WI0300427_Injection Event Record_20200612

LETTER OF TRANSMITTAL
DATE: 6/11 /2020
TO: DWR - UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
FROM: Travis O'Quinn
WE ARE SENDING YOU _X_ Attached _ Under separate cover via _ the following items:
_X_ Reports Prints Plans Samples
Copy of letter _ Other
S&ME,INC V14q
9751 Southern Pine Blvd.
Charlotte, NC 28273-5560
Phone: [phone]
Fax: [phone]
_Specifications
0
COPIES
DATE
NO.
DESCRIPTION
1
6/11/2020
1
Injection Event Record
Former Law Enforcement Center, Incident # 5703
101 S. McDowell Street, Charlotte, Mecklenburg County, NC
THESE ARE TRANSMITTED as checked below:
For approval
X For your use
X As requested by the NCDENR
For review and comment
FOR BIDS DUE 20_,
REMARKS:
PRINTS RETURNED AFTER LOAN TO US
find the attached Injection Event Record for the referenced UST Incident. Please contact us if you have any questions.
O'Quinn
COPY TO: File
Doug Pierotti, City of Charlotte
S&ME Project No.: 4335-14-169
Signed:
IF ENCLOSURES ARE NOT AS NOTED, PLEASE NOTIFY US AT ONCE.
This Letter of Transmittal and the documents accompanying this Letter of Transmittal contain information from S&ME, Inc., which is confidential and legally privileged. The
information is intended only for use of the individual or entity named on this Letter of Transmittal. If you are not the intended recipient, you are hereby notified that any
disclosure, copying, distribution or the taking of any action in reliance on these documents is strictly prohibited.

North Carolina Department of Environmental Quality - Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number WI0300427
1. Permit Information
City of Charlotte
Permittee
Former Law Enforcement Center, Incident #5703
Facility Name
101 S. McDowell Street, Charlotte, Mecklenburg County, NC
Facility Address (include County)
2. Injection Contractor Information
S&ME Inc.
Injection Contractor / Company Name
Street Address 9751 Southern Pine Blvd.
Charlotte NC 28272
City State Zip Code
704 523-4726
Area code - Phone number
3. Well Information
Number of wells used for injection 6
Well IDs MW-01, 101, 105, 13, 106, & 104
Were any new wells installed during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells 0
Number of Injection Wells 0
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells.
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
Provectus oxygen release socks and PRP Well Booms
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration See attached SDS or MSDS
If the injectant is diluted please indicate the source
dilution fluid.
Total Volume Injected (gal) - 48 pounds
Volume Injected per well (gal) - 8 pounds
5. Injection History
Injection date(s)
March 13, 2020
Injection number (e.g. 3 of 5) 1
Is this the last injection at this site?
❑ Yes ® No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
6/11 /2020
SIGNATURE OF INJECTION CONTRACTOR DATE
Travis O'Quinn / S&ME Project Manager
PRINT NAMF OP PRRQ(1N PRR1P(1RAAW . TAT: TNTR('TT(17,J
Submit the original of this form to the Division of Water Resources within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464 Rev. 3-1-2016

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o,i0SO
hJ80 ` 160 ® Monitoring Well
REFERENCE: 2019 AERIAL PHOTOGRAPH Suspected Horizontal Recovery Well
a GIS BASE LAYERS WERE OBTAINED FROM MECKLENBURG COUNTY. THIS MAP IS FOR
c INFORMATIONAL PURPOSES ONLY. ALL FEATURE LOCATIONS DISPLAYED ARE APPROXIMATED. Y
m �_ _ _ _; Approximate Former UST Area
THEY ARE NOT BASED ON CIVIL SURVEY INFORMATION, UNLESS STATED OTHERWISE.
6
SITE AREA SCALE: FIGURE NO.
1"=80'
2017 AERIAL PHOTOGRAPH DATE:
III = LAW ENFORCEMENT CENTER 6-3-19 1
CHARLOTTE, NORTH CAROLINA PROJECTNUMBER
4335-14-169

