WI0300290_DEEMED FILES_20150924

Permit Number WI0300290
Program Category
Deemed Ground Water
Permit Type
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
ebonee .shire
Coastal SWRule
Permitted Flow
Facility
Facility Name
Former Cemex Ready Mix Plant
Location Address
4206 Unionville-Indian Trail Rd
Lake Park
Owner
Owner Name
Cemex
Dates/Events
NC
Orig Issue
6/18/2015
App Received
6/16/2015
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
28079
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
9/24/2015
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
Denise Corrales
3820 Northdale Blvd
Tampa
Region
Mooresville
County
Union
FL
Issue
6/18/2015
Effective
6/18/2015
33624
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
Permit Number WI0300290
Program Category
Deemed Ground Water
Permit Type
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
ebonee.shire
Coastal SWRule
Permitted Flow
Facility
Facility Name
Former Cemex Ready Mix Plant
Location Address
4206 Unionville-Indian Trail Rd
Lake Park
Owner
Owner Name
Cemex
Dates/Events
NC
Orig Issue
6/18/2015
App Received
6/16/2015
Re gulated Activities
Groundwater remediation
Outfall
Waterbody Name
28079
Draft Initiated
Scheduled
Issuance Public Notice
Central Files : APS SWP
8/13/2015
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
Denise Corrales
3820 Northdale Blvd
Tampa
Region
Mooresville
County
Union
FL
Issue
6/18/2015
Effective
6/18/2015
33624
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
w�a3�J3°ro
EE
Environmental Services
June 2, 2015
Mr. Mike Rogers
Division of Water Resources
1611 Mail Service Center
Raleigh, North Carolina 27699-1611
Reference: Notification of intent to Construct or Operate Injection Wells
Former Cemex Ready Mix Plant
4206 Unionville -Indian Trail Road
Indian Trail, North Carolina
NCDENR IHSB Site #NONCD0002395
Dear Mr. Rogers:
EnviroTrac is pleased to submit the enclosed Notification of Intent to Install or Construct injection
Wells. The purpose of this corrective action is to target the localized area of elevated
trichloroethylene concentrations in monitoring well MW-4D at the site. Installing a passive
hydrogen injection device in the well would increase the degradation rate of chlorinated
hydrocarbons but still allow the well to be used as a monitoring point.
Should you have any questions regarding this notification or require additional information, please
contact the undersigned.
Very truly yours,
ENVIROTRAC LTD.
Craig D. Neil, P.G.
Senior Project Manager
Attachments: Notification of Intent to Install or Construct injection Wells
Cc: Ms. Denise Corrales, Cemex
11330 Vaen.•slcrry Drive, 1fimtt:rsrilic, NC'28078I Oflicc: (7041 897-0707 I tux: (704i 897•0.186
minv,cnvimmtrac,GOln

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT 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. This form shall be submitted at least 2 weeks prior to iniection.
AQUIFER TEST WELLS USA NCAC 02c .0220}
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION USA NCAC 02C .0225) or TRACER WELLS OSA 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.
2) Small-Scale Injection Operations -Injection wells located within a land surface area not to exceed l0,000
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 are 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.
Print Clearly or Type Information. lllegible Submittals Will Be Returned As Incomplete.
DATE: -"'Jun=ec..:2,..._ __ _,, 2015 PERMIT NO. ________ (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1)
(2)
(3)
(4)
(5)
(6)
___ .Air Injection Well ...........................•.......... Complete sections B-F, K, N
____ Aquifer Test Well ....................................... Complete sections B-F, K, N
_X~_Passive Injection System ............................... Complete sections 8-F, H-N
