WI0400110_Application_20090827

&-eo,ev)o )
State of N%J1 1 Carolina
Department of Environment and Natural Resources
Division of Water Quality
APPLICATION FOR PERiAITTO CONSTRUCT AND/OR USE A WELLS) FOR INJECTION
Type 5I Wefts — In Situ Groundwater Rem ediatioa 1 Type 5T Wells — Tracer- Injection
• Bo not use this form For remediation systems that extract contaminaled groundwater, treat it, and reinject the treated groundwater.
• Submit TWO copies of the completed application and all attachments to the address on [lie last page of this form
• Any changes made to this farm will result iji the appile-ation package being returned.
Application Nutnher (to be completed by DWQ):
I. GENERAL INFORMATION:
1. Applicant's Name {generally (lie msponsible party): High Point Regional Health Systems
2. Signing Official's Name: lVlS --"Q4 ,�"4W'-&r /-/L"4 Title:
3. Mailing address of applicant: Nigh Point Regional Health Systems Pd t'
P.O. Box HP-5
City: High Point State: NG Zip: 27261
Telephone number: [phone] (2488) Fax number: [phone]
4. Property Owner's Name (if different from Applicant): Harry Boles
5. Property Owner's mailing address: 115 S. Main St.
City: Kernersville State: NC Zip: 27285
6. Name and address of contact person who can answer questions about the proposed injection project:
Name: Lyndai Butler Title -.-Project Manager
Company: S&ME, Inc.
Add -Tess: 3718 Old Battleground Rd
City: Greensboro
Telephone number: 336-288-7180
Email Address: ([e-mail]
Lt. PERMIT INFORMATION:
State: NC Zip: 27410
Fax number: 336-288-8980
1. Project is: O New ❑ Modiftcatiaty 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 inodilication to an existing,}�erm provide:
existing permit number 19 6V Yo :)//0 and the issuance date AAA Ape:- 9,__
For renewal without modifications, fill out sections I & II only, sign the certification on the last page of this
form, and obtain the property owncr's signature to indicate consent (if the applicant is not the owner).
For all renewals, you must submit a states report includhig monitoring results of all injection activities to
date.
Revised 8/07 U1C-5115T Page I of I
REGEIV tJ ll:ivr. . i+ 1
AuG2i)2-011

APPLICATION FOR mcm i r TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 51 Wells — In Situ Ground►vater Remediation / Type 5T Wells — Tracer Injection
V1. CERTIFICATION
1, _ -J Y4n-t 0--- >_ . • P-� lYt4erg, , 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 iiidividuais iininediatcly 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:_
Title:
If authorized agent is acting on behalf of the applicant, supple a letter signed by the applicant authorizing the
above agent
VI1. 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 laird shall be deemed to vest ownership in the land owner, in the absence of
contrary agreement in writing)
I Harry Boles , ,, . , as owner of the property on which the
injection well 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: - n Date: �I �/ 2 �I
Title:
Submit TWO copies of the completed application package, including all attachments, to.
U1C Prograin
Aquifer Protection Section
North Carol'inn DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RE�ENED I oaik 10WQ
AQl11F`I~ WOTFTTINl SFCTION
Revised 8107 U[C-51/5T Page 7 of 7

ORIGINAL PERMIT APPLICATION

iJ ►�- r�'' t vt �
w i
State of North Carolina RECEIVED IDENRI DWO
Department of Eitvironill cnt and Natural Res o40WR PPnTF: Tlf1K} SECTION
Division of Water Quality MAY 2 8 2009
APPLICATION FOR PERM IT TO CONS`1'RUCI' AND/OR USE A WELL(S) FOR INJECTION
Type 51 WeIla —.flt Sitrr G1-0t[l1(INVIttel- Remediation 1 Type 5T Wells —Tracer Injection
■ Do not use this form for remcdiation systcnis that extract contaminated groundwater, treat it, and reinject the treated groundwater.
Submit TWO copies of the completed application and all attachments to (lie address on the last page of this Form.
10 Any changes made to this Form will result in the application package being rye -turned.
Application Number (Io be coniplered b), DK'Q): k/—T O //o
1. GENERAL 1NFOR1IATlON:
1. Applicant's Name (generally the responsible party): High Point Regional Health Systems
2, Signing Official's Dame: de yu 5 1 )lk-.? Title: r
3. Mailing address of applicant: High Point Regional Health Systems '] �e?, k r
P.O. Box HP-5
City: High Point State: NC Zip.. 27261
Telephone number: [phone] (2488) Fax number: [phone]
4, Property Owner's Name (if different from Applicant): Harry Bales
5, Property Owner's mailing address: 115 S. Main St.
City: Kernersvilie State: NC Zip: 27285
6. Name and address of contact person who can answer questions about the proposed injection project:
Name: Lyndal Butler Title: Project Manager
Company: SBME, Inc.
Address: 3718 Old Battleground Rd
City: Greensboro State: NC Zip: 27410
Telephone number: 336-288-7180 Fax number: 336-288-8980
Email Address: [e-mail]
H. PERMIT INFORMATION:
1. Project is: g New ❑ Modification of existing permit f_J Renewal of existing permit without modification
Renewal of existing permit with modification
1 If this application is being submitted For renewal or modification to an cxisling permit, provide:
existing permit number NA and the issuance date NA
For renewal without modifications, fill out sections i & I1 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 8107 t! lC-5i15 T Page 1 of 7

APPLICATION FOR PERMIT TO CONSTRUCT ANIVOR USE A NVELL(S) FOR INJECTION
Type 51 Wells — In Sim Groundwater Remediation / Type ST WOls—Tracer Injection
III. INCIDENT & FACILITY DATA
A. FACILITY INFORMATION
L Facility name: Dynamic Capital Mortgage, Inc. (Office Building)
Complete physical address o[the facility: 133 S. Main St
City: Kernersville
B, INCIDENT DESCRIPTION
I. Describe Elie source of the contamination:
Former 550 Gallon UST (heating oil)
County: Fors
State: NC lip: 27285
2. List all contaminants present in soils or groundwator at the site (contaminants maybe listed in groups, e.g.,
gasoline, diesel, jet fuel. fuel oil- chlorinated ethenes. chlorinated ctlianes. metals, pesticides/herbicides, etc):
Heating Oil #2
3. Has LNAPL or DNAPL ever been observed at the site (even if outside the injection cone)?
❑ Yes If yes, list maximum measured separate phase thickness feet
in soil
®No If no, list maximum concentration of total VOCs observed at site: C-9 C-18 Aliphatics11,925mglk� pp),
4. Agency managing the contamination incident:
91 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 Karen full
and phone number 33E-771-5000
6. Incident number or other site number assigned by the agency managing the contamination incident:
16401
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: None
2. DWQ Non -Discharge or NPDES permits: None
3. County or DEH subsurface wastewater disposal permits: None
4. Other environmental permits required by state or federal law: None
Revised 8107
U IC-511?T
Page 2 of 7

AI) pLICATIOrN' FOIt 1'ERINIITT❑ CONSTRUCT AND.:Iflt USE A XVELL(S) FOR INJECTION
Type 51 Wells— lit Sittr Groundwater Remediation 1 -I ype 5T Wells— Tracer Injection
IV. INJECTION DATA
A. INJECTION FLUID DATA
L List all proposed injectants,
NOTE: Any substance to be injected as a tracer till to prornole in situ reinediation must be reviewed by the
Occupational and Environmental Epideneiolog>> Section (OEES) ofthe Division of Public Health, Department of
Health and Human Services. Review the 1W of ee y�r(i (. �i igLr_tyrLisT or cornact the UIC Program to determine if
the injectants you are proposing have been reviewed bY OEES.
Injectant: Sodium persullate and calcium peroxide (Oxygen No Chem OBC)
Concentration at point of injection: 15% Weight by volume
Injectant:
Concentration at point of injection-
Injectant:
Concentration at point of injection:
Injectant:
Concentration at point of injection:
Injectant:
Concentration at point of injection. -
Source of fluids used to dilute or chase the injcctants listed above:
❑ None
® Municipal water supply
❑ Groundwater from private well or any well within `./a mile of injection site
❑ Air
❑ Other:
3. If any welt within '/4 mile of injection site, a private well, or surface water is to be used as the fluid source, supply
the following information:
a. LocationlID dumber of source; NA
Depth of source:
c. Formation:
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 tzot the proper- perrrait
application forne. Yore must apply for a closed -loop groundwater reanrediation permit using yLiplicatirrn for►rr
Gi!•RS_
Revised 8/07 1J1('-51.51 Page 3 of'7

APPLICATION FOR PERMIT TO ( WN.s I RU( I AND1011 USE' .X NVE LL(S) FOR INJECTION
Type 51 Wells — In Sim Groundwater Reni diation J Type ST Wells —Tracer Injection
B. PROPOSED OPERATfNG PARAMFTHS
I . Duration of Injection:
Maximum number of separate injection events:?
Expected duration of each injection event 6 Hours
Expected duration between events (if more than one event): NA
?. Injection rate per well; 2 to 10 gallons per minute (gpmi
3. Total injection volume: 480 gallons per day (gpd ): NA gallons per event (if separate events)
4. Injection pressure: 20 to 110 poundsisquure inch (psi)
5. Temperature at point of injectiot: Ambient °r
6. Briefly describe how the above narameters will he measured and controlled:
The injection solution will be mixed on -site pumped with a double diaphragm pump into the borings. Redox Tech
will monitor injectant pressures and volumes via the pump system.
7_ Estimated hydraulic capacity of the well: unknown gpel1
C. INJECTION WELL CONSTRUCTION DATA
1. Injection will be via:
❑ Existing well(s) proposed for use as an injection well. Provide [lie data in (2) tliro ugh (6) below to the best of
your knowledge.
9 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; Gary Meyers
NC Well Contractor Certification number: 3380
3. Date to be constructed: TBD Number of borings: 6
Approximate depth of each boring (feet): 18
4. Screened intervallInjection interval of injection wells:
Depth: 8 to 18 feet below ground surlitce (iI' multiple intervals, indicate shallowest and deepest. depth).
5. Well casing (NIA if injections is through direct push rods):
Type: ❑ PVC ❑ Stainless steel f 0111er; NA- Injection Through dinectpush rods
Casing depth: to ft.
6. Grout (NIA if injection is throLuglt direct push rods):
Type: 1F Cement Bentonite L Other: NA
Grout depth: In _ ft.
Revised 8107
I_J1C-5V5T
Page 4 of 7

APPLICATION FOR PERNHT TO C'ONS'1 RUCT AND101i US[_ A WELLS) FOR INJECTION
Type 5I Wells — In Situ Lrauttd►vater Recnediation 1 T-pc 5T Wills —Tracer Injection
V. ATTACHMENTS
Provide the following items as attachments with the given Itiading5:
A. SITE HISTORY
Provide a brief description of the site history including.
(I) site usage historically and present,
(2) origin of the contamination,
(3) previous remedial action(s).
NOTE: G.S. 89E-18 requires that air - geologic plans, rr::ports, or elocutnews in rwltdeb the pe+Jortnance is related to the
public vvelfare or safeguarding of the environrnew he prepared by a lice nseel geologist or subordinate under his or her
directio)v G.S. 89E-13 requires that all drriwmg. rcpurls, or documents involving geologic work which shall have been
prepared or approved by a licensed geologist or a Subordinate tarder his or leer direction he .signed and sealed by hint 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, anti 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 '!a 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 fat- selecting the injectanis uld concentrations proposed for injection, including:
(1) goals of the injection project;
(2) a description of the reactions between the injectan is 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 ❑f 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, illClUding:
(1) a list of existing and proposed monitoring wells to be used:
(2) a list of monitoring parameters and analytical methods to be ttsed; and
(3) a schedule for sampling to monitor the proposed injection.
NOTE: The selected monitoring wells must be localedso as to detect an'v Inovenrent ofinjection fluids, process by-
products, orformation fluids outside the injection area orsou4 The utoltiluring parameters should include the target
contaminants as well as secondary or ittternrediale ronlaminants which ma.y result front the injection and other
parameters which may serve to indirrate the prol,Tress uj the ill tended reaviions, such as pH. ORP, dissolved oxygen, and
Revised 8/07 UIC-5115'r Page 5 of 7

APPLICATION FOR PLRIIr fo Ct7; s'rIZUCT AND/OR U S F A W LLL(S) FOR INJECTION
"Type 5I Wells — ]it Sint Groundwater- Remediation p Type 5'T was —`tracer Injection
other electron acceptors and donors. The inonituriug sc hedide .shornId he consi.,aew ivffh the puce of the anticipated
reactions and rate of transport nj the inje.ctctnts and c t.miaininultt,s.
G. WELL DATA
Provide a tabulation of data oil all existing or abandoned wells within '.,4 mile ref the injection well(s) which penetrate the
proposed injection zone, including, but not limited to, monitoring weIIs anti w c I Is proposed f'or use as injection wells.
Such data shall include a description of each well's use (~eater supplN, monitoring, ctc), total depth, screened or open
borehole depth interval, and well construction orabandonmerit record, ifava11able.
H. MAPS
Attach the following scaled. site-specihc maps
(1 ) Area map based on the most recent USGS 7.5' topographic map of [lie area. at a scale of 1:24.000 and
showing the location of the propuscd injection sft!
(2) Site map including:
a. all property boundaries;
b. all buildings within the property boundary--
c. existing and proposed injection welts or w c I I lield(s)
d. any existing sources of potential or known groundwater contamination, including waste storage,
treatment or disposal systems within''/4 mile oftlie injection woll or well system;
e. all surface water bodies within 'l4 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 maps} 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 pluntc, including isoconcentraLion lines
b. existing and proposed monitoring wells
c. existing and proposed injection wells
(5) Cross -sections) 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-5I. �'i Page 6 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A 1VIA.L(S) ],OR INJECTION
Tvpe 51 Wells - fit Situ OrUundwaIer Rentoil ialion I Type ST 1VelIs - Tracer Injection
V1. CERTIFICATION
1, , hereby certify under penaIiy of law that
1 Have personally examined and ant familiar with the inlormation submitted in this doe ument and all attachments
thereto and that, based an Illy inquiry of those individuaIs imntediate] y responsible for obtaining said information,
I believe that the information is true, accurate and complete. l ani aware that there are significant penalties,
including the possibility of fines and imprisonment, for submitting false information. 1 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: late:
Title: C _ �� /GK r— ed .'
jaurhorired agent is acting on behalfgfthe applicant, suppl), a letter signed bye the applicant authorizing the
above agent.
V11. CONSENT OF PROPERTY OWNER (if the property is not owned by the applicant)
("Owner" tneans air). person who hol(ts the jee or other propert, rights in the well being constructed. A well is
real propert)? and its emisiruction an land shall he deemed to nest ownership in the land owner, in the absence of
contrary agreement in writing.)
I Marry Boles 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: if �( CL.�-�., _ _a — Dater
Title: AF +for°
Submit TWO copies of the completed application package, ineluding ail attachments, to:
UIC Program
Aquifer Protection Section
North Carolina DENR-D1 Q
1636 Mail Service Center
Raleigh, NC 27699-1636
Tcleplione [phone]
�b�t I VED 1 DENR 1 DWQ
AQUIFI=P PP0TF:rT1()tj SF,,,,,
MAY 2 B 2009
Revised 8107 l II Page 7 or7

High Point Regional . ,--._h Systems .... AE Project Number: 1584-08-051
Injection Well Permit North Carolina May B. 2009
A. SITE HISTORY
According to the Comprehensive Site Assessment/Corrective Action Plan prepared by
S&ME in response to the subject incident in June 1996, the subject property was
occupied by a private residence prior to development of the current structure in 1959,
The site is currently a commercial building. A 550 gallon heating oil UST for
consumptive use at the facility was installed in 1959. No indication of a release of
product from the UST system was docurnented prior to closure.
The subject UST was closed by removal in February 1996, and approximately 13 tons of
petroleum -impacted soil was excavated for off -site disposal. The amount of released
product was undetermined. The maximum soil total petroleum hydrocarbon (TPH)
concentration detected from the excavated soil was 46,500 parts per million (ppm). A
Tank Removal Report was prepared by S&ME in April 1996.
Field activities performed in April 1996 delineated the vertical extent of TPH impacts in
soil more than 5 feet shallower than the depth to groundwater. A Site Sensitivity
Evaluation report was prepared by S&ME in April 1996-
Five soil probes were performed in May 1996 to delineate the horizontal extent of TPH
impacts. Based on the analytical results of ten soil samples, the horizontal and vertical
extent of impacted soil was delineated. The Comprehensive Site Assessment/Corrective
Action Flan was submitted in June 1996.
Activities related to the release were temporarily suspended in 1996 in response to NC
Senate Bill 1317. High Point Regional Health Systems received a Notice of Regulatory
Requirements from the North Carolina Department of Environment and Natural
Resources requiring a Limited Site Assessment (LSA) in August 2008. On December 1,
2048, S&ME submitted an LSA report documenting the detection of C9-C 18 AIiphatics
and C9-C22 Aromatics at concentrations exceeding the corresponding residential
Maximum Soil Contaminant Concentration (MSCC) in soil sample SB-10-12 collected
and analyzed for the LSA. At 20 feet below grade, no target constituents were detected at
concentrations exceeding either the corresponding residential MSCC or sail -to -
groundwater MSCC. No dissolved impacts related to heating oil were detected in
groundwater. As an NCDENR-DWM low risk site, the site could be closed using a deed
restriction; however the responsible party has elected to remediate the subject impacted
soil to levels at less than the residential MSCCS.
I. Ed Henriques, a Licensed Geo ct ist (# 1216) for S&ME, Inc. do certify that the
information contained in i ;report is correct and accurate to the best of my knowledge.
n SE At
Seal and Signatur
S&ME, Inc. is lictice geology (certification #C-145) and engineering
(certification # F-0176) in North Carolina.
1-1

