Name Facility ID#(if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address,City,and Zip
FORSYTH 2LREMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL - 18.0 23.0 FEET
Sb.Latitude and Iongitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification: Ji.
36� 06' 48.33" N 80� 09' 43.32" W
----------- -------------- 12/29/2020
6.ls(are)the well(s): 1!IPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing thisform,1 hereby terrify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or I!INo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
Ifthis is a repair,fill out known well construction information and explain the nature o fthe ofthis record has beenprovided to the well owner.
repair under#21 remarks section or on the back o fthisform.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back ofthis page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER ofwells (add'See Over'in Remarks Box).You may also attach additional pages ifnecessary.
drilled:------------ 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 4_0_.0_______ (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths i fdifferent(example-3@200'and 2@100)
25 0 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing:-------'---- (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
Ifwater level is above casing use"+"
11.Borehole diameter:__ 6.0___ (in.) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method:__ S N I_C---------- - 24c.For Water Supply and Open-Loop Geothermal Return Wells:.Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department ofthe county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:_ Copy to DWR, CCPCUA
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method oftest:
13b.Disinfection type: Amount:
FormGW-1 North Carolina Department ofEnvironmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD IGW-11 For Internal Use Only:
1.Well Contractor Information:
KENNY SARGENT 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 4226
et. rt.
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a 6c Ie
GEOLOGIC EXPLORATION, INC FROM TO DIAMETER I THICKNESS MATERIAL
in.
Company Name
16.INNER CASING OR TUBING eotbermal closed-loop)
2.Well Construction Permit#' FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well constructionpermits(ie. UIC, County,State, Variance, etc.) 0,0 ft. 25.0 ft. 2.0 In' SCH 40 R%C
3.Well Use(check well use): ft. ft. In'
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE TICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 25.0 ft. 40.0 It. 2.0 in. .010 SCH40 PIC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft.
❑lndustriaWornmercial ❑Residential Water Supply(shared) IS.GROUT
❑Irrl ation ❑Wells> 100,000 GPO FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ff. 18.0 ft' PORTLAND BENTOWTE SLURRY
❑Monitoring ❑Recovery
Injection Well:
et. rt.
❑Aquifer Recharge WGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery El Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 23.0 ff• 40.0 ff• 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary
❑Geothermal (Heating/Cooling Return ❑Other(explain under#21 Remarks FROM TO DESCRIPTION color,hardness,soit/rock tvPe eraio size,etc.
0.0 ff• 1.0 ff• CONCRETE/GRAVEL
4.Date Well(s)Completed: 12/14/20 Well ID# I W-1-2 1.0 ft 29.0 ff• BROWN SILTY SANDY CLAY
Sa.Well Location: 29.0 ff' 40.0 tt' BROWN SANDY SILT
CCI FLEET SUPPLY
Facility/Owner Name Facility ID#(if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address,City,and Zip
FORSYTH 2LREMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL - 18.0 23.0 FEET
Sb.Latitude and Iongitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification: Ji.
36� 06' 48.33" N 80� 09' 43.32" W
----------- -------------- 12/29/2020
6.ls(are)the well(s): 1!IPermanent or ❑Temporary Signature ofCertified Well Contractor Date
By signing thisform,1 hereby terrify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or I!INo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
Ifthis is a repair,fill out known well construction information and explain the nature o fthe ofthis record has beenprovided to the well owner.
repair under#21 remarks section or on the back o fthisform.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back ofthis page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER ofwells (add'See Over'in Remarks Box).You may also attach additional pages ifnecessary.
drilled:------------ 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 4_0_.0_______ (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths i fdifferent(example-3@200'and 2@100)
25 0 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing:-------'---- (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
Ifwater level is above casing use"+"
11.Borehole diameter:__ 6.0___ (in.) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method:__ S N I_C---------- - 24c.For Water Supply and Open-Loop Geothermal Return Wells:.Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department ofthe county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:_ Copy to DWR, CCPCUA
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method oftest:
13b.Disinfection type: Amount:
FormGW-1 North Carolina Department ofEnvironmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD IGW-11 For Internal Use Only:
1.Well Contractor Information:
JACOB MESSICK 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 4252 ft. rt
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a ticable
GEOLOGIC EXPLORATION, INC FROM TO DIAMETER I THICKNESS MATERIAL
in.
Company Name
16.INNER CASING OR TUBING eotbermal closed-loop) _
2.Well Construction Permit#' FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well constructionpermits(ie. UIC, County,State, Variance, etc.) 0.0 tt' 26.0 ft 2.0 In' SCH 40 PVC
3.Well Use(check well use): ft• I ft. in.
17.SCREEN
Water Supply Well:
FROM TO DIAMETER SLOT SIZE TICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 26.0 ft. 41.0 p' 2.0 m' .010 SCH40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in•
❑lndustriaWornmercial ❑Residential Water Supply(shared) IS.GROUT
❑Irrl ation ❑Wells> 100,000 GPO FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 20.0 ft' PORTLAND BENTOWTE SLURRY
❑Monitoring ❑Recovery
Injection Well:
et. rt.
❑Aquifer Recharge WGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery El Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 23.0 ft• 41.0 ft 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary
❑Geothermal (Heating/Cooling Return ❑Other(explain under#21 Remarks FROM TO DESCRIPTION color hardness soil/rock tvPe eraio size,etc.
0.0 ft 5.0 ft RED/BROWN SILTY CLAY
4.Date Well(s)Completed: 01/14/21 Well ID# I W-2-1 5.0 ft• 20.0 ft TAN SILT
Sa.Well Location: 20.0 tt' 41.0 tt' BROWN SILT
CCI FLEET SUPPLY
Facility/Owner Name Facility ID#(if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address,City,and Zip
FORSYTH 2LREMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL 20.0 23.0 FEET
Sb.Latitude and Iongitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification:
- 36 06' 48_33" N 80 09' 43.32" W fa( "''° 1/15/2021
6.ls(are)the well(s): 1!IPermanent or []Temporary Signature ofCertified Well Contractor Date
By signing thisform,1 hereby terrify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or l!INo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
Ifthis is a repair,fill out known well construction information and explain the nature o fthe ofthis record has beenprovided to the well owner.
repair under#21 remarks section or on the back o fthisform.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back ofthis page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER ofwells (add'See Over'in Remarks Box).You may also attach additional pages ifnecessary.
drilled:____________ 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 4 1 ,U (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths i fdifferent(example-3@200'and 2@/00)
10. 30.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
Static water level below top of casing:----------- (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
Ifwater level is above casing use"+"
11.Borehole diameter: 8.0 (in.) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (NC)
-
-- --- Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method:__ AUGER _______ _ 24c.For Water Supply and Open-Loop Geothermal Return Wells:.Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department ofthe county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:_ Copy to DWR, CCPCUA
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method oftest:
13b.Disinfection type: Amount:
FormGW-1 North Carolina Department ofEnvironmental Quality-Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD IGW-11 For Internal Use Only:
1.Well Contractor Information:
JACOB MESSICK 14.WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
ft. ft.
A - 4252 ft. rt
NC Well Contractor Certification Number 15.OUTER CASING for multi-cased wells OR LINER if a ticable
GEOLOGIC EXPLORATION, INC FROM TO DIAMETER I THICKNESS MATERIAL
in.
Company Name
16.INNER CASING OR TUBING eotbermal closed-loop) _
2.Well Construction Permit#' FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well constructionpermits(ie. UIC, County,State, Variance, etc.) 0.0 tt' 26.0 ft 2.0 In' SCH 40 PVC
3.Well Use(check well use): ft• I ft. in.
17.SCREEN
Water Supply Well:
FROM TO DIAMETER SLOT SIZE TICKNESS MATERIAL
❑Agricultural ❑Municipal/Public 26.0 ft. 41.0 p' 2.0 m' .010 SCH40 PVC
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. in•
❑lndustriaWornmercial ❑Residential Water Supply(shared) IS.GROUT
❑Irrl ation ❑Wells> 100,000 GPO FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0.0 ft. 20.0 ft' PORTLAND BENTOWTE SLURRY
❑Monitoring ❑Recovery
Injection Well:
et. rt.
❑Aquifer Recharge WGroundwater Remediation
19.SAND/GRAVEL PACK if applicable)
❑Aquifer Storage and Recovery El Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage 23.0 ft• 41.0 ft 20-40 FINE SILICA SAND
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG attach additional sheets if necessary
❑Geothermal (Heating/Cooling Return ❑Other(explain under#21 Remarks FROM TO DESCRIPTION color hardness soil/rock tvPe eraio size,etc.
0.0 ft 5.0 ft RED/BROWN SILTY CLAY
4.Date Well(s)Completed: 01/14/21 Well ID# I W-2-2 5.0 ft• 20.0 ft TAN SILT
Sa.Well Location: 20.0 tt' 41.0 tt' BROWN SILT
CCI FLEET SUPPLY
Facility/Owner Name Facility 1D#(if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address,City,and Zip
FORSYTH 2LREMARKS
County Parcel Identification No.(PIN) BENTONITE SEAL 20.0 23.0 FEET
Sb.Latitude and Iongitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 22.Certification:
- 36 06' 48_33" N 80 09' 43.32" W fa( "''° 1/15/2021
6.ls(are)the well(s): 1!IPermanent or []Temporary Signature ofCertified Well Contractor Date
By signing thisform,1 hereby terrify that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or l!INo 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy
Ifthis is a repair,fill out known well construction information and explain the nature o fthe ofthis record has beenprovided to the well owner.
repair under#21 remarks section or on the back o fthisform.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back ofthis page to provide additional well construction info
construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER ofwells (add'See Over'in Remarks Box).You may also attach additional pages ifnecessary.
drilled:____________ 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 4 1 ,U (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths i fdifferent(example-3@200'and 2@/00)
10. 30.0 24a. For All Wells: Original form to Division of Water Resources (DWR),
Static water level below top of casing:----------- (ft.) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617
Ifwater level is above casing use"+"
11.Borehole diameter: 8.0 (in.) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (NC)
-
-- --- Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method:__ AUGER _______ _ 24c.For Water Supply and Open-Loop Geothermal Return Wells:.Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department ofthe county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:_ Copy to DWR, CCPCUA
Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13a.Yield(gpm) Method oftest:
13b.Disinfection type: Amount:
FormGW-1 North Carolina Department ofEnvironmental Quality-Division of Water Resources Revised 6-6-2018