___ Small-Scale Injection Operation ...................... Complete sections B-N
___ Pilot Test ................................................. Complete sections B-N
___ Tracer Injection Well ................................... Complete sections B-N
B. STATUS OF WELL OWNER: Choose an item.
C. WELL OWNER-State name of entity and name of person delegated authority to sign on behalf of the business
or agency:
Name: ----=C=em=ex=-...,M=s·c..::D=e=n=is=e'--'C""o::.:.rra=le:e,Se-____________________ _
Mailing Address: 3820 Northdale Blvd .. Suite 100B __________________ _
City: Tampa State: FL Zip Code:._..:a3=-36=2::..a4'--___ County: Hillsborough
Day Tele No.: [phone]
EMAIL Address: denise.corralesr@,ce=m=e=x=.c=om==-----
UIC//n Situ Remed. Notification (Revised 3/2/2015}
Cell No.: _________ _
Fax No.: __ _,_{8=1=3_,_) 2=6~9~-l=-==0=3.:::...0 __ _
Pagel
D. PROPERTY OWNER (if different than well owner)
Name: ----------------------------------
Mailing Address · _______________________________ _
City: ____________ State: _ZipCode: _______ County . _____ _
Day Tele No.: ___________ _ Cell No.: _________ _
EMAIL Address: ____________ _ Fax No .. __________ _
E. PROJECT CONT ACT -Person who can answer technical questions about the proposed injection project.
Name: Craig Neil. EnvfroTrac Ltd.
Mailing Address : 11330 Vani;torv Drive
City: Huntersville State: NC Zip Code:_=2~80~7~8 ____ County: Mecklenburg
Day Tele No.: [phone] Cell No.: <336) 407-45 85
EMAlL Address : [e-mail] Fax No.: __________ _
F. PHYSICAL LOCATION OF WELL SITE
(1)
(2)
Physical Address: ___ 4=2=06'-=--'U=n=io=n"'"vt""'l=le~-=ln=d=ian~T=ra=il~R=o=ad~CF~i.,.gur=e~l'""') __________ _
_________________ Cou nty :-"U..,,n=io=n.,_ _____ _
City: Indian Trail State: NC Zip Code: --=2=80"-'7""'9 _____ _
Geographic Coordinates: Latitude**: ___ 0 __ , __ "orlL_0 • 075091
Longitude**: D __ " or :fill_ 0 . __ 6=3=----4=5=0_,,4 __ _
Reference Datum: ________ Accuracy: _______ _
Method of Collection: http://itouchmap.com/latlong.htm I
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPl-IlC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume : ______ .square feet
Land surface area ofinj. well network: square feet~ 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be .:S 5% of plume for pilot test injections)
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 wel1s, and existing and
proposed injection wells; and
Figure 2 shows the site layout and existing monitoring well locations. Figure 3 shows the
horizontal extent of impacted groundwater. The passive hydrogen injection system is proposed to
be installed into MW-4D.
VICI In Situ Remed. Notification (Revised 3/2/201 S) Page2
(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)
Figure 4 shows the location of the cross section A -A', Figure 5 shows the cross section with
projected vertical extent of impacted groundwater that exceed the NCCS 21, Standard.
Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
Figure 6 is the potentiometric surface map showing the rate and direction of groundwater
movement based on data collected during the February 2015 sampling event.
DESCRIPTION OF PROPOSED INJECTION ACTIVITIES — Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, votunte, and duration
of injection over time.
The injection activities are intended to improve trichloroetlnn lone CfCE f concentrations. Results of the February
2015 samplings event suiyest TCE immacted groundwater is limited and only M W -4 D exhibits TCE and daughter
products at concentrations that exceed the groundwater remediation goals. Monitorinj_well MW-4D will have
a_passive hydrogen deliver3 system installed inside the monitoring well. This system will allow hY droeen to be
iniccted into the_t;roundwatcr affecting a localized area. The performance of this system will be monitored
quarterly. - -
J. INJECTANTS - Provide a MSDS and the following for each injectant. Attach additional sheets if necessary
NOTE: Approved injectants (tracers and remediation additives) can be found online at
hits.Ilvorial,ncdenr.oryfweblwglapslgwpro. .411 other substances must be reviewed by the Division of Public
Health, Department of Nealrh and .Human Services. Contact the UIC Program for more info (919-807-6496).
Injectant: _ Hydrogen - MSDS attached
Volume of injectant; continuous release of hydrogen Ras at one cubic foot per day
Concentration at point of injection: MW-4D will range from 2.4 to 2.5 PP (based on I to 19 feet of
subrnerycncei, The In drosen concentrations are estimated base.d un a saturated h. cfrotten cnntcnl of
1.6 ppm per atmosphere.
