WI0800547_Permit (Issuance)_20210331

ATC
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
March 15, 2021
Ms. Shristi Shrestha
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section, UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Reference: Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company
700 East Church Street
Atkinson, Pender County, North Carolina
NCDEQ Incident No. 16996
Dear Ms. Shrestha:
Ftzekvzo
MQR �:2021
Office
ATC Associates of North Carolina, P.C. (ATC) has prepared the enclosed Notice of Intent to
Construct or Operate Injection Wells on behalf of the North Carolina Department of
Environmental Quality State -Lead Program. The permit application covers the performance of
passive remediation in three monitoring wells associated with the above referenced site
If you have questions or require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Ashley M. Winkelman, P.G.
Senior Project Manager
cc: Hassan Osman, Hydrogeologist for NCDEQ
Attachments

Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company, Atkinson, North Carolina
NOTICE OF INTENT FORM
14TC
EIIYIE0111EEIIL• 0E01EC66ICEL
R1110116 SCIENCES • 6ETEIIELE TESTING

NC Department of Environmental Quality — Division of Water Resources (DWR)
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are `permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C.0200 (NOTE: This form must be received at least 14 DAYS prior to injection)
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells is located within an area that does not exceed five percent of the land surface
above the known extent of groundwater contamination. An individual permit shall be required to conduct more
than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
5) In -Situ Thermal Wells (IST) — Used to `heat' contaminated groundwater to enhance remediation
Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.
DATE: March 15 , 2021
PERMIT NO. WI0800547 (to be filled in by DWR)
NOTE- If this NOI is being submitted as notification of a modification of a previously issued NOI for this site (e.g.,
different injection wells, plume, additives, etc.) and still meets the deemed permitted by rule criteria, provide the
previously assigned permit tracking number and any needed relevant information to assess and approve injection:
A.
B.
Permit No. WI
Issued Date:
WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well Complete sections B through F, J, M
(2) Aquifer Test Well Complete sections B through F, J, M
(3) X Passive Injection System ..Complete sections B through F, H-M
(4) Small -Scale Injection Operation.. .Complete sections B through M
(5) Pilot Test Complete sections B through M
(6) In -Situ Thermal (IST) Well Complete all sections except K
STATUS OF WELL OWNER: State Government
Deemed Permitted GW Remediation NOI Rev. 2-14-2020
Page 1

C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name: Hassan Osman — Hydrogeologist, North Carolina Department of Environmental Quality
Mailing Address: 1646 Mail Service Center
City: Raleigh State: NC Zip Code: 27699-1646 County: Wake
Day Tele No.: 919-707-8167 Cell No.: Not Available
EMAIL Address: hassan.osman( ncdenr.gov Fax No.: Not Available
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Maulin Patel
Company Name Not Applicable
Mailing Address: 126 W. Church St
City: Atkinson State: NC Zip Code: 28421 County: Pender
Day Tele No.: 919-922-0563 Cell No.: Not Available
EMAIL Address: Not Available
Fax No.: Not Available
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name: Ashley M. Winkelman — ATC Associates of North Carolina, P.C.
Mailing Address: 2725 E. Millbrook Road. Suite 121
City: Raleigh State: NC_ Zip Code:27604 _ County: Wake
Day Tele No.: 919-871-0999 Ce11 No.: 919-830-3576
EMAIL Address: [e-mail]
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: _ Woodcock Oil Company
700 East Church Street
Fax No.: 737-207-8261
City: Atkinson County: Pender Zip Code: 28421.
(2) Geographic Coordinates: Latitude**: 0 " or 34 °.53189.
Longitude**: " or 78 °. 16374
Reference Datum: WGS84 Accuracy: 10-meter
Method of Collection: DO() — Acme Mapper 2.2
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: square feet
Land surface area of inj. well network: square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification.
(1)
Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
Included in the Figures section.
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
Included in the Figures section.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing and
proposed wells.
Included in the Figures section.
DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE — Provide a brief narrative
regarding the cause of the contamination, and purpose, scope, goals of the proposed injection activity:
ATC will install three Provect ORS sleeves each in monitoring wells AMW-4, AMW-8. and AMW-9 in order
to aide in natural attenuation and reduce compounds concentrations to below the North Carolina Groundwater
Quality Standards (2L Standards). Based on the most recent sampling event performed in May. 2020, the
following compounds exceeded the 2L Standards: benzene and naphthalene. The sleeves come in 3-foot
sections. ATC will install three 3-foot sections at the base of the wells, across the well screen. The socks will
release oxidizing solids into the groundwater for approximately 6 months, at which point the chemicals in the
socks will have depleted.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: Proposed 3 Existing (provide NC Well
Construction Record (GW-1) for each well) Included in Appendix B
(2) Appx. injection depths (BLS): 8.5-19.5
(3) For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
K. INJECTION SUMMARY
NOTE: Only injectants approved by the epidemiology section of the NC Division of Public Health, Department
of Health and Human Services can be infected. Approved iniectants can be found online at
http://deq.nc.eov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/ground-water-approved-iniectants. All other substances must be reviewed by the DHHSprior to use.
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 3

Contact the UIC Program for more info if you wish to get approval for a different additive. However, please
note it may take 3 months or longer.
Injectant: Provect ORS Sleeves Total Amt. to be injected (gal)/event: 3,114 in3 (volume of sleeves)
Amt. Water to be injected (gal/event): N/A
Total Amt. to be injected (gal/event): 3.114 in3 (volume of sleeves)
No. of separate injection events:1 Est. Total Amt. to be injected (gal): 3,114 in3 (volume of
sleeves)
Source of Water (if applicable): N/A
L. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
Approximately 6 months after the installation of the Provect ORS sleeves. ATC will collect a sample from the
wells for analysis of volatile organic compounds by EPA Method 6200B. The samples will be shipped to Pace
Analytical in Mt. Juliet, Tennessee. ATC will also measure dissolved oxygen. conductivity temperature, pH.
and oxygen reduction potential during the sampling event.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: "I hereby cert, under penalty of law, that I am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules."
Ashley Winkelman on behalf of Hassan Osman, NCDEO
Signature of Applicant Print or Type Full Name and Title
Property Owner (if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I 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
(15A NCAC 02C .0200)."
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the land owner, in the
absence of contrary agreement in writing.
See Appendix C Maulin Patel
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 4

Please send 1 (one) hard color copy of this NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 5

Ashley Winkelman
From: Osman, Hassan <[e-mail]>
Sent: Monday, March 15, 2021 11:09 AM
To: Ashley Winkelman
Subject: RE: [External] #16996 Woodcock Oil NOI
Hassan Osman from UST Section, Trust Fund Brach, I am giving a permission ATC to submit NOI on behalf of UST Section,
Trust Fund Brach. If you have any questions you can contact at [phone].
Thanks
Hassan
From: Ashley Winkelman <[e-mail]>
Sent: Monday, March 15, 2021 10:59 AM
To: Osman, Hassan <[e-mail]>
Subject: [External] #16996 Woodcock Oil NOI
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Hey Hassan,
I'm getting ready to submit the Notice of Intent for the ORS Sleeve installation at Woodcock Oil. Can you respond to this
email giving me permission to sign the NOI on your behalf?
Ashley M. Winkelman PGI SENIOR PROJECT MANAGER I ATC Group Services LLC
Direct [phone] I Cell [phone]
"- 1
2725 E. Millbrook Road, Suite 121 I Raleigh, NC 27604
Fax [phone] I ashley.winkelman_Y;atcgs.com I www.atcgroupservices.com
This email and its attachments may contain confidential and/or privileged information for the sole use of the intended recipient(s). If you are
not the intended recipient, any use, distribution or copying of the information contained in this email and its attachments is strictly prohibited.
If you have received this email in error, please notify the sender by replying to this message and immediately delete and destroy any copies
of this email and any attachments. The views or opinions expressed are the author's own and may not reflect the views or opinions of ATC.
1

Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company, Atkinson. North Carolina
FIGURES
ATC
EMEIRNNNENTAL • REATECNIICAL
INILIING SCIENCES • MATERIALS TESTING

H:V20201OTHER OFFICESWORTH CAROLINAWCDEQ-STATE LEADIWOODCOCK OILISLP1699602•BENZ.DWG, FIG5
v
♦
♦
♦
♦
LEGEND:
LEGEND:
AMW-11 MONITORING WELL
450.50 - Well Idanlfication
Benzene Concentration(Ng/L)
T-1 TYPE III MONITORING WELL
Well Identification
An_CCDW-1 WATER SUPPLY WELL
Well Identification
}CCDW-2 ABANDONED WATER SUPPLY WELL
Well Identification
---- SITE PROPERTY LINE
PARCEL LINE
—P—P— FORMER PRODUCT PIPING
w---w— WATER LINE
g FORMER DIESEL DISPENSER
O FORMER KEROSENE DISPENSER
© FORMER GASOLINE DISPENSER
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NOTE: ALL LOCATIONS ARE APPROXIMATE
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WOODCOCK OIL CO. = INCIDENT #16996
700 EAST CHURCH STREET
ATKINSON, PENDER COUNTY, NORTH CAROLINA
Date:
6120
Scale:
AS SHOWN
Figure:

LEGEND:
AMW-11 MONITORING WELL
. 1.0 ! �- Well Identification
TT Naphthalene Concentration (pg/L)
T-1 TYPE III MONITORING WELL
Well Identification
CCDW-1 WATER SUPPLY WELL
�--- Well Identification
CCDW-2 ABANDONED WATER SUPPLY WELL
Well Identification
-- SITE PROPERTY LINE
- PARCEL LINE
—P—P— FORMER PRODUCT PIPING
— —W— WATER LINE
El FORMER DIESEL DISPENSER
E FORMER KEROSENE DISPENSER
© FORMER GASOLINE DISPENSER
NAPHTHALENE ISOCONCENTRATION CONTOUR
(DASHED WHERE INFERRED) (pg/L)
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WOODCOCK OIL CO. - INCIDENT #16996
700 EAST CHURCH STREET
ATKINSON, PENDER COUNTY, NORTH CAROLINA
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Date:
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Scale:
AS SHOWN
Figure:

GRAVEL
AREA
P-1 (6")
P-1 (10'').
S-b0r
1
1
PAVED 1 $�
AREA fe
L
Former
Gasoline
Dis
nsers
STORE
Former
UST Basin I
DL 1
i►
111
S-8 Of
AP/ 11
S-71 / /DL2
li
LB1 DW-1
LEGEND
• Soil Sample Location
* Domesfic Well Location
Former
Loading
Rack
Former
Kerosene
Dispenser
11
DL-6
11
1 L-8
11
DL-7 VP- [ 7 •
1
DL-8 0
Dispenser Line
Trench Excavation
TIL-2 Former Diesel
L-3 and Kerosene
I-� Dispensers
L-4
-_- nag
AST-3
FORMER .
l OFFICE 5:
1
1 DL-9
DL-10W eAST-6
•
DL-lo •
Approx. Limits
Of Excavation
AST-4
•
1 AST-5
11111
1
c
W
70\"*.
pplied Resource Management PC
P.O. Box 882, Haptead, NC 28443
{9T0)270.29T9FAX [phone]
TITLE: SITE MAP WITH ABATEMENT
SOIL SAMPLE LOCATIONS
JOB: ; SCALE: DATE: : DRAWN BY:
9914 1" = 40' 1 /9/03 JLC/EFC
FIGURE:
2

• VR% MOW.1 ■RI ■% VRRow VVMR■ n.. ■
. ATKINSON, NORTH CAROLINA
Concentrations in Parts Per Million (mg/Kg)
SAMPLE LOCATION
EPA METHOD
FIELD
IDENTIFICATION
MAP
IDENTIFICATION
SAMPLE
DATE
SAMPLE
DEPTH
3550
5030
Pit 1
P-1
816/02
6'
<10
<5
Pit 1
P-1
8/6/02
10'
<10
<5
SW-1
S-1
8/6/02
12'
<10
<5
SSW-1
S-2 •
8/8/02
8'
<10
296
SSW-2
S-3
8/12./02
8'
<10
<5
EESW-1
S-4
8/12/02
6'
<10
<5
CWSW 1
S-5
8/8/02
8'
<10
39.7
NWESW-1
S-6
8/9/02
8'
<10
<5
NECSW-1
S-7
8/9/02
8'
<10
<5
NEESW-1
S-8
8/9/02
8'
<10
<5
DL-2
DL-2
8/7/02
4'
<10
<5
DL-3
DL-3
8/7/02
4'
<10
<5
ESWDL-4
DL-4
8/7/02
8-9'
<10
<5
DL-5
DL-5
8/12/02
4'
<10
<5
DL-6
DL-6
8/12/02
4'
<10
<5
DL-7
DL-7
8/13/02
4'
<10
<5
DL-8
DL-8
8113/02
4'
<10
<5
DL-9
DL-9
8/13/02
4'
<10
<5
DL-10
DL-10
8/13/02
4'
<10
<5
OL-1.OW
DL-10W
8/13/02
6'
<10
<5
LRNSW-3
L-1
8/12/02
6-8'
<10
y
<5
LRNSW-2
L-2
8/12/02
6-8'
<10
<5
LRNSW-1
L-3
8/12/02
5'
923
<5
L,RESW-1
L-4
8112/02
5'
<10
<5
LRESW-2
L-5
8/12/02
6'
<10
<5
LRSSW-1
L-6
8/12/02
8'
<10
<5
LRWSW-1
L-7
8/12/02
8'
<10
<5
LRSW 2
L-8
8/12/02
8'
11.6
<5
AST-1
AST-1
8/12/02
3'
<10
<5
• AST-2
AST-2
8/12/02
3'
<10
<5
AST-3
AST-3
8/12/02
3'
<10
l
<5
AST-4
AST-4
8/12/02
2"
<10
<5
AST-5
AST-5
8/12/02
2'
<10
<5
AST-6
AST-6
8/12/02
2'
<10
<5
Shaded areas represent non compliant hydrocarbon concentrations. Noncompliant defined as 40 mg/kg for
EPA Method 3550, and 10 mg/kg for EPA Method 5030.