Project Name: Former Law Enforcment Center
Project Location: 101 S Mcdowel St. Charlotte, NC.
Project Number: 4335-14-169 Date: March 13, 2020
Weather:
Sunny
Air Temp. (°F):
65
Water Level & Well Data
Depth to
Top of
Free Product
Free
Flush Mount
Free
Depth to
Total Well
Screen
Screen
Below Top of
Product
Well ID
/ Stick Up
Product
Water
Depth
Length
Depth
Well Screen?
Thickness
Notes
(ft-TOC)
(ft-TOC)
(ft-TOC)
(feet)
(ft-TOC)
(Yes/No)
(feet)
Removed (1) absorbent sock from MW-101,
MW-101
Flush Mount
9.30
9.59
30.0
20.0
10.0
No
0.29
100% saturated. Also installed a 2"x4' PRP
Wellboom (Unirem Tech) into MW-101.
MW-105
Flush Mount
NP
6.67
25.0
15.0
10.0
NP
0.00
18.02 ft of WC. Installed 5 (3'x2") Provectus
ORS socks in well.
MW-13
Flush Mount
NP
8.96
25.0
20.0
5.0
Not Present
0.00
16.00 ft of WC. Installed 5 (3'x2") Provectus
ORS socks in well.
Removed 2 absorbent socks from MW-01 (6")
that were 100% saturated and bailed approx. 3
MW-01 (6")
Flush Mount
9.08
10.28
33.0
23.0
10.0
No
1.20
gals. of product from well. Installed one large
4"x4' PRP Wellboom (Unirem Tech) into the
well.
MW-01(1 ")
Flush Mount
9.32
9.36
34.0
24.0
10.0
No
0.04
No socks installed.
MW-106
Flush Mount
NP
11.26
25.0
15.0
10.0
NP
0.00
13.47 ft of WC. Installed 4 (3'x2") Provectus
ORS socks in well.
MW-104
Flush Mount
NP
8.63
30.0
20.0
10.0
NP
0.00
21.37 ft of WC. Installed 7 (3'x2") Provectus
ORS socks in well.
Name Signature Date
(1) Matthew Brundage / Kelsey Murphy 3/13/2020
Notes: All measurements were collected from the Top of Casing (TOC)
NP = Not Present
Placed all bailed product and spent absorbent socks in drum located in the former system shed.

provectus
ENVIRONMENTAL PRODUCTS`
1.
2.
3.
MATERIAL SAFETY DATA SHEET: PROVECT-ORS Page: 1 of 5
PRODUCT IDENTIFICATION:
PRODUCT USE:
MANUFACTURER:
PROVECTUS ENVIRONMENTAL
2871 W. Forest Rd., Suite 2
Freeport, IL
61032
PROVECT-ORS
Soil and water treatment.
EMERGENCY PHONE:
USA: (S15) 650-2230
TRANSPORTATION OF DANGEROUS GOOD CLASSIFICATION:
Oxidizing Solid, n.o.s. (Calcium Peroxide), Class 5.1, PG II, UN1479
WHMIS CLASSIFICATION:
Oxidizer
COMPOSITIONANFORMATION ON INGREDIENTS
Ingredients
Calcium Peroxide
Inorganic Nutrients
PHYSICAL DATA
Appearance -----------------------
Physical state_____________________,
Odor threshold,___________________
Bulk Density______________________
Solubility in Water --------------
pH------------------------------------
Decomposition Temperature.
4. HAZARDS IDENTIFICATION
Chemical Formula CAS No. Percentage
Ca02 1305-79-9 75%-85%
15%-25%
White & brown granules
Solid
_None
500-650g/L
Insoluble
III
Self -accelerating decomposition with oxygen release starting from 275
degrees Celsius
Emergency overview
Oxidizing agent, contact with other material may cause fire. Under fire conditions this material may
decompose and release oxygen that intensifies fire. This product contains <1 % non -respirable crystalline
silica. The NTP and OSHA have not classified non -respirable crystalline silica as carcinogenic. Long term
exposure to hazardous levels of respirable silica dusts can cause lung disease (silicosis). ORS does not
contain respirable crystalline silica.
Potential Health Effects:
0 General_________________________ Irritating to mucous membrane and eyes.

Provectus
ENVIRONMENTAL PRODUCTS"
MATERIAL SAFETY DATA SHEET: PROVECT-ORS Page: 2 of 5
• Inhalation_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Irritating to respiratory tract. Long term inhalation of elevated levels
may cause lung disease (silicosis).
• Eye contact May cause irritation to the eyes; Risks of serious or permanent eye
lesions.
• Skin contact__________________ May cause skin irritation.
• Ingestion Irritation of the mouth and throat with nausea and vomiting.
5. FIRST AID MEASURES
• Inhalation Remove affected person to fresh air. Seek medical attention if effects
persist.
• Eye contact___________________ Flush eyes with running water for at least 15 minutes with eyelids
held open. Seek specialist advice.
• Skin contact Wash affected skin with soap and mild detergent and large amounts of
water.
• Ingestion ----------------------- If the person is conscious and not convulsing, give 2-4 cupfuls of
water to dilute the chemical and seek medical attention immediately.
Do not induce vomiting.
6. FIRE FIGHTING MEASURE
Flash Point
• Not applicable
Flammability
• Not applicable
Ignition Temperature
• Not applicable
Danger of Explosion
• Non -explosive
Extinguishing Media
• Water
Fire Hazards
• Oxidizer. Storage vessels involved in a fire may vent gas or rupture due to internal pressure.
Damp material may decompose exothermically and ignite combustibles. Oxygen release due to
exothermic decomposition may support combustion. May ignite other combustible materials.
Avoid contact with incompatible materials such as heavy metals, reducing agents, acids, bases,