High Point Regional th Systems __ME Project Number: 1584-08-051
Injection Well Permit North Carolina May $ 2009
B. HYDROGEOLOGIC DESCRIPTION
According to the review of 1985 Geologic Map of North Carolina, the site is in the
Charlotte Belt of the Piedmont Physiographic Province, and bedrock at the site and
surrounding area is comprised of intrusive Granitic Rock that is described as mega-
crystic and equigranular.
A review of the USGS Topographic map of the Kernersville quadrangle dated 1969
(photorevised 1987) shows that the site is located on an upland divide. The topographic
map shows minimal relief near the intersection of Main Street and Mountain Street, The
topography slopes from the upland divide to drainage features located north, south and
west of the intersection, Based oil the surrounding topography, the estimated
groundwater flow direction from the subject site is generally to the southwest.
During soil sampling activities performed by hydraulic -push techniques, apparent backfill
soil was encountered to a depth of approximately 9 feet below ground in soil probe SB-6
performed in the former UST basin. Tile underlying residual soil consisted of fine sandy
silt to a depth of 12 feet below ground. Underlying the sandy silt was silty fine to
medium sand to the probe termination depth of 31 feet below ground. Bedrock was not
encountered during soil sampling activities.
A permanent groundwater monitoring well (MW-1) was installed at the same location as
soil probe S13-6 with hollow -stem augers to a depth of 35 feet below ground. The depth
to water in monitor well MW-1 measured on October 15, 2008, was 28.6 feet below
ground. On April 2, 1996, the depth to water in temporary well KMC-I was 24.5 feet
below ground surface.
Data for hydraulic conductivity, transmissivity and specific yield of the injection aquifer
are not available. The proposed injection is planned in the unsaturated zone to address
soil contamination only.
C. INJECTION FLUID COMPOSITION
The proposed injectant is Oxygen BioChem (OBC), manufactured by Redox Technology,
LLC. OBC is composed of a mixture of sodium persulfate and calcium peroxide. This
product is utilized for chemical oxidation and aerobic bioremediation, petroleum
hydrocarbon remediation, creosote remediation, and partially halogenated hydrocarbon
remediation. It is an odorless, off-white fine granular solid. OBC does not pose a
radiological hazard. It is chemically classified as an oxidizer. Additional information
concerning OBC is provided in the attached Material Safety Data Sheets (MSDS).
D. INJECTION RATIONALE
The goals and expected accomplishments of the proposed injection are to remediate the
impacted soils in prevent the source area to the extent feasible. The remediation of
contaminated soils will help to prevent potential future migration of petroleum
contaminants into the groundwater. The total area of soils to be treated is approximately
10 feet by 12 feet in plan view and from 8 feet below ground to 18 feet below ground in

High Point Regional th Systems ME Project Number-.. 1584-08-051
Infection Well Permit North Carolina May 8. 2009
depth this soil volume Is equal to approximately 44 cubic yards. Based on recent depth to
groundwater measurements, the deepest injection level is approximately 10 feet above
groundwater.
Groundwater remediation is not proposed nor required by NCDENR-Underground
Storage Tank Section because the most recent sampling results do not document
dissolved impacts in monitoring well MW-1.
Redox Tech has formulated a mixture of sodium persulfate and calcium peroxide that
actually combines bioremediation and in -situ chemical oxidation (ISCO). This product,
Oxygen BioChem (OBC}r^', supports a two -fold mechanism for treating contaminants of
concern. ❑BC delivers the persulfate radical using FMC's patent -pending KlozurTm
activation chemistry for short term ISCO, and also provides electron acceptors (oxygen
and sulfate) for longer -term biological oxidation once the sulfate radicals are spent. The
compounds formed by the reaction of injected materials with groundwater are water,
oxygen, and sulfate. The sulfate continues on to react with the soils as part of the
anaerobic degradation process (i.e. bioremediation).
E. INJECTION PROCEDURE AND EQUIPMENT
We propose to use in -situ injection with OBC as the optimal method of remediation at the
site. Typically a total oxidant demand (TOD) test is suggested on a soil sample collected
from the site, so that the oxidant demand from the natural organics and metals (iron and
manganese) can be determined in addition to the stoichiometric oxidant demand of the
contaminants. However, due to the limited size of the treatment area, a conservative TOD
value has been assumed for this application based on experience in the area.
One injection event is proposed. The injection event will be scheduled within
approximately three to six weeks after approval of the injection permit. A letter report
including logs, field notes, post injection monitoring will be provided after completion of
the remediation.
JEM163 ►lam%I 1.111 i Lc�111V 1
S&ME would conduct past-remediation monitoring approximately 60 days after injection
to document the effectiveness of the soil treatment. Two soil samples each from two soil
probes advanced into the core of the contaminated soil zone will be collected. The four
soil samples collected at varying depths within the remediation area will be submitted for
laboratory analysis by EPA methods 8260 and 8270, and by the MADEP methods for
volatile petroleum hydrocarbons (VPH) and extractable petroleum hydrocarbons (EPH).
Target cleanup levels for soil will be the Residential MSCC.
The target contaminants are petroleum products within the soils onsite. There are no
other estimated degradation products including secondary or intermediate contaminants
which may result from the injection. The base of the proposed injection zone is
approximately 10 feet above the water table. Groundwater monitoring has not indicated
that presence of contaminants of concern within the monitoring well. Consequently,
there is no proposed groundwater monitoring.

High Point Regional :h Systems AE Project Number: 1584-08-051
Infection Well Permit North Carolina May 8, 2009
G. WELL DATA
Based on the findings front the well survey completed by S&ME as part of and reported
in the LSA dated December 1, 2008, no water supply wells were identified within'/4 mile
of the subject site.
One monitoring well MW-1 has been installed as part of the assessment activities
conducted to date. A well construction record is available for the monitoring well. A
copy is attached. The table below depicts a summary of the well data.
Well No.
MW-1
Date Installed
10-15-08
Well Use
Monitoring
Total Depth b s)
35
Depth to Water b s
28.60
Screen Interval
20-35
Status of Well
Active
Distance from Injection Point
--•3'
Notes: bgs = below ground surface
H. MAPS
A topographic map depicting the location of the subject site and vicinity is provided as
Figure 1. The Potential Receptor Map is provided as Figure 2. Figure 3 depicts site
features including a structure, a monitoring well, the former UST location and the soil
remediation area. Potentiometric maps are not available as only one monitoring well has
been installed. Groundwater impacts have not been detected in the monitoring well and
thus groundwater contaminant plume maps and associated cross -sections are not
provided.
t►AF

08-27-'09 09:01 FROM-DENR 3367714633
3367714633
T-216 P002/006 F-903
PHASE I LIMITED SITE ASSESSMENT
Former High Point Health Care Ventures
133 South Main Street
Kernersville, Forsyth County, North Carolina
S&ME Project No. 1584-08-051
Prepared For:
High Point Regional Health Systems
P.O, Box HP-5
High Point, North Carolina 27261
Prepared By:
S&ME, Inc.
3719 Old Battleground Road
Greensboro, North Carolina 27410
[phone]
December 2008
N.C. Lept. Of e14R
DEC I R 2008
M.1510n•salem
Regional off Ice

08-27-'09 09:01 FROM-DENR 3367714633
3367714633 T-216 P003/006 F-903
RESEARCh & ANA YTICAt
LAbotmraRiES, INC.
AnalyticailProcess Consultations
I. ,,a„<,,,aaa,,�e
rr 'a
7.
.•�E��q.; •\y
�-
NHrnrH,,,
Clie►►tical R►talysis for• Selected Pai-ameters acid Water- Santple Idettfifred ris High Pourt Regional HS
{�t S & A E, fn Prajert #1584-08-051, collected 17 October 2008}
[ Volatile Organics
Quantituliorl
MWI V.
Semi -Volatile Organics Qttantitaliart
t4IW-1
EPA Method 602
Limit
EPA Method 625 UNA
Limit
Parameter
m IL
(me11-1
Parameter
m IL
1ME W
Benxerle
0-0010
$QL
4 Chloto 3-methylphenol
0.010
BQL
Chldrobenzeae
0.0010
RQL
2-Chlaropltenol
0 010
8QL
1,3•Dithlorobenxene
0.0010
BQL
2,4-Drchloeophenol
0.010
BQL
1,4-Dichlomhenune
0.0010
BQL
2,4-Dlnuthylphenoi
0.010
BQL
1,2•Dlchlorobcnaeae
0.0010
BQL
2,4.Dlnnlrophenal
0.050
BQL
Fthylbeuulse
0.0010
BQL
2-Me1lsy1•4,6•dinitropheno1
9050
BQL
Toluene
0.0010
BQL
2-Xit101111en01
0-010
BQL
Tonal Xylcao
0.0010
SQL
4-Nitlapherwl
0.050
BQL
MTHE
0.0050
BQL
penlachtorophenol
0.050
BQL
Phenol
❑ 010
BQL
Dilution Faclet
I
2,4,6-Trichlnropheno
0.010
SQL
Aeemaphlhene
0.010
BQL
Atenaphthyle ne
0.010
BQL
An(hracene
0-010
BQL
• r [[ Method MADEP 98-1 YPH
Quantitation
MW-1
Benzidine
0.050
BQL
1 PArstrneter
Limit
Bento(a)awhracene
0-010
BQL
m 1L
m L)
Benza(a)pyrcne
0-010
BQL
k C5-C8 Aliphalics
O.i00
BQL
SCaza(b)fluoranthene
0010
BQL
C9-C12 Aliphahcs
0.100
SQL
Benso(8h1)pery1rne
0-010
BQI,
C9•C 10 AminaIic9
0-100
BQL
BellzEKk)nuorz,,a ,v
0.010
BQL
Beozyl butyl phthalate
0.010
BQL
�'. Dilution Faclor
I
8is(2-ch1aroc(hoxy)methane
0010
BQL
111s(2-Chloroelhyt)ether
0-010
BQL
Bis(2•ehlorois0propyl)elher
0010
BQL
Bis(2-e(hyl-h"y1)ph1hala1c
0,010
BQL
IIl. Method MADEP 98-1 EPH
Quantitation
MWA
4-Bronwphcuyl phenyl ether
0.010
BQL
Parameter
Limit
2-Chlorassaphshalane
0.010
BQL
fmrlL)
fm L
4-ChlomphcnylphenyIetlier
0-010
BQI,
C9-Ct8 Alsphallcs
0-100
11QL
cbrysene
0010
BQL
CI9-C36 Aliphalits
0.100
BQL
Dftiiu(a,h)anthracene
O.OIO
BQL
C I l C22 Aromatics
0.100
BQL
1,2-Dieblornbumene
0.010
BQL
1,3-D1chlornbc4imne
0,010
BQL
Dilution Fa of
I
1,4•Dithlomhcnune
0-010
BQL
3,3-Dieblasobenzidinc
0020
BQI.
Owhyl plsthaWe
0.010
BQI.
Dimcilsyl phthalate
0.010
BQL
IV, Tit's
DI-N•Butyl phthalate
0.010
BQL
2,4-Dlnitrololuene
0-010
BQL
NDPi
2,6•11)mitrololuenc
0010
BQL
Di-N-Orly; phthalate
0.010
BQL
1,2-D1phenylhydra6ne
0.050
BQL
Fluoranlhene
0.010
BQL
Hexachlorobeazene
0,010
BQL
Haxachlorobutadlcnc
OOIO
BQL
HexaehlorocydopentadiePie
0.010
BQL
f1ruchlornethane
0010
BQL
Sample Number
629958
lndeno(1,2,3-td) pyrene
0.010
BQL
Sample Dale
10/17/08
)sophorone
U10
BQL
Sample TitrlC (hrS)
[IOU
Naphlhalene
0-010
BQL
Nitrobenzene
0.010
BQL
N-NiuOwdinxlhylalmae
0.010
BQL
N-nirraaadi-n-prapylami:se
0.010
BQL
N-16imsodiphenylarniae
0.010
BQL
BQL - Below Quauldation Limits
Phenanthrelse
0 010
BOL
asgrl. - milligrams per Lau -parts per mlltion (ppnt)
Pyrwt
0.010
BQL
MIA - NolAwllable
1,2,4=rrieh;orobeazeim
OOW
SQL
NOPI - No Olhcs PeAt Identlfu4
2-Melhylraphtlla1ene
0.010
SQL
DJulie a Faclat
I
Sample Number
629958
Satnu)e Date
l0117109
Sample Titne f11rs)
1100

cv)
m
to
r�
w
m
d'
m
Q.
tY0
cq
c-I
ti
t`
co
M
cyl
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C(7
d'
c-T
t~
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to
CY)
M
a
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I
FAG
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I
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00
m
Client Name:
Project Name:
Site Location:
S & ME, Inc.
High Point Regional - #1584-08-05I
RAL # 629958
Laboratory Name: Research & Analytical Laboratories, Inc
NC Certification # (Lab) 34
Sample Matrix: Water
j�D[ai`ttstiva:atAiTila9>tYticli'
Method for Ranges: MADEP EPH
Sample Identification
MW-1
EPH Surrogate Standards
Date Collected
10/17/09
Date Received
10/17/08
Aliphatic: COD
Aromatic: o-terphenyl
Hate Extracted
10/21/08
EP11 Fractionation Surrogates
Date Analyzed
10/21/08
% Dry Sands
NIA
NIA
NIA
NIA
NIA
NIA
N/A
NIA
NIA
#1 2-Fluorobiphenyl
Dilution Factor
1
#2 2-Bromonaphthalene
Hydrocarbo
knits of
MDL
RL
Blank
NIA
NYA
NIA
NIA
NIA
NIA
NIA
NIA
N/A
a Ran es
pleasure
C4-cis
»
mg/L
0.063
0.100
BRL
BRL
Aliphatic
C19 -C35
mgfL
0.031
0.100
BRL
BRL
Aliphatics
Cll -C22
�
mglL
0-009
0-100
BRL
BRL
Amtnatics
Sample Surrogaw
N/A
NIA
40-140%
40-140%
40-140%
40-140%
40-140%
40-140°/a
40-140%
40-140%
40-140%
40-140%
Accr taace Range
Aliphatic Surrogate %
NIA
NIA
73
75
Recovery
Aromatic Surrogate %
Recover
NIA
NIA
59
66
Fractionation Surrogate
NIA
NIA
40.140%
40-140%
40-140%
40-140%
40-140%
40-140%
40-140%
40-140%
40-140%
40-140%
Acceptance Range
Fractionation Surrogate #1
% Recovery
NIA
NIA
NIA
NIA
Fractionation Surrogate #2
NIA
N/A
NIA
NIA
% Recovery
" Unadjusted value. Should exclude the concentration of any sarrogate(s), internal standards, and/or cmImtratioms of other ranges that elute within the specified =ge.
MDL = Method' Detection Limit RL- Reporting Limit Blank = Laboratory Method Blank or Trip Blank whichever is higher (indicate type)
EFH rev. 11/00
Were all perrormance/acceptable standards for required QAJQC procedures achieved?
©
Yes
No - Details Attached
Was blank correction applied as a significant modification of the method?
'yes
© No
Were any significant modifications to the $P13 method made? � No Yes - Details Attached

M
m
m
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m
m
m
t9
a
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co
M
M
(a
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VPH (Aliphatics/Aromatics) Laboratory Reporting Form OWN
Client Name: S &VIE, Inc -
Project Name. High Point Regional - #1584-08-051
Site Location: RAL # 529958
Laboratory Name: Research & Analytical Laboratories, Inc
NC Certification # (Lal34
Sample Matrix: Water
San,tp e Inf6rinad[lti and a.y tkAIR6Wts
Method for Ranges: MADEP VPH
Sample Identification
MW-1
Collection Option
VPH Surrogate Standards
N/A
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
(for soil)'
Date Collected
10/17/08
Aliphatic: Ftuorobc=crc
Date Received
10/17/08
Date Extracted
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
N/A
Aromatic: Fluorobemwe
Date Analysed
t0123/08
% Dry Solids
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
Marlon Factor
]
Hydrocarbo
units of
MDL
RL
Blank
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
NIA
a Ran es
Measure
C5 - C8
-
Miphatics -
mgfL
0.052
0.100
BRL
BRL
C9 • C12
Aliphatics
mg/L
0.018
0.100
BRL
BRL
C9 - CIO
-
Aromatics
mgfL
0.009
0.100
BRL
BRL
Sample Surrogate
Acceptance Range
NIA
NIA
70-130°/°
70-134°/°
70-130°%v
70130°!0
70-130°i°
70-130'/u
70.130°16
74-330°/°
70-130%
70130°/0
Aliphatic Surrogate'/o
Recovery - FID
NIA
NIA
Ito
103
.rvmatic Surrogate'/.
recovery - PID
NIA
NIA
106
101
' Option 1 = Established fell line on vial Option 2 = Sampling Device (indicate brand, e.g. EnCore) Option 3 = Field weight of soil
"Unadjusted value, Should excludc the concentration of any surrogate(s), internal standards, and/or concentrations of other ranges that elute within the specified range.
MDL = Method Detection Limit RL = Reporting Lunit Blank - Laboratory Method Blank or Trip Blank whichever is higher (indicate type)
VPH rev. 11100
Were all perforrnanceJacceptable standards for required QA/QC prodedures achieved?
Were any significant modifications to the VPH method trade'
FTYes a No - Details Attached
IKI No a Yes - Details Attached