AMW-8
(99.57)
Gasol
Dlsp
PAVED B-10
AREA
LEGEND
GRAVEL
AREA
T-1
Former tloo.00)
UST Basin 9 1
8)
Former
• Kerosene
Dispenser
STORE
B
AMW-10
(99.18)
-149
(99.05)
AMW-9
(99.40) AMW-2(9
(99.10)
LB1 DW-1
f FORMER
1:411k OFFtCE
Former Ir
UST Basin 1
AMW-4
(98.65)
• Exploratory Boring Location
9 Type II Monitoring Well Location
Type Iil Monitoring Well Location
* Approximate Domestic Well Location
(94.15) Top of Casing Elevation (in feet)
•
S-1
B-60
53
AMW-7
(98.33)
B' GRASSED
AREA
CNP`R CE
>� E Nay'
Diesel
and Kerosene
Dispensers
•
Diesel A51
Di®ol lS1
AMW-6
(96.42) CCDW-1
• B-3
S-3 AMW-59
S-2 (96.57)
5A
O B-5
CCDW-2 9 AMW-11
(98.15)
AMW-12S
(95.14)
AP
pplied Resource Management PC
.O. Box 882 Hampstead NC 28443
MO 210-29Ca F.AX 210-29as
TITLE:
SITE MAP WITH AQUIFER
TRANSECT LOCATIONS
JOB:
9914
SCALE:
1" = 40'
DATE: DRAWN BY:
5/16/00 DHC
FIGURF:

0
p?
A
. I
a )2,
m
0
0
<
E 2
co
,V-V 103SNVd1 d3d1110V
120.00 - —
100.00
80.00 —
60.00
40.00
A
AMW-8 B-2 AMW-3 T-2 AMW-9 AMW-2 B-4 E3-.3
(99.57')
(99.96) (100.07), (99.40') (99.10')
LEGEND
SP - Poorly graded sands or gravelly
20,00 — sands, little or no fines.
CH - inorganic clays of high plasticity, fat clays.
SC - Clayey sands, sand -clay mixtures.
00.00
A'
AMW-12
(95.14')
Groundwater table elevation
as of 3/21 /00. Scale: 1 '=40' horiz.
1"=20' vert.
40 80
120 160 200 240 280

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120,00
100.00
80,00
60.00
40.00
20.00
00.00 --
B
AMW-10
(99.18')
T-2 AMW-7
(700.07') (99.05')
LEGEND
Br
AMW-7
(98.33')
SP
SP - Poorly graded sands or gravelly
sands, little or no fines.
CH - Inorganic clays of high plasticity, fat clays.
. SC - Clayey sands, sand -clay mixtures.
r _ Groundwater table elevation
asof3/21/00.
Scale: 1'=40' horiz.
1 "=20' vert.
40 80 120 160 200 240 280

Gradient = 0.0221 ftift
OiL
,teV
44Z,
No NM \�
\a \
\ A 88,42. , >sterZ
/-7(
- -d9,11
AMW-8
,d
•
•
•
•
LEGEND:
AMW-11 \ MONITORING WELL
4E18.32 1 T- Well Identification
Relative Groundwater Elevation(f)
T-1 TYPE III MONITORING WELL
Well Identification
,CCDW-1 WATER SUPPLY WELL
Well Identification
rhCCDW-2 ABANDONED WATER SUPPLY WELL
T �-- Well Identification
SITE PROPERTY LINE
PARCEL LINE
FORMER PRODUCT PIPING
WATER LINE
FORMER DIESEL DISPENSER
FORMER KEROSENE DISPENSER
FORMER GASOLINE DISPENSER
GROUNDWATER ELEVATION CONTOUR
(DASHED WHERE INFERRED)
GROUNDWATER FLOW DIRECTION
NOTE: ALL LOCATIONS ARE APPROXIMATE
RESIDENTIAL
AMW-2 \\
\
\A\ :•.,ERAST
\\
LOCA - \
\
4 \\
87.97
WSW-2
(ABANDONED)
T-14-
+AMW-11
T
WSW-3
��Ah9W-7
CRMER
l IN
RESIDENTIAL
'AMW-16
r � 441164^0,
_
AMW-17
NM
0 10 20
SCALE:1" = 40'
Scale:
AS SHOWN
Figure: 4

Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company. Atkinson, North Carolina
APPENDIX A
MSDS FORM
34TC
ENTINONNENTAL• BEOTECNNICAL
BUILOINB SCIENCES • MATERIALS 'EMIRS

rovectus
ENVIRONMENTAL PRODUCTS"
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 1 of 5
1. PRODUCT IDENTIFICATION: PROVECT-ORS
PRODUCT USE: Soil and water treatment.
MANUFACTURER: EMERGENCY PHONE:
PROVECTUS ENVIRONMENTAL
2871 W. Forest Rd., Suite 2
Freeport, IL
61032
USA: [phone]
TRANSPORTATION OF DANGEROUS GOOD CLASSIFICATION:
Oxidizing Solid, n.o.s. (Calcium Peroxide), Class 5.1, PG II, UN1479
WHMIS CLASSIFICATION:
Oxidizer
2. COMPOSITION/INFORMATION ON INGREDIENTS
Ingredients
Calcium Peroxide
Inorganic Nutrients
3. PHYSICAL DATA
Chemical Formula
CaO2
CAS No. Percentage
1305-79-9 75%-85%
15%-25%
Appearance White & brown granules
Physical state Solid
Odor threshold None
Bulk Density 500-650g/L
Solubility in Water Insoluble
pH —11
Decomposition Temperature Self -accelerating decomposition with oxygen release starting from 275
degrees Celsius
4. HAZARDS IDENTIFICATION
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:
• General Irritating to mucous membrane and eyes.

i.»• 'ovectus
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,

` rovectus
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.

i)rovectus
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
• Oxygen which supports combustion

rovectus
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

Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company, Atkinson, North Carolina
APPENDIX B
MONITORING WELL CONSTRUCTION DETAILS
i4TC
E1111RRMREMIML • iER1ECNNICMI
1111101116 SLIMES • MEWLS TESTING

North Carolina - Department of Environement and Natural resources - Division of Water Quality - Groundwater Section
1936 Mall Service Center- Raleigh, N.C. 27699-1636- Phone [phone]
WELL CONSTRUCTION RECORD
AMW-4
WELL CONTRACTOR: ARM's Waterworks - Don Cummings
WELL CONTRACTOR CERTIFICATION #: 2412
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box):
Recovery Heat Pump Water injection
2. WELL LOCATION: (Show sketch of the location below
Nearest Town: Atkinson
Municipal
Other
700 East Church Street
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER • Woodcock Oil Company
Address 700 East Church Street
(Street or Route No.)
Atkinson. NC 28421
City or Town State Zip Code
4. DATE DRILLED 10/18/99 _
5. TOTAL DEPTH 17.5' -
6. CUTTINGS COLLECTED YES NO X
7. DOES WELL REPLACE EXISTING WELL? YES NO x
8. STATIC WATER LEVEL Below Top of Casing: 9 Ft.
9. TOP OF CASING IS 0 Ft. Above Land Surface*
"Top of casing terminated atlor below land surface requires a variance In accor-
dance with 16A NCAC 2C.0118
10. YIELD (gpm): NIA
11. WATER ZONES (depth):
12. CHLORINATION: Type N/A
13. CASING
Depth
METHOD OF TEST N/A
Surtcial Auuifer
Amount N/A
Wall Thickness
Industrial Agricultural
If Other, List use:
County: Pender
Diameter Or Weight/Ft. Material
From 0. To 7.5 Ft. 2"
From To Ft.
From To Ft.
14. GROUT
Depth
From 3.5 To 5.5 Ft.
From To Ft.
From To Ft.
15. SCREEN
SCH40
PVC
Material
Bentonite
Method
Poured
Depth Diameter Slot Size Material
From 7.5 To 17.5 Ft. 2" .010 PVC
From To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Depth
From 5.5 To 17.5
From To
From To Ft.
Size Material
Ft. __.. Torpedo Sand
Ft.
DRILLING LOG
From To
SEE ATTACHED
Monitoring
DEPTH
Formation Description
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
SEE ATTACHED
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO'y,OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Quad No:
FOR OFFICE USE ONLY
SIGNATURE OF PERSO
Submit original to Division of Water quundwater Section within 30 days
UCTING THE WELL
DAT