Provectus
ENVIRONMENTAL PRODUCTS}
MATERIAL SAFETY DATA SHEET: PROVECT-ORS Page: 3 of 5
combustible (wood, papers, cloths etc.) Thermal decomposition releases oxygen and heat.
Pressure bursts may occur due to gas evolution. Pressurization if confined when heated or
decomposing. Containers may burst violently.
Fire Fighting Measures
• Evacuate all non -essential personnel
• Wear protective clothing and self-contained breathing apparatus.
• Remain upwind of fire to avoid hazardous vapors and decomposition products.
• Use water spray to cool fire- exposed containers.
7. ACCIDENTAL RELEASE MEASURES
Spill Clean-up Procedure
• Oxidizer. Eliminate all sources of ignition. Evacuate unprotected personnel from equipment
recommendations found in Section 9. Never exceed any occupational exposure limit.
• Shovel or sweep material into plastic bags or vented containers for disposal. Do not return spilled
or contaminated material to inventory. Avoid making dust.
• Flush remaining area with water to remove trace residue and dispose of properly. Avoid direct
discharge to sewers and surface waters. Notify authorities if entry occurs.
• Do not touch or walk through spilled material. Keep away from combustibles (wood, paper, oils,
etc.). Do not return product to container because of risk of contamination.
8. HANDLING AND STORAGE
Storage
• Oxidizer. Store in a cool, well -ventilated area away from all source of ignition and out of direct
sunlight. Store in a dry location away from heat.
• Keep away from incompatible materials. Keep containers tightly closed. Do not store in
unlabeled or mislabeled containers.
• Protect from moisture. Do not store near combustible materials. Keep containers well sealed.
Ensure pressure relief and adequate ventilation.
• Store separately from organics and reducing materials. Avoid contamination that may lead to
decomposition.
Handling
• Avoid contact with eyes, skin, and clothing. Use with adequate ventilation.
• Do not swallow. Avoid breathing vapors, mists, or dust. Do not eat, drink, or smoke in work
area.
• Prevent contact with combustible or organic materials.
• Label containers and keep them tightly closed when not in use.
• Wash thoroughly after handling.

provectus
ENVIRONMENTAL PRODUCTS'
MATERIAL SAFETY DATA SHEET: PROVECT-ORS Page: 4 of 5
9. EXPOSURE CONTROLS/PERSONAL PROTECTION
Engineering Controls
• General room ventilation is required. Local exhaust ventilation, process enclosures or other
engineers controls may be needed to maintain airborne levels below recommended exposure limits.
Avoid creating dust or mist. Maintain adequate ventilation. Do not use in closed or confined
spaces. Keep levels below exposure limits. To determine exposure limits, monitoring should be
performed regularly.
Respiratory Protection
• For many condition, no respiratory protection may be needed; however, in dusty or unknown
atmospheres or when exposures exceed limit values, wear a NIOSH approved respirator.
Eye/Face Protection
• Wear chemical safety goggles and a full face shield while handling this product.
Skin Protection
• Prevent contact with this product. Wear gloves and protective clothing depending on condition of
use. Protective gloves: Chemical -resistant (Recommended materials: PVC, neoprene or rubber)
Other Protective Equipment
• Eye -wash station
• Safety shower
• Impervious clothing
• Rubber boots
General Hygiene Considerations
• Wash with soap and water before meal times and at the end of each work shift. Good
manufacturing practices require gross amounts of any chemical removed from skin as soon as
practical, especially before eating or smoking.
10. STABILITY AND REACTIVITY
Stability
Stable under normal conditions
Condition to Avoid
• Water
• Acids
• Bases
• Salts of heavy metals
• Reducing agents
• Organic materials
• Flammable substances
Hazardous Decomposition Products
0 Oxygen which supports combustion