S Akzo Nobel Functional Chemicals LLC
AKZO NOBEL MATERIAL SAFETY DATA SHEET
Dissolvine° E-FE-13
1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION
Product Name: Dissolvine® E-FE-13
Chemical Name: Ethylenediaminetetraacetic acid, ferric sodium complex
Synonym: Ferric sodium EDTA
C.A.S. Registry No.: 15708-41-5
Chemical Formula: C10 H12 Fe N2 O$ Na . 3H2O
Product Use: Chelating agent/ Plant nutrient
Manufacturer/Supplier
Akzo Nobel Functional Chemicals LLC
Chelates & Micronutrients
525 West Van Buren St., Chicago, IL 60607
Tel. [phone]
Emergency Telephone Numbers
FOR CHEMICAL EMERGENCY (Spill, Leak, Fire, Exposure or Accident)
■ CHEMTREC (24-hr): [phone] (Toll-free in the U.S.,Canada,and the U.S.Virgin Islands)
[phone] (For calls originating elsewhere/collect calls are accepted)
• CANUTEC (Canada): [phone]
FOR MEDICAL/ HANDLING EMERGENCIES: 1-914-693-6946 [Akzo Nobel - USA]
Date of First Issue: June 20, 1995 Revision No.: 11.0
Revision Date: June 14, 2006 Changes: Sections 1, 2, 3, 8, 9, 11, 12, 15, 16
2. HAZARDS IDENTIFICATION
EMERGENCY OVERVIEW
No significant immediate hazards for emergency response are known.
CAUTION: Contact with dust may cause discomfort and/or mild irritation.
Appearance and odor: Odorless yellow-green powder at 250C (770F).
POTENTIAL HEALTH EFFECTS [See section 11 for additional information]
Primary Route(s) of Exposure: Skin contact, eye contact and inhalation.
Acute Exposure
■ Inhalation: Exposure to an excessive concentration of dust may cause respiratory tract discomfort and/or
mild irritation.
• Skin Contact: Skin contact is not expected to cause irritation.
■ Eye Contact: Eye contact with dust may cause mild physical irritation.
■ Ingestion: This product has a low order of acute toxicity and is considered to be practically harmless by
ingestion.
Carcinogenicity: IARC, NTP, ACGIH and OSHA do not classify this material as a carcinogen or suspect
carcinogen.
Medical conditions aggravated: There are no data available that address medical conditions that are generally
recognized as being aggravated by exposure to this product.
POTENTIAL ENVIRONMENTAL EFFECTS[See Section 12 for additional information]
This product is not considered to be harmful to aquatic life, based on available data.
Issue date: 14-Jun-06 MSDS No.: 16-075280
Expiry date: 14-Jun-09 Page 1 / 7

Material Safety Data Sheet
Akzo Nobel Functional Chemicals LLC Dissolvine° E-FE-13
3. COMPOSITION/INFORMATION ON INGREDIENTS
INGREDIENTS [See section 8 for exposure limits] % w/w CAS Number
EDTA, ferric sodium complex 87.0—89.0 15708-41-5
Water 11.0— 13.0 7732-18-5
4. FIRST AID MEASURES
Inhalation: Inhalation of dust may affect respiratory system and cause symptoms of bronchitis. Remove victim
to fresh air. If symptoms persist, get medical attention.
Skin Contact: Remove contaminated clothing, shoes and equipment. Wash all affected areas with soap and
plenty of water for at least 15 minutes. Wash contaminated clothing and shoes before reuse. Get medical
attention if irritation occurs or persists.
Eye Contact: Flush eyes with large quantities of running water for a minimum of 15 minutes. If the victim is
wearing contact lenses, remove them. Hold the eyelids apart during the flushing to ensure rinsing of the entire
surface of the eye and lids with water. Get medical attention if eye irritation occurs.
Ingestion: ONLY induce vomiting at the instructions of a physician. If victim is conscious, rinse mouth and give
water to drink. Never give anything by mouth to an unconscious person. Get medical attention if health effects
occur.
Note to Physician: Attending physician should treat exposed patients symptomatically.
5. FIRE FIGHTING MEASURES
Conditions of Flammability: not flammable or combustible
Flash Point(Method): not applicable
Upper Flammable Limit (% by volume): not determined
Lower Flammable Limit(% by volume): not determined
Auto-Ignition Temperature: >392°F (>200°C)—glowing of 5 mm product layer:
Extinguishing Media: Use water fog or spray, dry chemical, foam or carbon dioxide extinguishing agents.
Fire Fighting Procedures: As in any fire, prevent human exposure to fire, smoke, fumes or products of
combustion. Evacuate all non-essential personnel from the fire area. Fire fighters should wear full-face, self-
contained breathing apparatus and impervious protective clothing.
Fire & Explosion Hazards: This product is not defined as flammable or combustible. When involved in a fire, it
does not contribute any unusual hazards.
Hazardous Combustion Products: Thermal decomposition products may release toxic and/or hazardous
fumes and gases, including nitrogen oxides and carbon oxides.
NPFA Hazard Rating—Health: 1 Fire: 0 Reactivity: 0 Other: None
[0-Minimal 1 -Slight 2-Moderate 3-High 4-Extreme]
6. ACCIDENTAL RELEASE MEASURES
Spill / Leak: Safely stop source of spill. Restrict non-essential personnel from area. All personnel involved in
spill cleanup should avoid skin and eye contact by wearing appropriate personal protective equipment.
Cleanup: Sweep up spilled solid material, being careful not to create dust. Return sweepings to stock or, if
contaminated, place into a chemical waste container for disposal. Flush remainder with water.
Issue date: 14-Jun-06 MSDS No.: 16-075280
Expiry date: 14-Jun-09 Page 2 / 7

Material Safety Data Sheet
Akzo Nobel Functional Chemicals LLC Dissolvine° E-FE-13
7. HANDLING AND STORAGE
Handling: Avoid inhalation and prolonged and/or repeated skin and eye contact. Minimize generation of dust.
In certain concentrations, the product may form an explosive dust-air mixture.
Storage: Keep containers closed and dry. This material is suitable for any general chemical storage area.
Isolate from strong oxidizing agents.
Maximum Storage Temperature: Store in a cool and dry place at ambient temperature (below 25°C/77°F).
General Comments: Containers should not be opened until ready for use.
8. EXPOSURE CONTROLS/PERSONAL PROTECTION
Applicable Exposure Limits: In addition to any exposure limits displayed below, exposures to this product
should be controlled below limits established for"Particulates Not Otherwise Classified (PNOC)":
• OSHA — 15 mg/m3 (total dust) ; 5 mg/m3 (respirable fraction)
OSHA— PELs ACGIH —TLVs NIOSH — RELs AIHA—WEELs
Chemical Name (MCI/m3 (Mg/ m3 (Mg/m3 (mg/m)
TWA STEL/ TWA STEL/ TWA STEL/ TWA STEL/
CEIL C CEIL C CEIL C CEIL C
EDTA, ferric sodium N/D N/D N/D N/D N/D N/D N/D N/D
complex
Water N/D N/D N/D N/D N/D N/D N/D N/D
[Ref:ACGIH Guide to Occupational Exposure Values,2006 Edition]
Legend:
CEIL: Ceiling Exposure Limit PEL: Permissible Exposure Limit REL: Recommended Exposure Limit
STEL: Short Term Exposure Limit TLV: Threshold Limit Value TWA: Time-Weighted Average
N/D: Not Determined WEEL: Workplace Environmental Exposure Level
ACGIH: American Conference of Governmental Industrial Hygienists
AIHA: American Industrial Hygiene Association
NIOSH: National Institute for Occupational Safety and Health
OSHA: Occupational Safety and Health Administration
Engineering Controls -Ventilation: Special ventilation is usually not required under normal use conditions.
However, ensure that existing ventilation is sufficient to prevent the circulation and/or accumulation of dust in the
air. If ventilation is inadequate based on conditions of use, personal protective equipment is needed.
Personal Protective Equipment(PPE)
■ Respiratory Protection: If handling operations generate dust, wear a NIOSH-approved half-mask, air
purifying respirator with dust, mist and fume filters to reduce potential for inhalation exposure. When using
respirator cartridges or canisters, they must be changed frequently (following each use or at the end of the
work shift)to assure breakthrough exposure does not occur.
■ Eye Protection: Indirect-vented, dust-tight goggles should be worn when handling this product.
■ Skin Protection: Skin contact with the product should be minimized or prevented through the use of
suitable protective clothing, gloves (nitrile gloves are recommended)and footwear selected according to use
condition exposure potential.
Other Protection: All food and smoking materials should be kept in a separate area away from the storage/use
location. Eating, drinking and smoking should be prohibited in areas where there is a potential for significant
exposure to this material. Before eating, drinking and smoking, hands and face should be thoroughly washed.
Issue date: 14-Jun-06 MSDS No.: 16-075280
Expiry date: 14-Jun-09 Page 3 / 7