North Carolina - Department of Envwronement and Natural resources - Division of Water Quality - Groundwater Section
1936 Mail Service Center - Raleigh, N.C. 27699-1636- Phone [phone]
WELL CONSTRUCTION RECORD
AMW 8
WELL CONTRACTOR: ARM's Waterworks - Don Cummings
WELL CONTRACTOR CERTIFICATION #: 2412
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box):
Recovery Heat Pump Water injection
Municipal Industrial Agricultural n Monitoring
Other If Other, List use:
2. WELL LOCATION: (Show sketch of the location below
Nearest Town: Atkinson County: Pender
700 East Church Street
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Woodcock Oil Company
Address . 700 East Church Street
(Street or Route No.)
Atkinson. NC 28421
City or Town State
4. DATE DRILLED 10/18/99
5. TOTAL DEPTH 17.5'
Zip Code
6. CUTTINGS COLLECTED YES NO X
7. DOES WELL REPLACE EXISTING WELL? YES NO x
8. STATIC WATER LEVEL Below Top of Casing: 10 Ft.
9. TOP OF CASING IS 0 Ft. Above Land Surface*
"Top of casing terminated atfor below land surface requires a variance in accor-
dance with 16A NCAC 2C.011B
DRILLING LOG DEPTH
From To Formation Description
SEE ATTACHED
10. YIELD (gpm): NIA METHOD OF TEST N/A
11. WATER ZONES (depth): Surficial Aquifer If additional space is needed use back of form
12. CHLORINATION: Type WA Amount N/A
13. CASING Wall Thickness.
Depth Diameter Or Weight/Ft. Material
From 0 To 7.5 Ft. 2" SCH40 PVC
From To Ft.
From To Ft.
14. GROUT
Depth Material Method
From 3.5 To 5.5 Ft. Bentonite Poured
From To Ft.
From To Ft.
15. SCREEN
Depth Diameter Slot Size Material
From 7.5 To 17.5 Ft. 2" .010 PVC
From _ To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Depth Size Material
From 5.5 To 17.5 Ft. Torpedo Sand
From To Ft.
From To Ft.
LOCATION .SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
SEE ATTACHED
17. REMARKS:
• I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF PERSON
3-A-M o
UCTING THE WELL D TE
Submit original to Division of Water qua Groundwater Section within 30 days

Noith Carolina - Department of Environement and Natural resources - Division of Water Quality - Groundwater Section
1936 Mail Service Center - Raleigh, N.C. 27699-1636- Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ARM's Waterworks - Don Cummings
AMW-9 WELL CONTRACTOR CERTIFICATION #: 2412
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): Municipal Industrial ❑ Agricultural
Recovery El Heat Pump Water injection — Other If Other, List use:
2. WELL LOCATION: (Show sketch of the location below
Nearest Town: Atkinson _ County: Pender
700 East Church Street
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Woodcock Oil Company
Address 700 East Church Street
(Street or Route No.)
Atkinson, NC 28421
City or Town State
4. DATE DRILLED 10/19/99
5. TOTAL DEPTH 19.5'
Zip Code
6. CUTTINGS COLLECTED YES NO X
7. DOES WELL REPLACE EXISTING WELL? YES — NO x
8. STATIC WATER LEVEL Below Top of Casing: 10.5 Ft.
9. TOP OF CASING IS 0 Ft. Above Land Surface*
*Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C.011 B
10. YIELD (gpm): N/A METHOD OF TEST N/A
Monitoring
DRILLING LOG DEPTH
From To Formation Description
SEE ATTACHED
11. WATER ZONES (depth): Surficial Aquifer If additional space is needed use back of form
12. CHLORINATION: Type N/A Amount N/A
13. CASING Wall Thickness LOCATION SKETCH
Depth Diameter Or Weight/Ft. Material (Show direction and distance from at least two State
Roads, or other map reference points)
From 0 To 9.5 Ft. 2" SCH40 PVC
From To Ft.
From To Ft.
14. GROUT
Depth Material Method
From 3.5 To 7.5 Ft. Bentonite Poured
From To Ft.
From To Ft.
15. SCREEN
Depth Diameter Slot Size Material
From 9.5 To 19.5 Ft. 2" .010 PVC
From To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Depth Size Material
From 7.5 To 19.5 Ft.. Torpedo Sand
From To Ft.
From To • Ft.
SEE ATTACHED
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Quad No:
FOR OFFICE USE ONLY
Submit original to Division of Water qual
s 3
SIGNATURE OF PE SON COCTING THE WELL DAT
roundwater Section within 30 days

Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company, Atkinson, North Carolina
APPENDIX C
ACCESS AGREEMENT FROM SITE PROPERTY OWNER
:4TC
ENNINNNNENIAL• CE/7ECNNICAL
INILNINC SCIENCES • NITENIALS 7ESTIIC

UNDERGROUND STORAGE TANK SECTION
February 10, 2020
Mr. Hassan Osman
Hydrogeologist
DWM/UST Section
1637 Mail Service Center
Raleigh, NC 27699-1637
Dear Mr. Osman
RE: Woodcock Oil Company
700 East Church Street
Atkinson, Pender County, North Carolina
Incident Number: 16996
I am/We are the owner(s) of a parcel of property, located at or near the incident in question, and
hereby permit the Department of Environmental Quality (Department) or its contractor to enter upon said
property for the purpose of conducting an assessment and/or remediation of the groundwater and/or soils
under the authority of G.S. 143-21594G.
I am/We are granting permission to the lands we own or control with the understanding that:
1. The investigation shall be conducted by the UST Section of the Department's Division of Waste
Management or its contractor.
2. The costs of construction and maintenance of the site and access shall be borne by the Department or
its contractor. The Department or its contractor shall protect and prevent damage to the surrounding
lands. Any damages will be restored by the Department or its contractor to as close to the pre -work
condition as practicably possible.
3. Unless otherwise agreed, the Department or its contractor shall have access to the site by the shortest
feasible route to the nearest public road. The Department or its contractor will notify the land owners
48 hours prior to entry and may enter upon the land at reasonable times and have full right of access
during the period of the investigation.
4. Any claims which may arise against the Department or its contractor shall be governed by Article 31
of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State Departments and
Agencies, and as otherwise provided by law.
5. The information derived from the investigation shall be made available to the owner upon request and
is a public record, in accordance with G.S. 132-1.

F
6. The activities to be carried out by the Department or its contractor are for the primary benefit of the
Department and of the State of North Carolina. Any benefits accruing to the owner are incidental.
The Department or its contractor is not and shall not be construed to be an agent, employee, or
contractor of the landowner. No representations or warranties, either expressed or implied, have been
made to me/by the Department, the State of North Carolina, or its/their contractor(s) regarding the
results that may be obtained or the quality of work to be performed.
I/We agree not to interfere with, remove or any ways damage the Department's well(s) or its
contractor's well(s) and equipment during the investigation.
Sincerely,
Signature
/(1q (-) PC` k-
Type/Print Name of Owner or Agent
9fq q22-05K3
Phone Number
tez L C/g' t
Address
2-I
City/State/Zip Code
2.0
Date
RE: Woodcock Oil Company
700 East Church Street
Atkinson, Pender County, North Carolina
Incident Number: 16996

ATC
ENVIRONMENTAL• GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
March 15, 2021
Ms. Shristi Shrestha
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section, UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Reference: Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company
700 East Church Street
Atkinson, Pender County, North Carolina
NCDEQ Incident No. 16996
Dear Ms. Shrestha:
RI
ATC Associates of North Carolina, P.C. (ATC) has prepared the enclosed Notice of Intent to
Construct or Operate Injection Wells on behalf of the North Carolina Department of
Environmental Quality State -Lead Program. The permit application covers the performance of
passive remediation in three monitoring wells associated with the above referenced site
If you have questions or require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Ashley M. Winkelman, P.G.
Senior Project Manager
cc: Hassan Osman, Hydrogeologist for NCDEQ
Attachments

Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company, Atkinson, North Carolina
NOTICE OF INTENT FORM
ATC
E.RON•ENIAL • OEORCMICAI
NII0.61s6iCIENLCi• k11ENatiiE511116

NC Department of Environmental Quality — Division of Water Resources (DWR)
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are `permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C.0200 (NOTE: This form must be received at least 14 DAYS prior to injection)
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells is located within an area that does not exceed five percent of the land surface
above the known extent of groundwater contamination. An individual permit shall be required to conduct more
than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
5) In -Situ Thermal Wells (IST) — Used to `heat' contaminated groundwater to enhance remediation
Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.
DATE: March 15 , 20_21 PERMIT NO. (to be filled in by DWR)
NOTE- If this NOI is being submitted as notification of a modification of a previously issued NOI for this site (e.g.,
different injection wells, plume, additives, etc.) and still meets the deemed permitted by rule criteria, provide the
previously assigned permit tracking number and any needed relevant information to assess and approve injection:
A.
B.
Permit No. WI Issued Date:
WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well Complete sections B through F, J, M
(2) Aquifer Test Well .Complete sections B through F, J, M
(3) X Passive Injection System ..Complete sections B through F, H-M
(4) Small -Scale Injection Operation Complete sections B through M
(5) Pilot Test Complete sections B through M
(6) In -Situ Thermal (IST) Well Complete all sections except K
STATUS OF WELL OWNER: State Government
Deemed Permitted GW Remediation NOI Rev. 2-14-2020
Page 1

C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name: Hassan Osman — Hydrogeologist, North Carolina Department of Environmental Quality
Mailing Address: 1646 Mail Service Center
City: Raleigh State: NC Zip Code: 27699-1646 County: Wake
Day Tele No.: 919-707-8167
Cell No.: Not Available
EMAIL Address: [e-mail] Fax No.: Not Available
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Maulin Patel
Company Name Not Applicable
Mailing Address: 126 W. Church St
City: Atkinson State: NC Zip Code: 28421 County: Pender
Day Tele No.: 919-922-0563 Cell No.: Not Available
EMAIL Address: Not Available
Fax No.: Not Available
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name: Ashley M. Winkelman — ATC Associates of North Carolina, P.C.
Mailing Address: 2725 E. Millbrook Road, Suite 121
City: Raleigh State: NC_ Zip Code:27604 County: Wake
Day Tele No.: 919-871-0999 Cell No.: 919-830-3576
EMAIL Address: [e-mail]
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Woodcock Oil Company
700 East Church Street
Fax No.: 737-207-8261
City: Atkinson County: Pender Zip Code: 28421
(2) Geographic Coordinates: Latitude**: " or 34 °.53189
Longitude**: " or 78 °. 16374
Reference Datum: WGS84 Accuracy: 10-meter
Method of Collection: DOQ — Acme Mapper 2.2
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: square feet
Land surface area of inj. well network: square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification.
(1)
Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
Included in the Figures section.
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3)
Included in the Figures section.
Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing and
proposed wells.
Included in the Figures section.
DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE — Provide a brief narrative
regarding the cause of the contamination, and purpose, scope, goals of the proposed injection activity:
ATC will install three Provect ORS sleeves each in monitoring wells AMW-4, AMW-8, and AMW-9 in order
to aide in natural attenuation and reduce compounds concentrations to below the North Carolina Groundwater
Quality Standards (2L Standards). Based on the most recent sampling event performed in May 2020, the
following compounds exceeded the 2L Standards: benzene and naphthalene. The sleeves come in 3-foot
sections. ATC will install three 3-foot sections at the base of the wells, across the well screen. The socks will
release oxidizing solids into the groundwater for approximately 6 months, at which point the chemicals in the
socks will have depleted.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: Proposed 3 Existing (provide NC Well
Construction Record (GW-1) for each well) Included in Appendix B
(2) Appx. injection depths (BLS): 8.5-19.5
(3) For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
K. INJECTION SUMMARY
NOTE: Only injectants approved by the epidemiology section of the NC Division of Public Health, Department
of Health and Human Services can be injected. Approved injectants can be found online at
http: //deq. nc. gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/ground-water-approved-injectants. All other substances must be reviewed by the DHHSprior to use.
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 3

Contact the UIC Program for more info if you wish to get approval for a different additive. However, please
note it may take 3 months or longer.
Injectant: Provect ORS Sleeves Total Amt. to be injected (gal)/event: 3,114 in3 (volume of' sleeves)
Amt. Water to be injected (gal/event) :
Total Amt. to be injected (gal/event):
No. of separate injection events:1
N/A
3,114 in3 (volume of sleeves)
Est. Total Amt. to be injected (gal): 3,114 in3 (volume of
sleeves)
Source of Water (if applicable): N/A
L. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
Approximately 6 months after the installation of the Provect ORS sleeves, ATC will collect a sample from the
wells for analysis of volatile organic compounds by EPA Method 6200B. The samples will be shipped to Pace
Analytical in Mt. Juliet, Tennessee. ATC will also measure dissolved oxygen, conductivity, temperature, pH,
and oxygen reduction potential during the sampling event.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: "I hereby cent , under penalty of lcnv, that I am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules."
Ashley Winkelman on behalf of Hassan Osman, NCDEQ
Signature of Applicant Print or Type Full Name and Title
Property Owner (if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I 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
(15A NCAC 02C .0200)."
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the land owner, in the
absence of contrary agreement in writing.
See Appendix C Maulin Patel
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 4

Please send 1 (one) hard color copy of this NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Page 5

Ashley Winkelman
From: Osman, Hassan <[e-mail]>
Sent: Monday, March 15, 2021 11:09 AM
To: Ashley Winkelman
Subject: RE: [External] #16996 Woodcock Oil NOI
Hassan Osman from UST Section, Trust Fund Brach, I am giving a permission ATC to submit NOI on behalf of UST Section,
Trust Fund Brach. If you have any questions you can contact at [phone].
Thanks
Hassan
From: Ashley Winkelman <[e-mail]>
Sent: Monday, March 15, 2021 10:59 AM
To: Osman, Hassan <[e-mail]>
Subject: [External] #16996 Woodcock Oil NOI
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Hey Hassan,
I'm getting ready to submit the Notice of Intent for the ORS Sleeve installation at Woodcock Oil. Can you respond to this
email giving me permission to sign the NOI on your behalf?
Ashley M. Winkelman PGI SENIOR PROJECT MANAGER 1 ATC Group Services LLC
Direct [phone] I Cell [phone]
ETC
2725 E. Millbrook Road, Suite 121 1 Raleigh, NC 27604
Fax [phone] I [e-mail] I www.atcgroupservices.com
This email and its attachments may contain confidential and/or privileged information for the sole use of the intended recipient(s). If you are
not the intended recipient, any use, distribution or copying of the information contained in this email and its attachments is strictly prohibited.
If you have received this email in error, please notify the sender by replying to this message and immediately delete and destroy any copies
of this email and any attachments. The views or opinions expressed are the author's own and may not reflect the views or opinions of ATC.
1

Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company, Atkinson, North Carolina
FIGURES
ATC
E.RON•ENIAL • OEORCMICAI
NII0.61s6iCIENLCi• k11ENatiiE511116

