WI0300136_Application_20090624

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells — In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
• Do not use this form for remediation systems that extract contaminated groundwater, treat it, and reinject the treated groundwater.
• Submit TWO copies of the completed application and all attachments to the address on the last page of this form.
• Any changes made to this form will result in the application package being returned.
Application Number (to be completed by DW& W ZO300�.�
I. GENERAL INFORMATION:
1. Applicant's Name (generally the responsible party): Sunoco Inc
2. Signing Official's Name: Devon Watts Title: Environmental Specialist
3. Mailing address of applicant: 203 South Falkenburg Road
City: T
State: FL Zip: 33619
Telephone number: [phone] Fax number: [phone]
4. Property Owner's Name (if different from Applicant): S Cashion LLC
5. Property Owner's mailing
322 E Fisher St
City: Salisbury State: NC Zip: 28144
6. Name and address of contact person who can answer questions about the proposed injection project:
Name: Scott Dunsmuir
Title: Operations Manager
Company: EnviroTrac Ltd
Address: 375 Winkler Drive; Suite E
City: Alpharetta State: GA Zip: 30004
Telephone number: [phone] Fax number:[phone]
Email Address: [e-mail]
II. PERMIT INFORMATION:
1. Project is: ® New ❑ Modification of existing permit ❑ Renewal of existing permit without modification
❑ Renewal of existing permit with modification
2. If this application is being submitted for renewal or modification to an existing permit, provide:
existing permit number and the issuance date
For renewal without modifications, 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 (if the applicant is not the owner).
For all renewals, you must submit a status report including monitoring results of all injection activities to
date.
Revised 8/07 UIC-50T RECEIVED I DENR / DWQ page 1 of 7
Aquifer Prntection Section
JUN 2 4 2009

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
III. INCIDENT & FACILITY DATA
A. FACILITY INFORMATION
1. Facility name: Former Country Cupboard Sunoco Inc
2. Complete physical address of the facility:
2010 Statesville Blvd
City: Salisbury County: Rowan State: NC Zip: 28144
B. INCIDENT DESCRIPTION
1. Describe the source of the contamination:
The apparent source of contamination at the site was identified as a combination of a leak from a gasoline UST
that occurred in October 1986 and an aboveground spill of approximately 146 gallons of unleaded gasoline that
occurred during refilling operations in June 1997.
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):
Gasoline.
3. Has LNAPL or DNAPL ever been observed at the site (even if outside the injection zone)?
❑x Yes If yes, list maximum measured separate phase thickness 2.24 feet
❑ No If no, list maximum concentration of total VOCs observed at site: ppb
4. Agency managing the contamination incident:
X UST Section ❑ Superfund Section (including REC Program and DSCA sites)
❑ DWQ Aquifer Protection Section ❑ Solid Waste Section
❑ Hazardous Waste Section ❑ Other:
5. Incident managers name Dan Graham
and phone number [phone]
6. Incident number or other site number assigned by the agency managing the contamination incident: ,
NCDENR Groundwater Incident #3519
C. PERMITS
List all permits or construction approvals that have been issued for the facility or incident, including those not
directly related to the proposed injection operation:
1. Hazardous Waste Management program permits under RCRA:
2. DWQ Non -Discharge or NPDES permits:
3. County or DEH subsurface wastewater disposal permits:
4. Other environmental permits required by state or federal law:
Revised 8/07 UIC-51(5T Page 2 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
IV. INJECTION DATA
A. INJECTION FLUID DATA
1. List all proposed injectants.
NOTE. Any substance to be injected as a tracer or to promote in situ remediation must be reviewed by the
Occupational and Environmental Epidemiology Section (GEES) of the Division of Public Health, Department of
Health and Human Services. Review the list ofapproved iniectantsT or contact the UIC Program to determine if
the injectants you are proposing have been reviewed by OEES.
Injectant: Regenox
Concentration at point of injection: Five Percent
Injectant:
Concentration at point of injection:
Concentration at point of inj
Inj
Concentration at point of injection:
Injectant:
Concentration at point of injection:
2. Source of fluids used to dilute or chase the injectants listed above:
❑ None
❑x Municipal water supply
❑ Groundwater from private well or any well within 1/4 mile of injection site
❑ Air
❑ Other:
3. If any well within 1/4 mile of injection site, a private well, or surface water is to be used as the fluid source, supply
the following information:
a. Location/ID number of
b. Depth of source:
c. Formation:
d. Rock/Sediment type:
e. In Attachment C, provide a current, complete 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.
NOTE.- If contaminated groundwater is to be used as the dilution or chase fluid, this is not the proper permit
application form. You must apply for a closed -loop groundwater remediation permit using application form
GWRS.
Revised 8/07 UIC-5I/5T Page 3 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
B. PROPOSED OPERATING PARAMETERS
1. Duration of Injection:
Maximum number of separate injection events: Three
Expected duration of each injection event: Eight Hours
Expected duration between events (if more than one event): 30 days
2. Injection rate per well: One gallons per minute (gpm)
3. Total Injection volume: 200 gallons per day (gpd); 200 gallons per event (if separate events)
4. Injection pressure: Less than 20 pounds/square inch (psi)
5. Temperature at point of injection: 72 OF
6. Brieflv describe how the above parameters will be measured and controlled:
Volume and flow will be measured using an in -line flow meter/totalizer. Pressure will be monitored with a
pressure gauge mounted on the injection manifold. Flow and pressure will be controlled via a gate valve
downstream from the pump, which can restrict the flow, and thereby lower the pressure.
7. Estimated hydraulic capacity of the well: Three . gpm
C. INJECTION WELL CONSTRUCTION DATA
1. Injection will be via:
❑x Existing well(s) proposed for use as an injection well. Provide the data in (2) through (6) below to the best of
your knowledge.
❑ Proposed well(s) to be constructed for use as an injection well. Provide the data in (2) through (6) below as
proposed construction specifications.
2. Well Drilling Contractor's Name: Bore and Core
NC Well Contractor Certification number: 763
3. Date to be constructed: October 1989 Number of borings: Four
Approximate depth of each boring (feet): 35
4. Screened interval/Injection interval of injection wells:
Depth: 7 to 35 feet below ground surface (if multiple intervals, indicate shallowest and deepest depth).
5. Well casing (N/A if injection is through direct push rods):
Type: ❑x PVC ❑ Stainless steel ❑ Other:,
Casing depth: to ft.
6. Grout (N/A if injection is through direct push rods):
Type: ❑x Cement ❑ Bentonite ❑ Other:
Grout depth: 1 to 4 ft.
Revised 8/07 UIC-5I/5T Page 4 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
V. ATTACHMENTS
Provide the following items as attachments with the given headings:
A.' SITE HISTORY
Provide a brief description of the site history including:
(1) site usage historically and present,
(2) origin of the contamination,
(3) previous remedial action(s).
NOTE: G.S. 89E-18 requires that any geologic plans, reports, or documents in which the performance is related to the
public welfare or safeguarding of the environment be prepared by a licensed geologist or subordinate under his or her
direction. G.S. 89E-13 requires that all drawings, reports, or documents involving geologic work which shall have been
prepared or approved by a licensed geologist or a subordinate under his or her direction be signed and sealed by him or
her.
B. HYDROGEOLOGIC DESCRIPTION
Provide a hydrogeologic description, soils description, and cross section of the subsurface to a depth that includes the
known or projected depth of contamination. The hydrogeologic description shall include:
(1) the regional geologic setting;
(2) significant changes in lithology;
(3) the hydraulic conductivity, transmissivity, and specific yield of the aquifer to be used for injection, including a
description of the test(s) used to determine these parameters; and
(4) the depth to the mean seasonal high water table.
C. INJECTION FLUID COMPOSITION
Describe the chemical, physical, biological and radiological characteristics of each injectant. Attach the Material Safety
Data Sheet (MSDS) for each injectant. If a private well or a well within 1/4 mile of the injection site is used as the source
well, include chemical analysis of source fluid here.
D. INJECTION RATIONALE
Attach a brief description of the rationale for selecting the injectants and concentrations proposed for injection, including:
(1) goals of the injection project;
(2) 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; and
(3) summary results of modeling or testing performed to investigate the injectant's potential or susceptibility to change
(biological, chemical or physical) in the subsurface.
E. INJECTION PROCEDURE AND EQUIPMENT
Provide a detailed description of all planned activities related to the proposed injection including but not limited to:
(1) construction plans and materials;
(2) operation procedures;
(3) a detailed diagram of the surface and subsurface portions of the system; and
(4) a planned injection schedule.
F. MONITORING PLAN
Provide a plan for monitoring the results of the injection, including:
(1) a list of existing and proposed monitoring wells to be used;
(2) a list of monitoring parameters and analytical methods to be used; and
(3) a schedule for sampling to monitor the proposed injection.
NOTE: The selected monitoring wells must be located so as to detect any movement of injection fluids, process by-
products, or formation fluids outside the injection area or zone. The monitoring parameters should include the target
contaminants as well as secondary or intermediate contaminants which may result from the injection and other
parameters which may serve to indicate the progress of the intended reactions, such as pH, ORP, dissolved oxygen, and
Revised 8/07 UIC-5I/5T Page 5 of 7