Material Safety Data Sheet
Akzo Nobel Functional Chemicals LLC Dissolvine° E-FE-13
9. PHYSICAL AND CHEMICAL PROPERTIES
Physical State/Appearance/Odor: odorless, yellow-green powder at 25°C (77°F)
Boiling Point: not applicable
Bulk Density: = 950 kg/m3
Cloud Point: not determined
Evaporation Rate (Butyl acetate=l): not determined
Melting Point: decomposes prior to melting
Odor Threshold: not determined
pH: =4.0 - 5.5 (1% solution)
Partition Coefficient(n-octanol/water): log POW < 0
Pour Point: not determined
Solubility in water: 90 g/L (at 20°C/68°F) ; 300 g/L (at 80°C/ 176°F)
Solubility in other solvents: not determined
Specific Gravity(H20=1): not determined
Vapor Density(Air=1): not determined
Vapor Pressure: not applicable
Viscosity: not determined
Volatiles (%by weight): not determined
Other: not applicable
Conditions of Flammability: not flammable or combustible
Flash Point(Method): not applicable
Upper Flammable Limit(%by volume): not applicable
Lower Flammable Limit(%by volume): not applicable
Auto-Ignition Temperature: >392°F (>200°C)—glowing of 5 mm product layer
< :less than >:greater than =: approximately
10. STABILITY AND REACTIVITY
Stability: This product is stable at ambient temperatures and atmospheric pressures. It is not self-reactive and
is not sensitive to physical impact.
Incompatibilities/Conditions to avoid: This product is incompatible with strong oxidizers and aluminum.
Avoid prolonged storage at elevated temperatures. Product layer on hot surface might cause glowing or
autoignition.
Polymerization: Hazardous polymerization is not expected to occur under normal temperatures and pressures.
Decomposition Products: Under fire conditions the product may support combustion and decomposes to give
off carbon oxides fumes (CO, CO2) and nitrogen oxides.
11.TOXICOLOGICAL INFORMATION
INHALATION
Acute exposure: No data available.
Chronic exposure: No known effects for this product.
SKIN
Acute contact: Dermal toxicity for this product is not available. It is not considered to be irritating to skin. A
related product containing 32%ferric sodium EDTA was slightly irritating to rabbit skin following repeated
application.
Chronic contact: No known effects for this product.
EYES: This product may be minimally irritating to the eyes (based on tests with a related product containing
32%ferric sodium EDTA). Ferric sodium EDTA has shown slight transient conjunctivitis and corneal opacity in
rabbits.
Issue date: 14-Jun-06 MSDS No.: 16-075280
Expiry date: 14-Jun-09 Page 4/ 7

Material Safety Data Sheet
Akzo Nobel Functional Chemicals LLC Dissolvine° E-FE-13
11.TOXICOLOGICAL INFORMATION (CONTINUED)
INGESTION
Acute exposure: The oral LD50 for Ferric sodium EDTA is 2710 mg/kg in male rats and 3160 mg/kg in female
rats.
Chronic exposure: Ingestion of up to 86.15 mg/kg/day of ferric sodium EDTA for 31 or 61 days by rats resulted
in an accumulation of iron in the liver, spleen, and kidneys. There were no abnormal necropsy or histopathology
findings.
SENSITIZATION: No data available.
CARCINOGENICITY: IARC, NTP, ACGIH and OSHA do not classify this material as a carcinogen or suspect
carcinogen.
MUTAGENICITY: Ferric sodium EDTA, when tested as a pure substance, gave a negative response in the
Ames Assay and the E. Coli bacterial reversion assay, but a positive response in the Mouse Lymphoma Assay
(in vitro)with and without metabolic activation at concentrations which were cytotoxic. The positive response was
attributed to a possible sensitivity of the cells to abnormal iron concentrations.
TERATOGENICITY/ EMBRYOTOXICITY: EDTA and its sodium salts have been reported, in some studies, to
cause developmental toxicity in laboratory animals only at exaggerated doses that were toxic to the mother.
These effects are likely associated with zinc deficiency due to chelation. Exposures having no effect on the zinc
level of the mother should have no effect on the fetus.
OTHER TOXICOLOGICAL EFFECTS: None known.
TARGET ORGANS: Skin and eyes.
12. ECOLOGICAL INFORMATION
Ecotoxicity: The following data is available for Ferric sodium EDTA:
Test Species Exposure/ Duration Test Results
Fish (bluegill) 96-h LC50 = 2592 mg/L (100% active)
NOEC = 1792 mg/L
Daphnia 24-h EC50 = 110 mg/L
Algae (S. capricornutum) 72-h EC50 = 76.7 mg/L
Chemical Fate/ Degradation
■ Abiotic: 90-94% photodegradation (aqueous) in 24 hours.
■ Biotic: 89% biodegradation in 5 days when evaluated using a mixed population of aerated bacteria.
Other information: Ferric sodium EDTA component is not likely to bioaccumulate due to its high water
solubility and a Log Pow= -10.6 (based on EPIWIN model).
13. DISPOSAL CONSIDERATIONS
Waste Disposal: In its unused condition, this product is not considered to be a RCRA-defined hazardous waste
by characteristics or listings. It is the responsibility of the waste generator to evaluate whether his wastes are
hazardous by characteristic or listing. Dispose in accordance with all local, state and federal regulations.
NOTE—State and local regulations may be more stringent than federal regulations.
Container Disposal: Containers should be cleaned of residual product before disposal or return. Since emptied
containers retain product residue, follow label warnings even after the container is emptied. Empty containers
should be disposed of or shipped in accordance with all applicable laws and regulations.
Issue date: 14-Jun-06 MSDS No.: 16-075280
Expiry date: 14-Jun-09 Page 5 / 7

Material Safety Data Sheet
Akzo Nobel Functional Chemicals LLC Dissolvine° E-FE-13
14.TRANSPORT INFORMATION
Shipping Information: Not regulated for transport.
Required Labels: No transport label required
Environmentally Hazardous Substances [49 CFR 172.101, Appendix A]: None
15. REGULATORY INFORMATION
Regulatory Lists:
Substance Name CAA CERCLA IARC US STATE RIGHT- PROP 65 SARA
TO-KNOW LISTS
EDTA,ferric sodium N/R N/R N/R N/R N/R N/R
complex
Water N/R N/R N/R N/R N/R N/R
National Chemical Inventories Status:
Substance Name US Canada EU Australia Japan Korea Philippines China
TSCA DSL NDSL EINECS AICS ENCS KEC/ P/CCS /ECSC
EDTA,ferric sodium X X X X X X X X
complex
Water X X X X X X X X
N/R=Non Regulated X=Listed and/or Regulated
Legend
AICS Australian Inventory of Chemical Substances
CA List California—Directors List of Hazardous Substances
CAA Clean Air Act,Section 112
CERCLA CERCLA Hazardous Substances
DSL Domestic Substances List—Canada
EINECS European Inventory of Existing Commercial Chemical Substances
ENCS Japan Existing and New Chemical Substances
FL List Florida—Substance List
IARC International Agency for Research on Cancer—Carcinogens—Groups 1,2A or 2B
IECSC China—Inventory of Existing Chemical Substances
IL List Illinois Toxic Substances Disclosure to Employees Act
KECI Korea Existing Chemicals Inventory
LA List Louisiana Right-to-Know Reporting List
MA List Massachusetts—R-T-K Substance List
MN List Minnesota—Hazardous Substance List
NDSL Non-Domestic Substances List—Canada
NJ R-T-K New Jersey—R-T-K Hazard List
PA List Pennsylvania Hazardous Substance List
PICCS Philippines Inventory of Chemicals and Chemical Substances
Prop 65 California Proposition 65
RI List Rhode Island—Hazardous Substance List
SARA SARA Title III,Section 302/313
TSCA Toxic Substances Control Act—USA
Micronutrient Approvals/ Registrations
■ California Department of Food and Agriculture (CDFA): Dissolvine E-FE-13 is approved for sale
and distribution in California.
■ Canadian Food Inspection Agency(CFIA): Dissolvine E-FE-13 is a registered micronutrient in
Canada under the Fertilizers Act [Registration Number 980018131
Canada -WHMIS (Workplace Hazardous Materials Information System): Not controlled
This product has been classified in accordance with the hazard criteria of the Controlled Products Regulations(CPR)and
the MSDS contains all the information required by the CPR.
HMIS RATING— Health: 1 Flammability: 1 Reactivity: 0 Other: none
[0—Minimal 1-Slight 2-Moderate 3-High 4-Extreme Chronic Health Hazard (see Section 11)]
Issue date: 14-Jun-06 MSDS No.: 16-075280
Expiry date: 14-Jun-09 Page 6/ 7