H.\2020\OTHER OFFICES \NORTH CAROLINA\NCDEQ-STATE LEAD\WOODCOCK OIL\SLP1699602-BENZ.DWG. FIG5
AMW-1
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NA\ LOCATION \ %
\
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LEGEND:
AMW-11 MONITORING WELL
5).50 Well Identification
Benzene Concentration (pg/L)
T-1 TYPE III MONITORING WELL
�- Well Identification
CCDW-1 WATER SUPPLY WELL
�- Well Identification
CCDW-2 ABANDONED WATER SUPPLY WELL
Well Identification
— SITE PROPERTY LINE
PARCEL LINE
FORMER PRODUCT PIPING
WATER LINE
O FORMER DIESEL DISPENSER
O FORMER KEROSENE DISPENSER
▪ FORMER GASOLINE DISPENSER
BENZENE ISOCONCENTRATION CONTOUR
(DASHED WHERE INFERRED) (Ng/L)
NOTE: ALL LOCATIONS ARE APPROXIMATE
P—P—
W—w—
i
AM W-7
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RESIDENTIAL
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AMW-8
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FORMER
UST BASIN
i
AMW-4
19
10
\
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w
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(ABANDONED)
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BENZENE ISOCONCENTRATION CONTOUR MAP
WOODCOCK OIL CO. = INCIDENT #16996
700 EAST CHURCH STREET
ATKINSON, PENDER COUNTY, NORTH CAROLINA
LL
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SCALE: 1" = 40'
Date
6/20
Scale'
AS SHOWN
Figure:

H.\2020\OTHER OFFICES \NORTH CAROLINA\NCDEQ-STATE LEAD\WOODCOCK OIL\SLP1699602-NAP.DWG. FIG6
AMW-8
8.7
\
LEGEND:
AMW-11 MONITORING WELL
+<1.0
Well Identification
Naphthalene Concentration (pg/L)
T-1 TYPE III MONITORING WELL
�— Well Identification
CCDW-1 WATER SUPPLY WELL
�— Well Identification
CCDW-2 ABANDONED WATER SUPPLY WELL
Well Identification
---- SITE PROPERTY LINE
PARCEL LINE
P P— FORMER PRODUCT PIPING
w— WATER LINE
FORMER DIESEL DISPENSER
FORMER KEROSENE DISPENSER
▪ FORMER GASOLINE DISPENSER
NAPHTHALENE ISOCONCENTRATION CONTOUR
(DASHED WHERE INFERRED) (Ng/L)
NOTE: ALL LOCATIONS ARE APPROXIMATE
(-' • T-14- \
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\ �m1' MW-17
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▪ 111111
RESIDENTIAL
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AMW-11
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(ABANDONED)
AM W-6
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SCALE: 1" = 40'
Project Number:
SLP1699602
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NAPHTHALENE ISOCONCENTRATION CONTOUR MAP
WOODCOCK OIL CO. - INCIDENT #16996
700 EAST CHURCH STREET
ATKINSON, PENDER COUNTY, NORTH CAROLINA
LL
>-
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Date
6/20
Scale:
AS SHOWN
Figure:

GRAVEL
AREA
Former
UST Basin
DL-3
P-1 (10_:) '• S-8 Er
' �/
s-6r Former S-7�' ,DL-2
1 Gasoline
PAVED 1
AREA o S 5
♦
STORE
euser ps
S-1
S-2 — i
S-3
7s4
LB 1 DW-1
LEGEND
• Soil Sample Location
* Domestic Well Location
Former
Kerosene
Dispenser
Dispenser Line
Trench Excavation
X X I I ILA Former Diesel
DL-6 I I L-3 and Kerosene
\ \ � Dispensers
\ \ L-8 i i L-4
-\• 411
• AST-1 I
Former DL 7 �' L-7 L-5 1
Loading AST-2 I
•
Rack ` •
L-6
A:3
1
AST-4
•
1
1
1
1 I
DL-8 \•
/,,,..,/ii/.iiii'/
FORMER
* OFFICE
/ ///7//////////% %
1
DL-9
DL-10W 0 •
AST-6•
DL-10 i•
Approx. Limits
Of Excavation
AST-5
•
Former AST Basin
71(ke.
pplied Resource Management PC
P.O. Box 882, Hampstead, NC 28443
[phone] FAX [phone]
TITLE: SITE MAP WITH ABATEMENT
SOIL SAMPLE LOCATIONS
JOB:
9914
SCALE:
1"=40'
DATE:
1 /9/03
DRAWN BY:
JLC/EFC
FIGURE:

TABLE 1
ABATEMENT SOIL SAMPLE RESULTS SUMMARY
EPA METHODS 3550 and 5030
FORMER WOODCOCK OIL COMPANY
ATKINSON, NORTH CAROLINA
Concentrations in Parts Per Million (mg/Kg)
SAMPLE LOCATION
EPA METHOD
FIELD
IDENTIFICATION
MAP
IDENTIFICATION
SAMPLE
DATE
SAMPLE
DEPTH
3550
5030
Pit 1
P-1
8/6/02
6'
<10
<5
Pit 1
P-1
8/6/02
10'
<10
<5
SW-1
S-1
8/6/02
12'
<10
<5
SSW-1
S-2
8/8/02
8'
<10
296
SSW-2
S-3
8/12/02
8'
<10
<5
EESW-1
S-4
8/12/02
6'
<10
<5
CWSW-1
S-5
8/8/02
8'
<10
39.7
NWESW-1
S-6
8/9/02
8'
<10
<5
NECSW-1
S-7
8/9/02
8'
<10
<5
NEESW-1
S-8
8/9/02
8'
<10
<5
DL-2
DL-2
8/7/02
4'
<10
<5
DL-3
DL-3
8/7/02
4'
<10
<5
ESWDL-4
DL-4
8/7/02
8-9'
<10
<5
DL-5
DL-5
8/12/02
4'
<10
<5
DL-6
DL-6
8/12/02
4'
<10
<5
DL-7
DL-7
8/13/02
4'
<10
<5
DL-8
DL-8
8/13/02
4'
<10
<5
DL-9
DL-9
8/13/02
4'
<10
<5
DL-10
DL-10
8/13/02
4'
<10
<5
DL-10W
DL-10W
8/13/02
6'
<10
<5
LRNSW-3
L-1
8/12/02
6-8'
<10
<5
LRNSW-2
L-2
8/12/02
6-8'
<10
<5
LRNSW-1
L-3
8/12/02
5'
923
<5
LRESW-1
L-4
8/12/02
5'
<10
<5
LRESW-2
L-5
8/12/02
6'
<10
<5
LRSSW-1
L-6
8/12/02
8'
<10
<5
LRWSW-1
L-7
8/12/02
8'
<10
<5
LRSW-2
L-8
8/12/02
8'
11.6
<5
AST-1
AST-1
8/12/02
3'
<10
<5
AST-2
AST-2
8/12/02
3'
<10
<5
AST-3
AST-3
8/12/02
3'
<10
<5
AST-4
AST-4
8/12/02
2'
<10
<5
AST-5
AST-5
8/12/02
2'
<10
<5
AST-6
AST-6
8/12/02
2'
<10
<5
Shaded areas represent non compliant hydrocarbon concentrations. Noncompliant defined as 40 mg/kg for
EPA Method 3550, and 10 mg/kg for EPA Method 5030.