Provectus
ENVIRONMENTAL PRODUCTS}
MATERIAL SAFETY DATA SHEET: PROVECT-ORS Page: 5 of 5
11. TOXICOLOGICAL INFORMATION
• LD50 Oral: Min.2000 mg/kg, rat
• LD50 Dermal: Min. 2000mg/kg, rat
• LD50 Inhalation: Min. 4580 mg/kg, rat
12. ECOLOGICAL INFORMATION
Ecotoxicological Information
• Hazards for the environment is limited due to the product properties of no bioaccumulation, weak
solubility and precipitation in aquatic environment.
Chemical Fate Information
• As indicated by chemical properties oxygen is released into the environment.
13. DISPOSAL CONSIDERATIONS
Waste Treatment
• Dispose of in an approved waste facility operated by an authorized contractor in compliance with
local regulations.
Package Treatment
• The empty and clean containers are to be recycled or disposed of in conformity with local
regulations.
14. TRANSPORT INFORMATION
• Proper Shipping Name: EHC-O
• Hazard Class: 5.1
• Labels: 5.1 (Oxidizer)
• Packing Group: II
15. REGULATORY INFORMATION
• SARA Section ------------------------------------------
Yes
• SARA (313) Chemicals
No
• EPA TSCA Inventory --------------------------------
Appears
• Canadian WHMIS Classification
C, D2B
• Canadian DSL..........................................
Appears
• EINECS Inventory
Appears

0
V
,IREMTECH
MATERIAL SAFETY DATA SHEET
450 Butler Street
Pittsburgh, PA 15223
[phone]
Email: sales(o)-unireminc.com
Prepared in accordance with EC directive 91/155/eec and subsequent directive
Effective Date: 1992
Revised: 2019
PETROLEUM REMEDIATION PRODUCT (PRP°) Family of Products
CHEMICAL IDENTIFICATION
Product Name: PRP° (Including Biosok°, Bioboom° and Wellboom®)
Manufacturer: United Remediation Technology, LLC
450 Butler Street
Pittsburgh, PA 15223
Main: [phone]
Emergency Number: Cell: [phone]
Robert Barrett, President & CEO
United Remediation Technology, LLC
Email: [e-mail]
COMPOSITION/INFORMATION ON INGREDIENTS
COMPONENT NAME
Filtered Beeswax
Filtered Soy Wax
HAZARDS IDENTIFICATION
Emergency Overview
% EXPOSURE LIMITS SEC 12 INFO
No Yes
No Yes

This is a non-combustible, non -reactive, granular, solid material. It is supplied in the form
of small particles. Use methods suitable to fight surrounding fire. Exposure to dusts may
be irritating to eyes, nose, and throat. At very high exposure levels, the dust may have an
effect on the lungs. Firefighters should wear self-contained breathing apparatus and full
protective clothing. Use extinguishing methods suitable for surrounding fire.
Potential Effects of Acute Exposure
Eye: Particles may cause mechanical eye irritation.
Skin Contact: May cause skin irritation. Long-term contact may cause depletion of
natural skin oils.
Skin Absorption: Component not known to be available for absorption through the skin.
Ingestion: May cause gastric disturbance if large amounts are swallowed.
Inhalation: Breathing large amounts may cause irritation to cause to the lungs.
Treat as a nuisance particulate.
Possible Effects
Of Chronic
Exposure: None known
FIRST AID MEASURES
Eyes: Flush eyes immediately with plenty of water for at least 15 minutes.
Consult Physician if irritation persists.
Skin: Wash skin thoroughly with mild soap and water.
Inhalation: Move person to non -contaminated air. Call a physician if irritation
persists.
Ingestion: If material is swallowed no need for first aid as anticipated.
FIRE FIGHTING MEASURES
2

General: The wax will burn at high temperature. As with other organic
material, any dust that is generated may be explosive if mixed with air
in critical proportions and in the presence of a course ignition.
Flashpoint: Greater than 230°C/400°F.
Flammability: Not available
Auto Ignition
Temperature: Not available
Hazardous
Combustion
Products: As product is heated, it proceeds to a liquid form, and at higher
temperatures, and it forms combustion products that include oxide of
carbon, sulfur and nitrogen.
Fire Fighting
Instructions: Wear full protective clothing; including helmet, self-contained positive
pressure or pressure demand breathing apparatus, protective
clothing and facemask.
ACCIDENTIAL SPILL/RELEASE MEASURES
General: The product is not considered hazardous material. The function of
this Product is to aid in spills/releases of oil -based products that may
be Regulated under Federal, state, and local authority.
Large/Small
Spill: Collect spill using a vacuum cleaner with HEPA filter. Place in a closed
container. Do not dry sweep.
Waste
Disposal: Product as produced contains no material regulated as hazardous.
When product is used to aid in clean up of oil -based product, the
treated oil product must be tested to determine its status as a
3