Material Safety Data Sheet
Akzo Nobel Functional Chemicals LLC Dissolvine° E-FE-13
15. REGULATORY INFORMATION (CONTINUED)
Other Regulatory Information: Contact Akzo Nobel for additional information regarding use and approval of
Ferric sodium EDTA complex as indirect food additive.
16. OTHER INFORMATION
Other Information: Dissolvine° is a registered trademark of Akzo Nobel Chemicals Inc.
Prepared by: Akzo Nobel Technology& Engineering, SHERA/Regulatory Toxicology
M. Morin—Tel. [phone]
Changes: Sections 1, 2, 3, 8, 9, 11, 12, 15, 16
The information in this Material Safety Data Sheet should be provided to all who will use,handle,store,transport or otherwise be exposed to this product. All
information concerning this product and/or all suggestions for handling and use contained herein are offered in good faith and are believed to be reliable as of the
date of publication. Akzo Nobel Functional Chemicals LLC, however, makes no warranty as to the accuracy of and/or sufficiency of such information and/or
suggestions,as to the product's merchantability or fitness for any particular purpose,or that any suggested use will not infringe any patent. Nothing contained
herein shall be construed as granting or extending any license under any patent. Buyer shall determine for himself, by preliminary tests or otherwise, the
suitability of this product for his purposes,including mixing with other products. The information contained herein supersedes all previously issued bulletins on
the subject matter covered.If the date of this document is more than three years old,please call to ensure that this sheet is current.
Issue date: 14-Jun-06 MSDS No.: 16-075280
Expiry date: 14-Jun-09 Page 7 / 7

ESSENTIAL CHEMISTRY. INNOVATIVE SOLUTIONS. SAFETY DATA SHEET
Print Date:July 14,2017
Section •• Company Information
Product Identifier: Sodium Hydroxide,25%Solution
Other Means of Identification
Product Number: No data available.
Recommended Use and Restrictions on Use
Recommended Use: Pulping and Bleaching,pH Neutralizer,Detergent,Soaps.
Restrictions on Use: None known.
Manufacturer/Importer/Supplier/Distributor Information
Company Name:CORECHEM Inc.
Address:4320 Greenway Drive
Knoxville,TN 37918
USA
Information Telephone Number: 1-865-524-4239
Fax Number: 1-865-524-3375
Website:www.corecheminc.com
Contact Person: Regulatory Manager
E-mail:[e-mail]
Emergency Phone Number:Chemtrec®1-800-424-9300/Outside USA 1-703-527-3887(monitored 24 hours/day)
Section 2:Hazards Identification
GHS Hazard Classification(s)
In accordance with OSHA Hazard Communication Standard 29CFR 1910.1200(HazCom 2012).
Physical Hazard(s)
Corrosive to Metals-1
Health Hazard(s)
Acute Toxicity,Oral-4
Corrosion/Irritation,Skin-1 A
(Corrosion)Damage/Irritation,Eye-1
Environmental Hazard(s)
Aquatic,Acute-3
Label Elements
Signal Word
DANGER
Hazard Symbol(s)
P '
Hazard Statement(s)
H290:May be corrosive to metals.
H 302:Harmful if swallowed.
H314:Causes severe skin burns and eye damage.
H318:Causes serious eye damage.
H402:Harmful to aquatic life.
Precautionary Statements
General
Not applicable.
Prevention
P234:Keep only in original container.
P260:Do not breathe dust/fume/gas/mist/vapors/spray.
P264:Wash face,hands and any exposed skin thoroughly after handling.
P270:Do not eat,drink or smoke when using this product.
P273:Avoid release to the environment.
P280:Wear protective gloves/protective clothing/eye protection/face protection.
Response
P301+P312:IF SWALLOWED:Call a POISON CENTER or doctor/physician if you feel unwell.
P301+P330+P331:IF SWALLOWED:rinse mouth.Do NOT induce vomiting.
P303+P361+P353:IF ON SKIN(or hair):Remove/Take off immediately all contaminated clothing.Rinse skin with water/shower.
Pagel of 7

ESSENTIAL CHEMISTRY. INNOVATIVE SOLUTIONS. SAFETY DATA SHEET
Print Date:July 14,2017
P304+P340:IF INHALED:Remove to fresh air and keep at rest in a position comfortable for breathing.
P305+P351+P338:IF IN EYES:Rinse cautiously with water for several minutes.Remove contact lenses,if present and easy to do.Continue rinsing.
P310:Immediately call a POISON CENTER or doctor/physician.
P321:Specific treatment(see supplemental first aid instructions on this label).
P330:Rinse mouth.
P363:Wash contaminated clothing before reuse.
P390:Absorb spillage to prevent material damage.
Storage
P405:Store locked up.
P406:Store in corrosive resistant container with a resistant inner liner.
Disposal
P501:Dispose of contents/container to an appropriate treatment and disposal facility in accordance with applicable laws and regulations,and
product characteristics at time of disposal.
Hazard(s)not otherwise classified(HNOC)
None known.
Section 3:Composition/information on Ingredients
Substance
Chemical Identity' Common Name/Synonym(s) CAS#' Weight% Impurity or Stabilizing Additive
Sodium Hydroxide Caustic Soda,Caustic,Alkali,Lye,Caustic 1310-73-2 24-26% No
Lye,Caustic Soda,Soda Lye,Liquid
Caustic,Sodium Hydrate
1.Information regarding the composition and the percent ranges of the mixtures ingredients are not presented as it Confidential Business Information(CBI).Where a medical emergency exists(as
determined by medical professional),timely disclosure of CBI is assured.The information omitted pertains to only the names of the substances and the concentration in the mixture(product)and
can only be requested by a doctor/physician or Local/State/Provincial or Federal Authority.
2.Non-hazardous ingredients are not presented as to protect the proprietary formula of the product.
3."—'Indicates ingredient is a mixture and contains multiple ingredients or may have no identifying CAS number.
Section 4:First-Aid Measures
General Information
Ensure that medical personnel are aware of the material(s)involved,and take precautions to protect themselves.In the case of accident or if you feel unwell,seek
medical advice immediately(show the label where possible).Wash contaminated clothing before reuse.
Inhalation
Move to fresh air.If breathing is difficult,give oxygen.If breathing stops,provide artificial respiration.Do not use mouth-to-mouth method if victim inhaled the
substance.Induce artificial respiration with the aid of a pocket mask equipped with a one-way valve or other proper respiratory medical device.Call a physician or
poison control center immediately.
Skin Contact
Take off immediately all contaminated clothing.Wash off IMMEDIATELY with plenty of water for at least 15-20 minutes.Get medical attention immediately!Wash
clothing separately before reuse.Destroy or thoroughly clean contaminated shoes.
Eye Contact
Immediately flush eyes with plenty of water for at least 15 minutes.Remove contact lenses,if present and easy to do.Continue rinsing.Call a physician or poison control
center immediately.
Ingestion
Call a physician or poison control center immediately.Do not induce vomiting.Immediately rinse mouth and drink plenty of water.If vomiting occurs,keep head low
so that stomach content doesn't get into the lungs.Never give anything by mouth to an unconscious person.Do not use mouth-to-mouth method if victim ingested
the substance.
Most important symptoms/effects,acute and delayed
Symptoms
Burning pain and severe corrosive skin damage.Permanent eye damage including blindness could result.Symptoms may include stinging,tearing,redness,
swelling,and blurred vision.Shortness of breath.
Indication of immediate medical attention and special treatment needed
Hazards
No data available.
Treatment
Provide general supportive measures and treat symptomatically.Symptoms may be delayed.Keep victim under observation.
Section 5: Fire—Fighting Measures
General Fire Hazards
No unusual fire or explosion hazards noted.
Suitable(and Unsuitable)Extinguishing Media
Suitable Extinguishing Media
Water fog.Foam.Dry chemical powder.Carbon dioxide.Use extinguishing agent suitable for type of surrounding fire.
Page 2 of 7

