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Home My WebLink AboutWI0400621_Notification of Intent (NOI) – GW Remediation_20240513 NC Department of Environmental Quality—Division of Water Resources (DWR) NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS The following are `permitted by rule"and do not require an individualpermit when constructed in accordance with the rules of 15A NCAC 02C.0200(NOTE: This form must be received at least 14 DAYS prior to injection) AQUIFER TEST WELLS(15A NCAC 02C.0220) These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics. IN SITU REMEDIATION(15A NCAC 02C.02251 or TRACER WELLS(15A NCAC 02C.0229): 1) Passive Injection Systems - In-well delivery systems to diffuse injectants into the subsurface. Examples include ORC socks,iSOC systems,and other gas infusion methods(Note: Injection Event Records(IER)do not need to be submitted for replacement of each sock used in ORC systems). 2) Small-Scale Injection Operations—Injection wells located within a land surface area not to exceed 10,000 square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required for test or treatment areas exceeding 10,000 square feet. 3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a remediation strategy in order to develop a full scale remediation plan for future implementation,and where the surface area of the injection zone wells is located within an area that does not exceed five percent of the land surface above the known extent of groundwater contamination. An individual permit shall be required to conduct more than one pilot test on any separate groundwater contaminant plume. 4) Air Injection Wells - Used to inject ambient air to enhance in-situ treatment of soil or groundwater. 5) In-Situ Thermal Wells(IST)—Used to `heat' contaminated groundwater to enhance remediation. Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete. DATE: 4/29 ,20_24_ PERMIT NO. WI0400621 (to be filled in by DWR) NOTE-If this NOI is being submitted as notification of a modification of a previously issued NOI for this site(e.g., different injection wells,plume, additives, etc.)and still meets the deemed permitted by rule criteria,provide the previously assigned permit tracking number and any needed relevant information to assess and approve injection: Permit No.WI WI0400621 Issued Date: 05/13/2024 A. WELL TYPE TO BE CONSTRUCTED OR OPERATED (1) Air Injection Well....................................... Complete sections B through F,J,M (2) Aquifer Test Well....................................... Complete sections B through F,J,M (3) Passive Injection System............................... Complete sections B through F,H-M (4) X Small-Scale Injection Operation...................... Complete sections B through M (5) Pilot Test................................................. Complete sections B through M (6) Tracer Injection Well................................... Complete sections B through M (7) In-Situ Thermal(IST)Well........................... Complete sections B through M B. STATUS OF WELL OWNER: Business/Organization Deemed Permitted GW Remediation NOI Rev.2-17-2020 Page 1 C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to sign on behalf of the business or agency: Name(s): Quality Oil Company Mailing Address: PO Box 2736 City: Winston-Salem State: NC Zip Code:27102-2736 County: Fors Day Tele No.: 800-672-6604 Cell No.: EMAIL Address: dmciver(d)gocnc.com Fax No.: D. PROPERTY OWNER(S)(if different than well owner/applicant) Name and Title: BHULLAR,GURDEV S;SINGH,AMARJEET;SINGH,AMRITPAL Company Name Mailing Address: 4196 N Patterson Ave. City: Winston-Salem State: NC_Zip Code:27105 County: Fors h Day Tele No.: Cell No.: EMAIL Address: Fax No.: E. PROJECT CONTACT(Typically Environmental Consulting/Engineering Firm) Name and Title: Ryan Kerins,Project Manager Company Name Terraquest Environmental Consultants,P.C. Mailing Address: 100 E Ruffin St City: Mebane State: NC_Zip Code: 27302 County:Alamance Day Tele No.: 919-563-9091 Cell No.: EMAIL Address: rdkerinsgterraquestpc.com Fax No.: 919-563-9095 F. PHYSICAL LOCATION OF WELL SITE (1) Facility Name&Address: 4196 N Patterson Ave. City: Winston-Salem County: Forsyth Zip Code: 27105 (2) Geographic Coordinates: Latitude": 0 "or 36 16699 Longitude": 0 "or -80 °. 