APPLICATION FOR PERNHT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells — In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
other electron acceptors and donors. The monitoring schedule should be consistent with the pace of the anticipated
reactions and rate of transport of the injectants and contaminants.
G. WELL DATA
Provide a tabulation of data on all existing or abandoned wells within '/4 mile of the injection well(s) which penetrate the
proposed injection zone, including, but not limited to, monitoring wells and wells proposed for use as injection wells.
Such data shall include a description of each well's use (water supply, monitoring, etc), total depth, screened or open
borehole depth interval, and well construction or abandonment record, if available.
H. MAPS
Attach the following scaled, site -specific maps:
(1) 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.
(2) Site map including:
a. all property boundaries;
b. all buildings within the property boundary;
c. existing and proposed injection wells or well field(s)
d. any existing sources of potential or known groundwater contamination, including waste storage,
treatment or disposal systems within '/4 mile of the injection well or well system;
e. all surface water bodies within'/4 mile of the injection well or. well system; and
f. all existing or abandoned wells within'/4 mile of the injection well(s) which penetrate the proposed
injection zone, including, but not limited to, monitoring wells and wells proposed for use as injection
wells.
(3) Potentiometric surface map(s) including:
a. direction of groundwater movement
b. existing and proposed monitoring wells
c. existing and proposed injection wells
(4) Contaminant plume map(s) including:
a. the horizontal extent of the contaminant plume, including isoconcentration lines
b. existing and proposed monitoring wells
c. existing and proposed injection wells
(5) Cross-section(s) to the known or projected depth of contamination, including:
a. horizontal and vertical extent of the contaminant plume, including isoconcentration lines
b. major changes in lithology
Revised 8/07 UIC-5U5T Page 6 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
VI, CERTIFICATION
I, (printed name of sienine official) , hereby certify under penalty of law that
I have personally examined and 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(s) and all related appurtenances in
accordance with the approved specifications and conditions of the Permit.
Signature: Date: (o g 'O9
Title: Environmental Specialist, Southeast
If authorized agent is acting on behayof the applicant, supply a letter signed by the applicant authorizing the
above agent.
VII. CONSENT OF PROPERTY OWNER (if the property is not owned by the 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 landowner, in the absence of
contrary //agreement in writing.) LLC r �c(rcira . k , Oa-5GI;o,�'1
I, (printed name of oropem mvner) , as owner of the property on which the
injection well(s) are to be constructed and operated, 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 (Title 15A NCAC 2C .0200)
Signature: ja (� _ Date:
Title: I'm 6 f
Revised 8/07
Submit TWO copies of the completed application package, including all attachments, to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECEIVED I DENR / DWQ
UIC-51/5T Aquifer Protection Section
JUN 2 4 2009
Page 7 of 7

Sunoco, Inc.
Assistant Secretary's Certificate In Lieu Of A Resolution
1, Michael L. Preston, the duly elected and qualified Assistant Secretary of Sunoco, Inc., a
corporation organized under the laws of the Commonwealth of Pennsylvania ("Sunoco" or the
"Company"), do hereby certify that-
Sunoco's Management Control, Process Policy ("Policy") was duly adopted by a
resolution of the Company's Board of Directors ("Board"), at a meeting duly called and
held on March 2, 2006, at which a quorum was present and acting 'throughout; such
resolution has not been amended, modified or revoked and remains in full force and
effect.
2. Pursuant to the Delegation, of Authority provisions of said Policy, the Board has
delegated to the Chief Executive Officer (the "CEO") the authority for stewardship
responsibilities with respect . to the execution of access agreements, discharge
monitoring reports, NPOES permits, notifications of release, deed notices, and permits
on behalf of Sunocc, and/or any of its subsidiaries including but not limited to Sunoco,
Inc. (R&M).
3. Further pursuant to the Delegation of Authority provisions of said Policy, at the discretion
of the CEO, the CEO may delegate in writing all or portions of the authority granted to
the CEO.
4, Under said Delegations of Authority, the CEO has delegated to Robert W. Owens,
Senior Vice President, Marketing, the authority for stewardship responsibilities with
respect to the execution of access agreements, discharge monitoring reports, NPDES
permits, notifications of release, deed notices, and permits on behalf of Sunoco and/or
any of its subsidiaries including but not limited to Sunoco, Inc. (R&M),
Further under said Delegations w.' Authority, Mr. Owens has delegated to Cynthia A.
Archer, Vice President, Marketing and Development the authority for stewardship
responsibilities with respect to the execution of access agreements, discharge
monitoring reports, NPDES permits, notifications of release, deed notices,, and permits
on behalf of Sunoco and/or any of its subsidiaries including but not limited to Sunoco,
Inc. ( R&M).
6. Further under said Delegations of Authority, ivIs. Archer has delegated to Richard E.
Oswald, Director, Technical Services the authority for stewardship responsibilities with
respect to the execution of access agreements, discharge monitoring reports, NPDES
permits, notifications of release, deed notices, and permits on behalf 04 Sunocc and/or
any of its subsidiaries including but not limited to Sunoco, Inc. (R&Mj).
7, Further under said Delegations of Authority, Mr, Oswald has delegated to Joseph W,
Roberts, Manager, Environmental Services, the authority for stewardship responsibilities
with respect to the execution of access agreements, discharge monitoring reports,
NPDES permits, notifications of release, dead notices, and permits on behalf of Sunoco
and/or any of its subsidiaries including but not limited to Sunoco, Inc. (R&M).
8- Further Linder said Delegations offAuthority, Joseph W. Roberts has delegated to Daniel
T,'WPDAT,A,',PresioiilDele(-,aticjii AO-,�] -Wails 10.22.07.docc

�0
P_ Shine, Senior Environmental Consultant the authority for stewardship responsibilities
with respect to the execution of access agreements, discharge monitoring reports,
NPDES permits, notifications of release, deed notices, and permits on behalf of, Sunoco
and/or any of its subsidiaries including but not limited to Sunoco, Inc. (R&N7).
9, Further under said Delegations of Authority, Daniel P. Shine has delegated to Devon
Watts, Environmental Specialist the limited authority for stewardship responsibilities with
respect to the execution of access agreements, discharge monitoring reports, NPDES
permits, notifications of release, deed notices, and permits, on behalf of, Sunoco and/or
any of its subsidiaries including but not limited to Sunoco, Inc, (R&M),
10. No action has been taken to amend or rescind the above Delegation of Authority to the
CEO, Mr. Owens, Ms. Archer, Mr- Oswal4-,,Mr. Roberts, fkr:\Shine or Ms.,�hatts,
Michael L. Preston, Assistaifit Secretary
October 7"), 2007
Philadelphia, PA
[Corporate Seal!
T:'�WPDAI'-A%PretL-itnI)eleaatioji A%D_-) -Waus, I 0=,07.doc

ATTACHMENTS

A. SITE HISTORY
Site Usage Historically and Present: The Country Cupboard Sunoco is a retail gasoline
and convenience store located at the intersection of Jake Alexander Boulevard (Highway
601) and Statesville Boulevard (Highway 70) in Salisbury, North Carolina. The site is
triangular in shape and approximately one-half acre in size. The 2,000 square foot
convenience store occupies the western half of the property. The site has been occupied
by a retail gasoline station for at least 47 years. The site is currently operating as a
British Petroleum (BP) retail petroleum and convenience store.
Origin of the Contamination: The apparent source of groundwater contamination at the
site was identified as a combination of a leak from a gasoline UST that occurred in
October 1986 and an aboveground spill of approximately 146 gallons of unleaded
gasoline that occurred during refilling activities in June 1987.
Previous Remedial Action(s): IT Corporation submitted a Corrective Action Plan (CAP)
in August 1993. The CAP proposed the use of soil vapor extraction (SVE) to remediate
the hydrocarbon compounds at the subject site. Following approval of the CAP, the SVE
system was activated in April 1994. A CAP Addendum, submitted in October 1996,
proposed the use of air sparging technology to address dissolved -phase petroleum
hydrocarbons in groundwater. Following approval of the CAP Addendum, the air sparge
system was activated on June 11, 1997. The AS/VE system is located at the rear of the
convenience store building. The system consists of an air sparge compressor that injects
compressed air beneath the zone of groundwater contamination through 10 air sparge
wells (SP-1, SP-2, SP-3, SP-4, SP-5, SP-6, SP-7, SP-8, SP-9, and SP-10). The system
also includes a vacuum extraction blower for recovering petroleum hydrocarbon vapors
through nine vapor extraction wells (VP-1, VP-2, VP-3, VP4, VP-4, VP-5, MW-1, MW-
4, MW-7, and RW-1). The extracted vapors are discharged to the atmosphere.
Through the end of August 2002, the AS/VE system was managed and operated by
Groundwater & Environmental Services (GES). ATC acquired the. AS/VE system in
September 2002. In October 2002, ATC personnel visited the site and noted that the

system was not operating. ATC personnel were able to troubleshoot and restart the SVE
blower; however, the air sparge unit required more extensive repair work. After
replacing several parts and hiring a vendor to perform additional maintenance, ATC
personnel restarted the air sparge unit in February 2003.
The ASNE system has been shut down since June 2007 while remedial alternatives are
being reviewed.
B. HYDROGEOLOGIC DESCRIPTION
Regional Geologic Setting: The Salisbury area is underlain by Paleozoic rocks of the
Carolina Slate Belt, which consist of granite, granodiorite, quartz monzonite, and a
mixture of granite and diorite. These rocks are generally fine to medium -grained and are
easily weathered producing a sandy, clayey saprolite. The saprolite may range in
thickness from a few feet to 50 feet.
Significant changes in lithology: None observed.
Hydraulic Conductivity, Transmissivity, and specific yield of the aquifer to be used for
injection, including a description of the test used to determine these parameters: A rising
head bail test was performed on well MW-3 in lieu of a groundwater pumping test to
assess aquifer characteristics of the saprolite. The bail test was performed on well MW-3
by quickly bailing water from the well until the well was nearly dry. Bailing was stopped
and rising water levels measured with an electric water level probe until the water level in
the well had recovered to near static conditions. A log drawdown versus time recovery
plot of water level data was prepared and evaluated using the Hvorslev method.
The hydraulic conductivity (K) of the saprolite in the vicinity of well MW-3 determined
from the bail test is approximately 1.34 gpd/ft3. This value is within the range for silt,