C �R_ 71=7 N4"
ESSENTIAL CHEMISTRY. INNOVATIVE SOLUTIONS. SAFETY DATA SHEET
Print Date:July 14,2017
Unsuitable Extinguishing Media
Do not use a solid water stream as it may scatter and spread fire.Do not use halogenated extinguishing agents.
Specific Hazards Arising from the Chemical
The product itself does not burn.May decompose upon heating to produce corrosive and/or toxic fumes.Contact with metal may release flammable hydrogen gas.
Special Protective Equipment and Precautions for Firefighters
Special Fire-Fighting Equipment Procedures
In case of fire and/or explosion do not breathe fumes.Move containers from fire area if you can do so without risk.Use water spray to cool unopened containers.
Special Protective Equipment for Fire-Fighters
As in any fire,wear self-contained breathing apparatus pressure-demand(OSHA/NIOSH approved or equivalent)and full protective gear.
Section 6:Accidental Release Measures
Personal Precautions,Protective Equipment and Emergency Procedures
Keep unnecessary personnel away.Wear appropriate protective equipment and clothing during clean-up.Do not touch damaged containers or spilled material unless
wearing appropriate protective clothing.Local authorities should be advised if significant spillages cannot be contained.
Methods and Materials for Containment and Clean-Up
Large Spills:Stop the flow of material,if this is without risk.Dike the spilled material,where this is possible.Absorb spill with inert material(e.g.,dry sand or earth),then
place in a chemical waste container.Following product recovery,flush area with water.
Small Spills:Absorb spill with vermiculite or other inert material.Clean surface thoroughly to remove residual contamination.
Never return spills in original containers for re-use.For waste disposal,see Section 13 ofthe SDS.
Notification Procedures
In the event of a spill or accidental release,notify relevant authorities in accordance with all applicable regulations.
Environmental Precautions
Avoid discharge into drains,water courses or onto the ground.
Section 7:Handling and Storage
Precautions for Safe Handling
Use caution when combining with water;DO NOT add water to caustic;ALWAYS add caustic to water while stirring to minimize heat generation.Do not get in eyes,on
skin,or on clothing.Do not taste or swallow.Do not breathe mist or vapor.Use only with adequate ventilation.Wear appropriate personal protective equipment.
Transfer and storage systems should be compatible and corrosion resistant.Observe good industrial hygiene practices.
Conditions for Safe Storage,including any Incompatibilities
Keep container tightly closed.Store in a cool,dry,well-ventilated place.Store in corrosive resistant container with a resistant inner liner.Store away from incompatible
materials(See Section 10).Store at temperatures not exceeding 40°C/104°F.Compatible storage materials may include,but not be limited to,the following:nickel and
nickel alloys,steel,plastics,plastic or rubber-lined steel,FRP,or Derakane vinyl ester resin.Do not allow material to freeze.
ExposureSection 8:
Control Parameters
Occupational Exposure Limits
Chemical Identity Type Value Source
Sodium Hydroxide PEL 1 2mg/m' USOSHATableZ-1
Sodium Hydroxide I Ceiling 1 2 mg/m' I US.ACGIH Threshold Limit Values
Biological Limit Values
The product does not contain any relevant quantities of hazardous materials with assigned biological limit values.
Appropriate Engineering Controls
No data available.
Individual protection measures,such as personal protective equipment(PPE)
General Information
Good general ventilation(typically 10 air changes per hour)should be used.Ventilation rates should be matched to conditions.If applicable,use process
enclosures,local exhaust ventilation,or other engineering controls to maintain airborne levels below recommended exposure limits.If exposure limits have not
been established,maintain airborne levels to an acceptable level.Eye wash facilities and emergency shower must be available when handling this product.
Eye/Face Protection
Wear chemical goggles and face shield.
Skin Protection
Hand Protection
Wear appropriate chemical resistant gloves.
Other
Wear appropriate chemical resistant clothing.
Respiratory Protection
If engineering controls do not maintain airborne concentrations below recommended exposure limits(where applicable)or to an acceptable level(in countries
where exposure limits have not been established),an approved respirator must be worn.Air-purifying respirator with an appropriate,government approved
(where applicable),air-purifying filter,cartridge or canister.Contact health and safety professional or manufacturer for specific information
Page 3 of 7

ESSENTIAL CHEMISTRY. INNOVATIVE SOLUTIONS. SAFETY DATA SHEET
Print Date:July 14,2017
Hygiene Measures
When using,do not eat,drink or smoke.Always observe good personal hygiene measures,such as washing after handling the material and before eating,drinking,
and/or smoking.Routinely wash work clothing and protective equipment to remove contaminants.Discard contaminated footwear that cannot be cleaned.Wash
hands before breaks and immediately after handling the product.Wash contaminated clothing before reuse.Avoid contact with eyes,skin,and clothing.
PropertiesSection 9:Physical and Chemical
Appearance:
Physical State: Liquid
Color: Clear to Hazy White
Odor: Odorless
Odor Threshold: No data available.
PH: 14
Melting Point/Freezing Point: 50-53°F(10-11.67°C)(50%solution)
Initial Boiling Point and Boiling Range: 266-284°F 030-140°C)(50%sol ution)
Flash Point: Not applicable.
Evaporation Rate(butyl acetate=l): No data available.
Flammability(solid,gas): No data available.
Upper/Lower Limit on Flammability or Explosive Limits
Flammability Limit-Upper: No data available.
Flammability Limit-Lower: No data available.
Explosive Limit-Upper: No data available.
Explosive Limit-Lower: No data available.
Vapor Pressure: 23.76 mm Hg(approximately)(77°F(25°C))
Vapor Density(air=1): No data available.
Relative Density(water-1): 1.2781-1.3317 @ 68°F
Solubility(ies):
Solubility in water: Completely miscible with water.
Solubility(other): No data available.
Partition coefficient(n-octanol/water): No data available.
Auto-Ignition Temperature: No data available.
Decomposition Temperature: No data available.
Viscosity: No data available.
Other Information:
Molecular Weight: 40.1 g/mol
Formula: NaOH
Section1
Reactivity
Contact with metal may release flammable hydrogen gas.
Chemical Stability
Material is stable under normal conditions.
Possibility of Hazardous Reactions
Hazardous polymerization does not occur.
Conditions to Avoid
Reacts violently with strong acids.This product may react with oxidizing agents.Do not mix with other chemicals.Corrosive to aluminum,tin,zinc,copper and most
alloys in which they are present including brass and bronze.Corrosive to steels at elevated temperatures above 40°C(104°F).
Incompatible Materials
Oxidizing agents.Acids.Phosphorus.Aluminum.Zinc.Tin.Initiates or catalyzes violent polymerization of acetaldehyde,acrolein or acrylonitrile.
Hazardous Decomposition Products
Contact with metals(aluminum,zinc,tin)and sodium tetrahydroborate liberates hydrogen gas.
•n 11:Toxicolo
Information on routes of exposure
Ingestion:Causes digestive tract burns.Harmful if swallowed.
Inhalation:May cause irritation to the respiratory system.
Skin Contact:Causes severe skin burns.
Eye Contact:Causes severe eye burns and damage.
Information on Toxicological Effects
Acute Toxicity(List all possible routes of exposure)
Oral
Sodium Hydroxide:LD50(Rat):300-500 mg/kg
Dermal
Sodium Hydroxide:LD50(Rabbit):>2 g/kg
Page 4 of 7

ESSENTIAL CHEMISTRY. INNOVATIVE SOLUTIONS. SAFETY DATA SHEET
Print Date:July 14,2017
Inhalation
No data available.
Repeated Dose Toxicity
Sodium Hydroxide:(Mouse):40 mg/kg,intraperitoneal
Skin Corrosion/Irritation
Causes severe skin burns.
Serious Eye Damage/Eye Irritation
Causes sever eye burns and damage.
Respiratory/Skin Sensitization
No data available.
Carcinogenicity
IARC Monographs on the Evaluation of Carcinogenic Risks to Humans
No component of this product present at levels greater than or equal to 0.1%is identified as probable,possible or confirmed human carcinogen by IARC.
US.National Toxicology Program(NTP)Report on Carcinogens
No component of this product present at levels greater than or equal to 0.1%is identified as a known or anticipated carcinogen by NTP.
US.OSHA Specifically Regulated Substances(29 CFR 1910.1001-1052)
No component of this product present at levels greater than or equal to 0.1%is identified as a carcinogen or potential carcinogen by OSHA.
Germ Cell Mutagenicity
In Vitro
No mutagenic components identified.
In Vivo
No mutagenic components identified.
Reproductive Toxicity
None known.
Specific Target Organ Toxicity-Single Exposure
None known.
Specific Target Organ Toxicity-Repeated Exposure
None known.
Aspiration Hazard
Droplets of the product aspirated into the lungs through ingestion or vomiting may cause serious chemical pneumonia.
Other Effects
None known.
Section 12:Ecological Information
Ecotoxicity
Acute Hazards to the Aquatic Environment
Fish
Sodium Hydroxide:LC50(Bluegill(Lepomis Macrochirus),48 h):99 mg/I
Sodium Hydroxide:LC50(Mosquitofish(Gambusia Affinis Affinis),96 h):125 mg/I
Aquatic Invertebrates
No data available.
Toxicity to Aquatic Plants
No data available.
Chronic Hazards to the Aquatic Environment
Fish
No data available.
Aquatic Invertebrates
No data available.
Toxicity to Aquatic Plants
No data available.
Persistence and Degradability
Biodegradation
Expected to degrade rapidly in air.
BOD/COD Ratio
No data available.
Bioaccumulative Potential
Bioconcentration Factor(BCF)
No data available on bioaccumulation.
Partition Coefficient n-octanol/water(log Kow)
Page 5 of 7

