WI0700459_Injection Event Record_20240229

RECENO
North Carolina Department of Environmental Quality—Division of Water Resources
INJECTION EVENT RECORD (IER) APR 2 4 2024
Permit Number W10700459 NO DEO/DWR
ont.
Were any wells abandoned during this injection
1. Permit Information event?
❑ Yes 52 No
West Pharmaceutical
Permittee If yes,please provide the following information:
West Pharmaceutical Number of Monitoring Wells
Facility Name
Number of Injection Wells
2525 Rouse Rd Exd Kinston, NC 28504 Lenoir County
Facility Address(include County) Please include a copy of the GW-30 for each well
abandoned.
2. Injection Contractor Information
4. Injectant Information
Arcadis G&M of North Carolina, Inc.
Injection Contractor/Company Name Molasses _
Injectant(s)Type(can use separate additional sheets
Street Address 175 Regency Woods Place, Suite 400 if necessary
Cary NC 27518 Concentration 0.5%
City State Zip Code
If the injectant is diluted please indicate the source
919 622-8313 dilution fluid.City of Kinston hydrant water
Area code—Phone number
Total Volume Injected(gal)98252
3. Well Information
Volume Injected per well(gal)3778
Number of wells used for injection 26
5. Injection History
Well IDs IW-01 through IW-26
Injection date(s) 2120-29/2024
Were any new wells installed during this injection
event? Injection number(e.g. 3 of 5) 2 of 2
❑ Yes 52 No
Is this the last injection at this site?
If yes,please provide the following information: 52 Yes ❑ No
Number of Monitoring Wells
I DO HEREBY CERTIFY THAT ALL THE
Number of Injection Wells INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
Type of Well Installed(Check applicable type): INJECTION WAS PERFORMED WITHIN THE
❑ Bored ❑ Drilled ❑Direct-Push STA,'DARDS LAID OUT IN THE PERMIT.
❑ Hand-Augured ❑ Other(specify) y !g Zvzq
SI ' URE OF INJECTION CONTRACTOR DATE
Please include a copy of the GW-1 form for each
well installed
PRINTF PERSON PERFORMING THL INJECTION
Submit the original of this form to the Division of Water Resources Form UIC-IER
Attn:UIC Program, 1636 Mail Service Center,Raleigh,NC 27699-1636,Phone No.919-807-6464 Rev.3-1-2016