WI0501030_Injection Event Record_20200701

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10501030
1. Permit Information
Lear Corporation
Permittee
Former Guilford Fibers Plant
Facility Name
_200 Dickens Rd, Fuquay-Varina, NC, Wake
Facility Address (include County)
?. Injection Contractor Information
TWS Environmental
Injection Contractor / Company Name
Street Address 3 Owls Nest Rd
Wilmin ton DE 19807
City State Zip Code
(_302 ) 661-1400
Area code — Phone number
3. Well Information
Number of wells used for injection 66
Well IDs IW-A1 — IW-D6, S,I,D
Were any new wells installed during this injection
event?
® Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells 66
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 1 (water supply well)
Number of Injection Wells 0
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
EDS-ER (EVO). sodium bicarbonate. KB-1 culture.
KB-1 primer
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 2 — 5 %
If the injectant is diluted please indicate the source
dilution fluid.Fuquay-Varina municipal water supply
Total Volume Injected (gal) 199,646
Volume Injected per well (gal)_3,025 (avg)
5. Injection History
Injection date(s) 4/23 — 5/18/2020
Injection number (e.g. 3 of 5)_1 of 1
Is this the last injection at this site?
® Yes ❑ No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDA AID O T THE PERMIT.
6/10/20
SIGNA JECTION 7ftRACTOR DATE
David Wiley, TWS Environmental
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