RESEARCH & ANAtyTICA!
WmATORIES f INC.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER 1 WASTEWATER I MISC. 1
CDMPANY `
JOB NO_
J 504 - 0$ - 05 l
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. s� F Q0 C7 9z Q' 4. 0`P 10 M�
`� ry ti`� ti` �� �" �-• y V REQUESTED ANALYSIS
STREET
3AOpRE55
-nib J.O
PftOJEC
CITY. STATE. Z)P 7
`-dum"IPYAQ � C- V14io
SAMPLER NAME (PLEASE PRINT)
CONTACT PHONE
L.`l r � - g �-ER- 'J34- 2$- 180
SAMPLEIpSIGNA
. •. .,.,.��
SANKus�"i'aLYjR
PATE
TIME
r'C
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�iq
sort[
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19 1a$
4 n
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REiINQIfIS :ED �BY
pA7Eli1FAE
RECEIVED BY
REMARKS:
, ,(
SAMPLE TEMPERATURE AT RECEIPT V �''
RELINOUISHED BY
6ATFffNE
RECEIVED BY

MATERIAL SAFETY DATA SHEET
❑xvgen BinChent (OBC-)®
A'1SDS Ref. iWo„ F18-44-8
*MC flute Approved: IW13f2005
Revision ,No.: I
This document has been prepared to meet the requirements of the U.S. OSHA Hazard Communication
Standard, 29 CFR 1910.1200; the Canadas Workplace Hazardous Materials information System (WHMIS)
and. the EC Directive, 2001159(F-C.
1. PRODUCT AND COMPANY IDENTIFICATION
PRODUCT N)S 1NlL.--
GENERAL USF:
MANUFACTURER
001` FMC CORPORATION
Active Oxidants Division
1735 Market Street
Philadelphia. PA 19103
(215) 299-50({} {General Informationy
r;
- - Oxygen H iaChcm (0BC)O - - — -
For clie tnical oxidation and aerobic bioremcdiation, petroleum
hydrocarbon remediation. creosote remediation and panially
halogcn,sied hydrocarbon rernedimion.
EMERGENCY TELEPHONE NUMBERS
(3031595.9048 (Medical - U.S. - Call Collcct)
For leak, fire. spill. or accident emergencies, call:
[phone] (CHEMTAEC • U.S.A. & Canada)
2. HAZARDS IDENTIFICATION
EIMERGENCY OVERVIEW:
• Odorle". off•u.hitc line granular solid (may have separation or noticeable two -lone appearance).
• Oxidizer.
• Contact with combustihlcs may cause lire.
■ Dtcampases in storage stnderconditions of moisture (wastdwaicr vapor) andlof excessive heat causing
rcicasc of oxides of sulfur and oxygen that supports combustion. Dccomposiiion could form a high
temperature melt- Sec Section 10 ("Siabiliiv and Reacti vity" y.
■ Deluge container with water at safe distnnce or its protected area,
• May be severely irritating to the eyes.
POTENTIAL HEALTH EFFECTS: Airborne dust may be irritating to eyes, nose, lungs.
throat and skin upon contact. Exposure to high levels of dust may clusu difficulty in breathing in sensitive
persons. No signil)cant long term inhalation hazard; irritation usually subsides alter exposure cease%.
Nee 10"ho

Dxygcn BioChent (08C)@ (F18-41-8)
Date: 12/1212005
3. composrriO 1 I INFORMATION ON INGREDIENTS
Clternicul'Nattie
CaSN
WL'YD
EC Na. EC Class
Proprietary lviixiurc
None Not classified
4, FIRST AID MEASURES
EYES: Immediately flush with ►►�atcr for at last 1s minutes, lifting ►he upper and lower eyelids
intermittently. See a medical doctor or nphthrtl uiologist immediatcly.
SKI -. Wash with plenty of snip and water. Get medical attention il' irritation occurs and persist~.
INGESTION: Rinse mouth with outer. Dilute by giving 1 or. 2 glasses of water. Do l:ot induce
vomiting. Never give anything by mouth to as uncansciaus person. See a medical doctor immediatcly,
INHALAT10N: Remove tq Fresh air, If breaching diMeuIIy or disc omfortoccurs and persists, obtain
medical attention.
NOTES TO M EDICAL DOCTOR: Modest irritation is the only expected effect. No
serious consequences ,See expected, except perhaps in the case of direct eye contact. Contaminated cxtemal
surfaces should be flooded with water. and direct t:yccontact desci-vus ophthalmnloeic evaluation. I
ingested, gastrointestinal irritation but not caustic burns ary to be expected; ditui ion with water indicated as
maybe gnstric evacuation via cniesis or lavagc if large doses or severe irritation is evident. Demulcents
should be helpful, No systemic effects are expected though human toxiciiy data is sparse.
5. FIRE FIGHTING MEASURES
EXTINGI.IISH ING MEDIA: ❑Ougw w h plenty of water.
FIRE 1 EXPLOS10N I3AZARDS: Product is non-coanbustible. Cinder fire conditions. may
decompose and release oxygen fiat, which timy intemi fy ere. Prescnec of water aeccIcrites decomposition.
hlixmures with polysulfidc polymers may ignite.
Fl RE FIGHTI NG PROCE❑URES: Use flooding quantitias of water- Use water spray to
krcp fire exposed containers cool. Do not uw carhop dioxide or other gas tilled hre exi1rig uishers; IItey
wilt have no effect on deeompusi(ion. Wear full protective clothing and sett -contained breathing apparatus.
Pale 2 of 10

Oxyecn BioChctn (0BC)@ (F18--3 -8) Date: 12112)2005
Pk FLAMMABLE LIMITS: Non-combustiblc
SENSI T€ V IT TO IMPACT: Qxidizabie materials can be ignited by grinding and may
become explosive.
SENSITIVITY TO STATIC DISCHARGE: Noiavailable
6. ACCIDENTAL RELEASE MEASURES
RELEASE NOTES: Confine and collect spill, put into an approved DOT container (do nos return
to original con(ainer] and isolate for disposal, Isolated material should be monitored for signs of
decomposilioo (fuming l smoking). If spilled material is -wet. dissolve with large quantities of water and
dispose as a hazardous waste. Runoff to sewer may crcatc fire or explosion hazard (do not nosh powdered
motto tl`isitb s wcr) DiTPY of u u3tvs sccordiag'to-the ]Tye thvd`oudined-in-Section 11-3; "Disposal —
Considerations".
7. HANDLING AND STORAGE
HANDLING: Avoid contact by using personal proicctivc equipment. Use respiratory protecdvc
equipment when release of airborne dust is expected. If compounded with organics or combustible
oft materists be sure to exeludc muisiure. Use clean plastic or siainless steel scoops nnly.
STORAGE: Keep dry (reacts with moisiurc). Use first in. first out storage system. Store unopened in
a cool, clean. dry place away from point sources of heat (e.g, steam pipes, radiant heaters, hot air vents or
welding sparks). Keep cdntaincr Iighily closed when not in use. Avoid contamination of opened product.
Avoid contact with red ueing'agenis: In cast of Fire or d remposi to i n (fuming 1 smoking) deluge with pienty
of water to control decomposition. Fore storage. refer to NFPA Bulletin 430 on storage of liquid and solid
oxidizing malcrials.
COMMENTS: VENTILATION: Pravidc mechanical general andlor local exhaust ventilation to
prevent release of dust into work environment. SpiII%shouId be collected into suitable containers to prevent
dispersion into the air. if ventilation is inadequate or not available, use dust respirator and cyc protection,
8. EXPOSURE CONTROLS 1 PERSONAL PROTECTION
EXPOSURE LIMITS
Chemical \ante
ACGIII
OS1-1A
Supplier
Proprietary ingrediem
0,1 mglm) (TWA)
Page 3 of 10

Oxygen BioChem;OBQ0 (F1844-1)
Uatc: 1 J 1212005
Chemical Name
ACCIFI
OSFL-k -Ter
Supplier
Proprietary ingredient
5 myrn {TLVA)
a mglm' (TWA)l
(TWA]
ENGINEERING CONTROLS: Pmvlde mechanical local exhaust ►•enrilation to prevent
release of dust into the work area. if release is expected use respiratory protection. Remove contaminated
Clothing immediately and wash before reuse.
PERSONAL PROTECTIVE EQUIPMENT
EYES AND FACE: Use cup type chemical goggles. Full face shield may be used.
RESPIRATORY: Use approved dust respirttorwith I'ull face piece.
- -PRO TECTI-V-E-C-60-T-H-I,NG:--Lon -sleeve shin; im ryinus'a rori ar-clzithhn . ---- - "�
€ Pe p � - -- -
Rubber or neoprene foutwear-
G LOVES: Rubber or neoprene gloves. Thoroughly wash the Outside of gloves with soap and
water prior to removal. Inspect regularly I -or leaks.
9. PHYSICAL AND CHEMICAL PROPERTIES
ODOR:
Odorless
APPEARANCE:
Off --white fnc granular solid
AUTO IGiNITION TEi1-iPERATIJRE:
Non-combustible
BOILING POINT:
No data available
COEF!! IC[ENT OF 01 L I ll'ATER:
Not available
DEN;SiTY /WEIGIIT PER VOLUME:
(Bulk) 60 1bslft' (lousc)
EVAPORATION RITE:
idol applicable (Butyl Acetate = 1)
FLASH POINT:
Not applicable
NIELTING POINT:
Decomposes an heating (About 275°C)
OXIDIZING PROPERTIES:
Oxidizer
PERCFXT VOLATTLE:
Nntapplicable
PH,
1 1-3- 12.) @ 2S0Cl I hour (I - Q17c. shirty, solulion)
SOLUBILITY IN M'ATER:
ItZNir (insoluble @ 25°C); 73`k (solubility (LD 25'C)
SPECIFIC GRAVITY:
2.6.2.92
VAPOR DENSITY-
Not applicable ( Air = 1)
VAPOR PRESSURE,:
Not:ipplicable
r�
Page 4 of 10

a I .
0
SA—
Oxygen BwChen} (OBQ0 (F 18-14-8)
10. STABILITY AND RE,LACTIVITY
COND1T1ONS TO AVOID:
STABILITY:
POLYMERIZATION
MOMPATIBI-L MATERIALS
Date: 1 J i V?OD5
Heat (decomposes at 275°C), moisture, reducing
agents. Grinding with organics.
Stable (decomposition could occur when exposed
to heat or moisture)
Wil l not accm-
Grind i ng iuixtures with organics (oxidizable
materials can be ignited by grinding and may
become explosive); heavy metals. Acids, alkalk.
halidts (Iluoridcs, chlorides, bromides and
iodidcs). combustible materials, most metals and
heavy metals, oxidizable materials, other oxidizers.
reducing agcrtts. rleancrs, and organic or cartion
containing co}npounds. Contact with incompatible
materials can resuh in a material decomposition or
other uncontrolled reactions.
Fl:t2ARl)OUS D1:COMPOSITEON. PRODUCTS: Oxygen that supports combustion and oxides of
sulfur, nitrogen, and calcium hydroxide.
COMMENTS: PRECAUTIONARY STATFMENT: Usu of persul fates in chemical reactions
requires appropriate precautions and design considerations for pressure and thennal relief.
Decomposing persulfales will evolve large volumes of gas and/or vapor, can :accelerate exponentially with
heat generu6on, and create significant and hazardous pressures if contained and not properly controlled or
mitigated.
Use with alcohols in the presence of water has bccp'demgnstrAied to generate conditions that require
rigorous adherence to process safety methods and standards to prevent escaIatinn to an unctnalrol led
reaction.
11. TOXICOLOGICAL INFORMATION
EYE EFFECTS: No Bala available far the mixture.
Proprietary Component: Non -irritating (rabbit)
Proprietary Component• Severely irrtaiing (on washcd); Minimally irritating (washed)
SKIN EFFECT'S: lqo data available for the mixture.
Fxpccled to be non -irritating (rabbit)
❑ERMAL LD-;o: , No data avail ahle for alte mixture.
Proprietary Components: > 10 VAS (rat)
ORAL Lip{It: No data available for the mixture.
Proprietary Component. 895 niglkg (rat)
Proprietary Component: 5 rAg (rat)
f'agc i of lit

Oxyger, BioChem {OBC,16 (F18.44.8) Date: 1 J12/2005
INHALATION LCSO: No data available for the mixture
Proprietary Componem: 5.1 mO (rat)
Proprietary Component: n 17 mg/1 [ 1 h) (rat)
SENSITIZATION: No data available for the mixture.
Proprietary Component; (%jn) May be wnsitiriag to allergic persons. (guinea pig)
TARGET ORGANS: Eyes, slain, respiratorypassagcs
ACUTE EFFECTS FROM OVEREXPOSURE: Modest irritaiion is the only expected
effect, No serious consequences are expected. except perhaps in the case of direct eyc contact- Bust may be
harmful and imtating to the eyes, nose, throat and lungs. May be harmful if swallowed.
CHRONIC EFFECTS FROM OVEREXPOSURE: No data available for the
mixture. Sensitive persons may develop dermatitk and asthma. One of the proprietary components was fed
to groups of male and femnle rats at 0, 300 attd 3,000 ppni in the dirt for 13 wee"' . followed by 5,000 ppm
or 5 weeks. MicSas—co pic examination ofiissuus iiiWEIe`d some-injury16 the gastratr�slinallra l 5l the -
highesi dose (3,000 ppm) only. This effect is not unexpected for an oxidizer at high concentrations -
CARCINOGENICITY:
NI'l':
Not listed
IARC:
Not listed
OSHA:
Not listed
OTFFER:
ACGihI: Not listed
12. ECOLOGICAL INFORMATION
ECOTOXIC0LOGICAL INFORMATION: No data available for the mixture.
Effect of low concentrations on aquatic life are tltld�.own.
� r
Proprietary Component
Biuegil) sunfish. 96-hour LCS4 = 771 mglL (FMC Study I92-12501
Rainbow trout, 96-hour LC5a = 163 rriglL I FMC Study 192-12511
Dnphnin, 48-hour LCfo = 133 mg[L I>~h1C Study 192-12521
Grass shrimp, 96•hour LCsQ = 519 mg/L (FMC Study 192-12531
CH EM ICAL FATE IN FORM ATION: As indicated by chemical properties oxygen is
released into the euviruntnent. Biodegradability does not apply to inorganic substances.
Page 6 of 10

Oxygen 13ioChcm (OB.C)i9 (F18µ4-9)
Dnlu: 1?1I712005
13. DISPOSAL. CONSIDERATIONS
DISPOSAL METHOD. Dissolve in waicr to allow the release of oxygen and dispose via a
treatment system in accordwicc with governmental agencies regulations. Contact appropriate regulatory
agency prior to disposal.
14. TRANSPORT INFORMATION
U.S. DEPARTMENT OF TRANSPORTATION (DOT)
------PROPER-SItIPPINC, M01E: — ---
-Oxidizing solid; mo:s: (sodium persuifatc.—
calcium peroxide)
PRIiNiARY HAZARD CLASS IDIVISION,
5.1 (Oxidizer)
UNINA N1I11BER:
UN 1479
PACKING GROUP:
11
LABEL(S):
5.1 [Oxidiz(:r}
PL.ACARD(S):
5.1 (Oxidizer)
NIARKING(S):
Oxidizing solid, n.o.s. (sodium persulfatc.
calcium peroxide). UN1479
ADDITIONAL. INFORMATION:
Hazardous Substance/RQ: Not -applicable
49 STCC Number: 4918733
This material is shipped in 55 lb.
polyethylene pail with vented sercw-on lid
(approx 6.5 gallon)
INTERNATIONAL MARITIME DANGEROUS
GOODS (MIDG)
PROPER S1IIPPING NAll'IE:
Oxidizing solid. n.o.s. (sodium persulfasc,
calcium peroxide)
INTERNATIONAL CIVIL AVIATION ORGANIZATION (ICAO) I
INTERNATIONAL AIR TRANSPORT ASSOCIATION (XATA)
PROPER SIIIITING NAME:
ADDITIONAL INFORMATION:
r
Page 7 410
Oxidizing solid, tl.o.s. (sodium parsulfate,
calcium peroxide)
Combination packaging is recommended
for uir transPon.