i
sandy silts, and clayey . silts, and clayey sands presented in the literature. Assuming a
minimum saturated thickness (b) of the saprolite to be 50 feet, then by the relationship T
= Kb, the minimum aquifer transmissivity (T) is approximately 67 gpd/ft.
Depth to the Mean Seasonal High Water Table: Water levels have been measured at the
site for several years, and it is apparent that he mean water level is approximately 32 feet
below land surface.
C. INJECTION FLUID COMPOSITION
See attached RegenoxTm Brochure. MSDS Sheets for RegenoxTm Part A and
Regenox Part B are also attached.
D. INJECTION RATIONALE
Based on review of historical groundwater analytical data and current site conditions, it
appears that dissolved -phase constituents of concern are isolated to four monitoring well
locations (MW-3, MW-5, MW-6, and VMW-7). Remediation of these areas via active
mechanical remediation may not reduce the current concentrations to the groundwater
governing standards applicable to this site (NCDENR Groundwater Quality 2L Standards)
in an acceptable timeframe. As such, an advanced chemical oxidation technology is
proposed to more rapidly and effectively destroy the targeted groundwater constituents. The
chemical -oxidizing agent (RegenoxTM, which is on the NCDENR approved -chemical list)
will be introduced to the subsurface as a slurry solution via direct -injection (geoprobe grout
pump) using the above -referenced monitoring wells as injection points. Once introduced to
the subsurface, efficient oxidation reactions will occur as a result of three mechanisms
including surface mediated oxidation, direct oxidation, and free radical oxidation.
RegenoXTM, which produces minimal heat, will continue to affect the oxidation process for
up to 30 days on a single injection.

E. INJECTION PROCEDURE AND EQUIPMENT
Construction Plans and Materials: There will be no construction in order to complete the
proposed injections. All necessary equipment will be mobilized to the site, the injection
will take place, then all equipment will be removed from the site.
Operation Procedures: The proposed injection wells, MW-3, MW-5, MW-6, and VMW-
7, will be measured for Depth to Water, Temperature, pH, Oxidation -Reduction Potential
(ORP), Dissolved Oxygen (DO), Conductivity, and Alkalinity, then will be hooked up to
a pumping system that will be used to inject the RegenoxTM compound. See diagram
below:
•
ZEBRA
CNAM ME
n �
Selected [L_ . __M °Vwft..:.t- R:.....»..
Pumps •Rod String Is advanced
by percussion
Injection Probe
Assembly
Injection Chemical

The pumping system will include a gate valve downstream from the pump for restricting
the flow, which will, in turn, allow the operator to control the pressure. There will be a
pressure gauge mounted on the injection manifold for monitoring pressure. The flow rate
and total flow volume will be measured with an in -line flowmeter, similar to the type
used for residential water supply lines.
Water quality parameters (pH, Temp, Conductivity, DO, ORP, and Alkalinity) will be
measured continuously throughout the injection, as well as at the conclusion of each
event.
Planned Injection Schedule: The first injection event will take place upon approval of
this permit application, and the second and third injection events will take place at 30 day
intervals afterward.
F. MONITORING PLAN
Monitoring of monitoring wells MW-3, MW-5, MW-6, and VMW-7 is proposed on a
quarterly basis to assess the effectiveness of the application of Regeno)Jm. The first
quarterly post -injection monitoring event will be conducted approximately 30 days
subsequent to the date of injection. Data collected during the post -injection monitoring will
be summarized and presented in a quarterly groundwater monitoring letter report.
Groundwater samples will be analyzed by EPA Method 624 including BTEX, MTBE,
DIPE, EDB, and Naphthalene. Additionally, pH, DO, temperature, ORP, and alkalinity
measurements will be collected from the above -referenced monitoring wells during
monitoring events subsequent to the injection.

G. WELL DATA
2010 Statesville Boulevard
Salisbury, North Carolina 28144
Sunoco Facility DUNS #0275-7383
NCDENR Groundwater Incident No. 3519
Well ID
Total
Depth
(feet)
Screened
Interval
(feet)
Casing
Diameter
(inches)
Well Type
Notes
MW-1
33.80
7-34
2
Typell
MW-2
35.75
7-36
2
TypeII
MW-3
37.10
7-37
2
Typell
MW-4
34.65
7-35
2
Typell
MW-5
35.65
7-36
2
Type II
MW-6
33.80
3-34
2
Typell
MW-7
35.40
7-35
2
Typell
VMW-7
54.05
51-54
2
Type III
MW-8
33.65
22-34
2
Typell
MW-9
38.48
23-38
2
Typell
MW-10
33.40
23-33
2
Ty e II
VMW-11
80.00
75-80
2
Type III
MW-13
45.00
20-45
2
Typell
RW-12
40.00
10-40
6
Type II
Harris Well
25.58
1 15-26
1 2
Type II
Notes:
1. * Monitoring well MW-8 may have been destroyed by property construction.

Potable Wells:
Distance from
Site
Hydraulic
City Water
Potable Well
Pro rt Owner
feet
Position
Connection
1920 Statesville
Blvd.
Anger Family Properties
276
Upgradient
No
170 Frances Street
Salisbury, NC 28147-
9009
1924 Statesville
Blvd.
Susan Barber
360
Upgradient
No
8965 Sherrils Ford Road
Salisbury, NC 28147
2021 Woodleaf Road
Dockins
224
Downgradient
Yes
2029 Woodleaf Road
Ann Miller Kieth
348
Downgradient
Yes
810 Duckview Court
Winston-Salem, NC
2740???
2034 Woodleaf Road
Harry L. Hipp, Jr.
360
Downgradient
No
2035 Woodleaf Road
Belle Realty Development
408
Downgradient
No
301 N. Main Street
P.O. Box 102
Salisbury, NC 28145
2036 Woodleaf Road
John H. Hipp
432
Downgradient
No
2036 Woodleaf Road
Salisbury, NC
2037 Woodleaf Road
Pinkston
480
Downgradient
No
2101 Woodleaf Road
Holly Leaf LLC
600
Downgradient
No
407 Riverbend Drive
Advance, NC 27006
2102 Woodleaf Road
Harry L. Hipp, Jr.
504
Downgradient
No
2104 Woodleaf Road
George L. Hipp
516
Downgradient
No

7.
genm
CHEMICAL OXIDATION REDEFINED...
RegenOx'" is an advanced in situ chemical oxidation technology* designed to treat organic
contaminants including high concentration source areas in the saturated and vadose zones
PRODUCT FEATURES:
Rapid and sustained oxidation of target compounds
Easily applied with readily available equipment
Destroys a broad range of contaminants
More efficient than other solid oxidants
Enhances subsequent bioremediation
Avoids detrimental impacts to groundwater aquifers
RegenOx product application
HOW IT WORKS:
RegenOx maximizes in situ performance using a solid alkaline oxidant that employs a sodium percarbonate complex with
a multi -part catalytic formula. The product is delivered as two parts that are combined and injected into the subsurface using
common drilling or direct -push equipment. Once in the subsurface, the combined product produces an effective oxidation
reaction comparable to that of Fenton's Reagent without a violent exothermic reaction. RegenOx safely, effectively and rapidly
destroys a wide range of contaminants in both soil and groundwater (Table 1).
ACHIEVES RAPID OXIDATION VIA A NUMBER OF MECHANISMS
RegenOx directly oxidizes contaminants while its unique catalytic complex generates a suite of highly charged, oxidative free
radicals that are responsible for the rapid destruction of contaminants. The mechanisms by which RegenOx operates are:
Surface- Mediated Oxidation: (see Figure 1 and description below)
Direct Oxidation: C,Cl, + 2 Na,CO, • 3 H2O, + 2 H2O 2CO, + 4 NaCl + 4 H2O + 2 H,CO,
Free Radical Oxidation:
Figure 1. RegenOx" Surface -Mediated Oxidation
— Perhydroxyl Radical (H0, •)
— Hydroxyl Radical (OH-)
— Superoxide Radical (0,•)
Figure 1. Surface -Mediated Oxidation is
responsible for the majority of RegenOx
contaminant destruction. This process takes
place in two stages. First, the RegenOx activator
complex coats the subsurface. Second, the
oxidizer complex and contaminant react with
the activator complex surface destroying the
contaminant.
• Patent applied for
Contaminai
breakdown
CO, and H,i
Activator Complex
(Surface)
Cc, n:prfe,x
ntaminant

TV
Regen
From Mass Reduction to Bioremediation:
RegenOx" is an effective and rapid contaminant mass reduction technology. A single injection will remove significant amounts
of target contaminants from the subsurface. Strategies employing multiple Regenox injections coupled with follow-on accelerated
bioremediation can be used to treat highly contaminated sites to regulatory closure. In fact, RegenOx was designed specifically to
allow for a seamless transition to low-cost accelerated bioremediation using any of Regenesis controlled release compounds.
Significant Longevity:
RegenOx has been shown to destroy contaminants for periods of up to one month.
Product Application Made Safe and Easy:
RegenOx produces minimal heat and as with all oxidants proper health and safety procedures must be followed. The necessary
safety guidance accompanies all shipments of RegenOx and additional resources are available on request. Through the use of
readily available, highly mobile, direct -push equipment and an array of pumps, RegenOx has been designed to be as easy to
install as other Regenesis products like ORC® and HRC•.
Effective on a Wide Range of Contaminants:
RegenOx has been rigorously tested in both the laboratory and the field on petroleum hydrocarbons (aliphatics and aromatics),
gasoline oxygenates (e.g., MTBE and TAME), polyaromatic hydrocarbons (e.g., naphthalene and phenanthrene) and chlorinated
hydrocarbons (e.g., PCE, TCE, TCA).
Oxidant Effectiveness vs. Contaminant Type:
Based on laboratory kinetic data, thermodynamic calculations, and literature reports.
Oxidant Effectiveness Key:
A = Short half life, low free energy (most energetically favored), most complete
B = Intermediate half life, low free energy, intermediate degree of completion
C = Intermediate half life, intermediate free energy, low degree of completion
D = Long half life, high free energy (least favored), very low degree of completion
RE+GENESIS
Advanced Technologies for Groundwater Resources
1011 Calle Sombre: San Clemente %California 92673-6244
Tel: 949.,366-8000; Fax: [phone]. ww .regenesis.com