26086 Reference Datum:World Geodetic System WGS84 Accuracy:2-5 metres Method of Collection: Google "FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES. G. TREATMENT AREA Land surface area of contaminant plume: 3,200 square feet Land surface area of inj.well network: 2,826 square feet(< 10,000 W for small-scale injections) Percent of contaminant plume area to be treated: 88 (must be<5%of plume for pilot test injections) Deemed Permitted GW Remediation NOI Rev.2-17-2020 Page 2 H. INJECTION ZONE MAPS—Attach the following to the notification. (1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and proposed injection wells; and (2) 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, changes in lithology, existing and proposed monitoring wells,and existing and proposed injection wells. (3) Potentiometric surface map(s)indicating the rate and direction of groundwater movement,plus existing and proposed wells. I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE —Provide a brief narrative regarding the cause of the contamination,and purpose, scope,goals of the proposed injection activity: This site is contaminated from a previous petroleum underground storage tank release incident. The proposed activities include the injection of oxygen biochem(OBC)into the aquifer to treat the contamination. J. WELL CONSTRUCTION DATA (1) No. of injection wells: 4 Proposed Existing(provide NC Well Construction Record(GW-1)for each well) (2) Appx.injection depths(BLS): 14-16' and 18-20' (3) For Proposed wells or Existing wells not having GW-Is,provide well construction details for each injection well in a diagram or table format. A single diagram or line in a table can be used for multiple wells with the same construction details. Well construction details shall include the following(indicate if construction is proposed or as-built): (a) Well type as permanent,Geoprobe/DPT,or subsurface distribution infiltration gallery (b) Depth below land surface of casing,each grout type and depth, screen,and sand pack (c) Well contractor name and certification number K. INJECTION SUMMARY NOTE: Only injectants approved by the epidemioloy section of the NC Division ofPublic Health,Department of Health and Human Services can be infected. Approved injectants can be found online at http: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 if you wish to get approval for a different additive. However,please note it may take 3 months or longer. If no injectants are to be used use N/A. Injectant:Oxygen Biochem Total Amt.to be injected(gal)/event: 1,000 a�gal/point 2,000#(500#/point) Injectant: Total Amt.to be injected(gal)/event: Injectant: Total Amt.to be injected(gal)/event: Injectant: Total Amt.to be injected(gal)/event: Deemed Permitted GW Remediation NOI Rev.2-17-2020 Page 3 Injectant: Total Amt.to be injected(gal)/event: Total Amt. to be injected (gal/event): No.of separate injection events: Total Amt. to be injected(gal): Source of Water(if applicable): L. MONITORING PLAN-Describe below or in separate attachment a monitoring plan to be used to determine if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity. Site is on a semi-annual groundwater monitoring plan. M. SIGNATURE OF APPLICANT AND PROPERTY OWNER Well Owner/Applicant: `I hereby certi)�, under penalty of law, that 1 am familiar with the information submitted in this document and all attachments thereto 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 significant 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 and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules." '&A� R' Don McIver Executive Vice President- Finance Signature of Applicant Print or Type Full Name and Title Properly Owner(if the property is not owned by the Well Owner/Applicant): "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.0200}." "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 conlrar agreement in writing. ,V4 lure, If Property Owner(if different from applicant) Print or Type Full Name and Title *An access agreement between the applicant and properly owner may be submitted in lieu of a signature on this form. Please send 1 (one) hard color copy of this NOI along with a copy on an attached CD or Flash Drive at least two(2)weeks prior to injection to: DWR-UIC Program 1636 Mail Service Center Raleigh,NC 27699-1636 Telephone: (919)707-9000 Deemed Permitted GW Remediation NOI Rev.2-17-2020 Page 4 REDOX TECH, LLC ► "Providing Innovative In Situ Soil and Groundwater Treatment" Material Safety Data Sheet—Oxygen BioChem 1. Identification Product