► 'f I
Oxygen B•:or-1cm (OBCA (F18-k-i•8)
Datc. 1 a 12/2005
OTHER I1'NFOMMATION:
Place splllcd prodtici in suitableconiainer and wash residue with pieniy of water.
See Section b (Accidental Rcicasc Measures) above for additional htstruciions.
15. REGULATORY INFORMATION
UNITED STATES
SARA TITLE III (SUPER FUND AsMENDNIENTS AND REAUTIIORIZATiOtN ACT)
SECTION 311 IIAZATID CATEGORIES (40 CFR 370):
Fire Hazard, Immediate (Acute) Health Hazard
SE t TION 312 "{ IRESHOLD PLANN_LIVS—ANT Y..(���a7 ),
The Threshold Planting Quantity (TPQ) far this product, if treated as a mixture, is 10.000 Ibs;
however, this product contains the following ingredients with a TPQ of less than 10.000 lbs.:
None
SECT101 30 REPORTABLE INGREDi EN rS (40 CFR 372):
Not listed
CERCLA (COMPREHENSIVE ENVIRONMENTAL RESPONSE COAIPENSATIO` AND
LIABILITYACT)
CERCLA DES] GNAT) ON & REPORTABLE QUANTITIES (RQ) (40 CFR 302.4):
Proprietary component: [enlisted, RQ = 100 lbs., Ignitsbility
TSCA (TOXIC SUBSTANCE CONTROL ACT)
TSCA CNTVE,NTORY STATus (40 CFR 710):
Listed (components)
RESOURCE CONSERVATION ANIy RECOVERY ACT {RCRA)
RCRA II ENT1FICATION Of I1AZARDOUS WASTE (40 CFR 261):
Waste Number. D00}
CANADA
I%fH;NIIS (WORKPLACE IRDOUS MATERIALS INFORMATION SYSTEM):
Chemical Nanic: Proprietary Component
Product IdeolllWation Number; 1505
Hazard Classification I Division; Class C (Oxidizer). Class D. Div, ?, SubOiv. B. (Toxic)
Ingredient Disclosure List: Listed
Chemical Name: Proprietary Component
product ldcnti0cadon Number: 1457 ,
Hazard Classification I Division: Class D, Div 3, Subdiv. B, Clasti C (Oxidirrr)
Ingredient Disclosure List- Listed
Pagc 8 of 10

P"
oph
Oxygen BWltcIn (0BC)G IFIS-4-'�I
INTERNATIONAL LISTINGS
Proprietary Compotscrlt
Australia WCS); Listed
China: Listed
Japan (ENCS): (1)-t 131
Korea: KE-12369
Philippines (PICCS): Listcd
Proprietary ComporlLnt
Australia (AICS): Listed
China: Listed
Japan [ENCS): (I)-181
}Cana: K E-04518
Philippines IMCCSI; Listed
Proprietary Component
Australia (AICS): Listed
Japan (ENCS): (1)-190
Korea- KE-04597
Philippines (PICCS): Listed
Date: 12/ 121-1005
HAZARD, RISk AND SAFETY PHRASE DESCRIPTIONS:
EC Symbols:
(Not Classified as hazardnus)
EC Risk Phases:
(Not classified as hazardous)
EC Safely Phrases:
(Not classiricd as hazardous)
16. OTHER INFORMATION
llnrls
�Hcalth
_Flanunabilit _ _ 4 J
Phvsical Hazard 1
Personal Protection (PPC—j—_
Protection = ] (.Safety gaggles, glovers, apron & combination dust & vapor respirator)
HMIS = Hazardous NIUT rials Identification System
Degree of Hazard Codc:
4 = Severe
3 = Serious
Paoc 9 of In

Oxygen 13ioChc m (08010 (F18-44.9) Date: 12MMIX)s
06
2 = Modcrate
1 = Slight
U = Minimal
r\FPA
Health 7
+ Flammability B
Reactivity 1
Special ❑x
SPECIAL. = ❑X (Oxidizer)
NFPA = National Fire Protection Association
Degree of Hazard Code-
4 = Extreme
- - - - - ---� -High --- - — — - - --
2 = Moderate
I = Slight
Q = Insignificant
REVISION SUNIN1 ARY:
New MSDS.
OW FMC Logo - FMC Corporation Trademark
Oxygen BioChem (08C) -Trademark of Redtrx Teen. LLC
Q 2005 FMC Corporation. Ali Rights Reserved.
FMC Corpomrian believes that the information and recommesidations cotturincd herein (including daw and
statements) are accurate as of the date hcrcof, NO WARRANTY OF FITNESS FOR ANY PARTICULAR
PURPOSE, WARRANTY OF MERCHANTABiLiTY, OR NY OTHER 1VARRANTY. EhPRE5SED
OR IMPLIED, IS MADE CON CFRNING THE INFORMATION PROVIDED HEREIN, The information
provided herein relAts Only to the specific produc: designated and may not he applicable where such
product is used in combinallan with any other materials or in any process. It is a violation of Federal law to
USC this product in a manner inconsistent with its labeling. Further, since the conditions and methods or use
are hcyond the control of FMC Corporation, FMC Corporation expressly disclaims any and all liability as
to any results obtained or prising from any use of tirc product or reliance on such information_
Page 10 of I a

�•%.• x' ;�■fit■ * ■ } ��:. -
*! ` •`.. _ '! REMEDIATIaN'
y ..; AREA *.� l
i
1b'� ,� "Jj * •fir �! ! t � � *y } F � •�a` saj-
1 �--_ I /• ! Y•. « �. _ + ' i�.r •_'fir �.. �7;
_ isvi
WT
g '
_
+v,. GRAPHIC SCALE
' e� ,1 L_ S+ .-� Ct cif —� !J! I SCALE 1" = OW
Y.c w
REFERENCE: KERNERSVILLE, NC. GUADRANGLE. 7 5•MINUTE SERIES USGS TOPOGRAPHIC MAP, DATED 19699REVISE0 1994)
SCALE: AS SHOWN
USGS FIGURE NO -
DATE:
oCToBER 2008*S&ME TOPOGRAPHIC MAP
DRAWN BY: RDM 133 S. MAIN STREET
PROJECT NO: WWW.SMEINC.COM KERNERSVILLE, NORTH CAROLINA
1584-08-051

NATURAL \
GAS
LINE
PROPOSED INJECTION WELL FIELD
\ AND APPROXIMATE HORIZONTAL EXTENT
OF CONTAMINATED SOIL
\~ ~ GAS METER
h+IYIF1lSB-e
` FORMER f'r
\ EXCAVATION / \
LIMITS �/ P
\ FORMER
TANK
\ LOCATION �¢ O+,�Q'� r
u
KEY
SOIL PROBE AND MONITORING WELL LOCATION GRAPHIC SCALE
30 15 6 30
SCALE: V = 30'
SCALE: AS SHOWN FIGURE NO,
3
DOTE: APRIL 2009 SITE MAP
DRA'DRAWNsr #S&MERDM 133 S. MAIN STREET
PROJECT NO: WWW.SMEINC.COM KERNERSVILLE, NORTH CAROLINA
1584-0$-d51

' C 1PLETION REPORT OF WEl Ito. MW-1 Sheet 1 of i
PROJECT.
Farmer High Point Health Care Ventures
PROJECT NO
1584-08-051
WATER LEVEL: 28.6
PROJECT LOCATION
Kernersville, North Carolina
DRILLING CONTRACTOR:
B. grown
LATITUDE:
DRILLING METHOD:
3 '/." H.S.A.
LONGITUDE
DATE DRILLED:
10115108 TOP OF CASING ELEVATION
NOTES:
DATUM:
LOGGED By L. Ennis
STRATA
WELL
DETAILS
w �
W
J
W
WELL CONSTRUCTION DETAILS
PROTECTIVE CASING
DESCRIPTION
m
cn
F
LU
n
0
0.00
GS
Diameter -
Type:
Interval:
Asphalt
1
0.50
Fill
RISER CASING
$
Diameter- 2"
Type: PVC
Interval: 0.2-20
10
GROUT
Type: Neat Cement Grout
Interval: 0.5-14
Residuum. Tan Gray
Sandy SILT;
Petroleum Odor from
10' to 12'
SEAL
Residuum: Tan White
Silty Medium to fine
SAND; Feldspathic;
Structures
i5
14.00
Type: Bentonite
interval, 14-16
16.00
FILTERPACK
Type: #2 Sand
Interval: 16-35
20
SCREEN
Diameter, 2"
Type: PVC
Interval: 20-35
25
LEGEND
l
FILTER PACK
_
■ BENTONiTE TOC TOP OF CASING
I
30
GS GROUND SURFACE
® CEMENT GROUT BS BENTONITE SEAL
® CUTTINGS / 13ACKFILL FP FILTER PACK
I Uncharacterized
TSC TOP OF SCREEN
1 STATIC WATER LEVEL SSC BOTTOM OF SCREEN
TD TOTAL DEPTH
35.00
CG CEMENT GROUT
F
1
COMPLETION REPORT OF
WELL No. MW-1
S&ME
y ENGINEERING - TESTING Sheei 1 of 1
ENIIRONMENTAf_ SERVICES

North Carolina
Beverly Eaves Perdue
Govemor
James Morton
High Point Regional Health Systems
P.Q. Box HP-5
High Point, NC 27261
AAA
NCDE14R
Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
October 17, 2011
Ref: Renewal of Injection Permit W10400110
Dynamic Capital Mortgage, Inc. Office Building
Kernersville, Forsyth County, North Carolina
Dear Mr. Morton:
Dee Freeman
Secretary
In accordance with the application received on August 29. 2011. we are forwarding herewith renewed permit number
W10400110. This permit is to inject Oxygen BioChem to chemically oxidize groundwater contaminated with #2 heating
oil at the site referenced above. It is our understanding that the injection portion of this operation has been completed, and
that post -injection monitoring is still in progress. This permit shall be effective from the date of issuance until August 31,
2012, and shall be subject to the conditions and limitations stated therein. including the requirement to submit a final
project evaluation as stated in PART VE — MONITORING AND REPORTING REQUIREMENTS. 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 919-715-6162 or david.goodrich Lamcdenngov if you
have any questions about your permit.
Best Regards,
David Goodrich
Hydrogeologist
cc; Sherri Knight, Winston-Salem Regional Office
Lyndal Butler- S&ME, Inc.. 3718 Old Battleground Road. Greensboro, NC 27410
Harry Boles. 115 S_ Main Street. Kernersville, NC 27285
WI0400110 Permit File
AQUIFER PROTECTION SECTION
1636 Mail 5erv+cb, Cenmr. Rale:nri. North Camllna 27699-163f•.
Lmahm. 2728 Capaal Boulevard. Ra�e;gr.. NarM Caralina 27&9 0n:
°none 919-733-3221 1 FAY 1 915-1115•05K. FAX 2: 91 5-715-6W Cusromfr.- 7erVrc .ti"-62`a•"o74i NorthCarolina
Intemer www.ngwalegualiry.orn
��LI�t(1'aAif
�uu�i ��pnnunr 4T:if:Ti311v� nCilCli• C^,ItMyE �' a

NCDEN
North Carolina Department of Environment and Natura
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sul ins
uovemor Director
September 1, 2011
James Morton — Director
High Point Regional Health Systems
PC Box HP-5
High Point, NC 27261
Dear Mr. Morton:
Resources
Dee Freeman
Secretary
Subject: Acknowledgement of
Application No. WI0400110
Dynamic Capital Mortgage, Inc
Injection In situ Groundwater
Remediation Well (51) System
Forsyth County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on August 29, 2011. Your application package has been assigned the number
listed above, and the primary reviewer is David Goodrich.
Central and Winston-Salem Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications. the Aquifer Protection Section requests your assistance in
providing a timely and complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions. please contact
David Goodrich at [phone] or david.goodrich(ancdenr.gov.
Sincerely.
,for Debra J. Watts
Groundwater Protection Unit Supervisor
cc: Winston-Salem Regional Office, Aquifer Protection Section
Lynda[ Butler — S&ME (3718 Old Battleground Road, Greensboro.NC 27410)
Harry Boles - 115 S. Main Street, Kernersville, NC 27285
Permit File W10400110
AQL1iFEP PROTECTION SF TION
1En Mail Sempe tenter, Ralegri, Noah Carolina 276%-1636
Lonitun 2728 Lavlal Boulevard, Raleigh. North Carolina 27M4
"none 996.7Y,-3229' F41 919'15-D589 FAX2?19-71f+ Ng Customer Service'-877-67av74E
+nsere, www ri ateraualnv.ora
One
Ivor hCarohrl
-• ���. : �nus;�rnr� rn•r �ari�= �G�����mpavr:

ORIGINAL PERMIT APPLICATION

XXXI
WDGN
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Bever#y waves Perdue Coieen H. vuiiins
Governor Director
August 28, 2009
James Morton
High Point Regional Health Systems
P.Q. Box HP-3
High Point, NC 27261
Ref: Issuance of Injection Permit W10400110
Dynamic Capital Mortgage, Inc. Office Building
Kernersville. Forsyth County. North Carolina
Dear Mr. Morton:
Dee Freeman
Secretary
In accordance with the application received on May 28. 2009, we are forwarding permit number W10400110. This permit
is to inject Oxygen B1oChem to chemically oxidize groundwater contaminated with #2 heating oil at the site referenced
above. This permit shall be effective from the date of issuance until August 31, 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
VII — MONITORING AND REPORTING REQUIREMENTS. 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 49 hours prior to initiation of operation of the facility. In order to
continue uninterrupted legal use of the iniection 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 if you
have any questions about your permit.
cc: Sherri knight_ Winston-Salem Regional Office
Lyndai Buticr. S&ME. Inc.
WI0400110 Permit File
AW FER ARM ECTION SEC 71ON
1536 Mail Seiwce Seller. Rbleigh. North Carolina 27699•1634
Locallbri 7728 i..aolral Boulevam, Ra"r,,, Nort. Carom,-eW.
Phone 91~-'M-MI � FAk. 1 5J4-715-DSBE, FA; '_ 91E-715-00 CasEornerSwm. 1.877.623-6748
lnlerrW ZW.ncwatemualitv.:)rr:
4� f-qual-,Vpmmiy ' AMr-mamo-;co- wmnlo w
Best Regards.
Thomas Slusser, L.G,
Program Manager
Underground Injection Control Program
On:
'_ti orthCaro:ITILk
�A'ldturally

Atl7k Mra
NCDEN
North Carolina Department of Environment and Natural Resources
Division of Water Quality_
Beverly Eaves Perdue Golden H. Sullins
Governor Director
June 1.2009
.lames Morton. Director
High Point Regional Health Systems
P.O. Box HP-5
High Point. NC 27261
Subject: Acknowledgement of Application No. WI0400110
Dynamic Capital Mortgage. Inc.
Injection In situ CGroundwater Remediation Well (5I)
Forsyth
Dear Mr. Morton:
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on May 2 8 - 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 thomas.slusser@. nedenr.gov. 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:11l12o.enr.state.nc-us/documents/�dwrI or2chart-ndf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAIONG INQUIRIES ON THIS PROJECT.
Sincer I .
L�
for Debra t-tts
Supervisor
cc Winston-Salem Regional Office, Aquifer Protection Section
Lynda] Butler (Project Manager. S&ME, Inc.. 3718 Old Battleground Rd.. Greensboro, NC 27410)
Permit Application File WI0400110
AOUIFER PROTECTION 5E; 10N
1636 Mail Service Center, Ralegh. North Carolina 27699-1636
I-ocatior. 2728 Capital $ou*vard. Raleigh. North Carotins 2750,1
Phone- 919-733-32211 FAX [phone]; FAY, 2 915415.6048 Customer Service 1.87?-623-6748
intemet www.nrwateerqual4V.orG
O
NorthCarolina
Ar Eaual OopAiunit•:. Athrmallve hCnun Ernviwer

Goodrich, David
From: Wang, Shuying
Sent: Thursday, October 13, 2011 3:12 PM
To: Goodrich, David
Subject: RE: GW-1 Well Construction Farms for Permit W10400110
i just checked the file, but did not find any. So you may have to ask the permittee/consultant. Thanks!
Shuying
From: Goodrich, David
Sent: Thursday, October 13, 2011 1:30 PM
To: Wang, Shuying
Subject: GW-1 Well Construction Forms for Permit W10400110
Shuying,
We are issuing the permit extension for the High Point Regional Health Systems injection permit.
A review of our files has shown that we evidently did not receive any GW-1 well construction forms for the six injection
wells at that facility.
Do you have copies of the completed forms that you could send to us, or should we contact the permittee / consultant
for them?
Thank you.
David Goodrich
L�,,4 I r,,f/" S t I'6-
r� l
I `1
-e c f 1 1 h � U r/� ei, � U �+�<j 4. �L C Gf YIj �t � � J 0 c� }
-t v-4 f f r [4 / " �- t!� . f7 j' Imp 1
cJ
r
I

AQUIFER PROTECTION SECTION --- GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
Date: September 21, 2011 Permittee(s):_ High Point Regional Health Systems
Permit No.: W10400110
To: APS Central Office County: Fars
Central Office Reviewer: D. Goodrich Project Name: Dynamic Capital Mortgage, Inc
Regional Login No:
1. GENERAL INFORMATION
1. This application is [cheek all that apply]: ❑ SFR Waste Irrigation System ® UIC We]l(s)
❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment 6 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:
b. Person contacted and contact information:
c. Site visit conducted by:
d. Inspection Report Attached: ❑ Yes or ❑ No.
2. Is the following information entered into the BIMS record for this application correct? �
® Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For SFR Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: Method Used (GPS, GoogleTM, etc.);
e. Regulated Activities 1 Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For UIC Injection Sites:
(If multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site, or attach additional pates for each site
a. Location(s):
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: Method Used (GPS, GoogleTM, etc.);
RECEIVED I DENR r DVQ
Aquifer Prolertion SeMon
OCT 10 2011
APS-GPU Regional Staff Report (Sept 09) Page 1 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
IV, INJECTION WELL PEIfMIT 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 (512 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)? . What is the distance of the injection well(s) from the pollution
source(s)7 ft.
4. What is the minimum distance of proposed injection wells from the property boundary?
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:
S. 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.
Injection Well Permit Renewal and Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
❑ Yes ❑ No. If yes, explain:
2. For closed -loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? ❑ Yes ❑ No. If yes, explain:
3. For renewal or modification of groundwater remediation permits (of any type), will
continued/additional/modified injections have an adverse impact on migration of the plume or management of
the contamination incident? ❑ Yes ❑ No. If yes, explain:
APS-GPU Regional Staff Report (Sept 04) Page 4 of 6 Pages

AQUIFER PROTECTION SECTION -- GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
4. Drilling Contractor: Name:
Address:
NC Certification number:
5. Complete and attach NEW Injection Facility Inspection Report, if applicable
V EIVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the Application: Since this renew request is only for
havingthe expiration date, of the existing permit extended for one year, from August 31, 2011 to August 31,
2012 to collect more data to evaluate the effectiveness, and in addition, the injection activities have been
completed, WSRD did not conduct a site visit to verify site conditions or compliance status and has no
objection to renew the permit.
2. Attach new Injection Facility Inspection Form, if applicable
3. Do you foresee any problems with issuance/renewal of this permit'' ❑ Yes ® No. If yes, please explain
briefly.
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
b. 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
APS-GPU Regional Staff Report (Sept 09) Page 5 of 6 Pages

AQUIFER PROTECTION SECTION — GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft pen -nit by regional office; ❑ Issue upon receipt of needed additional information:
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report Preparer(s):
hlgnature of AY7 regional supemisor:
Date:
V1. ADDITIONAL INFORMATIONAND SITE MAP (Sketch of site showing house and waste irrigation
system, spray or drip field, location of weli(sJ, and/or other relevant information- SHOW NORTHARRO99
APS-GPU Regional Staff Report (Sept 09) Page 6 of Pages

September 2, 2011
Renewal of Injection Permit W10400110
High Point Regional Health Systems
Dynamic Capital Mortgage, Inc. Office Building
Note of Clarification to Sherri Knight from David Goodrich:
I contacted Lydal Butler of S&ME ((336)-288-7180) to clarify exactly what was being asked for.
Evidently, they want to extend the expiration date of the existing permit from August 31, 2011 to August
31, 2012 to allow them mare time. The injection activities at this site have been completed, but they
need to continue monitoring to confirm its effectiveness.
Please have your staff review this from the standpoint of extending the permit expiration date.

AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: August 30, 2011
To: ❑
Landon Davidson, ARO-APS
❑
Art Barnhardt, FRO-APS
❑
Andrew Pitner, MRO-APS
❑
Jay Zimmerman, RRO-APS
From: David Goodrich , Land Application Unit
Telephone; 919 715-6162
E-Mail. david. goodrich&cdenr. eov
A. Permit Number: W I04001 10
B. Owner: Harry Boles
❑ David May, WaRO-APS
❑ Charlie Stehman, WiRO-APS
X Sherri Knight, WSRO-APS
Fax. [phone]
C. Facility/Operation: Dynamic Ca ital Mortgage, Inc.
❑ Proposed X Existing X Facility X Operation
D. Application:
1. Permit 7: pe: ❑ Animal ❑ Surface Irrigation ❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ VE Lagoon X GW Remediation (ND)SI Injection
❑ UIC - (5A7) open loop geothermal
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ❑ New ❑ Major Mod. ❑ Minor Mod. X Renewal ❑ Renewal wl Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please take the following actions:
X Return a. Completed APSARR Form. - Please comment
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer:
Date:
FORM: APSARR 07/06 Page 1 of I

Permit Number W10400110
Program Category
Ground Water
Permit Type
Injection In situ Groundwater Remediation Well (51)
Primary Reviewer
david.goodrich
Coastal SW Rule
Permitted Flow
Facility
Facility Name
Dynamic Capital Mortgage, Inc.
Location Address
133 S Main St
Kernersville NC 27285
Owner
Central Files: APS 5wp
09/01111
Permit Tracking Slip
Status Project Type
In review Renewal
Version Permit Classification
Individual
Permit Contact Affiliation
Lyndal Butler
Manager Project
3718 Old Battleground Rd
Greensboro NC 27410
MajorlMinor Region
Minor Winston-Salem
County
Forsyth
Facility Contact Affiliation
Owner Name Owner Type
Individual
Harry Boles Owner Affiliation
Harry Boles
115 S Main St
Kernersville NC 27285
DateslEvents
Scheduled
Ong Issue App Received Draft Initiated Issuance public Notice Issue Effective Expiration
08/27/09 08/29/11
Reaulated Activities Requested/Received Events
Groundwater remediatlon RO staff report received
RO staff report requested
❑utfall I:'. _
Waterbody Name Stream index Number Current Class Subbasin

ORIGINAL PERMIT APPLICATION

AQUIFER PROTECTION REGIONAL STAFF REPORT
Date: 06/17/2009 County: Forsyth
To: A uifer Protection Central Off ace Permittee: Hieh Point Regional Health -Systems
Central Office Reviewer: Thomas Slusser Project Name: Dynamic Capital Moq age
Regional Login No: NA Application No.: W10400110
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: None
b. Person contacted and contact information: NA
c. Site visit conducted by: NA
d. Inspection Report Attached: ❑ Yes or ® No.
2. Is the following information entered into the BIMS record for this application correct?
® Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
NA
For Disposal_ and Injection Sites:
NA
IL NEW AND MAJOR MODIFICA TIONAPPLICA TIONS (this section not needed for renewals or minor
modifications, skip to next section)
Description Of Waste[S] And Facilities
1, Please attach completed rating sheet. Facility Classification: NE
2. Are the new treatment facilities adequate for the type of waste and disposal system?
❑ Yes ❑ No ® NIA. If no, please explain:
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? ® Yes ❑ No ❑ NIA. If no, please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)?
Yes ❑ No ❑ N/A. If no, please explain:
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. ❑ Yes ❑ No
NIA, If no, please explain:
wl04001 ta_APSSRR

AQUIFER PROTECTION REGIONAL STAFF REPORT
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
® Yes ❑ No ❑ NIA. If no, please explain:
7. Are the new treatment facilities or any new disposal sites located in a I00-year floodplain?
❑ Yes ® No ❑ NIA. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV: NA
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? ❑ Yes or ® No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit: NA
g. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? ® Yes ❑ No ❑ N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries, If No, explain and recommend any
changes to the groundwater monitoring program: NA
10. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑ No ® N/A If yes, attach list of sites
with restrictions (Certification B?)
III. RENEWAL AND MODIFICATIONAPPLICATIONS (use previous section for new or maiar modifscation
s stems
NA
!V. 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 (SA7)
❑ Closed -loop heat pump system (5QM/5QW)
® In situ remediation (5I)
❑ Closed -loop groundwater remediation effluent injection (5U Non -Discharge")
❑ Other (Specify:
Z. 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 istare the pollution source(s)? NA. What is the distance of the infection well(s) from the pollution
sources ? NA ft.
4. What is the minimum distance of proposed injection wells from the property boundary? —30ftE &---44ftWest
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
WI0400110 APSSRR 2

AQUIFER PROTECTION REGIONAL STAFF REPORT
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program:
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 -
NA
V. EVAL UATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
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.
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
None NA
5. List specific Permit conditions that you recommend to be removed from the hermit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
None NA
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
None NA
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: T
8. Signature of report preparer(s):
Signature of APS regional supervisor:
Date: r7
— '
u
r
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
W104001 l o_APSSRR 3

North Carolina Department of Health and Human Services
Division of Public Health — Epidemiology Section
Occupational and Environmental Epidemiology Branch
1912 Mail Service Center • Raleigh, North Carolina 27699-1912
Telephone:[phone] Fax: [phone]
hEchael F. Easley, Governor Leah Devlin, DDS, MPFi
Dempsey Benton, Secretary State Health Director
A��l�CElVEp r aENR 1
August 25, 2008 pw
R �nnr�r��rZ�r O
�Fcrom
MEMORANDUM AUG 2 7 2008
To: Qu Qi — UIC Program
Aquifer Protection System
Division of Water Quality
Department of Environment and Natural Resources
From: Sandy Mort Ai--
Epidemiology Section
Division of Public Health
Department of Health and Human Services
Subject: Health Risk Assessment
Use of calcium peroxide or sodium hydroxide as activator for
groundwaterlsoil remediation with sodium persulfate
The following information is provided in response to Aquifer Protection Section's (APS)
request for a health risk evaluation regarding the use of sodium persulfate with calcium
peroxide or sodium hydroxide as activators for groundwater or soil remediation. These
chemicals are proposed for use at a Duracell battery manufacturing site contaminated
with chlorinated hydrocarbons, petroleum hydrocarbons, acetone, and carbon
tetrachloride. This review is provided as supplemental information to that provided to
APS in September 2003 by DPH regarding the use of hydrogen peroxide and iron-EDTA
activators with sodium persulfate.
The information provided to DPH indicates that calcium peroxide will be used at a
proportion of 20% calcium peroxide and 80% sodium persulfate. This mixture is diluted
to 30%, resulting in approximately 6% calcium peroxide and 24% sodium persulfate in
70% water. The information also states that sodium hydroxide will be used at 1 to 5%
with 30% sodium persulfate.
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Location: 5505 Six Forks U, ?"d Floor, Room 1-'-DI *Raleigh. NC27609
A n Eq*dl Ohxauouty E*o)er

Page 2 of9
NC DPH recommends that ail persons that will come into contact with the above
chemicals review the MSDS and other appropriate health and safety documents and have
undergone appropriate health and safety training. NC DPH also recommends that
transport of these chemicals off site be controlled to prevent potential human or
ecological impacts. Access to the area of application should be limited to workers
applying the product. In order to minimize exposure to unprotected individuals,
measures should be taken to prevent access to the area of application.
SODIUM PERSULFATE HEALTH RISK INFORMATION:
Formula: NaZS203
CASH: 7775-27-1
Synonyms: Sodium peroxydisulfate, Sodium persulfate
Classification: strong oxidant
Sodium persulfate is a strong oxidant and reacts with combustible and reducing
materials. Sodium persulfate decomposes on heating producing toxic and corrosive fumes
including sulfur oxides. It reacts violently with powdered metals and strong bases. In
solution in water it is a weak acid. Sodium persulfate becomes unstable when exposed to
heat, moisture and/or contamination. It is incompatible with acids, alkalis, halides
(fluorides, chlorides, bromides and iodides), combustible materials, most metals and
heavy metals, oxidizable materials, other oxidizers, reducing agents, cleaners, and
organic or carbon containing compounds. Oxidizing chemicals, including sodium
persulfate, should not be stored or directly mixed with combustible material (such as
fuels, papers or solvents) or reducing agents (such as metals or sulfites). Contact with
incompatible materials can result in a material decomposition or other uncontrolled
reactions. Oxidizing chemicals may react energetically with combustible materials or
reducing agents and also release oxygen and heat during decomposition that could help
support a fire. Some oxidizing agents are incompatible with one another. Decomposing
persulfates will evolve large volumes of gas and/or vapor, can accelerate exponentially
with heat generation, and create significant and hazardous pressures if contained and not
properly controlled or mitigated. Use with alcohols in the presence of water has been
demonstrated to generate conditions that require rigorous adherence to process safety
methods and standards to prevent escalation to an uncontrolled reaction.
Potential health effects: The primary route of toxicity is through direct inhalation of
airborne dust or mist, or direct contact. Airborne persulfate dust may be irritating to eyes,
nose, lungs, throat and skin upon contact. Dust dispersion should be controlled. Sodium
persulfate in identified as a strong oxidizer and an irritant. Inhalation of dust may cause
asthma -like reactions. Acute (short -terns) health effects that may occur immediately or
shortly after exposure include severe skin and eye irritation and burns. Breathing sodium
persulfate can irritate the nose, throat and lungs, causing coughing, wheezing and/or
shortness of breath. Long-term (chronic) or repeated exposure may cause a skin
allergy or dermatitis. If allergy develops, very low future exposure can cause itching and
a skin rash. An asthma -like allergy may also result from long-term or repeated inhalation
exposures with future exposure potentially causing asthma attacks with shortness of
La��n
bxation: 5505 Sia Fnrks Rd., ?' Flaar, Room 1-2-DI -Raleigh. N.C. '76114
An Equal Qpporrm¢rry Emplr ver

Page 3 of U
breath, wheezing, cough, and/or chest tightness. General allergic reactions, like urticaria
(hives) or shock, may occur. Sodium persulfate has not been tested for its ability to cause
cancer or reproductive effects.
Evidence of exposure includes:
Inhalation: cough, labored breathing, sore throat, wheezing
Skin: redness, pain
Eves: redness, pain
Ingestion: diarrhea. nausea, sore throat, vomiting
Recommended personal protective equipment (PPE): Prevent release of dust into the
work environment with room ventilation. All persons working with sodium persulfate
should use appropriate PPE, including:
Eyes and face: Use cup type chemical goggles. Full face shield may be used.
Respiratory Use approved dust respirator when airborne dust is expected. A NIOSH 100
HEPA tight -fitting half -face unit is recommended (with fit testing).
Protective clothing: Normal work clothes. Rubber or neoprene footwear.
Gloves: Rubber or neoprene gloves. Thoroughly wash the outside of gloves with soap
and water prior to removal. Inspect regularly for leaks.
First Aid:
Eye contact: Immediately flush with large amounts of water for at least 15 minutes,
occasionally lifting upper and lower lids. Seek medical attention immediately.
Skin Contact: Quickly remove contaminated clothing. Immediately wash contaminated
skin with large amounts of soap and water,
Breathing: Remove the person from exposure_ Begin rescue breathing (using universal
precautions) if breathing has stopped and CPR if heart action has stopped. Transfer
promptly to a medical facility.
Additional safety recommendations: Prevent release of dust into the work environment
with room ventilation. Workers whose clothing has been contaminated with sodium
persulfate should change into clean clothing promptly. On skin contact immediately
wash or shower to remove the chemical. Remove contaminated clothing immediately
and wash before reuse. At the end of the work shift, wash any areas of the body that may
have contacted sodium persulfate, whether or not known skin contact has occurred. Do
not take contamnated work clothes home to prevent exposure of family members.
Contaminated work clothes should be laundered by individuals who have been informed
of the hazards of exposure to sodium persulfate.
Eye wash fountains should be provided in the immediate work area for emergency use. If
there is the possibility of skin exposure, emergency shower facilities should be provided.
Do not eat, smoke, or drink where sodium persulfate is handled, processed, or stored,
since the chemical can be swallowed. Wash hands carefully before eating, drinking,
smoking, or using the toilet,
Handling and storage: Use adequate ventilation when transferring product from bags or
drums. Provide mechanical general and/or local exhaust ventilation to prevent release of
Location; 5505 Six Forks R4 ?"`' Flog, Rrrom 1-?-DI • Raleigh, N. C ?7609
An Equal Dpporasnin• Erprplrircr

Page 4 of 9
dust into work environment, Spills should be collected into suitable containers to prevent
dispersion into the air. Wear respiratory protection if ventilation is inadequate or not
available. Use eye and skin protection. Use clean plastic or stainless steel scoops only.
Store (unopened) in a cool, clean, dry place away from point sources of heat, e.g. radiant
heaters or steam pipes. In case of fire or decomposition (fuminglsmoking) deluge with
plenty of water to control decomposition. Use a vacuum or a wet method to reduce dust
during clean-up. DO NOT DRY SWEEP.
CALCIUM PEROXIDE HEALTH RISK INFORMATION:
Formula:
Ca02
CASH:
1305-79-9
Synonyms:
calcium dioxide, calcium superoxide, Calper, Calper G
Classification:
oxidizer
Calcium peroxide is an oxidizer, thus contact with combustible materials (paper, cotton,
organics, leather, reducing agents, and other oxidizers) should be avoided. Calcium
peroxide is not flammable but will contribute oxygen to feed a tire. Contamination, heat,
and humid conditions will enhance and accelerate decomposition. Decomposition is
endothermic, unlike most oxidizers. Store calcium peroxide in a clean, dry place. Do not
expose to heat sources or high humidity. Store away from combustible materials. Keep
containers closed when not in use. Dilute spills with water.
Potential health effects: Contact can severely irritate and bum the skin and eyes with
possible eye damage. Breathing calcium peroxide can irritate the nose, throat and lungs
causing coughing, wheezing and/or shortness of breath. Harmful if swallowed. The
following acute (short-term) health effects may occur immediately or shortly after
exposure. Contact can severely irritate and bum the skin and eyes with possible eye
damage. Breathing calcium peroxide can irritate the nose, throat and lungs causing
coughing, wheezing and/or shortness of breath. Chronic (long-term) health effects can
occur at some time after exposure and can last for months or years and include lung
irritation. Repeated exposure may cause bronchitis with cough, phlegm, and/or shortness
of breadth. Calcium peroxide has not been tested for its ability to cause cancer or
reproductive effects. Calcium peroxide should be handled in well ventilated, dust
controlled areas. When handling large quantities, use a dust mask, goggles, and gloves.
Evidence of exposure includes:
[nhalation: nose and throat irritation
Skin: irritation
Eves: irritation
Ingestion: irritation of mouth and stomach
Recommended personal protective equipment (PPE): Avoid skin contact with
calcium peroxide.
Eyes and face: Wear chemical safety goggles. Wear a face shield along with goggles
when working with corrosive, highly imitating or toxic substances.
1
Location: 5505 Sir Forks Rd.. 3 Floor. Roan l-7-Ql ■ Raleigh, N.C. ?7609
` An Equal Opporlunin^ E'mplgver

page i of IJ
Respiratory: Use NIOSH certified toxic dust respirator_ A NIOSH 100 HEPA tight-
fitting half -face unit is recommended (with fit testing).
Protective clothinK: Wear protective gloves and full cover clothing
All protective clothing (suits, gloves, footwear, headgear) should be clean, available each
day, and put on before work.
First Aid:.
Eyes: Immediately flush with water for at least 15-30 minutes, lifting the upper and lower
eyelids intermittently. See a medical doctor or ophthalmologist immediately.
Skin: Remove contaminated clothing. Wash with plenty of soap and water. Get medical
attention if irritation occurs and persists.
Ingestion: If conscious rinse mouth with water. Dilute by giving 1 or 2 glasses of water or
milk. Do not induce vomiting. See a medical doctor immediately.
Inhalation: Remove to fresh air. If breathing difficulty or discomfort occurs and persists,
obtain medical attention.
Additional safety recommendations: Workers whose clothing has been contaminated
by calcium peroxide should change into clean clothing promptly. Do not take
contaminated work clothes home. Family members could be exposed.
Contaminated work clothes should be laundered by individuals who have been infonrted
of the hazards of exposure to calcium peroxide.
Eye wash fountains should be provided in the immediate work area for emergency use. If
there is the possibility of skin exposure, emergency shower facilities should be provided.
On skin contact with calcium peroxide, immediately wash or shower to remove the
chemical.
Do not eat, smoke, or drink where calcium peroxide is handled, processed, or stored.
since the chemical can be swallowed. Wash hands carefully before eating, drinking.
smoking, or using the toilet.
Use a vacuum or a wet method to reduce dust during clean-up. DO NOT DRY SWEEP,
Handling and storage: Calcium peroxide must be stored to avoid contact with
combustibles; hydrocarbons; fuels; cellulose. hydrogen peroxide; and organic materials
since fires may occur. Store in tightly closed containers in a cool, well -ventilated area.
SODIUM HYDROXIDE HEALTH RISK INFORAMTION:
Formula: NaOH
CASH: 131 0-73-2
Synonyms: Caustic soda. Lye, Soda lye_ Sodium hydrate
Classification: alkaline, corrosive
s ' Location: �505 Six Furkc' Rd.. 1"d Flom •. Ronny 1-2-DI • Raleigh. N.C. "6I�i+
l An Equal OPPriraanin• FMr1fWer