B
AMW-10
(99.18)
LEGEND
GRAVEL
AREA
_ 1
Former 4100.00)
UST Basin
Former
• Kerosene
• e Dispenser
7)
AMW-9 •
(99.40) AMW-2s
(99.10)
LB1 DW-1
i FORMER
*OFFICE
•
S-1
B-6•
53
AMW-7
(98.33)
B' GRASSED
AREA
Diesel
and Kerosene
Dispensers
•B-4
Diesel AST
Dies OAST
Gas AST
Gas AST
• B-3
AMW-6
(96.42)
S3•AMW-5�
Former r • S-2 (96.57)
UST Basinn" ' B-5A
AMW-4
(98.65)
• Exploratory Boring Location
O Type II Monitoring Well Location
& Type III Monitoring Well Location
* Approximate Domestic Well Location
(94.15) Top of Casing Elevation (in feet)
Gas AST
• B-5
CCDW-2 • AMW-11
(98.15)
AMW-12Q
(95.14)
*
CCDW-1
A
pplied Resource Management f C
(9
P.O. Box 882. Ho,w teas. NC 28443
10)270-2919 FAX [phone]
TITLE:
SITE MAP WITI-I AQUIFER
TRANSECT LOCATIONS
JOB:
9914
SCALE:
1 " = 40'
DATE:
5/16/00
DRAWN BY:
DHC
FIGIJRF:
5

0
n z
,V-V 1O3SNV2112133If10V
os
120.00
100.00
80.00
60.00
40.00
A
AMW-8 8-2 AMW-3 T-2 AMW-9 AMW-2 8-4 B-3
(99.57')
(99.96') (100.07') (99,40) (99.10')
LEGEND
20.00 — SP - Poorly graded sands or gravelly
sands, little or no fines.
00,00
CH - Inorganic clays of high plasticity, fat clays.
• . SC - Clayey sands, sand -clay mixtures.
V Groundwater table elevation
r — as of 3/21 /00.
A'
AMW-12
(95.14')
Scale: 1 "=40' horiz.
1 "=20' vert.
40 80 120 160 200 240 280

euWW aa,inoGapaij
0
co
o D
m
0
0
0
z
n z
co
,9-9133SNV2112J3difl©V
m
C
m
120.00
100.00
80.00
60.00
40.00
20,00 --I
00.00
B
AMW-10
(99.18')
T-2 AMW-1
(100.07') (99.05')
LEGEND
SP - Poorly graded sands or gravelly
sands, little or no fines.
CH - Inorganic clays of high plasticity, fat clays.
• SC - Clayey sands, sand -clay mixtures.
— Groundwater table elevation
as of 3/21 /00,
40 80 120
B'
AMW-7
(98.33')
Scale: 1 "=40' horiz,
1 "=20' vert,
I I I I I
160 200 240 280

H.\2020\OTHER OFFICES \NORTH CAROLINA\NCDEQ-STATE LEAD\WOODCOCK OIL\SLP1699602-POT.DWG. FIG4
AMW-8
89.11
LEGEND:
AMW-11 MONITORING WELL
8.32 Well Identification
Relative Groundwater Elevation (ft)
T-1 TYPE III MONITORING WELL
— — Well Identification
CCDW-1 WATER SUPPLY WELL
�— Well Identification
CCDW-2 ABANDONED WATER SUPPLY WELL
7 Well Identification
— p—p-
- ww - w—
❑K
O
— 89.0—
SITE PROPERTY LINE
PARCEL LINE
FORMER PRODUCT PIPING
WATER LINE
FORMER DIESEL DISPENSER
FORMER KEROSENE DISPENSER
FORMER GASOLINE DISPENSER
GROUNDWATER ELEVATION CONTOUR
(DASHED WHERE INFERRED)
GROUNDWATER FLOW DIRECTION
NOTE: ALL LOCATIONS ARE APPROXIMATE
AMW-3R
91.87
STOR
AMW-1
88.53
t
RESIDENTIAL
RESIDENTIAL
1
AMW-16
-N.87 3
L
WSW-2*
(ABANDONED)
AMW-12
86.92
AMW-13
10- NM . 411.110
_AMW-15
NM
rt
•
AMW-17
NM
tMW-14
864h+■
iff
OP r
tee,
■
40
41a-
i
10 20 30 40
SCALE: 1" = 40'
1
u-
>-
cn
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W a
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>-
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°oaa
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Project Number:
Date
6/20
SLP1699602
GROUNDWATER ELEVATION CONTOUR MAP
Scale:
AS SHOWN
Figure:
WOODCOCK OIL CO. - INCIDENT #16996
700 EAST CHURCH STREET
ATKINSON, PENDER COUNTY, NORTH CAROLINA

Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company, Atkinson, North Carolina
APPENDIX A
MSDS FORM
ATC
En1RON•ENIAL • OEORCMICAI
NII0.61s6iCIENLCi• k11EN14iiE511116

* rovectus
El*1VIRONMENTAL PRODUCTS
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 1 of 5
1. PRODUCT IDENTIFICATION: PROVECT-ORS
PRODUCT USE: Soil and water treatment.
MANUFACTURER: EMERGENCY PHONE:
PROVECTUS ENVIRONMENTAL
2871 W. Forest Rd., Suite 2
Freeport, IL
61032
USA: ($15) 650-2230
TRANSPORTATION OF DANGEROUS GOOD CLASSIFICATION:
Oxidizing Solid, n.o.s. (Calcium Peroxide), Class 5.1, PG II, UN1479
WHMIS CLASSIFICATION:
Oxidizer
2. COMPOSITION/INFORMATION ON INGREDIENTS
Ingredients
Calcium Peroxide
Inorganic Nutrients
3. PHYSICAL DATA
Chemical Formula
CaO2
CAS No. Percentage
1305-79-9 75%-85%
15%-25%
Appearance White & brown granules
Physical state Solid
Odor threshold None
Bulk Density 500-650g/L
Solubility in Water Insoluble
pH —11
Decomposition Temperature Self -accelerating decomposition with oxygen release starting from 275
degrees Celsius
4. HAZARDS IDENTIFICATION
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:
• General Irritating to mucous membrane and eyes.

rovectus
ENVIRONMENTAI. 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,

rovectus
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.

* rovers
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
• Oxygen which supports combustion

rovectus
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

Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company, Atkinson, North Carolina
APPENDIX B
MONITORING WELL CONSTRUCTION DETAILS
ATC
En1RON•ENIAL • OEORCMICAI
NII0.61s6iCIENLCi• k11EN14iiE511116

North Carolina - Department of Environement and Natural resources - Division of Water Quality - Groundwater Section
1936 Mail Service Center - Raleigh, N.C. 27699-1636- Phone [phone]
WELL CONSTRUCTION RECORD
AMW-4
WELL CONTRACTOR: ARM's Waterworks - Don Cummings
WELL CONTRACTOR CERTIFICATION #: 2412
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): Municipal Industrial Agricultural a Monitoring El
Recovery El Heat Pump Water injection Other If Other, List use:
2. WELL LOCATION: (Show sketch of the location below
Nearest Town: Atkinson County: Pender
700 East Church Street
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Woodcock Oil Company
Address 700 East Church Street
(Street or Route No.)
Atkinson, NC 28421
City or Town State Zip Code
4. DATE DRILLED 10/18/99
5. TOTAL DEPTH 17.5'
6. CUTTINGS COLLECTED YES NO X
7. DOES WELL REPLACE EXISTING WELL? YES _ NO x
8. STATIC WATER LEVEL Below Top of Casing: 9 Ft.
9. TOP OF CASING IS 0 Ft. Above Land Surface*
'Top of casing terminated atior below land surface requires a variance In accor-
dance with 16A NCAC 2C.0118
10. YIELD (gpm): N/A METHOD OF TEST N/A
DRILLING LOG DEPTH
From To
SEE ATTACHED
Formation Description
11. WATER ZONES (depth): Surficial Aquifer If additional space is needed use back of form
12. CHLORINATION: Type N/A Amount N/A
13. CASING Wall Thickness LOCATION SKETCH
Depth Diameter Or Weight/Ft. Material (Show direction and distance from at least two State
Roads, or other map reference points)
From
To 7.5 Ft. 2" SCH40 PVC
From To Ft.
From To Ft.
14. GROUT
Depth Material Method
From 3.5 To 5.5 Ft. Bentonite Poured
From To Ft.
From To Ft.
15. SCREEN
Depth Diameter Slot Size Material
From 7.5 To 17.5 Ft. 2" .010 PVC
From To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Depth Size Material
From 5.5 To 17.5 Ft. Torpedo Sand
From To Ft.
From To Ft.
SEE ATTACHED
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
OWNER.
99-ieje)
UCTING THE WELL DAT
Quad No:
FOR OFFICE USE ONLY
SIGNATURE OF PERSO
Submit original to Division of Water qu7" 'undwater Section within 30 days