Regen OX — Part A (Oxidizer Complex)
Material Safety Data Sheet (MSDS)
Last Revised: October 1, 2007
Section 1 — Supplier Information and Material Identification
Supplier:
PIN
REGENESiS
1011 Calle Sombra
San Clemente, CA 92673
Telephone: [phone]
Fax: [phone]
E-mail: [e-mail]
Chemical Description: A mixture of sodium percarbonate [2Na-)CO3.3H20f]1
sodium carbonate [Na,)C031, sodium silicate and silica gel.
Chemical Family: Inorganic Chemicals
Trade Name: Regen Ox — Part A (Oxidizer Complex)
Product Use: Used to remediate contaminated soil and groundwater
(environmental applications)
Section 2 — Chemical Information/Other Designations
CAS No.
Chemical
Percenta6e
15630-89-4
Sodium Percarbonate
60 -100 %
5968-11-6
Sodium Carbonate Monohydrate
10 — 30 %
7699-11-6
Silicic Acid
< 1 %
63231-67-4
Silica Gel
< 1 %
Section 3 — Physical Data
Form:
Powder
Color:
White
Odor:
Odorless
Melting Point:
NA
Boiling Point:
NA

RegenOx — Part A
Section 3 — Physical Data (cont)
Flammability/Flash Point:
NA
Vapor Pressure:
NA
Bulk Density:
0.9 — 1.2 g/cm3
Solubility:
Min 14.5g/100g water @ 20 °C
Viscosity:
NA
pH (3% solution):
10.5
Decomposition
Self -accelerating decomposition with oxygen release starts
Temperature:
at 50 °C.
Section 4 — Reactivity Data
Stability:
Stable under normal conditions
Conditions to
Acids, bases, salts of heavy metals, reducing agents, and
Avoid/Incompatibility:
flammable substances
Hazardous Decomposition
Oxygen. Contamination with many substances will cause
Products:
decomposition. The rate of decomposition increases with
increasing temperature and may be very vigorous with
rapid generation of oxygen and steam.
Section 5 — Regulations
TSCA Inventory Listed: Yes
CERCLA Hazardous Substance (40 CFR Part 302)
Listed Substance: No
Unlisted Substance: Yes
SARA, Title III, Sections 313 (40 CFR Part 372) — Toxic Chemical Release Reporting:
Community Right -To -Know
Extremely Hazardous No
Substance:
WHMIS Classification: C, D2B
Canadian Domestic Appears
Substance List:
J:\Operations\MSDS\Regenox Page 2

RegenOx — Part A
Section 6 — Protective Measures, Storage and Handling
Technical Protective Measures
Storage: Oxidizer. Store in a cool, well ventilated area away from
all sources of ignition and out of the direct sunlight. Store
in a dry location away from heat and in temperatures less
than 40 *C.
Keep away from incompatible materials and keep lids
tightly closed. Do not store in improperly labeled
containers.
Protect from moisture. Do not store near combustible
materials. Keep containers well sealed.
Store separately from reducing materials. Avoid
contamination which may lead to decomposition.
Handling: Avoid contact with eyes, skin and clothing. Use with
adequate ventilation.
Do not swallow. Avoid breathing vapors, mists or dust.
Do not eat, drink or smoke in the work area.
Label containers and keep them tightly closed when not in
use.
Wash hands thoroughly after handling.
Personal Protective Equipment (PPE)
Engineering Controls: General room ventilation is required if used indoors. Local
exhaust ventilation, process enclosures or other
engineering controls may be needed to maintain airborne
levels below recommended exposure limits. Avoid
creating dust or mists. Maintain adequate ventilation at all
times. Do not use in confined areas. Keep levels below
recommended exposure limits. To determine actual
exposure limits, monitoring should be performed on a
routine basis.
Respiratory Protection: For many conditions, no respiratory protection is
necessary; however, in dusty or unknown conditions or
when exposures exceed limit values a NIOSH approved
respirator should be used.
Hand Protection: Wear chemical resistant gloves (neoprene, rubber, or
PVC).
J:\Operations\MSDS\Regenox Page 3

RegenOx — Part A
Section 6 — Protective Measures, Storage and Handling (cont)
Eye Protection: Wear chemical safety goggles. A full face shield may be
worn in lieu of safety goggles.
Skin Protection: Try to avoid skin contact with this product. Chemical
resistant gloves (neoprene, PVC or rubber) and protective
clothing should be worn during use.
Other: Eye wash station.
Protection Against Fire & Product is non -explosive. In case of fire, evacuate all non -
Explosion: essential personnel, wear protective clothing and a self-
contained breathing apparatus, stay upwind of fire, and use
water to spray cool fire -exposed containers.
Section 7 — Hazards Identification
Potential Health Effects
Inhalation:
Causes irritation to the respiratory tract. Symptoms may
include coughing, shortness of breath, and irritations to
mucous membranes, nose and throat.
Eye Contact:
Causes irritation, redness and pain.
Skin Contact:
Causes slight irritation.
Ingestion:
May be harmful if swallowed (vomiting and diarrhea).
Section 8
— Measures in Case of Accidents and Fire
After Spillage/Leakage:
Eliminate all ignition sources. Evacuate unprotected
personnel and never exceed any occupational exposure
limit. Shovel or sweep spilt material into plastic bags or
vented containers for disposal. Do not return spilled or
contaminated material to the inventory.
Extinguishing Media:
Water
First Aid
Eye Contact:
Flush eyes with running water for at least 15 minutes with
eyelids held open. Seek a specialist.
Inhalation:
Remove affected person to fresh air. Seek medical
attention if the effects persist.
Ingestion:
If the individual is conscious and not convulsing, give two-
four cups of water to dilute the chemical and seek medical
attention immediately. Do Not induce vomiting.
J:\Operations\MSDS\Regenox Page 4

RegenOx — Part A
Section 8 — Measures in Case of Accidents and Fire (cont)
Skin Contact: Wash affected areas with soap and a mild detergent and
large amounts of water.
Section 9 — Accidental Release Measures
Precautions:
Cleanup Methods: Shovel or sweep spilt material into plastic bags or vented
containers for disposal. Do not return spilled or
contaminated material to the inventory.
Section 10 — Information on Toxicology
Toxicity Data
LD50 Oral (rat): 2,400 mg/kg
LD50 Dermal (rabbit): Min 2,000 mg/kg
LD50 Inhalation (rat): Min 4,580 mg/kg
Section 11— Information on Ecology
Ecology Data
Ecotoxicological NA
Information:
Section 12 — Disposal Considerations
Waste Disposal Method
Waste Treatment: Dispose of in an approved waste facility operated by an
authorized contactor in compliance with local regulations.
Package (Pail) Treatment: The empty and clean containers are to be recycled or
disposed of in conformity with local regulations.
J:\Operations\MSDS\Regenox Page 5

r
Section 13 — Shipping/Transport Information
RegenOx — Part A
D.O.T. Shipping Name: Oxidizing Solid, N.O.S. [A mixture of sodium
percarbonate [2Na-)CO3-3H2O-], sodium carbonate
[Na2CO3], sodium silicate and silica gel.]
UN Number: 1479
Hazard Class: 5.1
Labels: 5.1 (Oxidizer)
Packaging Group: III
HMIS® Rating
Section 14 — Other Information
Health — 1 (slight)
Flammability — 0 (none)
Reactivity — 1 (slight)
Lab PPE — goggles, gloves,
and lab coat
HMIS® is a registered trademark of the National Painting and Coating Association.
Section 15 — Further Information
The information contained in this document is the best available to the supplier at the
time of writing, but -is provided without warranty of any kind. Some possible hazards
have been determined by analogy to similar classes of material. The items in this
document are subject to change and clarification as more information become
available. This document is intended only as a guide to the appropriate precautionary
handling of the material by a properly trained person. Individuals receiving this
information must exercise their independent judgment in determining its
appropriateness for a particular purpose.
J:\Operations\MSDS\Regenox Page 6

Regen OX — Part B (Activator Complex)
Material Safety Data Sheet (MSDS)
Last Revised: November 7, 2005
Section I — Supplier Information and Material Identification
Supplier:
REGENESIS
1011 Calle Sombra
San Clemente, CA 92673
Telephone: [phone]
Fax: [phone]
E-mail: [e-mail]
Chemical Description:
A mixture of sodium silicate solution, silica gel and
ferrous sulfate
Chemical Family:
Inorganic Chemicals
Trade Name:
Regen Ox — Part B (Activator Complex)
Product Use:
Used for environmental remediation of contaminated
soils and.groundwater
Section 2 —
Chemical Information/Other Designations
CAS No.
Chemical
1344-09-8
Silicic Acid, Sodium Salt, Sodium Silicate
63231-67-4
Silica Gel
7720-78-7
Ferrous Sulfate
7732-18-5
Water
Section 3 — Physical Data
Form:
Liquid
Color:
Blue/Green
Odor:
Odorless
Melting Point:
NA
Boiling Point:
NA
Flammability/Flash Point:
- NA
Vapor Pressure:
NA