Page h of 9
Sodium hydroxide is classified as a corrosive material. Sodium hydroxide is
incompatible with water, acids, flammable liquids, organic halogens, organic peroxides,
metals such as aluminum, tin, zinc, or nitromethane. It is corrosive to metals. Keep this
compound separated from acids, easily ignitable materials, explosives, metals, organic
peroxides, and water or any moisture. Sodium hydroxide will react with water to release
heat and contact with aluminum, tin, lead and zinc will release flammable and explosive
hydrogen gas. Contact with nitromethane and other nitro compounds may result in the
formation of shock -sensitive or explosive salts. Contact with moisture or water may generate
sufficient heat to ignite combustible substances.
Potential health effects: Sodium hydroxide is a corrosive irritant of the skin, eyes, and
mucous membranes. Sodium hydroxide both in solid and in solution has a markedly
corrosive action upon all body tissues causing burns and frequently deep maceration,
with ultimate scarring. Inhalation of the dust or concentrated mist can cause damage to
the upper respiratory tract and to lung tissue, depending upon the severity of the
exposure. Effects of inhalation may vary from mild irritation of the mucous membranes
at 2 mg/m3 to severe pneumonitis at higher airborne concentrations. Inhalation of
alkaline vapors can produce upper airway edema, respiratory failure, wheezing,
pulmonary edema, and pneumonitis. Exposure to the dust or mist may cause pain,
redness, irritation or full thickness bums. Contact with the eyes causes disintegration and
sloughing of conjunctival and corneal epithelium, corneal opacification (renders the
cornea opaque), marked edema, and ulceration. Permanent visual loss may occur. After 7
to 13 days, either gradual recovery begins, or there is progression of ulceration and
corneal opacification. On the skin, solutions of 25 to 50% sodium hydroxide cause a
sensation of irritation within about 3 minutes; with 4% solutions, irritation does not
develop for several hours. If it is not removed from the skin, severe burns with deep
ulceration may occur. Produces severe abdominal pain, corrosion of the lips, mouth,
tongue, esophagus, and pharynx, and the vomiting of large pieces of mucosa. It can cause
perforation and scarring. Glottic edema and upper airway obstruction may occur
following ingestion. Cases of squamous cell carcinoma of the esophagus have occurred
with latent periods of 12 to 42 years after ingestion. These cancers were the sequelae of
tissue destruction and possible scar formation, rather than due to a direct carcinogenic
action of sodium hydroxide itself: The greatest industrial hazard is rapid tissue
destruction of eyes or skin upon contact with either the solid or concentrated solutions.
Acute (short-term exposure) health effects which may occur immediately or shortly
after exposure include with contact severe irritation and burning the skin and eves with
possible eye damage or clouding of the eyes with loss of vision. Breathing sodium
hydroxide can irritate the mouth, nose and throat. Breathing can also irritate the lungs
causing coughing and/or shortness of breath. Higher exposures can cause a build-up of
fluid in the lungs (pulmonary edema), a medical emergency, with severe shortness of
breath. Chronic (long-term exposure) health effects can occur at some time aver
exposure to and can last for months or years, Very high chronic exposure may cause lung
damage. Sodium hydroxide has not been tested for ability to cause cancer in animals.
There is no evidence it effects reproduction.
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r Locn6on_ 5505 Six For-ks Rd., 2'x1 Floor, Boon: 1-'-OI •Raleigh, MC2?609
An Equal Oppm-itioury Empinver ��

Pinar 7 or')
E-vidence of exposure includes:
Inhalation: irritation of mucous membranes, pneumonitis
Skin: irritation, burns. temporary loss of hair
Eyes: irritation, corneal damage
Ingestion: irritation of mucous membranes, severe abdominal pain, corrosion of
the lips, mouth, tongue, and pharynx, and the vomiting of large pieces
of mucosa, upper airway obstruction may occur
Workplace exposure linxits:
These exposure limits are for air levels only.
OSHA: The legal airborne permissible exposure limit (PEL) is 2 mglm3 averaged over
an 8-hour work shift.
NIOSH: The recommended airborne exposure limit is 2 mg31m3, which should not be
exceeded at any time. The NIOSH IDLH value is 10 mglm .
ACGIH: The recommended airborne exposure limit is 2 mglm3, which should not be
exceeded at any time_
Recommended personal protective equipment (PPE): Appropriate, impervious,
protective clothing (including gloves) should be worn to prevent skin contact. Protective
equipment should not be made of aluminum, copper, soft iron, tin, or zinc (or alloys
made of these metals.
Eves and face: For solid sodium hydroxide wear impact resistant eye protection with side
shields or goggles. For liquids wear indirect -vent, impact and splash resistant goggles. A
face shield along with goggles is recommended when working with corrosive, highly
irritating or toxic substances. Contact lenses should not be warn when working with this
substance. Eyewash fountains should be provided.
Respiratory: Use NIOSH certified toxic dust respirator. A NIOSH 100 HEPA tight-
fitting half -face unit is recommended (with fit testing). Where the potential exists for
exposure over 2 mgitn3, use a MSHAINIOSH approved supplied -air respirator with a full
face piece operated in a pressure -demand or other positive -pressure mode. For increased
protection use in combination with an auxiliary self-contained breathing apparatus
operated in a pressure -demand or other positive -pressure mode. Exposure to 10 rnglm3 is
immediately dangerous to life and health. If the possibility of exposure above 10 mg/m'
exists, use a MSHAINIOSH approved self-contained breathing apparatus with a full face
piece operated in a pressure -demand or other positive -pressure mode.
Gloves: Impervious. ACGIH recommends polyvinyl chloride, butyl, butyllneoprene,
natural rubber, neoprene, polyethylene, Saranex, Teflon and Vitonlneoprene as protective
materials.
First Aid:
Eves: Irrigate immediately
Skin: Water flush immediately. Clothing which becomes significantly contaminated, or
wet, should be removed as quickly as possible.
Breathing: Respiratory support
Ingestion: Medical attention immediately
Location- 5505 Sir Fnrks Rd.. '" Floor. Room 1-7 D! • Raleigh. rV.C. 7609
Art Equal OpporthnilY E11rf71h1vr

Page 8 of 9
Handling and storage: Store in tightly closed containers in a cool, dry, well -ventilated
area away from moisture. Wherever sodium hydroxide is used, handled, manufactured,
or stored, use explosion -proof electrical equipment and fittings. Keep sodium hydroxide
separated from acids, easily ignitable materials, explosives, metals, organic peroxides,
and water (or any moisture).
Additional safety recommendations: Workers whose clothing has been contaminated
by sodium hydroxide should change into clean clothing promptly. Do not take
contaminated work clothes home. Family members could be exposed.
Contaminated work clothes should be laundered by individuals who have been informed
of the hazards of exposure to sodium hydroxide.
Eye wash fountains should be provided in the immediate work area for emergency use.
If there is the possibility of skin exposure, emergency shower facilities should be
provided. On skin contact sodium hydroxide, immediately wash or shower to remove the
chemical. At the end of the work shift, wash any areas of the body that may have
contacted sodium hydroxide, whether or not known skin contact has occurred.
Do not eat, smoke, or drink where sodium hydroxide is handled, processed, or stored,
since the chemical can be swallowed. Wash hands carefully before eating, drinking,
smoking, or using the toilet.
For solid sodium hydroxide use a vacuum to reduce dust during clean-up. DO NOT DRY
SWEEP.
Location: 5505 .Sir Forks fld- 2`0 Moor. Room 1 -Ul • Raleigh, N.C. 276U9
Air Equal Oppomewty Emplo►wr

I
Page 9 01, 1
References:
1. International Chemical Safety Cards (ICSCs): International Programme on Chemical
Safety. CDC, NIOSH, ht!p://www.cdc.gov/niosh/ipcs/icstart.html
2. New Jersey Department of Health and Senior Services Hazardous Substances Fact
Sheets.
3. Sodium Persul fate MSDS. FMC MSDS no.: 7775-27-4, April 30, 2006, revision no. 12.
FMC Corporation.
4. Calcium Peroxide Technical Data Sheet. FMC Corporation.
5. TOXNET Toxicology Data Network. US National Library of Medicine.
http-//toxnet.nim.nih.gov
6. Calcium Peroxide MSDS. FMC MSDS no.: 1305-79-9-1, April 30, 2006, revision no. 9.
FMC Corporation.
7. Thomson MICROMEDEX.
8. NIOSH Pocket Guide to Chemical Hazards. CDC.
9. Technical and Regulatory Guidance for In Situ Chemical Oxidation of Contaminated Soil
and Groundwater, Second Edition. The Interstate technology & Regulatory Council In
Situ Chemical Oxidation Team. January 2005. http:l/www.itreweb.org/Documents/ISCO-
?.pdf
Nc air_, J
1 Y Location: 3505Sir Forkr Rd., "'Flow-,
Flanr, Room 1—'-D! •Raleigh, 1,.C. 2761+�
,� An Equal dpporduna,r Enipl(�ver "��

August 25, 2011
NCDENR-Division of Water Quality
Aquifer Protection Section
Underground Injection Control Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Attention: Mr. Thomas Slusser, L.G.
Program Manager
Reference: STATUS REPORT — INJECTION PERMIT WI004001I0
133 South Main Street
Kernersville, North Carolina
NCDENR Incident #16401
S&ME Project No. 1584-08-05I
Dear Mr. Slusser:
S&ME appreciates your assistance with the above referenced injection permit dated
August 28, 2009, Enclosed with this letter are copies of the following submittals.
■ Field Summary Report for the Former High Point Health Care Venture Site in
Kernersviile, NC; Redox Tech, LLC (November 20, 2009)
■ Research & Analytical Laboratories, Inc.; soil analytical report for soil samples
PR-1-15, PR-1-19, PR-2-15, PR-2-20, collected on February 24, 2010 following
the first injection event
• Injection diagram
■ Site Map showing the proposed injection well field
• Page 1 of 7 and executed copy of page 7 of 7 of Injection Permit W100400110
Injection of Oxygen BioChem was completed by Redox `Tech, LLC., at the permitted six
locations on November 9, 2009. The attached summary report describes the injection
procedure and documents the proper abandonment of each injection point.
On February 24, 2010, S&ME collected two soil samples each from two soil probes
performed within the injection field. The analyses of soil samples collected from probe
PR -I performed in the northwest portion of the injection field did not detect target
analyses by EPA Methods 8260B and 8270 BNA and by the MADEP Methods for
volatile petroleum hydrocarbons (VPH) and extractable petroleum hydrocarbons (EPH).
The analyses of soil samples collected from probe PR-2 performed in the southeast
portion of the injection field detected one semi -volatile organic compound, C9-C 18
Aliphatics and C11-C22 Aromatics at concentrations above the corresponding targeted
MSCC soil to groundwater clean-up goals.
SWE, INC. / 3718 Old Battleground Road / Greensboro, NC 2741 a / p 335.288.7180 f 336.288.8980 / www.smeinc.corn

Status Report- Injectio -mit WI0400110 58 Project No. 1584-08-051
Farmer High Point Health Care Ventures, Kemersville, NC August 25, 2011
High Point Regional Health Systems (permit holder) has authorized S&ME to provide a
second phase of injection using four injection points to be performed in the southeast end
of the previous injection field. Please contact S&ME if you have any questions
concerning the proposed second injection phase under this permit.
Sincerely,
S&ME, Inc.
Ly dal Butler
Project Manager
LBllss
High Point Regional Health Systems
P.O. Box HP-5
High Point, NC 27261

8/19/2011
Project: Kemersville, NC
Summary Report
Field Summary Report for the Former High Point Health Care
Venture Site in Kernersville, N C
Prepared by David Halsclawon Novem6er20, 2009
Field Contractor
Redox Tech, LLC I
Client
S&ME
Project Lead
Dave Holsclaw
Project Lead
L ndal Sutler
Phone Number
843-991-9771
Phone Number
336-288-7180
Email Address
Holsclaw redox-
Email Address
LButler(d,SMEINC.com
T
tech.com
Start Date
1119109
End Date
1119109
Chemical
OBC
Total Gallons
480
Injection Points
6
Injection Intervals
6 to 18 feet b s
Brief Narrative:
On November 9, 2009, Redox Tech performed injections at the Former High Point
Health Care Venture Site in Kernersville, NC. A total of 480 gallons of OBC solution
was injected into 6 locations. Injections were performed using 1.5" direct push
technology (DPT) bottom out injection rods. This allowed injections to be completed
over a I2-foot interval. (6'-18' bgs) Each of the 6 locations received 80 gallons of OBC
solution. If dayiighting occurred the point was either moved or the additional volume was
added by reducing injection pressures and flow rates. An injection summary table from
this event is provided in Appendix A.
The OBC solution was prepared using a Redox Tech injection trailer. A water source for
injections was supplied on site, The 480-gallon solution consisted of 800lbs of OBC and
480 gallons of water. The solution was mixed thoroughly using a trash pump and
powered mixing rod.
Prior to injection S&ME laid out the injection grid and had all utilities cleared. Injection
rods were then advanced to a depth of 18' bgs. Injection pressures were maintained
between 22 psi and 30 psi. Approximately 27 gallons of solution was injected at 18', 12',
and 6' in order to distribute the solution over the vertical interval as described in the
Redox Tech work plan.
Once the injection was complete, points were abandoned from the top of the injection
interval to ground surface using granular bentonite. Asphalt patch was used to complete
the abandonment of each injection location.
Page l
Redox Tech, LLC.

8/19/2011
Project: Kernersville, NC
Summary Report
APPENDIX A:
INJECTION SUMMARY TABLE
Injection Summary Data Table For Kernersville, NC
Injection
Point
date
Start Time
End Time
Depth
Interval
ft.
Flow
Rate
m
Amount
Injected
al.
IP-1
11/9/2009
1021
1040
8'-18'
4.2
80
1 P-2
11/9/2009
1358
1446
8'-16'
1.7
80
1P-3
11/9/2009
1113
1205
8'-18'
1.5
80
I P-4
11/9/2009
1050
1515
8'-18'
.3
80
IP-5
11/9/2009
1256
1319
8'-18'
3.5
80
IP-6
1119/2009
1206
1254
8'-18'
1.7
80
Page 2
Redox Tech, LLC.