identifier Oxygen Biochem (OBC)TM Other means of identification Not available. Recommended use Oxygen Biochem (OBC)TM is used to promote chemical oxidation and aerobic bioremediation of petroleum compounds in groundwater. Recommended restrictions Use in accordance with supplier's recommendations. Manufacturer/Importer/Supplier/Distributor information Manufacturer/Supplier Redox Tech, LLC Address 200 Quade Drive Cary NC 2751 Telephone +1 919-6780140 E-mail haselow@redox-tech.com Contact person Dr. John Haselowi Emergency Telephone For Hazardous Materials[or Dangerous Goods] Incidents ONLY (spill, leak,fire, exposure or accident), call CHEMTREC at CHEMTREC@, USA: 001 (800)424-9300 CHEMTREC@, Mexico(Toll-Free-must be dialed from within country): 01-800-681-9531 CHEMTREC@, Other countries: 001 (703)527-3887 2. Hazard(s) identification Physical hazards Oxidizing solids Category 3 Health hazards Acute toxicity, oral Category 4 Skin corrosion/irritation Category 2 Serious eye damage/eye irritation Category 2 Sensitization, respiratory Category 1 Sensitization, skin Category 1 Specific target organ toxicity, single exposure Category 3 respiratory tract irritation OSHA defined hazards Not classified. Label elements < >< X > • r Signal word Danger Hazard statement May intensify fire; oxidizer. Harmful if swallowed. Causes skin irritation. Causes serious eye irritation. May cause allergy or asthma symptoms or breathing difficulties if inhaled. May cause an allergic skin reaction. May cause respiratory irritation. Precautionary statement Prevention Keep away from heat. Keep/Store away from clothing and other combustible materials. Take any precaution to avoid mixing with combustibles.Wear protective gloves/eye protection/face protection. Wash thoroughly after handling. Do not eat, drink or smoke when using this product. Avoid breathing dust/fume. In case of inadequate ventilation wear respiratory protection. Contaminated work clothing must not be allowed out of the workplace. Use only outdoors or in a well-ventilated area. Response In case of fire: Use foam, carbon dioxide, dry powder or water fog for extinction. If swallowed: Call a poison center/doctor if you feel unwell. Rinse mouth. If on skin:Wash with plenty of water. If skin irritation or rash occurs: Get medical advice/attention. Take off contaminated clothing and wash before reuse. If in eyes: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. If eye irritation persists: Get medical advice/attention. If inhaled: If breathing is difficult, remove person to fresh air and keep comfortable for breathing. If experiencing respiratory symptoms: Call a poison center/doctor. Oxygen Biochem (OBC)TM SIDS US 920293 Version#:01 Revision date:- Issue date:09-May-2014 1 /7 Storage Store in a well-ventilated place. Keep container tightly closed. Store locked up. Disposal Dispose of contents/container in accordance with local/regional/national/international regulations. Hazard(s) not otherwise None known. classified (HNOC) 3. Composition/information on ingredients Mixtures Chemical name CAS number % Sodium persulfate 7775-27-1 70-90 Calcium peroxide 1305-79-9 10-20 Composition comments All concentrations are in percent by weight unless ingredient is a gas. Gas concentrations are in percent by volume. 4. First-aid measures Inhalation Move to fresh air. Do not use mouth-to-mouth method if victim inhaled the substance. For breathing difficulties, oxygen may be necessary. Call a physician or poison control center immediately. Skin contact Remove and isolate contaminated clothing and shoes. For minor skin contact, avoid spreading material on unaffected skin.Wash clothing separately before reuse. If skin irritation or an allergic skin reaction develops, get medical attention. 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. Get medical attention if irritation develops and persists. Ingestion Rinse mouth. Do not induce vomiting without advice from poison control center. If vomiting occurs, keep head low so that stomach content doesn't get into the lungs. Do not use mouth-to-mouth method if victim ingested the substance. Induce artificial respiration with the aid of a pocket mask equipped with a one-way valve or other proper respiratory medical device. Get medical attention if any discomfort continues. Most important May cause redness and pain. Symptoms may include coughing, difficulty breathing and shortness symptoms/effects, acute and of breath. delayed Indication of immediate Provide general supportive measures and treat symptomatically. medical attention and special treatment needed General information Ensure that medical personnel are aware of the material(s)involved, and take precautions to protect themselves. 