regulated waste and disposed of in accordance with all applicable
regulations.
HANDLING AND STORAGE
General Handing
Precautions: Avoid inhalation of dusts. Avoid contact with skin and eyes. Wash
thoroughly. Keep container closed and dry.
Storage
Requirements: Store in a dry cool area. Avoid temperatures in excess of 35°C/95°F
Incompatibility: Detergents/Surfactants
EXPOSURE CONTROL/PERSONAL PROTECTION
Ventilation: Wherever dusts are generated, use appropriate local exhaust
ventilation to keep exposures below the regulated limits.
Chemical
Name: OSHA: TWA-STEL ACGIH: TWA-STEL OTHER: TWA-STEL
Exposure Limits: OSHA: Total dust: 15mg/m3
Particulates
(not otherwise
regulated): Respirable Fraction: 5mg/m3
NFP A Rating: Health - 0, Flammability - 1, Reactivity - 0
Personal Protective
Equipment
Eye Protection: Wear safety glasses side shields.
Skin Protection: Wear cotton, rubber or other appropriate work gloves, if necessary
for type of operation.
Protective
N

Clothing: Coveralls, apron.
Respiratory
Protection: Not normally needed. If permissible, levels are exceeded use NIOSH
approved dust respirator.
PHYSICAL AND CHEMICAL PROPERTIES
Physical State: Solid (particulate)
Odor and
Appearance: Yellow/White/Amber (Honey Odor)
Specific Gravity
(density): 0.97gm/cm3
Boiling Point: Not applicable
Vapor Pressure: Not applicable
Percent Volatile: Not applicable
Vapor Density: Not applicable
Softening Point: pH Not applicable
Solubility in H2O: Insoluble
Freezing Point: Not applicable
Evaporation Rate: Not applicable
Viscosity:
Melting Point
Not applicable
130oF/55oC
5

STABILITY AND REACTIVITY
Stability: Stable at temperatures below 230oC/400oF.
Conditions to
Avoid: Sparks, flames, and exposure to heat.
Hazardous
Polymerization: Will not occur
Incompatibility: Detergent & Surfactants
TOXICOLOGICAL INFORMATION
Eye effects: Particles may cause mechanical irritation. Symptoms can include
irritation and redness.
Skin effects: Particles may cause irritation.
Acute Oral: No adverse health effects are known for this product. Ingestion may
cause transient irritation of throat, stomach and gastrointestinal tract.
Chronic effects Long-term skin contact with this product may lead to
depletion of natural skin oils.
ECOLOGICAL INFORMATION
Ecological
Information: None known
DISPOSAL CONSIDERATION
None needed if product is totally biodegraded, otherwise dispose of in
accordance with local, state or federal regulations.
C:

TRANSPORTATION INFORMATION
This product is not regulated as a hazardous material by the United
States (DOT) or Canadian (TGD) transportation regulations.
REGULATORY INFORMATION
TSCA Status: The component is listed on the TSCA inventory.
CERCLA/SARA: This product does not contain any ingredient that is subject to the
reporting requirements of Section 313 of SARA and its associated
regulations.
RCRA: This product does not contain any component identified as hazardous
under 40 CFR 261.24. Waste must be handled in accordance with all
applicable regulations. Purchaser is advised to review regulations
referenced for applicability as determined by purchaser's use of
product.
OTHER
INFORMATION
Disclaimer: Seller warrants that the goods will, assuming proper application,
enhance and stimulate the biodegradation of certain hydrocarbons.
Seller expressly limits its obligation and liability under this limit
warranty to either, at seller's option, replacement of the defective
goods or granting buyer credit in the amount paid for the defective
goods. If requested by seller, goods for which a warranty claim is
made will be returned to seller, transportation prepaid. Seller
expressly limits its warranty to the terms set forth above and hereby
excludes all other warranties expressed or implied, in particular
excluding any and all warranties of merchantability and warranties of
fitness for any particular purpose. Seller likewise limits the remedies
available to those set forth in this limited warranty. In no event shall
seller be responsible for any loss of income, loss of profits or any
other form of consequential or indirect damages whatsoever.
VA