ESSENTIAL CHEMISTRY. INNOVATIVE SOLUTIONS. SAFETY DATA SHEET
Print Date:July 14,2017
No data available.
Mobility in Soil
No data available.
Other Adverse Effects
None known.
SectionDisposal
Disposal Instructions
Collect and reclaim or dispose in sealed containers at licensed waste disposal site.This material and its container must be disposed of as hazardous waste.Do not allow
this material to drain into sewers/water supplies.Do not contaminate ponds,waterways or ditches with chemical or used container.Dispose of contents/container in
accordance with local/regional/national/international regulations.
Contaminated Packaging
Handle contaminated packages in the same way as the substance itself.Emptied containers may retain hazardous residue and explosive vapors. Keep away from heat,
sparks,and flames.Do not cut,puncture,or weld on or near this container. Follow label warnings until container is thoroughly cleaned or destroyed.
TransportationSection 14:
US Department of Transportation(DOT)
UN Number: UN1824
UN Proper Shipping Name:Sodium Hydroxide Solution
Technical Name: -
Hazard Class:8
Subsidiary Hazard Risk: -
Packing Group: II
DOT Label/Placard Exemptions: Not determined
Special Provisions: B2,IB2,N34,T7,TP2
Packaging Exceptions:49CFR 173.154
Packaging Non-Bulk:49CFR 173.202
Packaging Bulk:49CFR 173.242
Reportable Quantity(RQ): 1,0001b(454kg)
Marine Pollutant: No
Poison Inhalation Hazard: No
Special precautions for user:Transport within user's premises:always transport in closed containers that are upright and secure.Ensure that persons
transporting the product know what to do in the event of an accident or spillage.
Emergency Response Guidebook(ERG)#: 154
Important Note:Shipping descriptions may vary based on mode of transport,quantities,package size,and/or origin and destination.Consult your company's Hazardous
Materials/Dangerous Goods expert forinformation specific to your situation.
Section 15:Regulatory Information
US Federal Regulations
Toxic Substance Control Act(TSCA),Chemical Substance Inventory,Section 8(b)
This product or ingredient(s)are listed on the TSCA inventory.Any impurities present in this product are exempt from listing.
Comprehensive Environmental Response,Compensation,and Liability Act(CERCLA)Hazardous Substance List(40 CFR 302.4)
The following chemical(s)in this material are subject to reporting levels established by CERCLA:
Sodium Hydroxide(CAS#1310-73-2)
Clean Air Act(CAA),Section 112(r)
No chemical(s)in this material are subject to the reporting requirements of CAA.
Emergency Planning and Community Right-To-Know Act(EPCRA)
EPCRA 302 Extremely Hazardous Substance
No chemical(s)in this material are subject to the reporting requirements of SARA Title III,Section 302.
EPCRA 304 Emergency Response Notification
No chemical(s)in this material are subject to the reporting requirements of SARA Title III,Section 304.
EPCRA 311/312 Emergency and Hazardous Materials Reporting
Fire Hazard: No
Sudden Release of Pressure: No
Reactive:Yes
Acute(Immediate)Health Hazard:Yes
Chronic(Delayed)Health Hazard: No
EPCRA 313 Toxic Chemical Release Inventory(TRI)Reporting
This material does not contain any chemical(s)with known CAS numbers that exceed the threshold(De Minimis)reporting levels established by SARA Title
III,Section 313.
US State Regulations
California Safe Drinking Water and Toxic Enforcement Act of 1986(Proposition 65)
This product does not contain any chemicals known to State of California to cause cancer,birth defects,or any other reproductive harm.
Page 6 of 7

C �R_ 7 1=IIIF M'"
ESSENTIAL CHEMISTRY. INNOVATIVE SOLUTIONS. SAFETY DATA SHEET
Print Date:July 14,2017
Important Note:Due to the changing nature of regulatory requirements,the information in this document should NOT be considered all-inclusive or authoritative.Users should make
their own investigations to determine the suitability of the information for their particular purposes.International,Federal,State and Local regulations should be consulted to
determine compliance with all required reporting requirements.
SectionOther
Hazardous Materials Identification System(HMIS®)Classification
Health Hazard:3
Chronic Health Hazard:/
Flammability:0
+ 1
(Hazard Rating:0-Minimal/1-Slight/2-Moderate/3-Serious/4-Severe)
National Fire Protection Association(NFPA 704)Rating
Health Hazard:3
Fire Hazard:0
Reactivi—"-- - -
Special: N/A
(Hazard Rating:O-Minimal/1-Slight/2-Moderate/3-Serious/4-Severe)
Prepared By: Regulatory Manager
Version#:001
Issue Date:July 31,2015
Revision Date:-
Revisions:-
Key to Abbreviations and Acronyms
ATE-Acute Toxicity Estimate ACGIH-American Conference of Industrial Hygienists
BCF-Bioconcentration Factor AIHA-American Industrial Hygiene Association
EC50-Effective concentration,50% BEI-Biological Exposure Indices
IDHL-Immediately Dangerous to Life and Health CAS-Chemical Abstracts Service
Kg-Kilogram DOT-US Department of Transportation
I-Liter EPA-US Environmental Protection Agency
lb-Pound GHS-Globally Harmonized System of Classification and Labelling of Chemicals
LC50-Lethal Concentration,50% IARC-International Agency for Research on Cancer
LD50-Lethal Dose,50% IATA-International Air Transport Association
mg-milligram IBC-Intermediate Bulk Container
ml-milliliter IMDG-International Maritime Dangerous Goods
N/A-Not Applicable NIOSH-National Institute for Occupational Safety and Health
N/D-Not Determined NTP- National Toxicology Program
PEL-Permissible Exposure Limit OSHA-US Occupational Health and Safety Administration
REL-Recommended Exposure Limit SARA-US EPA Superfund Amendments and Reauthorization Act
STEL-Short-term Exposure Limit TSCA-US EPA Toxic Substances Control Act
TWA-Time weighted average UN-United Nations
References
HSDB®-Hazardous Substances Data Bank
Disclaimer
The information in this SIDS was obtained from sources which we believe are reliable.HOWEVER,THE INFORMATION IS PROVIDED WITHOUT ANY WARRANTY,EXPRESS
OR IMPLIED,REGARDING ITS CORRECTNESS.The conditions or methods of handling,storage,use,and disposal of the product are beyond our control and may be
beyond our knowledge.FOR THIS AND OTHER REASONS,WE DO NOT ASSUME RESPONSIBILITY AND EXPRESSLY DISCLAIM LIABILITY FOR LOSS,DAMAGE OR EXPENSE
ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE HANDLING,STORAGE,USE OR DISPOSAL OF THE PRODUCT.This SIDS was prepared and is to be used only for
this product.If the product is used as a component in another product,this SDS information may not be applicable.
Page 7 of 7