5. Fire-fighting measures Suitable extinguishing media Water fog. Foam. Dry chemical powder. Carbon dioxide(CO2). Unsuitable extinguishing None known. media Specific hazards arising from Contact with combustible material may cause fire. the chemical Special protective equipment Self-contained breathing apparatus and full protective clothing must be worn in case of fire. and precautions for firefighters Fire-fighting In the event of fire, cool tanks with water spray. equipment/instructions General fire hazards May intensify fire; oxidizer. 6. Accidental release measures Personal precautions, Keep unnecessary personnel away. Keep people away from and upwind of spill/leak. Wear protective equipment and appropriate protective equipment and clothing during clean-up. Do not touch damaged containers emergency procedures or spilled material unless wearing appropriate protective clothing.Avoid skin contact and inhalation of vapors during disposal of spills.Ventilate closed spaces before entering them. Local authorities should be advised if significant spillages cannot be contained. For personal protection, see Section 8 of the SDS. Methods and materials for Stop the flow of material, if this is without risk. Prevent entry into waterways, sewer, basements or containment and cleaning up confined areas. Following product recovery,flush area with water. For waste disposal, see Section 13 of the SDS. Environmental precautions Avoid discharge into drains,water courses or onto the ground. Oxygen Biochem (OBC)TM SIDS US 920293 Version#:01 Revision date:- Issue date:09-May-2014 2/7 7. Handling and storage Precautions for safe handling Avoid inhalation of vapors/dust and contact with skin and eyes.Wash thoroughly after handling. Keep away from clothing and other combustible materials. Use only with adequate ventilation. Do not taste or swallow.Wear appropriate personal protective equipment(See Section 8). Observe good industrial hygiene practices. Conditions for safe storage, Store in original tightly closed container. Store away from incompatible materials(See Section 10). including any incompatibilities Keep locked up. 8. Exposure controls/personal protection Occupational exposure limits US.ACGIH Threshold Limit Values Components Type Value Sodium persulfate(CAS TWA 0.1 mg/m3 7775-27-1) Biological limit values No biological exposure limits noted for the ingredient(s). Appropriate engineering Observe occupational exposure limits and minimize the risk of exposure. Ensure adequate controls ventilation, especially in confined areas. Individual protection measures,such as personal protective equipment Eye/face protection Wear safety glasses with side shields(or goggles). Skin protection Hand protection Wear protective gloves. Other Neoprene or rubber gloves are recommended.Apron and long sleeves are recommended. Respiratory protection In the case of respirable dust, use self-contained breathing apparatus. Wear positive pressure self-contained breathing apparatus (SCBA). Thermal hazards Wear appropriate thermal protective clothing, when necessary. General hygiene Always observe good personal hygiene measures, such as washing after handling the material considerations and before eating, drinking, and/or smoking. Routinely wash work clothing and protective equipment to remove contaminants. 9. Physical and chemical properties Appearance Off-white, granular solid. Physical state Solid. Form Solid. Color Off-white. Odor Odorless. Odor threshold Not available. pH 11.7±0.4(1-40%solution, slurry) Melting point/freezing point Not available. Initial boiling point and boiling Not applicable. range Flash point Not available. Evaporation rate Not available. Flammability(solid, gas) Not available. Upper/lower flammability or explosive limits Flammability limit-lower Not available. (%) Flammability limit-upper Not available. (%) Explosive limit-lower(%) Not available. Explosive limit-upper(%) Not available. Vapor pressure Not applicable. Vapor density Not applicable. Relative density 2.76±0.16(25°C) Oxygen Biochem (OBC)TM SIDS US 920293 Version#:01 Revision date:- Issue date:09-May-2014 3/7 Solubility(ies) Solubility(water) Soluble in water. Partition coefficient Not available. (n-octanol/water) Auto-ignition temperature Not available. Decomposition temperature Not available. Viscosity Not available. Other information Oxidizing properties Oxidizing. 