RegenOx — Part B
Section 3 — Physical Data ( cont)
Specific Gravity
Solubility:
Viscosity:
pH (3% solution):
Hazardous Decomposition
.Products:
1.39 g/cm3
Miscible
NA
11
Oxides of carbon and silicon may be formed when
heated to decomposition.
Section 4 — Reactivity Data
Stability: Stable under normal conditions.
Conditions to Avoid: None.
Incompatibility: Avoid hydrogen fluoride, fluorine, oxygen difluoride,
chlorine trifluoride, strong acids, strong bases, oxidizers,
aluminum, fiberglass, copper, brass, zinc, and
galvanized containers.
Section 5 — Regulations
TSCA Inventory Listed: Yes
CERCLA Hazardous Substance (40 CFR Part 302)
Listed Substance: No
Unlisted Substance: Yes
SARA, Title III, Sections 302/303 (40 CFR Part 355) — Emergency Planning and
Notification
Extremely Hazardous No
Substance:
SARA, Title III, Sections 311/312 (40 CFR Part 370) — Hazardous Chemical
Reporting: Community Right -To -Know
Hazard Category: Acute
SARA, Title III, Sections 313 (40 CFR Part 372) — Toxic Chemical Release
Reporting: Community Right -To -Know
Extremely Hazardous No
Substance:
Page 2

RegenOx — Part B
Section 6 — Protective Measures, Storage and Handling
Technical Protective Measures
Storage: Keep in a tightly closed container (steel or plastic) and
store in a cool, well ventilated area away from all
incompatible materials (acids, reactive metals, and
ammonium salts). Store in a dry location away from
heat and in temperatures less than 242C. Do not store in
aluminum, fiberglass, copper, brass, zinc or galvanized
containers.
Handling: Avoid contact with eyes, skin and clothing. Avoid
breathing spray mist. Use with adequate ventilation.
Do not use product if it is brownish -yellow in color.
Personal Protective Equipment (PPE)
Engineering Controls: General room ventilation is required if used indoors.
Local exhaust ventilation, process enclosures or other
engineering controls may be needed to maintain airborne
levels below recommended exposure limits. Safety
shower and eyewash station should be within direct
access.
Respiratory Protection: Use NIOSH-approved dust and mist respirator where
spray mist exists. Respirators should be used in
accordance with 29 CFR 1910.134.
Hand Protection: Wear chemical resistant gloves.
Eye Protection:. Wear chemical safety goggles. A full face shield may
be worn in lieu of safety goggles.
Skin Protection: Try to avoid skin contact with this product. Gloves and
protective clothing should be worn during use.
Other:
Protection Against Fire & Product is non -explosive and non-combustible.
Explosion:
Page 3

RegenOx — Part B
Section 7 — hazards Identification
Potential health Effects
Inhalation:
Causes irritation to the respiratory tract. Symptoms may
include coughing, shortness of breath, and irritations to
mucous membranes, nose and throat.
Eye Contact:
Causes irritation, redness and pain.
Skin Contact:
Causes irritation. Symptoms include redness, itching
and pain.
Ingestion:
May cause irritation to mouth, esophagus, and stomach.
Section 8 — Measures in Case of Accidents and Fire
After Spillage/Leakage
Mop up and neutralize liquid, then discharge to sewer in
(small):
accordance with local, state and federal regulations.
After Spillage/Leakage
Keep unnecessary personnel away; isolate hazard area
(large):
and do not allow entrance into the affected area. Do not
touch or walk through spilled material. Stop leak if
possible without risking injury. Prevent runoff from
entering into storm sewers and ditches that lead to
natural waterways. Isolate the material if at all possible.
Sand or earth may be used to contain the spill. If
containment is not possible, neutralize the contaminated
area and flush with large quantities of water.
Extinguishing Media:
Material is compatible with all extinguishing media.
Further Information:
First Aid
Eye Contact:
Flush eyes with running water for at least 15 minutes
with eyelids held open. Seek a specialist.
Inhalation:
Remove affected person to fresh air. Give artificial
respiration if individual is not breathing. If breathing is
difficult, give oxygen. Seek medical attention if the
effects persist.
Ingestion:
If the individual is conscious and not convulsing, give
two-four cups of water to dilute the chemical and seek
medical attention immediately. DO NOT induce
vomiting.
Skin Contact:
Wash affected areas with soap and a mild detergent and
large amounts of water. Remove contaminated clothing
and shoes.
Page 4

Section 9 — Accidental Release Measures
Precautions:
RegenOx — Part B
PPE: Wear chemical goggles, body -covering protective
clothing, chemical resistant gloves, and rubber boots
(see Section 6).
Environmental hazards: Sinks and mixes with water. High pH of this material
may be harmful to aquatic life. Only water will
evaporate from a spill of this material.
Cleanup Methods: Pick-up and place in an appropriate container for
reclamation or disposal. US regulations (CERCLA)
require reporting spills and releases to soil, water and air
in excess of reportable quantities.
Section 10 — Information on Toxicology
Toxicity Data
Sodium Silicate: When tested for primary eye irritation potential
according to OECD Guidelines, Section 405, a similar
sodium silicate solution produced corneal, iridal and
conjunctival irritation. Some eye irritation was still
present 14 days after treatment, although the average
primary irritation score has declined from 29.7 after 1
day to 4.0 after 14 days. When tested for primary skin
irritation potential, a similar sodium silicate solution
produced irritation with a primary irritation index of 3 to
abraded skin and 0 to intact skin. Human experience
confirms that irritation occurs when sodium silicates get
on clothes at the collar, cuffs, or other areas where
abrasion may exist.
The acute oral toxicity of this product has not been
tested.
Ferrous Sulfate: LD50 Oral (rat): 319 mg/kg not.a suspected carcinogen.
Page 5

RegenOx — Part B
Section 11— Information on Ecology
Ecology Data
Ecotoxicological Based on 100% solid sodium silicate, a 96 hour median
Information: tolerance for fish of 2,320 mg/l; a 96 hour median
tolerance for water fleas of 247 mg/L; a 96 hour median
tolerance for snail eggs of 632 mg/L; and a 96 hour
median tolerance for Amphipoda of 160 mg/L.
Section 12 — Disposal Considerations
Waste Disposal Method
Waste Treatment: Neutralize and landfill solids in an approved waste
facility operated by an authorized contactor in
compliance with local regulations.
Package (Pail) Treatment: The empty and clean containers are to be recycled or
disposed of in conformity with local regulations.
Section 13 — Shipping/Transport Information
D.O.T. This product is not regulated as a hazardous material so
there are no restrictions.
Section 14 — Other Information
HMIS® Rating Health — 2 (moderate) Reactivity — 0 (none)
Flammability — 0 (none) Lab PPE — goggles,
Contact — 1 (slight) gloves, and lab coat
HMIS® is a registered trademark of the National Painting and Coating Association.
Section 15 — Further Information
The information contained in this document is the best available to the supplier at
the time of writing, but is provided without warranty of any kind. Some possible
hazards have been determined by analogy to similar classes of material. The items.
in this document are subject to change and clarification as more information
become available. This document is intended only as a guide to the appropriate
precautionary handling of the material by a properly trained person. Individuals
receiving this information must exercise their independent judgment in determining
its appropriateness for a particular purpose.
Page 6

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MONITORING WELL (TYPE 2)
FORMER MONITORING WELL
AIR SPARGE WELL
® SOIL VAPOR EXTRACTION WELL
INFERRED GROUNDWATER FLOW DIRECTION
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FIGURE #
3
REVISION DATE:
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R�� gy_ �

MW-9
Benzene ug/L
<0.9
Toluene ug/L
<0.8
Ethylbenzene ug/L
<0.8
Total Xylenes ug/L
<0.9
Total BTEX ug/L
ND
MTBE ug/L
<1
EDB ug/L
<1
SEAFOOD
RESTAURANT
HARRIS WELL
Benzene ug/L
<0.9
Toluene ug/L
<0.8
Ethylbenzene ug/L
<0.8
Total Xylenes ug/L
<0.9
Total BTEX ug/L
ND
MTBE ug/L
<1
EDB ug/L
<1
LEGEND:
EMI
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0
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MONITORING WELL (TYPE 2)
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Benzene ug/L
440
Toluene ug/L
6,500
Ethylbenzene ug/L
1,600
Total Xylenes ug/L
9,600
Total BTEX ug/L
18,140
MTBE ug/L
280
EDB ug/L
28
° 15FT. FORMER COUNTRY CUPBOARD SUNOCO CHEMICALS OF CONCERN IN GROUNDWATER FIGURE #
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Benzene ug/L
<0.9
Toluene ug/L
<0.8
Ethylbenzene ug/L
<0.8
Total Xylenes ug/L
<0.9
Total BTEX ug/L
ND
MTBE ug/L
<1
1,2—Dichloroethane ug/L
<1
EDB ug/L
<1
HARR
Benz,
Tolue
Ethyll
Total
Total
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Terto
LEGEND:
® MONITORING WELL LOCATION (TYPE 1)
$ MONITORING WELL LOCATION (TYPE 2)
®SOIL VAPOR EXTRACTION WELL
o AIR SPARGE WELL
o POWER POLE
— — OVERHEAD ELECTRICAL LINE
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— — NATURAL GAS LINE
— UNDERGROUND TELEPHONE LINE
PHONE.,
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740
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4.300
I Tertachloroethene ug/L I <1
0 10 Fr. 20
REVISION DATE SCALE: REVISED BY: TB
JANUARY 9, 2009 ,• _ 20 FEET
MW-7
Benzene ug/L
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Toluene ug/L
<0.8
Ethylbenzene ug/L
<0.8
Total Xylenes ug/L
<0.9
Total BTEX ug/L
ND
MTBE ug/L
<1
1,2—Dichloroethane ug/L
<1
EDS ug/L
<1
Tertachloroethene ug/L
<1
MW-5
Benzene ug/L
39
Toluene ug/L
1
Ethylbenzene ug/L
<0.8
Total Xylenes ug/L
<0.9
Total BTEX ug/L
40
MTBE ug/L
310
1,2—Dichloroethane ug/L
24
EDB ug/L
<1
Tertachloroethene ug/L
<1
MYr- I u
Benzene ug/L
<0.9
Toluene ug/L
<0.8
Ethylbenzene ug/L
<0.8
Total Xylenes ug/L
<0.9
Total BTEY ug/L
ND
MTBE ug/L
<1
1,2—Dichloroethane ug/L
<1
EDB ug/L
<1
Tertachloroethene ug/L
<1
FORMER COUNTRY CUPBOARD SUNOCO
2010 STATESVILLE BOULEVARD
SALISBURY, NORTH CA.ROLINA
MW-4
Benzene ug/L
<0.9
Toluene ug/L
<0.8
Ethylbenzene ug/L
<0.8
Total Xylenes ug/L
<0.9
Total BTEX ug/L
NO
MTHE ug/L
<1
1,2—Dichloroethane ug/L
<1
EDB ug/L
<1
Tertachloroethene ug/L
<1
ug/L
<0.9
ug/L
<0.8
e ug/L
<0.8
rs ug/L
<0.9
ug/L
ND
/L
<1
oethane ug/L
<1
'L
<1
ethene ug/L
110
CHEMICALS OF CONCERN IN GROUNDWATER
Nov. :7-O-OF
RGURE #
4