Percent if in a mixture with other injectants NA
Injectant:
Volume of injectant:
Concentration at point of injection: __
Percent if in a mixture with other ixtjectants: -
Injectant: _
Volume of injectant
Concentration at point of injection:
Percent if in a mixture with other injectants
UIC/In Situ Reined. Notification (Revised 3/2/2015)
Page 3

K. WELL CONSTRUCTION DATA
(1) Number of injection wells: Proposed. __ ---= ___ Existing
(2) 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:
(a) well type as permanent, direct-push, or subsurface distribution system (infiltration gallery)
(b) depth below land surface of grout, screen, and casing intervals
(c) well contractor name and certification number
A passive hydrogen injection system diagram with well construction details for MW-4D is
attached. The well contractor name and certification number are unknown.
L. SCHEDULES -Briefly describe the schedule for well construction and iajection activities.
Envirotrac will travel to the si te and insta ll the de li ven s, stem u, , in rece ip t o f the permit. The h, d rogen will
be iniectcd ctimin uouslv and the content of the h , drm;.en c , linders and lidJ parameters will be mon itored
monthlv.
M. MONITORING PLAN -Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subcharter 02L result from the injection activity.
Groundwater samples will be collected from M W-4D quarterh. The performance of the passive h~ dr l!en
deliverv svstem will be evaluated followine three months of operation.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, 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 i,iformation is true, accurate and complete. I am aware that
there are significant penalties, including the possibility of fines and imprisonment, for submitting false
i,iformation. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
~ re.late·d. appurrrnces in acco:dance ~ith the 15A . ·c IC f 2C 0200 Rules. "A } · ~ ~ ~I\,~ L.ot'r<X-le'
• ig n t~ or Applicant J:. . Print or Type Full Name
\) \ e..e.c::fo( L.,f\Vi rbf\~,--A--L
PROPERTY OWNER (if the property is not owned by the permit 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
(I 5A NCAC 02C .0200)."
UIC/Jn Situ Remed. Notification (Revised 3/2/2015) Page4
"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.
Signature* of Property Owner (If different from applicant) Print or Type Full Name
• An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Submit the completed notification package to:
UIC//n Situ Remed. Notification (Revised 3/2/2015)
DWR -UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Pages
!cnviro ra
EnvirOnlnsnlll SeivIcex
PASSIVE HYDROGEN INJECTION SYSTEM DIAGRAM
PROJECT Farmer Cernex Ready Mix Plant- Indian Trail
PROJECT NUMBER 11.990021.00
WELL NUMBER MW-4D
ELEVATION OF TOP OF WELL CASING 643.17 feet MSL
HYDROGEN INSTALLED ON June 2015 - Proposed
STEEL WELL
VAULT
L A
18.13'
18.13'
23.13'
DEPTH TO WATER FROM
TOP OF WELL CASING 6.52 feet
WATER LEVEL ELEVATION 836.85 feet MSL
WATER LEVEL MEASURE[] ON 02/1212015
NOTE: DRAWING NOT TO SCALE
GROUNDING
ROD
,v
SUPPLY LINE
SUPPORT CABLE
TOP OF FILTER PACK'
TOP OF SCREEN
-- HYDROGEN
DIFFUSER
BOTTOM OF WELL 23
REGULATOR/
PRESSURE
GAUGE
HYDROGEN
CYLINDER
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DATE: 212712015
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SITE LOCATION MAP
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UNIONVILLE-INDIAN TRAIL ROAD
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LEGEND
�Approximate Groundwater trlonFtorknq
1%11 Location
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Ali CONCENTHAT1ONS IN MICROGRAMS PER
UTER. ONLY CONCENIRAIHNS WESTER
THAR 2L STANDARDS SHOWN.
FIGURE 3
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FORMER READY MIX P APIT
UNIDIMLLE-FRAIL ROAD
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MW-B UONITOISNO WALL LOCATION
APPROXIMATE ABANDONED
usi-2 MONITORING WELL LOCATION
FJGUR£4
CROSS SECTION LOCATION MAP
FORMER READY MIX PLANT
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TCE=116
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COCLIRRANOM OP UTRIl9VES
HORIZONTAL SCALE
1
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A'
VERTICAL SCALE EXAGGERATED BY 3.