10. Stability and reactivity Reactivity The product is stable and non-reactive under normal conditions of use, storage and transport. Chemical stability Material is stable under normal conditions. Possibility of hazardous No dangerous reaction known under conditions of normal use. reactions Conditions to avoid Contact with combustibles. Incompatible materials Combustible material. Oxidizing material. Reducing agents. Hazardous decomposition No hazardous decomposition products are known. products 11. Toxicological information Information on likely routes of exposure Ingestion Harmful if swallowed. Inhalation May cause irritation to the respiratory system. Skin contact Causes skin irritation. Eye contact Causes serious eye irritation. Symptoms related to the May cause redness and pain. Exposed individuals may experience eye tearing, redness, and physical, chemical and discomfort. Symptoms may include coughing, difficulty breathing and shortness of breath. toxicological characteristics Information on toxicological effects Acute toxicity Harmful if swallowed. Skin corrosion/irritation Causes skin irritation. Serious eye damage/eye Causes serious eye irritation. irritation Respiratory or skin sensitization Respiratory sensitization May cause allergy or asthma symptoms or breathing difficulties if inhaled. Skin sensitization May cause an allergic skin reaction. Germ cell mutagenicity No data available. Carcinogenicity This product is not considered to be a carcinogen by IARC,ACGIH, NTP, or OSHA. Reproductive toxicity No data available. Specific target organ toxicity- May cause respiratory irritation. single exposure Specific target organ toxicity- No data available. repeated exposure Aspiration hazard Not applicable. Chronic effects Prolonged exposure may cause chronic effects. Further information No data available. 12. Ecological information Ecotoxicity This product's components are not classified as environmentally hazardous. However,this does not exclude the possibility that large or frequent spills can have a harmful or damaging effect on the environment. Persistence and degradability No data is available on the degradability of this product. Bioaccumulative potential No data available for this product. Oxygen Biochem (OBC)TM SIDS US 920293 Version#:01 Revision date:- Issue date:09-May-2014 4/7 Mobility in soil Not available. Other adverse effects No data available. 13. Disposal considerations Disposal instructions Consult authorities before disposal. Dispose in accordance with all applicable regulations. Hazardous waste code The Waste code should be assigned in discussion between the user, the producer and the waste disposal company. Waste from residues/unused Dispose of in accordance with local regulations. products Contaminated packaging Empty containers should be taken to an approved waste handling site for recycling or disposal. 14. Transport information DOT UN number UN1479 UN proper shipping name Oxidizing solid, n.o.s. (Sodium persulfate) Transport hazard class(es) Class 5.1 Subsidiary risk - Packing group II Environmental hazards Marine pollutant No Special precautions for user Read safety instructions, SDS and emergency procedures before handling. Special provisions 62, I135, IP1 Packaging exceptions None Packaging non bulk 211 Packaging bulk 242 IATA UN number UN1479 UN proper shipping name Oxidizing solid, n.o.s. (Sodium persulfate, Calcium peroxide) Transport hazard class(es) Class 5.1 Subsidiary risk - Label(s) 5.1 Packing group II Environmental hazards No ERG Code 5L Special precautions for user Read safety instructions, SDS and emergency procedures before handling. IMDG UN number UN1479 UN proper shipping name OXIDIZING SOLID, N.O.S. (Sodium persulfate, Calcium peroxide) Transport hazard class(es) Class 5.1 Subsidiary risk - Label(s) 5.1 Packing group II Environmental hazards Marine pollutant No EmS F-A, S-Q Special precautions for user Read safety instructions, SDS and emergency procedures before handling. Transport in bulk according to This product is not intended to be transported in bulk. Annex II of MARPOL 73/78 and the IBC Code 15. Regulatory information US federal