RESTAURANT
S
� .
�G
G
HARRIS 0J� ASPHALT
WELL r PARKING
A vMv
rDRAW-/
dWf � STORAGE
r' TANK AREA
\r
\
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\ MW-13
_2 A'
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MW-1
STATESVILLE I BLVD.
ASPH
PARK
MW-10
B'
�1 RW-12 AREA
T MW-6
0
r&-MJ
LEGEND
+ MONITORING WELL
o VERTICAL DEFINITION -
MONITORING WELL
RECOVERY WELL
tN
100 0
SCALE FEET
SOURCE: JAMES L. HAINES - 6/3/93 SURVEY
1000 PERIMETER PARK DR
0019 GROUNDWATER SUITE I
yORRISNLLE. NC 27560
00 TECHNOLOGY [phone]
REV. NO.: ORAMN DATE: ACAD FILE:
86931 5398-SIT
LINES OF
GEOLOGIC CROSS -SECTIONS
A -A' & B-B'
CLIENT: PM:
SUN COMPANY, INC.
LOCATION: PE RG:
2001 WOODLEAF RD.
SALISBURY, NC
DESIGNED: DETAILED: PROJECT NO.: FIGURE:
TLW DKP 053245398 4

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.
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645
640
635
630
625
620
GRAVEL (DGA)
® CLAY
® CLAYEY SILT
PSH PHASE —SEPARATED
HYDROCARBONS
0 SILTY SAND (FILL)
1171, SILT
® SAPROLITE
BDL BELOW DETECTION LIMI
NS NOT SAMPLED
IWELL SCREEN
(18,540) TOTAL DISSOLVED BTEX
CONCENTRATION (ug/L)
TOTAL DISSOLVED
OCONCENTRATIONBTEX CONTOUR (ug/L)
T WATER —TABLE
ELEVATION (feet)
VERTICAL SCALE AS SHOWN
100 0 100 ti
HORIZONTAL SCALE IN FEET
SOURCE: WELL LOO INFORMATION
1000 PERIMETER PART( DI
:101 GROUNDWATER SUITE IAlE, NC 27sso
3E TECNHNOgLOGY (919) 4B7-2 NC
Ev. No.: DRAB/ 11 /9 ACAD FILE: 5398-XAA
GEOLOGIC CROSS-SECTION
A -A'
UENT: Pi
SUN COMPANY, INC.
2001 WOODLEAF DR.
SALISBURY, NC
IGNED: DETAILED: PROJEC NO.: FIGURE
TLW FKP 053245398 . s

2104
2161 \
2102 j
HOLLY AVENUE 2036
2037 /
\ 2034
2035
2029
\ �\ R04D
\ 2021 \ /' 2012 > �O
srgr � SITE �
ESttk, BCV
C l p (Nwy 70)
i�
i
O WATER
TOWER
1924 / 1920 I
LEGEND
PREVAILING GROUNDWATER
FLOW DIRECTION (JUNE 1996)
NOTE: THE BOLD NUMBERS SHOWN ON
THE PROPERTY PLOTS INDICATE
PROPERTIES WITH PRIVATE
POTABLE WATER WELLS. TABLE 3
PRESENTS THE NAMES AND
ADDRESSES OF THE TWELVE (12)
PROPERTY OWNERS LOCATED
WITHIN 1500 FEET OF THE SITE.
100 200
SCALE FEET
SOURCE: WITHERS h RAVENEL
ENGINEERING, INC. (I

HCDENR
North Carolina Department of Environment and
Beverly Eaves Perdue
Governor
Division of Water Quality
Coleen H. Sullins
Director
October 12, 2009
Devon Watts
Sunoco, Inc.
203 South Falkenburg Road
Tampa, FL 33619
Ref: Issuance of Injection Permit WI0300136
Country Cupboard
Salisbury, Rowan County, NC
Dear Ms. Watts:
Natural Resources
Dee Freeman
Secretary
In accordance with the application received on June 24, 2009, and the supporting data received October 2, 2009, we are
forwarding permit number WI0300136. This permit is to inject RegenOx to remediate groundwater contaminated with
gasoline at the facility referenced above. This permit shall be effective from the date of issuance until September 30,
2011, and shall be subject to the conditions and limitations stated therein, including the requirement to submit a final
project evaluation as stated in PART VH = MONITORING AND REPORTING REQUIREMENTS. Please note that
some of the monitoring requirements have changed from your application Please read the entire permit to ensure that you
are aware of all compliance requirements of the permit.
You will need to notify this office by telephone 48 hours prior to initiation of operation of the facility. In order to
continue uninterrupted legal use of the injection facility for the stated purpose, you must submit an application to renew
the permit 120 days prior to its expiration date. Please contact me at 919-715-6164 or [e-mail] if you
have any questions about your permit.
cc: Andrew Pitner, Mooresville Regional Office
Scott Dunsmuir, EnviroTrac, Ltd.
WI030.0136 Permit File
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] FAX 1: 919-715-0588; FAX 2: 919-715-60481 Customer Service: 1-877-623-6748
Internet: www.ncwaterouality.org
An Equal Opportunity \ Affirmative Action Employer
Be4wr-vz
t Regards,
Thomas Slusser, L.G.
Program Manager
Underground Injection Control Program
One
Nortb Carolina
Na'rally

Slusser, Thomas
From:
John Coyne [e-mail]]
Sent:
Friday, October 02, 2009 4:01 PM
To:
Slusser, Thomas; Schutte, Maria
Subject:
Salisbury UIC permit application
Attachments:
Water Supply Well Data —Updated 2009.xis; ET Salisbury -Area Map 1 to 150.pdf
Hello Maria and Thomas,
Over the last several weeks we have been conducting investigations, interviews, research, and collecting data about the
properties surrounding 2100 Statesville Boulevard in Salisbury, NC. Specifically, yesterday I completed.a door-to-door
survey of residents. I have attached an updated Water Supply Well Table which shows all of the Potable Wells around
the site. I have also attached an updated Water Supply Well Location Map. You will note that there are only three wells
inside_ of the 1000' radius that are being used for drinking water (or being used at all for that matter).' The nearest of
which being on the David Tod Hipp property located at 2034 Woodleaf Road. That property is 722' from our site.
The results of our investigations revealed that there have been no changes since the last Receptor Survey was
conducted by the previous consultant in July 2005. All of the properties which were on city water then are still on city
water, and all of the properties that were on private wells are still on private wells.
All of the properties that are cross -gradient or up -gradient within the 1000' radius are commercial in nature, and are all
believed to be on city water. There were no wells found in any other area of the 1000' radius of the site.
It should be noted that the seven properties that still use wells as their water source do have access to city water. There
is a water main that runs down Woodleaf Road; those property owners simply choose not to be connected to the city
water lines.
None of the property owners interviewed knew exactly how old or how deep their wells were. We included the years
that the homes were built on our table of information, however, because it stands to reason that the homes all had
water after they were built, and conversely, it's unlikely that the wells were installed long before the homes were built,
as there would be no rationale for that. As for the depths, we heard guesses from property owners ranging from 50 feet
to 150 feet, but none of that is known or can be proved. Similarly, there was no knowledge of screen depths or
screened intervals.
Hope this information helps with the issuance of the UIC permit. Please let us know if there's any other information
needed, or if you have any more questions or concerns.
John Coyne
EnviroTrac Ltd
375 Winkler Drive; Suite E
Alpharetta, GA 30004
[phone]

1
TABLE 1
Water Supply Well Data
Former County Cupboard Sunoco, Inc. Facility
2010 Statesville Boulevard
Salisbury, North Carolina
Sunoco Facility DUNS #0275-7383
NCDENR Groundwater Incident No. 3519
Distancefrom
'Hydraulic
City Water
Year Home
Potable --Well
Property Owner
Site feet
Position
Connection
Built
2021 Woodleaf Road
James E. Dockins Jr.
Yes
2021 Woodleaf Road
372
Downgradient
Water supply well
1948
Salisbury, NC 28147
is inactive (does
not produce water
2029 Woodleaf Road
Ann Miller Keith
Yes
3331 E. Kingsfield Road
590
Downgradient
Water line for
1949
Pensacola, FL 32514
supply well has
been disconnected
2034 Woodleaf Road
David Tod Hipp
2034 Woodleaf Road
722
Downgradient
No
1971
Salisbury, NC 28147
704 278-3253
2035 Woodleaf Road
Michael T. and Rhonda B. Hollowa
2035 Woodleaf Road
737
Downgradient
No
1949
Salisbury, NC 28147
704 637-2099
2036 Woodleaf Road
John H. Hipp
2036 Woodleaf Road
876
Downgradient
No
1965
Salisbury, NC 28147
704 636-2509
2037 Woodleaf Road
Piedmont Land Developers, LLC
854 Valley Road
857
Downgradient
No
1949
Mocksville, NC 27028
336 751-7007
2101 Woodleaf Road
Holly Leaf LLC
407 Riverbend Drive
1194
Downgradient
No
1940
Advance, NC 27006
336 998-2787
2102 Woodleaf Road
Harry L. Hipp, Jr.
2102 Woodleaf Road
1035
Downgradient
No
1973
Salisbury, NC 28147
704 633-2958
2104 Woodleaf Road
George L. Hipp
2104 Woodleaf Road
1184
Downgradient
No
1973
Salisbury, NC 28147
704 636-0256
"All of the above information was verified on October 1, 2009 by conducting a door-to-door survey""