NOTES:
RASED ON EA ENGINEERING, SCIENCE, AND
TECHNOLOGY, INC. PROTECT NO. 12415.01, FIGURE 9,
DATED 5/1993.
ALL CONCENTRATIONS SHOWN IN MICROGRAMS PER
LITER.
ONLY CONCENTRATIONS GREATER THAN 2L
5T AN DA ROS SHOWN,
LEGEND
MW-40
uw-2
C-DCE
TCE
VC
CaDIKAVATER ELEVATION
DATA ER4M 23 MARCN 1993
90
GROUNDWATER ELEVATION
DATA FROM FEB 2C15
yr
80
-- 70
60
APPROXIMATE GROUNDWATER MONITORING
WELL .00ATI ON
AP PROXIMATE ABANDONED
MONITORING WELL tOCATICMI
APPROX MATE EXTENT OF GROUNDWATER
EMEEDANCES (N1 STORK}
AP PROXIMATE EXTENT OF GRO UNXIrrATER
EXCEEDAItCES(CURRENT)
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TRILHLCROETHENE
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LEGEND
µ�APPRPXO,ATE GROUNDWATER
8 UDNITnRiNG WELL LOCATION
APPROXIMATE GROW1DWATER
(640.30 ELEVATEON CONTOURS (ft)
GROUNDWATER CONTOUR LINE
GROUNDWATER FLOW DIRECTION
RGURE 6
GROUNDWATER POTENTIOMETRICSURFACE MAP
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HYDROGEN MSDS
SAFFTV DATA SHEET
Hydrogen
Airgas
LSection 1. Identification
GH$ product identifier
Chemical name
Other means of
Identification
Product use
Synonym
SOS #
Suppliers details
Emergency telephone
number (with hours of
operation)
Hydrogen
hydrogen
Dihydrogen; o-Hydrogen; p-Hydrogen; Molecular hydrogen; H2; UN 1049
Synthetic/Analytical chemistry.
Dihydrogen; o-Hydrogen; p-Hydrogen; Molecular hydrogen; H2; UN 1049
001026
Airgas USA, LLC and its affiliates
259 North Radnor -Chester Road
Suite 100
Radnor, PA 19087-5283
1-610-687-5253
1-866-734-3438
Lsection 2. Hazards identification
OS HAIHCS status
Classification of the
substance or mixture
[3HS label elements
Hazard pictograms
Signal word
Hazard statements
Precautianary atement-
General
Prevention
Response
Storage
Disposal
ate of issue/Date of revision
This material is considered hazardous by the OSHA Hazard Communication Standard
(29 CFR 1910.1200).
FLAMMABLE GASES - Category 1
GASES UNDER PRESSURE - Compressed gas
I `I
Danger
• Extremely flammable gas.
Contains gas under pressure; may explode if heated
Burns with invisible flame.
May displace oxygen and cause rapid suffocation,
Read and follow ail Safety Data Sheets (SDS'S) before use. Read label before use.
Keep out of reach of children. If medical advice is needed, have product container or
label at hand. Close valve after each use and when empty. Use equipment rated for
cylinder pressure. Do not open valve until connected to equipment prepared for use.
Use a back flow preventative device in the piping. Use only equipment of compatible
materials of construction. Approach suspected leak area with caution_
Never Put cylinders into unventilated areas of passenger vehicles, Keep away from
heat, sparks, open flames and hot surfaces. - No smoking. Use and store only outdoors
or in a well ventilated place.
Leaking gas fire: Do not extinguish, unless leak can be stopped safety. Eliminate all
ignition sources if safe to do so.
Protect from sunlight Protect from sunlight when ambient temperature exceeds
52T/125°F. Store in a well -ventilated place
Not applicable.
1O/I5P2014. Dale of previous issue : 10/2J21014. Version :0.02 1/12 }
rewfw nd by rl bs

------------------------------Hydrogen
Section 2. Hazards identification
Hazards not otherwise
classified
: In addition to any other important health or physical hazards, this product may displace
oxygen and cause rapid suffocation.