RFscARCh & Ar TicAl
LAbDRATORIES, INc.
- a00ly11callPFo esS Cor$$U1tQuans
Chemical Analysis far Selected Parameters and Sampling Locations Identified as 133 S. 4vailr Street
_ (A S & ME-, Ine. Project #1584-08-051, collected 24 February 2010)
[ Valalile0rgaolcs
ifuantilafeon
PR•1-I5
PR•1.19
PR-2-19
PH-2-20
EPA Method $260 B
Limit
pargutetcr
fmglkgl
tmelkel
fenelkel
tmglkgl
(nwjw
Acclnne
0.100
BQI.
BQL
BQI.
BQI,
Bemzene
0,005
BQL
BQI,
BQL
BQL
Bromob(. v=ne
0,005
HQL
BQL
BQL
BQL
Bmmochloromethane
0.005
BQL
BQL
BQL
BQL
Brornoft-Nommcthane
0.005
BQL
BQL
BQL
SQL
Bromoform
OA05
BQI.
BQL
BQI.
BQL
Brosnomcthane
0,010
BQL
BQL
BQL
BQL
2-Butanone
0.100
BQL
BQL
BQL
BQL
N-Butylbenzene
0.005
BQL
BQL
5.07
4.87
Sec-Butylbenzene
0.005
BQL
BQL
517
SAS
Ten-Butylbenzene
0.005
BQL
BQi,
BQL
BQL
Carbon Tetrachloride
0.010
BQL
BQL
BQI.
BQI.
Chlombenzene
0.005
BQL
BQI-
BQL
BQL
DlhromochIoromethane
0.005
BQL
BQL
BQL
BQL
Chlomethane
0.010
BQL
BQL
BQL
BQ[.
Chlorofann
0,005
BQL
BQL
BQi.
BQL
Chiomilohane
0.010
BQL
SQL
BQL
BQL
2-Chlorololuene
0,005
BQL
BQL
BQL
BQL
4-Chlor010lucne
0,005
BQL
BQL
BQL
BQL
12-Dibromoethane(EDB)
9,005
BQL
BQL
BQL
BQL
12-Dichlomhenzene
0.005
BQL
BQL
BQL
BQI.
1.3-Dichlorubctuene
0.005
BQL
BQL
BQI.
BQL
I A-Dichlrrmbenzene
0,005
BQL
BQL
BQL
BQL
D1Chloroditluommthane
01005
SQL
BQI.
BQL
BQL
l,l-Dielilomcthane
0,005
BQL
BQL
JBQL
I3QL
12-Diehlomethane
0,005
BQL
BQL
BQL
BQL
l,l-Dichlaroethene
0.005
BQL
BQI.
BQL
BQL
Cis-1,2-Dichloroethcne
0.005
BQL
BQI.
BQL
BQL
Trans- l,2-Dichlorocthe ne
0.005
BQL
BQL
BQL
BQL
1,2-Dichloropropam
0.005
BQL
BQI.
BQL
BQL
1.3-DichIompropane
0.005
BQL
BQL
BQL
BQL
2,2-Dichlormpropam
0.005
BQL
BQL
BQL
SQL
1,1-Dichloropropane
0,005
BQL
BQL
BQi.
BQL
Cis- 1,3-Dichloropropcne
0,010
BQL
BQL
BQL
BQL
Trans-43-Dichlompropene
0.010
BQL
BQL
BQL
BQL
Ethyl Acetate
0.010
BQL
BQL
BQi.,
BQI.
Ethyl Benzene
0,005
BQL
BQL
BQL
BQL
2-Hexanone
0.050
BQL
BQL
BQL
BQL
1-Propyibenzene
0,005
BQL
BQL
BQL
BQL
Isopropylether (IPE)
0,010
BQL
BQI.
BQL
BQL
p-Isopropyllolucne
0,005
BQL
BQL
8,70
7.91
Methylene Chloride
0,020
BQL
BQL
BQL
BQL
4-Methyl-2-Pentanone
0.100
BQL
BQL
BQL
BQL
Methyl-Tert-Butyl etlier(MTBE)
0,010
BQL
BQL
BQL
BQI.
Naphthalene
0.010
BQL
BQL
41.7
8.18
N-Propylberuxnc
0.005
BQL
BQL
BQi.
3.66
Styrene
0.010
BQL
BQL
BQL
13QL
l,i•2,2-Te1rachloroethane
0.005
BQL
BQL
BQI,
SQL
Tetrachloroetliene
0.005
BQL
BQL
BQL
BQL
Toluene
0.005
BQL
BQL
BQL
BQL
1, 1. 1 -Trichlormtl we
0,005
BQL
BQL
BQL
BQL
l,U-Trichloroethane
0.005
BQL
BQL
BQL
BQL
Trichlomethene
0.005
BQL
BQL
BQL
BQL
TrichloroOuoromethane
U05
BQL
BQL
BQL
BQL
1,2.3•Trichlorobenzetre
0.005
BQL
BQL
BQL
BQL
12,4-Trichlambenzene
0,005
8QL
BQL
BQL
13QL
1,2,3-TricldompnVane
0.015
BQL
BQL
BQL
BQL
1,44-Trimetlrylbenzene
(1005
BQL
BQL
36.7
23.6
13.5-Trime1hylbenzene
0.005
BQL
BQL
15A
20A
Vinyl Acetate
0.050
BQL
BQL
BQI,
13QL
Vinyl Chloride
0,010
BQL
BQL
BQL
BQL
Tora1 Xylcrus
0,005
BQL
BQL
BQL
BQL
Carbon DisuiCtde
0,100
BQL
BQL
13QL
BQL
Aerylorwrile
0,200
BQI.
BQL
BQL
BQL
Tram- l,4-Dichlcro-2-butenc
0,100
BQL
BQL
13QL
BQL
Methyl iodide
0,010
BQL
BQL
BQL
BQL
Dibrnmemelhane
0.010
BQL
BQL
BQL
BQL
1,1,12-TetraclJoraethane
0.005
SQL
BQL
BQL
BQL
I-'0bramo-3-ChlompropanclDBCP)
0.025
BQL
BQI.
BQL
BQL
Dilution Factor
l
I
500
500
Sample Number
667841
667842
667843
667844
Sample Date
C12/24110
02/24/10
02/24/10
02/24/10
Sample Time (hrs)
0935
0948
1012
I042
Date Analyzed
02/26/10
02/26/10
02/26/10
02/26210
rnWkg = milligarns per kiiogam = parts per rruilion (ppmy
BQL = Below Quanlitalion Limits

�E5EAf2C 4EL AryAL TicAL
Rnc7{yrriccalfF'r�CE7ss GE7:i9u1id74C?nS � � �'�F��.
f
Chemical Analysis for Selected Parameters and .Sannpling Locations Identified as 133 S Main Street
(A S & rblF., Inc. Proiect 415$4-08-051, collected 4 I'ehrisar 1010)
11. Semi -Volatile Organics Quantitation Pft-1-15 PR-1-19 PR-2-19 PR-2-20
EPA Method $270 BNA limit
Paramcter frng�kg fial [melkel m k fmalkel
Acenaphtbene
0.33
BQL
BQL
BQL
BQ1.
Acenaphthylene
0.33
BQL
BQL
BQL
BQL
Anthracene
0.33
BQL
BQL
BQL
BQL
Bertzoic Acid
6.67
BQL
BQL
BQL
BQL
Benzo(a)atlivacene
0.33
BQL
BQL
SQL
BQL
Benno(b)fluoranthene
0.33
BQL
BQL
BQL
BQI.
Benzo(k)Bucranthene
0.33
BQL
BQL
BQL
BQL
Benzo(ghi)perylene
0.33
BQL
BQL
BQL
L
Benzo(a)yrene
0.33
BQL
BQI.
BQL
BQI.
Benzyl Alcohol
3.33
BQL
BQL
BQL
BQL
Bis(2-chloroethoxy)methane
0.33
BQI.
BQL
BQL
BQL
Bis(2-chloroethyl)ether
0.33
BQL
BQL
B L
BQL
Bis(2-chloroisoprapyl)ether
0.33
BQL
BQL
Bt L
BQL
Bis(2-ethyl-hcxyl)phthalate
0.33
BQL
BQL
BQL
BQL
4-Bromnphenyl phenyl ether
0,33
BQL
BQI,
BQL-
SQL
Benzyl buryi phthalate
0.33
BQL
BQL
BQL
BQL
4-Coroanilim
1.65
BQL
BQL
BQL
SQL
4-Chloro-3-methy[phenol
2-Chloronaphthalene
0.33
0.33
BQL
BQL
BQL
BQL
BQL
BQL
BQL
2-Chlorophenol
0.33
BQL
BQL
SQL
BQL
BQL
4-Chlorophenyi phenyl ether
0.33
BQL
BQL
BQL
BQL
Chrysene
0.33
BQL
BQI,
BQL
BQL
Dibenzo(a,h)anthracene
0.33
BQL
BQL
BQL
BQL
Dibenwfitran
0.33
BQL
SQL
BQL
BQL
Di -NI -Butyl phthalate
0.33
BQL
BQL
13QL
BQL
1.2-Dichlorobenzene
0.33
BQL
BQL
BQL
BQI.
1,3-Dichlorobertzene
0.33
BQL
BQL
BQL
BQL
14-Dichlorobenzene
0.33
BQL
BQL
BQL
BQL
3,3-Dichiorobenzidine
0.66
BQL
BQL
BQL
BQL
2,4-Dichlorophenol
0.33
BQL
SQL
BQL
BQI.
Diethyl phthalate
0.33
BQL
BQL
BQL
BQL
2 4-DimethyyIphenol
0.33
BQL
BQL
8QL
B I.
5ienetlryl phtlralnte
0.33
BQL
BQL
BQL
BQL
4,6-Dinitro-2-methylphenol
1.65
9QL
BQL
BQL
BQL
2,4-Dinitrophenol
1.65
BQL
BQL
BQL
BQL
2,4•Dinitrotoluene
0.33
BQL
BQL
SQL
BQL
2 6-Dinitrotoluene
0,33
BQL
BQL
BQL
SQL
Di-N{lctyl phthalate
0.33
BQL
BQL
BQL
BQL
Azobenzene
3,33
L B
BQL
SQL
BQL
Fluoranihene
0.33
BQL
BQL
SQL
BQL
Fluorene
0.33
BQL
BQL
SQL
BQL
Hexachiombenxene
0.33
BQL
BQL
BQL
BQL
llexachlorobutadiene
0.33
BQL
BQL
BQL
BQL
Hexachlorocyclopentadiene
0.33
BQL
BQL
BQL
BQL
ilexachloroethane
0.33
13QL
BQL
BQL
BQL
In&,rw(1,2,3-cd) pyrene
0.33
BQL
QL
BQLL
BQL
0.33
BQL
B
SIsophorone
BQL
2-Methyhaaphtalene
0.33
BL
BQL
101
39.9
2-Methylphenol
1.65
BQL
BQL
BQL
BQL
4-Methylphenol
1.65
BQL
BQL
BQL
BQL
Nitrobenzene
0.33
BQL
BQL
BQL
BQL
2-Nitropheexrl
0.33
BQL
BQL
BQL
BQL
4-Nitrophewl
1,65
BQL
BQL
BQL
BQL
N-Nitrosodiphenylarnim
0.33
BQL
BQI.
SQL
BQL
N-nitrosodi-n-propylatnine
0.33
BQL
BQL
BQL
BQL
Pentachlorophenol
1.65
BQL
BQL
BQL
BQI.
Phenanthrene
0.33
BQL
BQL
25.4
9.36
Phenol
0.33
BQL
BQI.
BQL
BQL
Pyrene
0.33
BQL
BQL
BQL
BQL
1,2,4-Trichlorobeuene
0.33
BQL
BQL
BQL
BQL
2,4,6-Trichlorophenol
0.33
BQI_
SQL
BQL
BQL
2-Methyl-4,6dmitrophenol
1.65
BQL
BQI.
BQL
BQL
Benzidme
1.65
BQI.
BQL
BQL
SQL
l2-Diphcnylhydrazine
1.65
BQL
SQL
BQL
BQI.
N-Nitrosodimethylamine
0.33
BQL
BQL
BQL
BQL
Dilution Factor
1
1
20
10
Sample Number
667841
667842
667843
667844
Sample Date
02/24/10
02/24/10
02/24/10
02/24110
Sample Time (hrs)
0935
0948
1012
1042
Date Extracted
03/03/10
03103110
03/03/10
03/03/10
Date Analyzed
031041i0
03104110
03/04/10
03/04/10
trtg,kg = nulligranis per kilognun = parts per million (ppm)
l3QL = Below Quanfitation i.imits BNA = Base -Neutral Acid EAtraetahles - = Not Available

R ESEARCh & r%NA[yT1CA[ ,�•`''b�►�! � •
LAbQRATQRIES� INC.cFy-0o=
NOON xl S
Analytical/Process consuitatians
.
Clretnical Analysis for Selected Parameters and Sanepling Locations Identified as 133 S. :Vain Street
(A S & AfE, 111C. Project 41584-08-051, collected 24 February 2010)
11[, Method MADEP 98-1
Quantization
PR-1-I5
PR-1-19
PR-2-19
PR-2-20
VPH
Limit
Parameter
Lrttgllce}
fFmA2l
(MWIZ
rmgrkgl
(11WY g]
C5-CS Aliphatics
10.0
BQL
BQL
BQL
BQL
C9-C12 Aliphatics
10.0
BQL
BQL
966
1,050
(79-C10 Aromatics
10.0
BQL
BQL
213
158
Dilution Factor
l
1
10
1 (}
1V. Method MADEP 98-1
Quantitation
PR-1-15
PR-t-19
PR-2-19
PR-2 20
EPH
Litnit
Parameter
fm 1a)
fmgzw)
(MWI 1
(¢
1 r 1t ]
C9-C18 Aliphatics
10.0
BQL
BQL
6,740
4,800
C-19-C-36 Aliphatics
10.0
BQL
BQL
518
382
C11-C22 Aromatics
10.0
BQL
BQL
3,640
1,390
Dilution Factor
1
I
1
1
Sample Number
Sample Date
Sample Time (hrs)
667841 667842 667843 667844
02/24/10 0224/10 0?124/10 02/24/10
0935 0948 1012 1042
MADEP EPH 98-1 = Extractable Petroleum Hydrocarbons via the Massachusetts Department of Envimnmentat Protection Method
MADEP VP 99-1 = Volatile Petiole= Hydrocarbons via the hassachusem Department of Environmental Protection Method
mg/kg = milligrains per kilogram = parts prr million (pptn)
BQL = Below Quantization Urnios NR =Nat Requeslcd

EPH (Aliphatics/Aromatics) Laboratory Reporting Form
Client Name:
Project Name:
Site Location:
S & ME, Inc
133 S. Main Street -# 1584-08-051
RAL Ws 667841-44
Laboratory Name: Research & Analytical Laboratories, Inc
NC Certification N (Lab) 34
Sample Matrix: Solid
Sample Information and Analytical Results
Method for Ranges: MADEP EPH
Sample Identification
PR-1-15
PR-1-19
PR-2-19
PR-2-20
EPH Surrogate Standards
Date Collected
02/24/10
02/24/10
02/24/10
02/24/10
Date Received
02/24/10
L'2J24110
02/24/10
02/24/10
Aliphatic: COD
Date Extracted
02/25/10
02/25/10
02/25/10
02/25/10
Aromatic: u-terphenyl
Date Analyzed
02/26/10
*62/26/10
02/26/10
02/26/10
EPH Fractionation Surrogates
% Dry Solids
79.4
82.2
81.6
78.4
91 2-Fluorohiphcnyl
Dilution Factor
l
l
1
1
92 2-Bromonaphthalene
Hydrocarbo
Units of
MDL
RL
Blank
NIA
NIA
NIA
NIA
N. A
N A
N. A
N :�
n Ran es
Measure
C9 - C18
mg/kb
5.3
lrt.[t
BRL
BRL
BRL
6,740
4,800
Aliphatics
C19-C36
mglkg
14
Itt i1
13R1
BRL
BRL
518
382
Aliphatics
Cil-C22
mglkg
�.
I().i1
BRI-
BRL
BRL
3,640
1,390
Aromatics
Sample Surrogate
NIA
N/A
40-140%
40-140%
Io-140%
40-140%
40-140%
40-140%
40-140%
40-140%
40-140%
Aeec tance Range
Aliphatic Surrogate %
N/A
N/A
97
77
85
96
87
Recovery
Aromatic Surrogate %
MA
NIA
99
85
87
89
113
Recovery
Fractionation Surrogate
NIA
NIA
40-140%
40-140%
40-140%
40-140%
40-140%
40-140%
40-140%
40-140%
40-140%
Acceptance Range
Fractionation Surrogate #1
NIA
NIA
65
NIA
NIA
75
106
% Recovery
Fractionation Surrogate 42
NIA
NIA
51
NIA
NIA
71
78
% Recovery
Unadjusted value_ Should exclude the concentration of any surrogate(s), internal standards, and/or concentrations of other ranges that elute within the specified range.
MDL = Method Detection Limit RL = Reporting Limit Blank = Laboratory Method Blank or Trip Blank whichever is higher (indicate type)
Were all performancelacceptable standards for required QAIQC procedures achieved?
Was blank correction applied as a significant modification of the metbod?
Yes FI No - Details Attached
Yes FT No
Were any significant modifications to the EPH method made". KI No ❑ Yes - Details Attached