SAFETY DATA SHEET
Sodium Persulfate
SIDS# : 7775-27-1
Revision date: 2021-10-14
Format: NA
Version 1.07
EVonlK
Leading Beyond Chemistry
1. PRODUCT AND COMPANY IDENTIFICATION
Product Identifier
Product Name Sodium Persulfate
CAS-No 7775-27-1
Synonyms Sodium Peroxydisulfate; Disodium Peroxydisulfate; Peroxydisulfuric acid, disodium salt;
Peroxydisulfuric acid, sodium salt.
Recommended use of the chemical and restrictions on use
Recommended Use: Polymerization initiator; Etchant and cleaner for printed circuit boards; Hair bleaching
formulations; Secondary oil recovery; Oxidizing agent for a variety of organic reactions.
Restrictions on Use No uses to be advised against were identified.
Manufacturer/Supplier
Evonik Active Oxygens, LLC
2005 Market Street
Suite 3200
Philadelphia, PA 19103
Phone: [phone] (General Information)
E-Mail: [e-mail]
Emergency telephone numbers
For leak,fire, spill or accident emergencies, call:
1 800/424 9300 (CHEMTREC-U.S.A.)
1 703/527 3887 (CHEMTREC-Collect-All Other Countries)
+1 303/389-1409(Medical -U.S. -Call Collect)
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Sodium Persulfate
SIDS# : 7775-27-1
Revision date: 2021-10-14
Version 1.07
2. HAZARDS IDENTIFICATION
Classification
OSHA Regulatory Status
This material is considered hazardous by the OSHA Hazard Communication Standard (29 CFR 1910.1200)
Acute toxicity-Oral Category 4
Skin corrosion/irritation Category 2
Serious eye damage/eye irritation Category 2B
Respiratory sensitization Category 1
Skin sensitization Category 1
S ecific target organ toxicity(single exposure) Cate o 3
Oxidizing Solids ICategory 3
GHS Label elements, including precautionary statements
EMERGENCY OVERVIEW
Danger
Hazard Statements
H334-May cause allergy or asthma symptoms or breathing difficulties if inhaled
H335-May cause respiratory irritation
H320-Causes eye irritation
H315-Causes skin irritation
H317-May cause an allergic skin reaction
H302-Harmful if swallowed
H272-May intensify fire; oxidizer
< 0 4
�
Precautionary Statements-Prevention
P261 -Avoid breathing dust/fume/gas/mist/vapors/spray
P285- In case of inadequate ventilation wear respiratory protection
P280-Wear protective gloves/protective clothing/eye protection/face protection
P264-Wash face, hands and any exposed skin thoroughly after handling
P272-Contaminated work clothing should not be allowed out of the workplace
P270- Do not eat, drink or smoke when using this product
P210- Keep away from heat, hot surfaces, sparks, open flames and other ignition sources. No smoking
P220- Keep away from clothing and other combustible materials
Precautionary Statements-Response
P305+ P351 + P338-IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to
do. Continue rinsing
P337+ P313- If eye irritation persists: Get medical advice/attention
P302+ P352- IF ON SKIN:Wash with plenty of water.
P333+ P313- If skin irritation or rash occurs: Get medical advice/attention
P362+ P364-Take off all contaminated clothing and wash it before reuse
P304+ P340- IF INHALED: Remove person to fresh air and keep comfortable for breathing
P342+ P311 - If experiencing respiratory symptoms: Call a POISON CENTER or doctor
P301 + P312- IF SWALLOWED: Call a POISON CENTER or doctor if you feel unwell
P330-Rinse mouth
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Sodium Persulfate
SIDS# : 7775-27-1
Revision date: 2021-10-14
Version 1.07
P370+ P378- In case of fire: Use water for extinction
Precautionary Statements-Storage
P403+ P233-Store in a well-ventilated place. Keep container tightly closed
P405-Store locked up
Precautionary Statements-Disposal
P501 - Dispose of contents/container to an approved waste disposal plant
Hazards not otherwise classified(HNOC)
No hazards not otherwise classified were identified.
Other Information
Risk of decomposition by heat or by contact with incompatible materials
Unknown acute toxicity
0%of the mixture consists of ingredient(s)of unknown toxicity
3. COMPOSITION/INFORMATION ON INGREDIENTS
Chemical name CAS-No Weight%
Sodium Persulfate 7775-27-1 >99
Sodium sulfate 7757-82-6 < 1
4. FIRST AID MEASURES
General Advice Remove from exposure, lie down. Show this material safety data sheet to the doctor in
attendance.
Eye Contact Rinse thoroughly with plenty of water for at least 15 minutes, lifting lower and upper eyelids
intermittently. Consult a physician. In case of contact, immediately flush eyes with plenty of
water. If symptoms persist, call a physician.
Skin Contact Wash off immediately with soap and plenty of water while removing all contaminated
clothes and shoes. Get medical attention if irritation develops and persists.
Inhalation Remove from exposure, lie down. If breathing is irregular or stopped, administer artificial
respiration. Call a physician immediately.
Ingestion Do NOT induce vomiting. Call a physician or poison control center immediately. Rinse
mouth. Drink 1 or 2 glasses of water.
Most important symptoms and Itching; Redness; Coughing and/or wheezing.
effects, both acute and delayed
Indication of immediate medical Treat symptomatically
attention and special treatment
needed, if necessary
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Sodium Persulfate
SDS# : 7775-27-1
Revision date: 2021-10-14
Version 1.07
5. FIRE-FIGHTING MEASURES
Suitable Extinguishing Media Water. Cool containers with flooding quantities of water until well after fire is out.
Unsuitable extinguishing media Do not use carbon dioxide or other gas filled fire extinguishers;they will have little effect on
decomposing persulfate.
Specific Hazards Arising from the Decomposes under fire conditions to release oxygen that intensifies the fire.
Chemical
Explosion data
Sensitivity to Mechanical Impact Not sensitive.
Sensitivity to Static Discharge Not sensitive.
Protective equipment and As in any fire,wear self-contained breathing apparatus pressure-demand, MSHA/NIOSH
precautions for firefighters (approved or equivalent)and full protective gear.
6. ACCIDENTAL RELEASE MEASURES
Personal Precautions Keep off any unprotected persons.Avoid contact with the skin and the eyes.Avoid
breathing dust.Wear personal protective equipment.
Other Never add other substances or combustible waste to product residues.
Environmental Precautions Knock down dust with water spray.Avoid penetration into waterways, sewers, soil or
groundwater. Local authorities should be advised if significant spillages cannot be
contained.
Methods for Containment Vacuum, shovel or pump waste into a drum and label contents for disposal.Avoid dust
formation. Store in closed container.
Methods for cleaning up Clean up spill area and treat as special waste. Dispose of waste as indicated in Section 13.
7. HANDLING AND STORAGE
Handling Wear personal protective equipment.Avoid breathing dust. Handle product only in closed
system or provide appropriate exhaust ventilation at machinery.Avoid contact with skin and
eyes. Remove and wash contaminated clothing before re-use.
Storage Keep containers tightly closed in a dry, cool and well-ventilated place. Keep away from
heat. Do not store near combustible materials.Avoid contamination of opened product.
Keep away from food, drink and animal feedingstuffs.Avoid formation and deposition of
dust.
Incompatible products Bases, Halides, Oxidizing agents, Strong reducing agents, Combustible materials.
8. EXPOSURE CONTROLS/PERSONAL PROTECTION
Control parameters
Exposure Guidelines
Chemical name ACGIH TLV OSHA PEL NIOSH Mexico
Sodium Persulfate TWA: 0.1 mg/m3 - - -
7775-27-1
Chemical name British Columbia Quebec Ontario TWAEV Alberta
Sodium Persulfate TWA: 0.1 mg/m3 - TWA: 0.1 mg/m3 TWA: 0.1 mg/m3
7775-27-1
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Sodium Persulfate
SIDS# : 7775-27-1
Revision date: 2021-10-14
Version 1.07
Appropriate engineering controls
Engineering measures Ensure adequate ventilation, especially in confined areas.
Individual protection measures, such as personal protective equipment
Eye/Face Protection Eye protection recommended. Chemical goggles consistent with EN 166 or equivalent.
Skin and Body Protection Wear long-sleeved shirt, long pants, socks, and shoes.
Hand Protection Protective gloves: Neoprene gloves, Polyvinylchloride, Natural Rubber.
Respiratory Protection If exposure limits are exceeded or irritation is experienced, NIOSH/MSHA approved
respiratory protection should be worn: particulate filtering facepiece respirators.
Hygiene measures Keep away from food, drink and animal feeding stuffs. Do not eat, drink or smoke when
using this product.Wash hands before breaks and after shifts. Keep work clothes separate,
remove contaminated clothing-launder after open handling of product.
General information Protective engineering solutions should be implemented and in use before personal
protective equipment is considered.
9. PHYSICAL AND CHEMICAL PROPERTIES
Information on basic physical and chemical properties
Appearance Crystalline solid
Physical State Solid
Color White
Odor odorless
Odor threshold Not applicable
pH 6.0 (1%solution)
Melting point/freezing point 180 °C (Decomposes)
Boiling Point/Range Decomposes on heating
Flash point Not flammable
Evaporation Rate Not applicable
Flammability(solid,gas) Not flammable
Flammability Limit in Air Not applicable