Section 3. Composition/information on ingredients
Substance/mixture
Chemical name
Other means of
Identification
CAS number/other Identifiers
CAS number
Product code
Ingredient name
hydrogen
Substance
hydrogen
Dihydrogen; a-Hydrogen; p-Hydrogen; Molecular hydrogen; H2; UN 1049
1333-74-0
001026
%
100
CAS number
1333--74-0
There are no additional ingredients present which, within the current knowledge of the supplier and in the
concentrations applicable, are classified as hazardous to health or the environment and hence require reporting
in this section.
Occupational exposure llmlts, if available, are listed in Section 8.
[ Section 4. First aid measures
Description of necessary flrst aid measures
Eye contact Immediately flush eyes with plenty of water, occasionally lifting the upper and lower
eyelids. Check for and remove any contact lenses. Continue to rinse for at least 1 O
minutes. Get medical attention tf irritation occurs.
Inhalation Remove victim to fresh air and keep at rest in a position comfortable for breathing. If
not breathing, if breathing is irregular or if respiratory arrest occurs, provide artificial
respiration or oxygen by trained personnel. It may be dangerous to the person providing
aid to give mouth-to-mouth resuscitation. Get medical attention if adverse health effects
persist or are severe. If unconscious, place in recovery position and get medical
attention immediately. Maintain an open airway. Loosen tight clothing such as a collar,
tie, belt or waistband.
Skin contact
Ingestion
Flush contaminated skin with plenty of water. Remove contaminated clothing and
shoes. To avoid the risk of static discharges and gas ignition, soak contaminated
clothing thoroughly with water before removing it. Get medical attention if symptoms
occur. Wash clothing before reuse. Clean shoes thoroughly before reuse.
As this product is a gas, refer to the inhalation section.
Most important symptoms/affects, acute and delayed
Potential acute health effects
Eye contact
Inhalation
Skin contact
Frostbite
Ingestion
Contact with rapidly expanding gas may cause bums or frostbite .
No known significant effects or critical hazards.
Contact with rapidly expanding gas may cause bums or frostbite
Try to warm up the frozen tissues and seek medical attention.
As this product is a gas, refer to the inhalation section.
over-exposure signs/symptoms
Eye contact No specific data.
Inhalation
Skin contact
No specific data.
No specific data.
Date of Issue/Date of revision : 10/15/2014. Date of previous Issue 10/2/2014. Version :0.02
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2112
Hydrogen
Section 4. First aid measures
ingestion No specific data.
Indication of immediate medical attention and ste#aJ tie Invent needed. if nece %.1Si
Notes to physician : Treat symptomatically. Contact poison treatment specialist immediately if large
quantities have been ingested or inhaled.
Specific treatments No specific treatment.
Protection of first -alders
: No action shall be taken involving any personal risk or without suitable training. It may
be dangerous to the person providing aid to give mouth-to-mouth resuscitation.
See toxicological information (Section 11)
Section 5. Fire -fighting measures
F.tgulshing media
Suitable extinguishing
media
Unsuitable extinguishing
media
Specific hazards arising
from the chemical
Hazardous thermal
decomposition products
Special protective actions
for fire-fighters
Special protective
equipment for fire-fighter=:.
Use an extinguishing agent suitable for the surrounding fire.
None known.
Contains gas under pressure. Extremely flammable gas. In a fire or if heated, a
pressure increase will occur and the container may burst, with the risk of a subsequent
explosion.
- No specific data.
Promptly isolate the scene by removing a]! persons from the vicinity of the incident if
there is a fire. No action shall be taken involving any personal risk or without suitable
training. Contact supplier immediately for specialist advice. Move containers from fire
area if this can be done without risk. Use water spray to keep fire -exposed containers
cool. If involved in fire, shut off flow immediately if it can be done without risk. !f this is
impossible, withdraw from area and allow fire to burn. Fight fire from protected location
or maximum possible distance. Eliminate all ignition sources if safe to do so_
Fire-fighters should wear appropriate protective equipment and self-contained breathing
apparatus (SCBA) with a full face -piece operated in positive pressure mode_
[Section 6. Accidenta
_
I release measures
Personal Precautions projective
For non -emergency
personnel
For emergency responders
Environmental precautions
Mtternent.nsl.gmel.9.e_e__efeetilt
Accidental releases pose a serious fire or explosion hazard. No action shall be taken
involving any personal risk or without suitable training. Evacuate surrounding areas.