VPH (Aliphatics/Aromatics) Laboratory Reporting;
Client Name:
Project Name:
Site Location:
S & ME, Inc
133 S. Main Street-#1584-08-051
RAT. Ws 667841-44
Laboratory Name: Research & Analytical Laboratories, Inc
NC Certification # (Lab): 34
Sample Matrix: Solid
Sample information and Analytical Results
Method for Ranges: MADEP VPH
Sample Identification
PR-1-15
PR-1-19
PR-2-19
PR-2-20
VPH Surrogate Standards
Collection option
(for soil)*
l
1
l
l
Aliphatic: Fluorobeimene
Date Callected
02/24/10
02/24/10
02/24/10
02'24110
Date Received
02/24/10
02/24/10
02/24/10
02/24/10
Aromatic: Fluorobeuenc
Date Extracted
NIA
N/A
NIA
NIA
NIA
MIA
N-A
N/A
Date Analyzed
U2126110
02/26/10
02/26/10
02/26/10
% Dry Solids
79.4
82.2
81.6
78.4
Dilution Factor
I
1
10
l0
llydrocarbo
n Ranges
Units of
Measure
MDL
RL
Blank
NIA
N/A
NIA
NIA
NIA
NIA
NIA
NIA
C5 - C8
Aliphatics
mg/kg
2.84
10.0
BRL
BRL
BRL
BRL
BRL
C9 -C12
Aliphatics
mglkg
0.90
10.0
BRL
BRL
BRL
966
1,050
C9-C10
Aromatics
mg/kg
0.66
10.0
BRL
BRL
BRL
213
158
Sample Surrogate
Acceptance Range
N/A
NIA
70-130%
70-130%
70-130%
70-130%
70-130%
70-130%
70-130%
70-130%
70-130%
Aliphatic Surrogate %
Recovery - FID
N1A
N/A
102
84
76
90
96
Aromatic Surrogate %
Recovery - PI D
NIA
[VIA
85
74
74
79
86
Option I = Established fill line on vial Option 2 = Sampling Device (indicate brand, e.g. Encore) Option 3 = Field weight of soil
Unadjusted value. Should exclude the concentration of any surrogates), internal standards, and/or concentrations of other ranges that elute within the specified range.
MDL = Method Detection Limit RL = Reporting Limit Blank = Laboratory Method Blank or Trip Blank whichever is higher (indicate type)
VPH rev. l IMG
Were all performance/acceptable standards for required QA/QC prodedures achieved?
EYes F7 No - Details a
Were any significant modifeatinos to the VPH method made? EJ No 71Yes - Details

RESEARCh & ANA1yTICA1
LAboRATORiES, INC.
Analytical 1 Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER 1 WASTEWATER I mim
COMPANY r - !' _
JOB NO,
_{LAB
n' r
to y p_
C �Q'
Z a} Qp
c'q
4Q-
ry ' c
REGIESTED ANALY
STREETAO RESS
!f k d
PROJECT
J
J 1�'[(iI
C[TY. STATE, ZIP
SAMPLER NAME (PLEASE PRINT)
CONTACT PHONE
SAMP ER SIGNATURE
NUMBER
USE ONLY}
GATE
TIME
DY
CNI
RES
Cl
RE�axSAMP
h..
RELINQUISHED BY
DATEITlME
%Y
RECEIVED Y
REMARKS:
SAMPLE TEMPERATURE AT RECEIPT
C
RELfNQUISHE BY
DATEITIME
RECElVEq
'

RESEARCh of ANALyTiCAL
LkORATWES, INC.
Analytical/Process Consultations
CASE NARRATIVE FOR ORGANICS
Four (4) soil samples were received in good condition on 24 February 2010.
The samples were analyzed without difficulties unless noted below.
Sidney L. Champion
Director of Laboratory Services
a3-a,7-)0
Date
P.C. Box 473 • 106 Short Street • Kernersville, North Carolina 27284 •336-996-2841 ■ Fax [phone]
www.randalabs.com

QA/QC Summary
Method 8260 (100/200/400/1000/2000 PPB QC}
IFILE NAME: SQCO226A
CLIENT: S & ME (PROJECT:133 S. MAIN ST.: JOB
# 1584-08-051)
1 Page 1 of 2
Sample ID
667841-844
VOA INSTRUMENT(MS-2)
Extraction Method
5035
Date Extracted
NIA
Weight/Volume Used
5G15ML
Final Volume
5G15ML
Date Analyzed
02/26/10
% Surrogate Recovery
104
100
98
Acceptance Range
(70 -130)
(70 -130)
(70 -130)
LCS
Range
QC
LIMITS
Compound
p
MDL
m a
Method
Blank
LCS %Acceptance
Recover
MS
% Rec. *
MSD
❑/a Rec. *
RPD
RPD
PERCENT
RECOVERY
Dichlorodifluoromethane
0.00047
ND
74
56 - 126
Chloromethane
0.00050
ND
97
62 - 133
Vinyl Chloride
0.00059
ND
105
67 - 136
Bromomethane
0.00028
ND
102
72 - 130
Chloroethane
0.00029
ND
105
73 - 138
Trichlorofluoromethane
0.00037
ND
98
78 - 131
Acetone
0.00159
ND
74
62 - 119
Acrylonitrile
0.00036
ND
98
76 - 135
2-Butanone
0.00152
ND
94
62 - I22
1,I-Dichloroethene _
0.00059
ND
106
82 - 133
100
99
1
14
61-145
Methyl Iodide
0.00307
ND
106
70- 136
Carbon Disulfide
0.00042
ND
100
76 - 132
Methylene Chloride
0,00138
ND
103
68 - 135
Trans-1,2-Dichloroethene
0.00107
ND
105
SO- 134
1,1-Dichloroethene
0.00036
ND
103
74- 140
Isopropyl ether (IPE)
0.00024
ND
108
67 - 139
Methyl-Tert-Butyl ether (MTBE)
0.00032
ND
101
68 - 131
Vinyl Acetate
0.00035
ND
107
67 - 127
Cis-1,2-Dichloroethene
0,00031
ND
107
78 - 133
2,2-Dichloropropane
0.00029
ND
85
72-123
Bromochloromethane
0.00049
ND
103
71 - 139
Chloroform
H0029
ND
101
8I - 126
1,1,1-Trichioroethane
0.00028
ND
103
76- 129
Carbon Tetrachloride
0.00081
ND
102
81 - 133
1,1-Dichloropropene
0.00059
ND
105
80- 135
Benzene
0.00038
ND
103
78 - 131
94
95
1
11
76-127
Ethyl Acetate
0.00074
ND
103
63 - 122
1,2-Dichloroethane
0.00055
ND
99
72 - I32
Trichloroethene(TCE)
0.00028
ND
98
79 - 126
92
95
3
14
71-120
1,2-Dichioropropane
0.00023
ND
100
79 - 126
Dibromomethane
0.00043
ND
10I
71- 129
NIA = Data Not Available

QAIQC summary
Method 826Q (100/200/40011000/2000 PPB QC] IFILE NAME: SQCO226A (MS-2)
CLIENT: S & NI (PROJECT: 133 S. MAIN ST.: JOB # 1584-08-051)
Page 2 ❑f 2
LCS
Acceptance
Range
QC LIMITS
Compound
MDL
mg/kgmg/kg
Method
Blank
LCS %
Recovery
MS
% Ree. *
MSD
°/„ Rec. *
RPD
RPID
PERCENI
RF.COVkRti
Bromodichloromethane
0.00026
ND
97
71 - 126
4-Methyl-2-Pentanonc
0.00052
ND
87
67 - 122
Cis-1,3-❑ichloropropene
0,00023
ND
91
70 - 125
Toluene
0A0027
ND
65 - 139
87
88
1
13
76-125
Trans-1,3-Dichloropropene
0.00052
ND
65-131
1,1,2-Trichloroethane
0.00041
ND
2103
64- 137
Tetrachloroethene(PCE)
0,00026
ND
61 - 164
2-Hexanone
0,00050
ND
105
63 - 1 l8
Dibromochloromethane
0.00037
ND
92
60 - 138
1,3-❑ichloropropane
0.00033
ND
103
64 - 135
1,2-Dibromoethane (EDB)
0.00074
ND
91
68 - 131
Chlorobenzene
0.00029
ND
105
87- 121
102
106
4
13
75-130
1,1,2,2-Tetrachtoroethane
0.00041
ND
106
85 - 131
Ethyl Benzene
0.00028
ND
101
91 - 12I
Total Xylenes
0.00056
ND
104
88-127
Styrene
0.00037
ND
I04
88 - 124
Bromoform
0.00045
ND
113
66 - 133
Isopropyibenzene
0.00027
ND
105
90 - 125
Bromobenzene
0.00028
ND
109
81 - 128
1,2,3-Trichloropropane
0.00043
ND
96
66 - 132
Trans-1,4-Dich]oro-2-butene
0.00050
ND
103
77 - 120
N-Propylbenzene
0.00058
ND
101
88 - 123
2-Chlarotvluene
0.00050
ND
103
86 - 126
4-Chloratoluene
0.00042
ND
104
82 - 125
1,3,5-Trimethylbenzene
0.00054
ND
105
89 - 124
Tert-Butylbenzene
0.00029
ND
l08
89 - 128
1,2,4-Trimethylbenzene
0.00056
ND
I06
87-125
Scc-Butylbenzene
0.00042
ND
104
88- 127
1,3-Dichlorobenzene
0.00041
ND
106
79- 127
1,1,2,2-Tetrachloroethane
0.00078
ND
107
72- 128
p-Isopropyltoluene
0.00048
ND
103
86 - 128
1,4-Dichlorobenzene
0.00042
ND
104
80 - 122
1,2-Dichlorobenzene
0,00039
ND
106
80 - 123
N-Butylbenzene
0,00033
ND
100
84 - 127
1,2-Dibromo-3 -Ch loropropane(DBCP)
0.00067
ND
107
66- 125
1,2,4-Trichlorobenzene
0.00025
ND
107
76 - 1 l7
Naphthalene
0.00047
ND
106
79 - 119
1,2,3-Trichlorobenzene
0,00036
ND 1
109
72 - 1 I8
NIA = Data Not Available

Q?AIQC Summary
Method: 8270 100/200 PPP, r C
FILE NAME: SLC0304-MSI
Page I of 2
CLIENT: S&ME (133 S. MAIN ST)
Sample ID:
667841-44
INSTILMENT: MS-1
Extraction Method
3550
Date Extracted
113103Y111
Weight Extracted
1L
Final Extract Volume
1ML
Date Analyzed
03104/11)
% Surrogate Recovery
97
84
91
119
98
110
Acceptance Range
(21 - 11{1]
(10 - 11(1]
(35 - 114)
(10 - 123)
(43 - 116)
(33 - 141)
LCS
Accept.
Range
MS
MS❑
RPD
QC LIMITS
Compound
MDL
Method
LCS %
% Rec.
'Yo Rec.
1n Ik
Blank
Recover
R1aD
'�o REC
N-Nitrosodimethylanime
0.047
ND
77
66-109
Bis(2-chloroethyl)ether
0.066
ND
89
64-103
Pheftol
0.066
ND
78
65-104
47
44
8
42
12-110
2-Chlorophenal
0.060
ND
87
63-100
57
55
5
40
27-123
1,3-Dichlorohenzeria
0.085
ND
87
63-97
1,4-Dichlorohenzene
0.050
ND
88
64-97
77
77
0
28
36-97
1,2-Dichlorobenzene
0.047
ND
92
61-91
Ber¢Vl Alcohol
0.087
ND
89
46-122
2-Methyiphenol(O-CREOSOL)
0.072
ND
86
52-107
3&4-Medty1pherto1(M&P CREOSOL)
0.063
ND
86
67-1 13
Bis(2-chloroisopropyl)ether
0.063
ND
84
57-97
N-nitrosodi-n-propylamine
0.057
ND
91
58-102
76
70
'.)
38
41-116
Hexachloroethane
0.069
ND
92
62-95
2-Nitraphenol
0.066
ND
93
60-104
274-Dimelhylphenol
0.079
ND
92
60-105
Nitrohenrene
0.072
ND
94
67-108
Isophara$e
0.079
ND
93
43-123
Sis(2.-ch1oroe1hoxy)methane
0.063
ND
88
63-102
Benzoic Acid
0.348
ND
105
40-111
2,4-Dichlorophenol
0.066
ND
99
65-101
1,2,4-Trichlarobenzene
0.047
ND
95
67-100
88
88
1
28
39-98
4-Chloro-3-methylphenol
0.141
ND
98
59-101
fit
61
3
42
23-97
4-Chloroattiline
0.479
ND
83
33-96
HexachloroUntadiene
0.057
ND
98
65-96
2-Me1hylnaphthalene
0.056
ND
95
68-106
Dihenzotitran
0.063
ND
95
66-97
2,4,6-Trichlorophenal
0.044
ND
97
63-109
2,4,5-Trichlorophenol
0.107
ND
94
56-1(15
NIA
= Data Not Avaiia6le = OUT OF RANGE

Method: 8270 100/201) PPS OCI
IFILE NAME: SLC0304-MS1
Page 2 of 2
CLIENT: S& M E ( 133 S. MAIN ST)
LCS
Acceptr
ange
QC LIMITS
Compound
MDL
Nlethod
LCS %
MS
RPD
mg/kg
Blank
Recovery
[/R Rec.
�MS.D
/o Rec.
2-Methyl-4,6-Dinitropltenol
0.170
ND
101
46-118
RPD
% REC
4-Nitrophenol
0,232
ND
103
58-124
S9
53
9
50
10-80
Hexachlorocyclopentadiene
O} 079
ND
88
56-116
2-Chloronaphthalene
O.046
ND
89
65-106
Dirn hyl plthalate
O,066
ND
96
67-106
Aunaplithylene
0,066
ND
89
68-101
2,6-Dinitroteluenc
0.075
ND
99
63-108
Aeenaphtltene
0.057
ND
91
66-100
74
74
[1
31
46-118
2,4-Dinitrotoluene
0.079
ND
90
65-105
69
66
3
3$
24-96
PIuorene
0.060
ND
91
62-109
Diethyl phthalate
0.072
ND
97
63-109
4-Chlorophenyl phenyl ether
0,050
ND
73
62-98
2,4-Dinitropheaml
0.188
ND
92
45-110
Axobetucne
0.083
ND
100
56-144
Pent:uhlomphertol
0.129
ND
99
64-109
55
5[I
11
51)
9-103
N-Witrosodiphenylamina
0.066
ND
84
56-105
4-Bromopliertyl pheml ether
0,085
ND
91
64-105
Hexachlorobenxane
0.069
ND
91
67-104
Phenantkene
0.075
ND
88
68-104
Anthracene.
0.072
ND
86
64-104
Di-N-Butyl phthalate
0.097
ND
90
59-113
Pluoranthene
0.085
ND
87
62-11.3
Benzidine
0.049
ND
I3
❑-47
Pyrene
0,038
ND
81
58-114
37
39
4
31
26-127
Benzyl butyl phthalate
0.060
ND
80
62-1 l4
13enca(a)a2ithra=ic
0.050
ND
81
67-110
3.3-Dichlombenzidine
0.122
ND
40
25-107
Chryscnc
0.060
ND
79
67-107
Ris(2-ethyl-hcVl)plitlta late
0.066
ND
96
63-105
Di-N-Oayl plthalate
O.079
ND
76
56-115
Benzo(h)llucrantherie
0.122
ND
74
60-116
Benzo(k)tluorcmthene
0.110
ND
76
68-114
Benxo(a)pyrene
0.047
ND
73
65-116
lndeno(1,2,3-cd)pyrene
0.094
ND
84
67-140
Dibenzo(a,h)anthracene
0.088
ND
79
73-131
Benzo(&ki)perylenc
0.097
ND
83
75-133
NIA

OA/QC.Summary
Method VPH
Project: S & ME -133 S. Main St
Page 9 of I
Sample ID
667841-844
Date Analyzed
02/24/10
% Surrogate Recovery
102
85
Acceptance Limits
(70-130)
(70-130)
LCS
MDL
Method
Trip/Field
LCS %
Acceptance
MS
MSD
Control Limits
9'�RP�]
Control Limitx
Compound
m Ik
Blank
Blank
Recovery
Range
C5-C8 Ali hatics
2.84
BQL
NIA
97
70-130
100
106
70-130
6
50%
C9-C12 Ali hatics
0,90
BQL
NIA
83
70-130
86
70-130
14
C9-C10 Aromatics
M6
BQL
NIA
123
70-130
121
120
70-130
1
50%
NIA = Data Not Available

OA1OC summary
Method EPH
Project: S&ME - 133 S. Main Sat
Page 1 of 1
Sample 1D
667841-844
Date Analyzed
02/26/ 10
°/o Surrogate Recovery
97
99
:acceptance Limits
(40-1.40)
(40-140)
LCS
MDL
Method
Trip/Field
LCS %
Acceptance
Compound
Fng/kp,
Blank
Blank
Recoveryi
Range
M5
MSD
Control Limits
%RlxD
Central Limits
C9-Cl8 Aliphatic
5.30
BQL
NIA
97
40-140
84
80
40-140
5
50%
2.40
BQL
NIA
114
40-140
95
9'
40-140
5
50%
C-19-C36 Aliphatic
4.30
BQL
NIA
104
40-140
89
82
40-140
8
5a°/ti
C1 i-C22 Aromatics
NIA = Data Not Available

JOB NAME
SUBJECT
JOB NO. �V • ('Jr
SHEET NO- I
DATfE
4+ #.
"k /YA

NATURAL
GAS
LINE
PROPOSED INJECTION WELL FIELD
\ AND APPROXIMATE HORIZONTAL EXTENT
OF CONTAMINATED SOIL
�~ ~ GAS METER MwLusa� ~
` FORMER ff'!
\ EXCAVATION
LIMITS
\ FORMER
TANK 4J
\ LOCATION �4 }tie'
1z° /
C
\ f
v
KEY GRAPHIC SCALE
SOIL PROBE AND MONITORING WELL LOCATION
w is o as
SCALE: 7" = W
SCALE: AS SHOWN FIGURE NO.
DATE: ApRIL 2009 *S&ME
SITE MAP
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