regulations This product is a"Hazardous Chemical'as defined by the OSHA Hazard Communication Standard, 29 CFR 1910.1200. All components are on the U.S. EPA TSCA Inventory List. TSCA Section 12(b) Export Notification (40 CFR 707, Subpt. D) Not regulated. Oxygen Biochem (OBC)TM SIDS US 920293 Version#:01 Revision date:- Issue date:09-May-2014 5/7 US. OSHA Specifically Regulated Substances (29 CFR 1910.1001-1050) Not listed. CERCLA Hazardous Substance List(40 CFR 302.4) Not listed. Superfund Amendments and Reauthorization Act of 1986(SARA) Hazard categories Immediate Hazard-Yes Delayed Hazard-Yes Fire Hazard-Yes Pressure Hazard-No Reactivity Hazard- No SARA 302 Extremely hazardous substance Not listed. SARA 311/312 Hazardous Yes chemical SARA 313(TRI reporting) Not regulated. Other federal regulations Clean Air Act(CAA)Section 112 Hazardous Air Pollutants(HAPs) List Not regulated. Clean Air Act(CAA)Section 112(r)Accidental Release Prevention (40 CFR 68.130) Not regulated. Safe Drinking Water Act Not regulated. (SDWA) US state regulations This product does not contain a chemical known to the State of California to cause cancer, birth defects or other reproductive harm. US. Massachusetts RTK-Substance List Not regulated. US. New Jersey Worker and Community Right-to-Know Act Calcium peroxide(CAS 1305-79-9) Sodium persulfate(CAS 7775-27-1) US. Pennsylvania Worker and Community Right-to-Know Law Not listed. US. Rhode Island RTK Not regulated. US.California Proposition 65 US-California Proposition 65-Carcinogens &Reproductive Toxicity(CRT): Listed substance Not listed. International Inventories Country(s)or region Inventory name On inventory(yes/no)" Australia Australian Inventory of Chemical Substances(AICS) Yes Canada Domestic Substances List(DSL) Yes Canada Non-Domestic Substances List(NDSL) No China Inventory of Existing Chemical Substances in China (IECSC) Yes Europe European Inventory of Existing Commercial Chemical Yes Substances(EINECS) Europe European List of Notified Chemical Substances(ELINCS) No Japan Inventory of Existing and New Chemical Substances(ENCS) Yes Korea Existing Chemicals List(ECL) Yes New Zealand New Zealand Inventory Yes Philippines Philippine Inventory of Chemicals and Chemical Substances Yes (PICCS) United States&Puerto Rico Toxic Substances Control Act(TSCA) Inventory Yes *A"Yes"indicates this product complies with the inventory requirements administered by the governing country(s). A"No"indicates that one or more components of the product are not listed or exempt from listing on the inventory administered by the governing country(s). Oxygen Biochem (OBC)TM SIDS US 920293 Version#:01 Revision date:- Issue date:09-May-2014 6/7 16. Other information, including date of preparation or last revision Issue date 09-May-2014 Revision date - Version# 01 Further information HMIS®is a registered trade and service mark of the NPCA. NFPA Ratings 4 0 ox List of abbreviations NFPA: National Fire Protection Association. References Registry of Toxic Effects of Chemical Substances(RTECS) HSDB®- Hazardous Substances Data Bank Disclaimer The information contained herein is accurate to the best of our knowledge. However, data, safety standards and government regulations are subject to change and,therefore, holders and users should satisfy themselves that they are aware of all current data and regulations relevant to their particular use of product. CARUS CORPORATION DISCLAIMS ALL LIABILITY FOR RELIANCE ON THE COMPLETENESS OR ACCURACY OR THE INFORMATION INCLUDED HEREIN. CARUS CORPORATION MAKES NO WARRANTY, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO,ANY WARRANTIES OF MERCHANTIABILITY OR FITNESS FOR PARTICULAR USE OR PURPOSE OF THE PRODUCT DESCRIBED HEREIN.All conditions relating to storage, handling, and use of the product are beyond the control of Carus Corporation, and shall be the sole responsibility of the holder or user of the product. (Carus and design)is a registered service mark of Carus Corporation. Oxygen Biochem (OBC)TM SIDS US 920293 Version#:01 Revision date:- Issue date:09-May-2014 7/7 - d =850- <<R - � o 9aD - h Q �yo 0 PIN£BROp I 2 R KAREN CIR w" ku 52 o a - \ o� A ro R `v qo0 y / u I o roo �ti Z OAK SUMMIT RD \ P9ri _ �ilRpP � Sp o9 yFo"P Lu ovE' ma on A ra ccl A-ZACEA DR - 350 0 or s 1 W G 0 D� h 00 C'reewn Luke Lake o BRANDEMERE LN A- Y ( O Eabc-ck yam Y Q 52 A F z 1,ake W� w AQ yFP9 3 m MO q50 `t�S' RETNUH DR s. AAVE 950 ,�,t`4 I INDIAN P 01.09Y LN Oo PJ. tT I I l5P p'�� -66 B50 m��OJF O 8 KAP G P Sr ,llcipclr, � MAP SOURCE: USGS 7.5 MINUTE TOPOGRAPHICS — RURAL HALL AND WALKERTOWN, NC GRAPHIC SCALE 0' 2000' 4000' SITE LOCATION MAP ue 52 SHELL STATION 4196 PATTERSON AVENUE, WINSTON-SALEM, NC _�_-� ---_ QUALITY OIL COMPANY, LLC WINSTON-SALEM, NC ENVIRONMENTAL CONSULTANTS, P.C. PROJECT NO. 00295 DRAWN BY: RDK DATE: 4/29/24 SCALE: 1" = 2000' 1 CHECKED BY: MJB I FIGURE NO. 1 5040 00 fisz8 63�9091. ''2 7 967.0 t.; 6a - 711.00 8 9 " • "/j 00 0186.00 5.00 =82 1- 3:D0 .6828-ot-9 500 1-55a :00 as o0 71-02';'�.00 1 ,000 "NI ` ✓r U l 6828-81-2124:00 - ^1-t0 1.00 t e -- 0 6 270-09 0:00 - 8-80-49 1, GRAPHIC SCALE 0' 400' 800, SITE VICINITY MAP ue 52 SHELL STATION 4196 PATTERSON AVENUE, WINSTON-SALEM, NC QUALITY OIL COMPANY, LLC WINSTON-SALEM, NC ENVIRONMENTAL CONSULTANTS, P.C. 1PROJECT NO. 00295 DRAWN BY: RDK DATE: 4/29/24 SCALE: 1" = 2000' 1 CHECKED BY: MJB FIGURE NO. 2 LEGEND04 a N $ TYPE II WELL O WLu z Z PATTERSON AVENUE ® TYPE III WELL J Z J u o W :2 Lu ESTIMATED O < m MW4 EXTENT OF Of 10x2B - INJECTION POINT Z z Q STANDARDS Q:� O 0 O N MW5 z U r / MW3 0 Lj J w m J Y z / PZ3 = O Z P71 0 i / A o Qaza U o GRASS�� / RW2 �� RW1�M JOO N MvV10* J (n U o ^II \ o / O = w -i / Q o � MW 6 i UST PAD J00 z W a�6 0 I 13 N o a I I 52 & 8 SHELL I SERACE�&4YS a in I I I MW8 op MW7 Qp MW1 :J MW2 � �CS1 /" ULVERT 1 1 ■ TRIBUTARY STREAM pal N(UNNAMED) Q CS3 z \ U J \, H DIRECTION LEAK FORK o OF FLOW (CLASS C SURFACE WATER) GRAPHIC SCALE 9� z / 0 20 40 80 1� 1W FEET LEGEND N N TYPE II WELL Lu z PATTERSON AVENUE ® TYPE III WELL z c� a � o 90.00, 7PZ4 w90.08'�' i � GROUNDWATER EQUIPOTENTIAL QiGIW4 ------- - 89.00' i i� CONTOURS, ARROW INDICATES DIRECTION m Of - OF GROUNDWATER FLOW QALL ELEVATIONS ARE IN FEET O 88. 0' RELATIVE TO AN ARBITRAY DATUM PLANEWOF 100.00'�- ---- MW5 CONTOUR INTERVAL IS 1.00' QmM _ 87.35 L� J }/ - --- 87.00' Lv J w °� i Z Z Lu 3 / /� ------------___ (n O W i PZ �� 86.00' U O QQ < ,—GRASS Y/ i LL� RW2 ' (n z g n /RW1� M W JO0OU o II Myd10 ------- ------ 5.00' w O' O MW6 i UST PAD ------- 84 00' z 00 a z i � 0.3 Cfl J U N d7 � 83 0 J I -Z .00 � O a c(on /52 & 8 SHELL, RVICEI&4YS MW op 84.07' Mw7 '/� 180.93'-- 81.00' Mwi �� 1 CULVERT 1 ■ TRIBUTARY STREAM pal N(UNNAMED) Q CS3 z \ U J \, H Z DIRECTION LEAK FORK o OF FLOW (CLASS C SURFACE WATER) GRAPHIC SCALE 9: z 0 20 40 80 w FEET Contaminant of Concern LEGEND a N �\ ) °1 $ TYPE II WELL N v \ v Ln v X z C L ��' Well ID Date Collected m w PATTERSON AVENUE ® U MW3 9/5/2023 <0.500 <0.900 <0.500 <1.60 TYPE III WELL Z c� MW6 9/5/2023 <0.500 7.6 <0.500 <1.60 J W MW7 9/5/2023 278 38.4 147 400 J MW9 9/5/2023 3,190 56,400 4,590 25,100 ESTIMATED m MW4 EXTENT OF W I M � Of MW10 9/5/2023 4,820 <45.0 2,000 260 10x2B �' Z Q PZ2 9/5/2023 6,540 19,700 5,130 20,500 STANDARDS Groundwater analytical results in ug/L 0 0 PZ3 9/5/2023 3,570 68,900 5,950 32,400 J from the 9/5/23 sampling event are N RW2 9/5/2023 4,350 1,050 891 2,710 summarized here Further summary is U Z CS1 9/5/2023 <0.500 <0.900 <0.500 <1.60�---- ESTIMATED MW5 provided on Table 5 and the full analytical Cj m C53 9/5/2023 <0.500 <0.900 <0.500 <3�60 .per MW3 EXTENT OF 2L report is provided in Appendix D of the J o m LJ 2L Sta nda rd 1 600 600 500 / STANDARD 9/2023 Monitoring Report. Q Z J VIOLATIONS 2B Surface Water Standards 51 11 97 670LU PZ3 z O W U o 10 x 2B Standards 510 110 970 6,700 / PZ2L Q Q Q zQ GCL 5,000 260,000 84,50 85,500 RW2 C�1' � Cl) Z a! 12 RW1 M W JOO N II MVN10 ~ J (n U o I o / = w -i / I o C/) �= �D 6 i UST PAD Z O ~ \ I I Q I I C CD V 0 \ 52 & 8 SHELL j �ERVICEj&4YS a �' � 1' I !yam \ I \ TOP MW7 I � � MW1 J MW2 CS1 � CULVERT 1 1 ■ TRIBUTARY STREAM �I N (UNNAMED) Q CS3 z \ U J \, H DIRECTION LEAK FORK o OF FLOW (CLASS C SURFACE WATER) GRAPHIC SCALE o: z / 0 20 40 80 W FEET A A' N U � 0_ � O Z W Y w W w � w � LL- M :2 v U o DEPTHS ARE RELATIVE z ' TO AN ARBITRARY DATUM 100 OF 100 FEET Ld 90' — - - - - - - - - - - - - - _ Q < 80' - - -- - _ - - - —_ - - - - - - - - . . _ - _ . TL . . _ - - - - _ . . _ O z m0 70' ................................................... ..................... _ . . _ . . _ . . _ . . _ . . - - - - - ...................................................... .................. ............... ................... W _ m r o m w z 60' Y . . . . . . . . . . . . . . .:F-+ ......... ................ ...................................................................................................................................... V ------------ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + O z <-> o 50' + + + + + + + + + - + + + + + + I + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + L�.I r + + + + + + + + + + + + + + + + + + + + + - + + + + + + + + + + + + + + + + + + + + + + + + + + + f O Q Q Q + + + + + + + + + - + + + + + + r + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + U 40' + + + + + + + + + + + + + + + + + + + + + - + + + + + + + + + + + + + + + + + + + + + + + + + + + f U Z ul o J O U rn M + + + + + + + + + + + + + + + + + + + + + + - + + + + + + + + + + + + + + + + + + + + + + + + + + + i J (n U o II 30' + + + + + + + + + - + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + C� w 0' O — = W J CD ESTIMATED EXTENT OF 2L VIOLATION LEGEND G 0000 < O FAO Q � J Denotes areas of soil impacted by petroleum. W N _ O u7 4 a N G SILTY CLAY - red/orange to red/brown to green, variable amounts of silt 15% to 50%, generally micaceous, sparse fine to coarse grained sand and gravel, fill. B ca B' -- m CLAY - red to red/orange, mostly clay, few to trace ,. o -- amounts of coarse grained sand and gravel, occasionally LO -- slightly silty, micaceous, fill. DEPTHS ARE RELATIVE TO AN ARBITRARY DATUM 00 OF 100 FEET ® Denotes areas where the presence of organic matter may 100' mark the location of the original ground surface. 1 SAPROLITE - silty clay, grey and white, fine grained, weathered gniess — — - — — — — — — — — — — — 80' — — — — — — — — — — — — — — — — — — —..—... ■ - — — — — — — — — — — — — — — — +++ BEDROCK - gneiss and schist _ _ _ _ _ _ _ _ _ _ _ _ _ _ ........................... ......... ............................................ 70' ............................................................. ...................................... .................................................................. ' U F.7 _ o CLAYEY SILT - re brown micaceous relict foliation and 60' 9 Y/ vi .................................. I I calcic bands r z 50' + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + MONITORING WELL WIDTHS ARE NOT DRAWN TO SCALE N + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + z + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + O 40' + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + MONITORING WELL , U + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + Q 30' + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ONITORING WELL I z SCREEN 4J z ESTIMATED EXTENT OF 2L VIOLATION GRAPHIC SCALE w 0' 15 30 60 FEET NO VERTICAL EXAGGERATION U Z W N J 9 r- N C C z 00 � Z Cw z o w LIMIT OF UST EXCAVATIONry o DEPTHS ARE RELATIVE TO AN ARBITRARY DATUM 100'OF 100 FEET — — 90' / I 0 m 0 (� a m C) Y Z LL I J W Q 70' (� = o' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � Z U 0 : . . . : . . . : . . . . . . . . . . . . . . . . . 0 Q Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0_ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60' (, Z Ln 0 N EXTENT OF GROUNDWATER IMPACT U = w 0 ^II 40' LEGEND o � < z ® Denotes areas of soil impacted by petroleum. 0 w Cj Impacted soil in the UST bed was excavated and disposed L1J Gn Q 0 Q of during the UST closure. 04 � 0 SILTY CLAY — red/orange to red/brown to green, variable amounts of silt 15% to 50%, generally micaceous, 9 sparse fine to coarse grained sand and gravel, fill. D LIMIT OF UST EXCAVATION D __ CLAY — red to red/orange, mostly clay, few to trace amounts of coarse grained sand and gravel, occasionally _ slightly silty, micaceous, fill. DEPTHS ARE RELATIVE 2 TO AN ARBITRARY DATUM OF 100 FEET ❑ SILT — orange to brown, moist, mostly silt, 1 100'— go,— trace clay I/ S P IT — i I i fin grained, - A ROL E silty clay, grey and white, e g a ned, weathered gniess - DENOTES THE WATER TABLE SURFACE IF,80' 0 MONITORING WELL WIDTHS ARE NOT DRAWN TO SCALE a MONITORING WELL z 70' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J MONITORING WELL D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SCREEN z vi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I Z 40' '2 z 0 GRAPHIC SCALE > z EXTENT OF GROUNDWATER IMPACT 01 10 20 40 FEET NO VERTICAL EXAGGERATION TYPICAL INJECTION POINT DETAIL GENERAL INFORMATION LAND SURFACE Well Driller: 0' Terraquest Environmental Consultants, P.C. — Wesley J. Sorrells #3577 TEMPORARY BORING FOR INJECTION POINT 20' - BOTTOM uest ENVIRONMENTAL CONSULTANTS, P.C.