I
i
I
I
i
i
i
r
/
I
r
I
II
r
/
I
HOLLY LEAF. LLC
(2101)
WATER LINE FROM THE WATER
SUPPLY WELL TO THE HOUSE
HAS BEEN DISCONNECTED
ANN MILLER P \\
KEITH \
` (2029)
HARRY L
HIPP JR. `
(2102) , \
\\\ (VAMM,/HILDA H. `\
\� SHAVER
(2012) />
/
I
SITE `
EXXON
_JE
GLARIA
I�N'
STATE
IUHEI
CHURCH'
FIDELITY
BANK
PROPERTIES
<<
cvs
(908)
PHARMACY
LEGEND:
�IBA�RBEHR AI
iI
PHAR
I ®
---- PROPERTY BOUNDARY ', 1�-- �-
_
KELLY &
I
© WATER SUPPLY WELL �� `
APPLIANCES. /
SAMCo
I
® CITY WATER
INC. PROPERTIES
/
/
I
� McDONALD'S
/ RESTAURANT
/
/
\ /
/
`\ / •
BANK
o ,so Fr. FORMER COUNTRY CUPBOARD SUNOCO FIGURE #
�virO rac REVISION DATE: SCALE :®� 2010 STATESVILLE BOULEVARD WATER SUPPLY WELL LOCATION MAP 3
375 PHONE: (77o m ii i A`F,v" no'�m 1786� s/e/os 1 • = 1 so FEET REVISED e�` Bs - SALI S B U RY, NORTH CAR O LI N A

Slusser, Thomas ,
From: John Coyne [e-mail]]
Sent: Tuesday, July 21, 2009 2:05 PM
To: Schutte, Maria
Cc: Slusser, Thomas
Subject: RE: W10300136 - Former Country Cupboard Sunoco, Inc.
Attachments: Salisbury Potable well table.pdf
Hi Maria,
I've attached the table that should've accompanied our Figure 10 in the UIC Permit application. This is the most recent
well survey that we have and it is correct to the best of our knowledge. Let us know if there's anything else we can
provide you in order to get this application approved. Thanks!
John
From: Schutte, Maria [mailto:[e-mail]]
Sent: Monday, July 20, 2009 4:42 PM
To: John Coyne
Cc: Pitner, Andrew; Slusser, Thomas
Subject: RE: WI0300136 - Former Country Cupboard .Sunoco, Inc.
John,
We will need a current 1/4mile survey and well table. You mail email them and please copy
[e-mail].
Thank You!
Maria
From: John Coyne [mailto:[e-mail]]
Sent: Monday, July 20, 2009 2:43 PM
To: Schutte, Maria
Cc: Scott Dunsmuir
Subject: RE: WI0300136 - Former Country Cupboard Sunoco, Inc.
Hello Maria,
Here's what I could find out about the above referenced site:
Apparently during the Comprehensive Site Assessment conducted in 1992, the potable well located at 2012 Woodleaf
Road aka the McBride property, was overlooked. The environmental consultant at the time, Withers and Ravenel
Environmental Engineering, received a letter from a Staff Engineer from the City of Salisbury which listed all of the wells
in the area, and that well was not listed.
When the Corrective Action Plan Addendum was prepared in 1996 by the next consultant, Fluor Daniel GTI, the well at
2012 Woodleaf was identified. It is not known if that well is still in existence and use currently.

TABLE 3
Summary of Private Wells
Mid-State/Sun
.2010 Statesville Boulevard, Salisbury, NC
----------
- - -- ----- '.
N
..........
. . . . . . . . . . . . . . .
1920 Statesville Blvd.
Larry Bums
276
Upgradien t
1924 Statesville Blvd
Mrs. Barber
360
Upgradlent
2012 Woodleaf Ave.
Mrs. McBride
240
Downgradieni
2021 Woodleaf Ave.
Unknown
2.24
Downgradieni
2029 Woodleaf Ave.
Wesley Kieth
348
Downgradieni
2034 Woodleaf Ave.
Unknown
360
Downgradie
2035 Woodleaf Ave.
Mike Holloway
408
Downgradient
2036 Woodleaf Ave.
John H. Hipp
432
Downgradieni
2037 Woodleaf Ave.
Cecil Pinkston
480
Downgradient
210I Woodleaf Ave.
Ron Arey
600
Downgradieni
2102 Woodleaf Ave.
H.L. Hipp Jr.
504
Downgradieni
2104 Woodleaf Ave.
H.L. Hipp Sr.
516
Downgradieni
aA027573831Tbl3.Wk4

HCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
June 26. 2009
Devon Watts
Sunoco, Inc
203 South Falkenburg Road
Tampa. FL 33619
Subject: Acknowledgement of Application No. WI0300136
Former Country Cupboard Sunoco Inc
Injection In situ Groundwater Remediation Well (5I)
Rowan
Dear Devon:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on June 26, 2009. This application package has been assigned the number listed above and will be reviewed by
Thomas Slusser.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete
application.
If you have any questions, please contact Thomas Slusser at 919-715-6164, or via e-mail at [e-mail]. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to http://h2o.enr.state.ne.us/documents/dwq_orQchart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincerely,
0 W�L kp�.
for Debra J. Watts
Supervisor
cc: Mooresville Regional Office, Aquifer Protection Section
Scott Dunsmuir (EnviroTrac Ltd - 375 Winkler Drive, Ste E, Alpharetta, GA 30004)
Permit Application File W10300136
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard. Ralegh, North Carolina 27604 One
Phone: [phone] l FAX 1: 919-715-0588; FAX 2: 919-715-60481 Customer Service: 1-877-623-6748 NorthCarolina
Internet: ,nrww.ncwateroualitv.ora Naturally Equal Opportunity � Affirmative Action Employer

•
rol
Environmental Services
375 Winkler Drive; Suite E, Alpharetta, GA 30004
PH: [phone] FAX: [phone]
June 22, 2009
Thomas Slusser, L.G.
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Re: Former Country Cupboard Sunoco, Inc.
2010 Statesville Boulevard
Salisbury, Rowan County, North Carolina 28114
Sunoco Facility DUNS# 02757383
NCDENR Groundwater Incident # 3519
Dear Mr. Slusser,
Enclosed please find two copies of revised Applications for Permit to Construct and/or use a Well(s) for Injection.
EnviroTrac Ltd. has revised these applications on behalf of Sunoco Inc., per your request for the site referenced
above. The following corrections have been made:
1. The permit application has been completed in the name of Sunoco Inc, who is the responsible party,
instead of EnviroTrac, who is the consultant currently conducting remediation activities on their behalf.
2. The permit application has been signed by Devon Watts from Sunoco Inc.
3. The proposed injection wells are shown on Figure 2 as MW-3, MW-5, MW-6, and VMW-7. We propose
injecting Regenox directly into the specified monitoring wells.
4. Item B.3 on Page 4 of the permit application has been filled in to show that we will be injecting 200 gallons
per day, which is 200 gallons per eight -hour event. There will be three events, spaced thirty days apart, so
after roughly 90 days, we will have injected 600 gallons, but each individual event is one day/eight hours.
5. Item B.6 has been edited to discuss how the injection rate, volume, and pressure will be measured and
controlled. There is a limited amount of space available on the form, so in the attachment under letter E,
Operation Procedures, we go into greater detail about flow, pressure, and rate controls.
6. The groundwater elevation contour map has been redrawn to correct errors.
If you have any questions or comments regarding this submittal, please contact me at [phone] or
[phone], or email me at [e-mail]. Thank you.
Sincerely,
EnviroTrac Ltd.
'7"�"' V A).. -
Scott Dunsmuir
Senior Project Manager
Attachment(s):
Two revised Applications to Construct and /or Use a Well(s) for Injection and all attachments.
RECEIVED / DENR / DWQ
Aquifer PrntPrtinn Ser..tion
JUN 2 4 2009

�CDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Scott Dunsmuir
EnviroTrac Environmental Services
375 Winkler Drive, Suite E
Alpharetta, GA 30004
Division of Water Quality
Coleen H. Sullins
Director
June 1, 2009
RE: Return of Incomplete Application for a Type 5I Injection Well Permit
Former Country Cupboard Sunoco
Salisbury, Rowan- County, NC
Dear Mr. Dunsmuir:
Dee Freeman
Secretary
The Underground Injection Control (UIC) Program is returning two copies of the subject application
package for an injection well permit since it is incomplete as submitted. Please resubmit the application
with the following corrections and/or missing information:
1. The permit application should be completed in the name of whoever is responsible for the
remediation activity, not in the name of the consultant currently scheduled to conduct the
remediation activity on their behalf.
2. The permit application should be signed by a responsible corporate officer or other such person as
described in the North Carolina Administrative Code, Title 15A, Subchapter 2C .0211(b). If an
authorized agent signs the permit application, then include a letter from the signing official
authorizing the selected agent to sign the permit application on their behalf.
3. The proposed injection wells were not indicated on any of the maps submitted.
4. Item 13.3 on Page 4 of the permit application form does not specify the volume of Regenox to be
injected for each of the three injection events.
5. Item B.6 does not describe how the proposed injection rate, volume, and pressure will be
measured and controlled.
6. The groundwater elevation contour map is not conducive for calculating the site hydraulic
gradient. Plus, there seems to be a discrepancy with groundwater elevation data for MW-2,
669.26 feet, and the adjacent groundwater elevation contour line of 667.25 feet.
RECEIVED / DENR / DWQ ,
Aquifer Protection Section REC D J UN 4 - 2009
AQUIFER PROTECTION SECTION JUN 2 4 2009
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604 �71
Phone: [phone] FAX 1: 919-715-0588: FAX 2: 919-715-60481 Customer Service: 1-877-623-6748 ne
1 O13e 1 CcliO1111S
Internet: www.ncwaterouali�.o� An Equal Opportunity 1 Affirmative Action Employer att1auflff

Scott Dunsmuir
Return Incomplete Application
Former Country Cupboard Sunoco
June 1, 2009
Page 2 of 2.
Please contact me at thomas.slusser(a)ncdenr.gov or 919-715-6164 if you have any questions.
Best Reg ds,
Thomas Slusser, L.G.
Hydrogeologist
Underground Injection Control Program
cc: UIC Program files
Dan Graham, DWM UST Section

•
enviroirac
Environmental Services
375 Winkler Drive; Suite E, Alpharetta, GA 30004
PH: [phone] FAX: [phone]
May 18, 2009
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Re: Former Country Cupboard Sunoco, Inc.
2010 Statesville Boulevard
Salisbury, Rowan County, North Carolina 28114
Sunoco Facility DUNS# 02757383
NCDENR Groundwater Incident # 3519
Dear Sir or Madam,
Enclosed please find two completed Applications for Permit to Construct and/or use a Well(s) for Injection.
EnviroTrac Ltd. has prepared these applications on behalf of Sunoco Inc. for the site referenced above.
If you have any questions or comments regarding this submittal, please contact me at [phone] or
[phone]. Thank you.
Sincerely,
EnviroTrac Ltd.
Scott Dunsmuir
Senior Project Manager
Attachment(s):
Two completed Applications to Construct and /or Use a Well(s) for Injection and all attachments.
RECEIVED I DENR I DWQ
RECEIVED / DENR / DWQ AQUIFFR PROTFPTm SFUION
Aquifer Prntectinn Section MAY 2 U 2009
JUN 2 4 Z009

AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: 07/20/09 County: Rowan
To: Aquifer Protection Central Office Permittee: Sunoco Inc
Central Office Reviewer: Thomas Slusser Project Name: Former Country Cupboard
Regional Login No: Application No.: WI0300136
L GENERAL -INFORMATION
1. This application is (check an that apply): ® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface -Disposal
❑ Closed -loop Groundwater Remediation ® Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: 07/16/09
b. Person contacted and contact information: Scott Dunsmuir, Operations Manager w/ Enviro Trac Ltd.,
Alpharetta, GA (770) 77771711. Call returned by John Coyne w/Enviro Trac Ltd. They did not have
anyone local to meet me, but he provided the store manager information, so I could introduce myself upon
arrival. Country Cupboard Store Manager : Chrissy Cain [phone].
c. Site visit conducted by: Maria Schutte
d. Inspection Report Attached: ❑ Yes or ® No.
2. Is the following information entered into the RIMS record; for this application correct?
N Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities: info in BIMS for the facility was undated by MRO
a. Location:
b. Driving Directions:
c. ; USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e. Regulated Activities / Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For Disposal and Iniection Sites: info in BIMS for the facilitv was undated by MRO
(If multiple sites either indicate which sites the information annlies to. conv and haste a new section into the
document for each site, or attach additional pages for each site
a. Location(s): see above
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
IL NEWAND MAJOR MODIFICATIONAPPLICATIONS (this section not needed for renewals or minor
modifications, skin to next section)
Section 11 is not applicable to this UIC project.
FORM: APRSR040929-UIC review Country Cupboard - July 2009

AQUIFER PROTECTION REGIONAL STAFF REPORT
III. RENEWAL AND MODIFICATIONAPPLICATIONS (use previous section for new or major modification
stems
Section III is not applicable to this project.
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed -loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well(S) And Facilities — New, Renewal, And Modification
1. Type of injection system:
❑ Heating/cooling water return flow (5A7)
❑ Closed -loop heat pump system (5QM/5QW)
® In situ remediation (5I)
❑ Closed -loop groundwater remediation effluent injection (51,/"Non-Discharge")
❑ Other (Specify:
2. Does system use same well for water source and injection? - ❑ Yes ® No
3. Are there any potential pollution sources that may affect injection? ® Yes ❑ No
What is/are the pollution source(s)? This is a small scale infection at an active convenience store / gas station.
The contamination.plume is near the current USTs and above ground Kerosene dispenser.
What is the distance of the injection well(s) from the pollution source(s)? 5 —15 ft from USTs and Kerosene
Dispenser.
4. What is the minimum distance of proposed injection wells from the property boundary? —5ft. from Statesville
Boulevard right-o -way.
5. Quality of drainage at site: ❑ Good ®Adequate ❑ Poor
6: Flooding potential of site: ® Low ❑ Moderate ❑ High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ® No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater -monitoring program: Proposal uses exiting, monitoring wells as the injection wells and then plans
to sample them over time. Recommend installation.ofini ction wells and monitor progress via existing MWs.
8.. Does the map presented represent the actual site (property lines, wells, surface drainage)? ® Yes or ❑ No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Iniection Well Permit Renewal And Modification Only:
This section not applicable to this project.
FORM: APRSR040929-UIC revi -� �'ountry Cupboard - July 2009 -- 2

AQUIFER PROTECTION REGIONAL STAFF REPORT
V. EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application: The injection proposal is for a 5%
RegenOx solution (diluted with a municipal water source) intended to remediate petroleum products from a
1986 UST leak and a 1987 above ground unleaded gasoline spill. (Typing error in application for spill says
June 1997; clarified with consultant should be June 1987.) The injection site is an active convenience store /
gas station. The Country Cupboard still exists but now offers BP products. Due to concerns about the current
status of nearby wells, the MRO has requested a current '/ mile survey / table / map of water supply wells.
Noted under section IV #7: The project proposes injecting and sampling from same wells (MW-3, MW-5, MW-
6 & VMW-7). The MRO recommends separate injection / monitoring wells. Should the CO agree and the
consultant opt to install injection wells note this site is riddled with drilling obstacles: There are overhead and
underground utilities, AST's and USTs, a gaspump canopy and this is a fairly busy - high traffic volume store.
2. Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ® Yes ❑ No. If yes, please explain
briefly. Injecting and sampling from same well is not an accurate measure ofplume response_
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition
Reason
Install separate injection wells
Injecting and sampling from same well
is not an accurate measure of plume.
7. Recommendation: ® Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information; ❑
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report preparer(s): Maria Schutte
Digitally signed by Andrew Pitney
N: ZAntlrew y, 0, ou=DWD�A
Andrew PitnereOmaikandrew.pitnerPitnetmn<dencgov. r-PS,US
Signature of APS regional supervisor: Andrew Pitner Date:2009.0I21085107-04'00'
Date: July 21, 2009
FORM: APRSR040929-UIC review Country Cupboard - July 2009 3

North Carolina Department of Health and Human Services
Division of Public Health • Epidemiology Section
1912 Mail Service Center • Raleigh, North Carolina 27699-1912
Tel [phone] • Fax [phone]
Michael F. Easley, Governor
September 5, 2007
MEMORANDUM
TO: Qu Qi ..
Underground hij ection Control Program.
Aquifer Protection Section
FROM: Luanne K. Williams, Pharm.D., Toxicologist
Medical Evaluation and Risk Assessment Unit
Occupational and Environmental Epidemiology Branch
North Carolina Department of Health and Hunan Services
Carmen Hooker Odom, Secretary
SUBJECT: Use of Non -Biological Products RegenOxTm to Enhance Biodegradation of
Contaminated Groundwater
I am writing in response to a request for a health risk evaluation regarding the use of non -
biological product R.egenOxTM to enhance biodegradation of contaminated groundwater. Based
upon my review of the information submitted, I offer the following health risk evaluation:
Some effects or hazards reported to be associated with the chemicals proposed for use are
as follows:
• Exposure can cause severe irritation and possibly burns to the skin, eyes, nose, throat,
lungs, and gastrointestinal tract (Micromedex TOMES Plus System CD-ROM
Database, Volume 73, 2007)
2. If the products are released into the environment in a way that could result in a
suspension of fine solid or liquid particles (e.g., grinding, blending, vigorous shaking or
mixing), then proper personal protective equipment should be used.
Persons working with this product should at least wear goggles or a face shield, gloves,
and protective clothing. Face and body protection should be used for anticipated splashes
or sprays.
4. Eating, drinking, smoking, handling contact lenses, and applying cosmetics should never
be permitted in the application area during or iminediately following application. Safety
controls should be in place to ensure that the check valve and the pressure delivery
systems are working properly.
e Location: 5505 Six Forks Road, 2nd F16or, Room D7 • Raleigh, N.C. 27609 An Equal Opportunity Employer

The Material Safety Data Sheets should be followed to prevent adverse reactions and
injuries.
C. Access to the area of application should be limited to the workers applying the product.
Fri order to minimize exposure to unprotected individuals, measures should be taken to
prevent access to the area of application.
7. Efforts should be made to prevent contamination of existing or future wells and surface
waters that may be located near the application area.
Please do not hesitate to call me if you have any questions at [phone].
r