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Home My WebLink AboutFA-1286_24238_CA_O_20210903_IER WI0600230Submit the original of this form to the Division of Water Resources within 30 days of injection. Form UIC-IER Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464 Rev. 3-1-2016 North Carolina Department of Environmental Quality – Division of Water Resources INJECTION EVENT RECORD (IER) Permit Number___WI0600230__________________ 1. Permit Information __Terracon Consultants, Inc. Permittee _Blalock Fina_____________________ Facility Name __3574 NC HWY 55, Angier, Harnett Co., NC____ Facility Address (include County) 2.Injection Contractor Information ___Terracon Consultants, Inc.______________ Injection Contractor / Company Name Street Address_2401 Brentwood Road, Suite 107____ __Raleigh NC__________27604______ City State Zip Code (919) _436-2965_______________ Area code – Phone number 3.Well Information Number of wells used for injection ____18______ Well IDs__N/A____________________________ Were any new wells installed during this injection event? Yes No If yes, please provide the following information: Number of Monitoring Wells _______________ Number of Injection Wells__________________ Type of Well Installed (Check applicable type): Bored Drilled Direct-Push Hand-Augured Other (specify) _Soil Boring Please include a copy of the GW-1 form for each well installed. Were any wells abandoned during this injection event? Yes No If yes, please provide the following information: Number of Monitoring Wells _______________ Number of Injection Wells__________________ Please include a copy of the GW-30 for each well abandoned. 4.Injectant Information __RemRx, Iron EDTA________________________ Injectant(s) Type (can use separate additional sheets if necessary Concentration 2,700 lbs of dry RemRx, 108 lbs dry Iron EDTA If the injectant is diluted please indicate the source dilution fluid.____________________________ Total Volume Injected (gal) 2,700 lbs dry RemRx, 108 lbs dry Iron EDTA Volume Injected per well (gal)_150 lbs dry RemRx, 6 lbs dry Iron EDTA 5.Injection History Injection date(s)____8/23/21-8/25/21___________ Injection number (e.g. 3 of 5)______1 of 1_______ Is this the last injection at this site? Yes No I DO HEREBY CERTIFY THAT ALL THE INFORMATION ON THIS FORM IS CORRECT TO THE BEST OF MY KNOWLEDGE AND THAT THE INJECTION WAS PERFORMED WITHIN THE STANDARDS LAID OUT IN THE PERMIT. ___________________________________________________09/03/2021__ SIGNATURE OF INJECTION CONTRACTOR DATE Submit the original of this form to the Division of Water Resources within 30 days of injection. Form UIC-IER Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464 Rev. 3-1-2016 Ethan Dinwiddie ____________________________________________________________ PRINT NAME OF PERSON PERFORMING THE INJECTION