Keep unnecessary and unprotected personnel from entering. Shut off all ignition
sources. No flares, snicking or flames in hazard area. Avoid breathing gas. Provide
adequate ventilation. Wear appropriate respirator when ventilation is inadequate. Put
on appropriate personal protective equipment.
If specialised clothing is required to deal with the spillage, take note of any information
in Section 8 on suitable and unsuitable materials. See also the information in "For non -
emergency personnel .
Ensure emergency procedures to deal with accidental gas releases are in place to avoid
contamination of the environment. Inform the relevant authorities if the product has
caused environmental pollution (sewers, waterways, soil or air).
Methods and materials for containment and clashing uQ
Date of Issue/0 of revisian
- 10/152014. Date of previous issue 1012n014 Version . 0.02 3/12
:wmr t!Po IH5

Hydrogen
Section 6. Accidental release measures
Small spill Immediately contact emergency personnel. Stop leak if without risk. Use spark-proof
tools and explosion-proof equipment.
Large spill Immediately contact emergency personnel. Stop leak if without risk. Use spark-proof
tools and explosion-proof equipment. Note: see Section 1 for emergency contact
information and Section 13 for waste disposal.
I Section 7. Handling and storage
Precautions for safe handling
Protective measures
Advice on general
occupational hygiene
Conditions for safe storage,
including any
incompatibilities
Put on appropriate personal protective equipment (see Section 8). Contains gas under
pressure. Avoid contact with eyes, skin and clothing. Avoid breathing gas. Use only
with adequate ventilation. Wear appropriate respirator when ventilation is inadequate.
Do not enter storage areas and confined spaces unless adequately ventilated. Store
and use away from heat, sparks, open flame or any other ignition source. Use
explosion-proof electrical (ventilating, lighting and material handling) equipment. Use
only non-sparking tools. Empty containers retain product residue and can be hazardous.
Do not puncture or incinerate container. Use equipment rated for cylinder pressure.
Close valve after each use and when empty. Protect cylinders from physical damage;
do not drag, roll, slide, or drop. Use a suitable hand truck for cylinder movement.
Eating, drinking and smoking should be prohibited in areas where this material is
handled, stored and processed. Workers should wash hands and face before eating,
drinking and smoking. Remove contaminated clothing and protective equipment before
entering eating areas. See also Section 8 for additional information on hygiene
measures.
Store in accordance with local regulations. Store in a segregated and approved area.
Store away from direct sunlight in a dry, cool and well-ventilated area, away from
incompatible materials (see Section 10). Eliminate all ignition sources. Keep container
tightly closed and sealed until ready for use. Cylinders should be stored upright, with
valve protection cap in place, and firmly secured to prevent falling or being knocked
over. Cylinder temperatures should not exceed 52 °C (125 °F).
!Section 8. Exposure controls/personal protection
control parameters
Occuoational exoosure limits
Ingredient name
hydrogen
Appropriate engineering
controls
Envlronmental exposure
controls
lndjyjduaf protection measures
Date of issue/Data of revision
Exposure limits
Oxygen Depletion [Asphyxiant]
Use only with adequate ventilation. Use process enclosures, local exhaust ventilation or
other engineering controls to keep worker exposure to airborne contaminants below any
recommended or statutory limits. The engineering controls also need to keep gas,
vapor or dust concentrations below any lower explosive limits. Use explosion-proof
ventilation equipment.
Emissions from ventilation or work process equipment should be checked to ensure
they comply with the requirements of environmental protection legislation. In some
cases, fume scrubbers, filters or engineering modifications to the process equipment
will be necessary to reduce emissions to acceptable levels.
: 10/15/2014. Date of previous issue : 10/2/2014. VetS/on :0.02
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Hydrogen
Section 8. Exposure controls/personal protection
Hygiene measures
Eye/face protection
Skin protection
Hand protection
Body protection
Other skin protection
Wash hands, forearms and face thoroughly after handling chemical products, before
eating, smoking and using the lavatory and at the end of the working period.
Appropriate techniques should be used to remove potentially contaminated clothing.