Upper flammability limit: No information available
Lower flammability limit: No information available
Vapor pressure 6.07E-30 mm Hg at 25°C
Vapor density No information available
Density 2.59 g/cm3(crystal density)
Specific gravity No information available
Water solubility 42 %@ 25°C
Solubility in other solvents No information available
Partition coefficient No information available
Autoignition temperature No evidence of combustion up to 600°C
Decomposition temperature > 100 °C (assume)
Viscosity, kinematic No information available (Solid)
Viscosity, dynamic No information available
Explosive properties Not explosive
Oxidizing properties oxidizer
Other Information
Molecular weight 238.1
VOC content(%) Not applicable
Bulk density 1.12 g/cm3(loose)
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Sodium Persulfate
SDS# : 7775-27-1
Revision date: 2021-10-14
Version 1.07
10. STABILITY AND REACTIVITY
Reactivity Strong oxidizer. Oxidizer. Contact with other material may cause fire.
Chemical Stability Decomposition can occur on exposure to heat or moisture.
Possibility of Hazardous Reactions Use of persulfates in chemical reactions requires appropriate precautions and design
considerations for pressure and thermal relief.
Decomposing persulfates will evolve large volumes of gas and/or vapor, can accelerate
exponentially with heat generation, and create significant and hazardous pressures if
contained and not properly controlled or mitigated.
Use with alcohols in the presence of water has been demonstrated to generate conditions
that require rigorous adherence to process safety methods and standards to prevent
escalation to an uncontrolled reaction.
Hazardous polymerization Hazardous polymerization does not occur.
Conditions to avoid Heat. (decomposes at 275°C); Moisture.
Incompatible materials Bases, Halides, Oxidizing agents, Strong reducing agents, Combustible materials.
Hazardous Decomposition Products Oxygen which supports combustion; Sulfur oxides.
11. TOXICOLOGICAL INFORMATION
Product Information
Unknown acute toxicity 0%of the mixture consists of ingredient(s)of unknown toxicity
LD50 Oral 895 mg/kg (rat)(Sodium Persulfate)
LD50 Dermal > 10,000 mg/kg (rabbit)(Sodium Persulfate)
LC50 Inhalation > 5.1 mg/L (rat)(4-hr)(Sodium Persulfate)
Serious eye damage/eye irritation Irritating to eyes.
Skin corrosion/irritation Minimally irritating.
Sensitization Sensitizing to skin and respiratory system.
Component Information
Information on toxicological effects
Symptoms Symptoms of allergic reaction may include rash, itching, swelling and trouble breathing.
Delayed and immediate effects as well as chronic effects from short and long-term exposure
Irritation Irritating to eyes, respiratory system and skin.
corrosivity None.
Carcinogenicity Did not show carcinogenic effects in animal experiments.
Mutagenicity In vivo tests did not show mutagenic effects.
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Sodium Persulfate
SIDS# : 7775-27-1
Revision date: 2021-10-14
Version 1.07
Reproductive toxicity This product is not recognized as reprotox by Research Agencies.
STOT-single exposure May cause respiratory irritation.
STOT-repeated exposure Not classified.
Subchronic toxicity Oral (NOAEL)= 131.5 mg/kg bw(Sodium Persulfate)
Inhalation (NOAEC)= 10.3 mg/m3(Ammonium Persulfate) Dermal: No data available
Target organ effects Eyes, Skin, Respiratory System.
Aspiration hazard Not applicable.
12. ECOLOGICAL INFORMATION
Ecotoxicity
Ecotoxicity effects
Sodium Persulfate 7775-27-1
Active Ingredient(s) Duration Species Value Units
Sodium Persulfate 96 h LC50 Rainbow trout 163 m /L
Sodium Persulfate 48 h LC50 Daphnia ma na 133 m /L
Sodium Persulfate 96 h LC50 Grass shrimp 519 m /L
Sodium Persulfate 72 h EC50 Algae Selenastrum 116 mg/L
ca ricornutum
Persistence and degradability Biodegradability does not pertain to inorganic substances.
Bioaccumulation Does not bioaccumulate.
Mobility Dissociates into ions.
Other Adverse Effects None known.
13. DISPOSAL CONSIDERATIONS
Waste disposal methods Dispose of in accordance with all applicable national environmental laws and regulations.
US EPA Waste Number D001.
Contaminated Packaging Dispose of in accordance with local regulations.
14. TRANSPORT INFORMATION
DOT
UN/ID no UN 1505
Proper Shipping Name SODIUM PERSULFATE
Hazard class 5.1
Packing Group III
TDG
UN/ID no UN 1505
Proper Shipping Name SODIUM PERSULFATE
Hazard class 5.1
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Sodium Persulfate
SIDS# : 7775-27-1
Revision date: 2021-10-14
Version 1.07
Packing Group III
MEX
UN/ID no UN 1505
Proper Shipping Name SODIUM PERSULFATE
Hazard class 5.1
Packing Group III
ICAO/IATA
UN/ID no 1505
Proper Shipping Name SODIUM PERSULFATE
Hazard class 5.1
Packing Group III
IMDG/IMO
UN/ID no 1505
Proper Shipping Name SODIUM PERSULFATE
Hazard class 5.1
Packing Group III
ADR/RID
UN/ID no UN 1505
Proper Shipping Name SODIUM PERSULFATE
Hazard class 5.1
Packing Group III
ADN
Proper Shipping Name SODIUM PERSULFATE
Hazard class 5.1
Packing Group III
15. REGULATORY INFORMATION
U.S. Federal Regulations
SARA 313
Section 313 of Title III of the Superfund Amendments and Reauthorization Act of 1986(SARA). This product does not contain any
chemicals which are subject to the reporting requirements of the Act and Title 40 of the Code of Federal Regulations, Part 372
SARA 3111312 Hazard Categories
This product has the following hazards that are reportable under The Emergency Planning and Community Right-to-Know rule
(EPCRA Tier II):
•Oxidizer
•Acute toxicity
• Skin corrosion/irritation
• Serious eye damage/eye irritation
• Respiratory/skin sensitization
• Specific Target Organ Toxicity(STOT)-Single Exposure
Clean Water Act
This product does not contain any substances regulated as pollutants pursuant to the Clean Water Act(40 CFR 122.21 and 40
CFR 122.42)
CERCLA/EPCRA
This material, as supplied, does not contain any substances regulated as hazardous substances under the Comprehensive
Environmental Response Compensation and Liability Act(CERCLA)(40 CFR 302)or the Superfund Amendments and
Reauthorization Act(SARA)(40 CFR 355). There may be specific reporting requirements at the local, regional, or state level
pertaining to releases of this material
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Sodium Persulfate
SDS# : 7775-27-1
Revision date: 2021-10-14
Version 1.07
US State Regulations
U.S.State Right-to-Know Regulations
This product contains the following substances regulated under state Right-to-Know laws:
Chemical name Massachusetts New Jersey Pennsylvania Illinois Rhode Island
Sodium Persulfate X
Sodium sulfate X X
California Proposition 65
This product does not contain any Proposition 65 chemicals
California- Perchlorate Best Management Practices Act
Perchlorate Material-special handling may apply
CANADA
Environmental Emergencies
This product contains no substances listed under Canada's Environmental Emergency regulations.
Canadian National Pollutant Release Inventory
This product contains no substances reportable under Canada's National Pollutant Release Inventory regulations.
International Inventories
Chemical name TSCA DSL EINECS/EL ENCS China KECL PICCS AICS NZIoC
(United (Canada) INCS (Japan) (IECSC) (Korea) (Philippines (Australia) (New
States) ((Europe) Zealand
Sodium Persulfate X X 231-892-1 X X X X X X
7775-27-1
Sodium sulfate X X 231-820-9 X X X X X X
7757-82-6
All ingredients are directly listed on the active TSCA Inventory
Mexico
Mexico-Grade Slight risk, Grade 1
16. OTHER INFORMATION
NFPA Health Hazards 1 IFlammability 0 IStability 1 Ispecial Hazards OX
HMIS Health Hazards 1 IFlammability 0 lPhysical hazard 1 ISpecial precautions J
NFPA/HMIS Ratings Legend Severe=4; Serious=3; Moderate=2; Slight= 1; Minimal =0
OX= Oxidizer
Protection=J (Safety goggles, gloves, apron, combination dust and vapor respirator)
Revision date: 2021-10-14
Revision note Manufacturer name changed.
Issuing Date: 2021-10-14
Disclaimer
This information and any recommendations,technical or otherwise,are presented in good faith and believed to be correct
as of the date prepared. Recipients of this information and recommendations must make their own determination as to
its suitability for their purposes. In no event shall Evonik assume liability for damages or losses of any kind or nature
that result from the use of or reliance upon this information and recommendations. EVONIK EXPRESSLY DISCLAIMS
ANY REPRESENTATION AND WARRANTIES OF ANY KIND,WHETHER EXPRESS OR IMPLIED,AS TO THE ACCURACY,
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Sodium Persulfate
SDS# : 7775-27-1
Revision date: 2021-10-14
Version 1.07
COMPLETENESS, NON-INFRINGEMENT, MERCHANTABILITY AND/OR FITNESS FOR A PARTICULAT PURPOSE (EVEN IF
EVONIK IS AWARE OF SUCH PURPOSE)WITH RESPECT TO ANY INFORMATION AND RECOMMENDATIONS PROVIDED.
Reference to any trade names used by other companies is neither a recommendation nor an endorsement of the
corresponding product and does not imply that similar products could not be used. Evonik reserves the right to make
any changes to the information and/or recommendations at any time,without prior or subsequent notice.
Prepared By:
Evonik
©2021 Evonik. All Rights Reserved.
End of Safety Data Sheet
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