North Carolina - Department of Environement and Natural resources - Division of Water Quality - Groundwater Section
1936 Mail Service Center - Raleigh, N.C. 27699-1636- Phone [phone]
WELL CONSTRUCTION RECORD
AMW-8
WELL CONTRACTOR: ARM's Waterworks - Don Cummings
WELL CONTRACTOR CERTIFICATION #: 2412
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): Municipal Industrial Agricultural 0 Monitoring El
Recovery D Heat Pump Water injection Other If Other, List use:
2. WELL LOCATION: (Show sketch of the location below
Nearest Town: Atkinson County: Pender
700 East Church Street
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Woodcock Oil Company
Address 700 East Church Street
(Street or Route No.)
Atkinson. NC 28421
City or Town State Zip Code
4. DATE DRILLED 10/18/99
5. TOTAL DEPTH 17.5'
6. CUTTINGS COLLECTED YES NO X
7. DOES WELL REPLACE EXISTING WELL? YES _ NO x
8. STATIC WATER LEVEL Below Top of Casing: 10 Ft.
9. TOP OF CASING IS 0 Ft. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 16A NCAC 2C.0118
10. YIELD (gpm): N/A METHOD OF TEST N/A
DRILLING LOG DEPTH
From To
SEE ATTACHED
Formation Description
11. WATER ZONES (depth): Surficial Aquifer If additional space is needed use back of form
12. CHLORINATION: Type N/A Amount N/A
13. CASING Wall Thickness. LOCATION SKETCH
Depth Diameter Or Weight/Ft. Material (Show direction and distance from at least two State
Roads, or other map reference points)
From 0 To 7.5 Ft. 2" SCH40 PVC
From To Ft.
From To Ft. 14. GROUT SEE ATTACHED
Depth Material Method
From 3.5 To 5.5 Ft. Bentonite Poured
From To Ft.
From To Ft.
15. SCREEN
Depth Diameter Slot Size Material
From 7.5 To 17.5 Ft. 2" .010 PVC
From To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Depth Size Material
From 5.5 To 17.5 Ft. Torpedo Sand
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF PERSON
Submit original to Division of Water qu
S/aa%p 0
UCTING THE WELL D TE
Groundwater Section within 30 days

1 North Carolina - Department of Environement and Natural resources - Division of Water Quality - Groundwater Section
1936 Mail Service Center - Raleigh, N.C. 27699-1636- Phone [phone]
WELL CONSTRUCTION RECORD
AMW-9
WELL CONTRACTOR: ARM's Waterworks - Don Cummings
WELL CONTRACTOR CERTIFICATION #: 2412
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): Municipal Industrial Agricultural Monitoring ❑x
Recovery Heat Pump Water injection Other If Other, List use:
2. WELL LOCATION: (Show sketch of the location below
Nearest Town: Atkinson County: Pender
700 East Church Street DRILLING LOG DEPTH
Formation Description
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Woodcock Oil Company
Address 700 East Church Street
(Street or Route No.)
Atkinson, NC 28421
City or Town State Zip Code
4. DATE DRILLED 10/19/99
5. TOTAL DEPTH 19.5'
6. CUTTINGS COLLECTED YES _ NO X
7. DOES WELL REPLACE EXISTING WELL? YES _ NO x
8. STATIC WATER LEVEL Below Top of Casing: 10.5 Ft.
9. TOP OF CASING IS 0 Ft. Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): N/A METHOD OF TEST N/A
From To
SEE ATTACHED
11. WATER ZONES (depth): Surficial Aquifer If additional space is needed use back of form
12. CHLORINATION: Type N/A Amount N/A
13. CASING Wall Thickness LOCATION SKETCH
Depth Diameter Or Weight/Ft. Material (Show direction and distance from at least two State
Roads, or other map reference points)
From 0 To 9.5 Ft. 2" SCH40 PVC
From To Ft.
From To Ft.
14. GROUT
Depth Material Method
From 3.5 To 7.5 Ft. Bentonite Poured
From To Ft.
From To Ft.
15. SCREEN
Depth Diameter Slot Size Material
From 9.5 To 19.5 Ft. 2" .010 PVC
From To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Depth Size Material
From 7.5 To 19.5 Ft. Torpedo Sand
From To Ft.
From To Ft.
SEE ATTACHED
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
5faa bt)
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF PE SON CO '•f : ACTING THE WELL DAT
roundwater Section within 30 days
Submit original to Division of Water qua!'

Notice of Intent to Construct or Operate Injection Wells
Woodcock Oil Company, Atkinson, North Carolina
APPENDIX C
ACCESS AGREEMENT FROM SITE PROPERTY OWNER
ATC
En1RON•ENIAL • OEORCMICAI
NII0.61s6iCIENLCi• k11EN14iiE511116

UNDERGROUND STORAGE TANK SECTION
February 10, 2020
Mr. Hassan Osman
Hydrogeologist
DWM/UST Section
1637 Mail Service Center
Raleigh, NC 27699-1637
Dear Mr. Osman
RE: Woodcock Oil Company
700 East Church Street
Atkinson, Pender County, North Carolina
Incident Number: 16996
I am/We are the owner(s) of a parcel of property, located at or near the incident in question, and
hereby permit the Department of Environmental Quality (Department) or its contractor to enter upon said
property for the purpose of conducting an assessment and/or remediation of the groundwater and/or soils
under the authority of G.S. 143-215.94G.
I am/We are granting permission to the lands we own or control with the understanding that:
1. The investigation shall be conducted by the UST Section of the Department's Division of Waste
Management or its contractor.
2. The costs of construction and maintenance of the site and access shall be borne by the Department or
its contractor. The Department or its contractor shall protect and prevent damage to the surrounding
lands. Any damages will be restored by the Department or its contractor to as close to the pre -work
condition as practicably possible.
3. Unless otherwise agreed, the Department or its contractor shall have access to the site by the shortest
feasible route to the nearest public road. The Department or its contractor will notify the land owners
48 hours prior to entry and may enter upon the land at reasonable times and have full right of access
during the period of the investigation.
4. Any claims which may arise against the Department or its contractor shall be governed by Article 31
of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State Departments and
Agencies, and as otherwise provided by law.
5. The information derived from the investigation shall be made available to the owner upon request and
is a public record, in accordance with G.S. 132-1.

6. The activities to be carried out by the Department or its contractor are for the primary benefit of the
Department and of the State of North Carolina. Any benefits accruing to the owner are incidental.
The Department or its contractor is not and shall not be construed to be an agent, employee, or
contractor of the landowner. No representations or warranties, either expressed or implied, have been
made to me/by the Department, the State of North Carolina, or its/their contractor(s) regarding the
results that may be obtained or the quality of work to be performed.
I/We agree not to interfere with, remove or any ways damage the Department's well(s) or its
contractor's well(s) and equipment during the investigation.
Sincerely,
Signature
Type/Print Name of Owner or Agent
gri 92-0563
Phone Number
% 2C2 aura_ 52.
Address
tic q 2-
City/State/Zip Code
Date
RE: Woodcock Oil Company
700 East Church Street
Atkinson, Pender County, North Carolina
Incident Number: 16996