Wash contaminated clothing before reusing. Ensure that eyewash stations and safety
showers are close to the workstation location.
Safety eyewear complying with an approved standard should be used when a risk
assessment indicates this is necessary to avoid exposure to liquid splashes, mists,
gases or dusts. If contact is possible, the following protection should be worn, unless
the assessment indicates a higher degree of protection: safety glasses with side-
shields.
Chemical-resistant, impervious gloves complying with an approved standard should be
worn at all times when handling chemical products if a risk assessment indicates this is
necessary. Considering the parameters specified by the glove manufacturer, check
during use that the gloves are still retaining their protective properties. It should be
noted that the time to breakthrough for any glove material may be different for different
glove manufacturers. In the case of mixtures, consisting of several substances, the
protection time of the gloves cannot be accurately estimated.
Personal protective equipment for the body should be selected based on the task being
performed and the risks involved and should be approved by a specialist before
handling this product. When there is a risk of ignition from static electricity, wear anti-
static protective clothing. For the greatest protection from static discharges, clothing
should include anti-static overalls, boots and gloves.
Appropriate footwear and any additional skin protection measures should be selected
based on the task being performed and the risks involved and should be approved by a
specialist before handling this product.
Respiratory protection Use a properly fitted, air-purifying or air-fed respirator complying with an approved
standard if a risk assessment indicates this is necessary. Respirator selection must be
based on known or anticipated exposure levels, the hazards of the product and the safe
working limits of the selected respirator.
[ Section 9. Physical and chemical properties
Appearance
Physical state
Color
Molecular weight
Molecular fonnula
Bolllng/condensation point
Melting/freezing point
Critical temperature
Odor
Odor threshold
pH
Flash point
Bumingtime
Burning rate
Evaporation rate
Flammability (solid, gas)
Lower and upper explosive
(flammable) limits
Date of Issue/Date of revision
Gas
Colorless.
2.02 g/mole
H2
-2s3•c (-423.4°F}
-259.15°C (-434.S"F)
-240.15°C (-400.3°F}
Odorless.
Not available.
Not available.
Not available.
Not applicable.
Not applicable.
Not available.
Extremely flammable in the presence of the following materials or conditions: oxidizing
materials.
Lower: 4%
Upper: 76%
: 10/15/2014 Date of previous issue : 10/2/2014 VetSion :0.02 5112
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Hydrogen
Section 9. Physical and chemical properties
Vapor pressure
Vapor density
Specific Volume (ft 3/lb)
Gas Density (lblft 3)
Relattve density
Solubility
Solubility In water
Not available.
0.07 (Air= 1)
191.9386
0.00521
Not applicable.
Not available.
Not available.
Liquid Density@BP: 4.43 lb/fl:3 (70.96 kg/m3)
Partition coefficient: n-Not available.
octanol/water
Auto-Ignition temperature 500 to 571 °c (932 to 1059.8°F)
Decomposition temperature Not available.
SADT Not available.
Viscosity Not applicable.
jsection 10. Stability and reactivity
Reactivity
Chemical stability
Possibility of hazardous
reactions
Conditions to avoid
lncompatibiUty with various
substances
No specific test data related to reactivity available for this product or its ingredients.
The product is stable.
Under normal conditions of storage and use, hazardous reactions will not occur
Avoid all possible sources of ignition (spark or flame). Do not pressurize, cut, weld,
braze, solder, drill, grind or expose containers to heat or sources of ignition.
Extremely reactive or incompatible with the following materials: oxidizing materials.
Hazardous decomposition
products
Under normal conditions of storage and use, hazardous decomposition products should
not be produced.
Hazardous polymerization : Under normal conditions of storage and use, hazardous polymerization will not occur.
jsection 11. Toxicological information
Informat ion on tox icological effects
Acute toxk;Hy
Not available.
lrdtat;on/Cormsfoo
Not available.
Sensitization
Not available.
Mutagenfclty
Not available.
earc1nogan1ctty
Date of fsaue/Dste of revision 10/15/2014. Date of previous Issue : 10/2/'2014. Version : 0 02
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Hydrogen
Section 11. Toxicological information
Not available.
Btproductlya toxicltY
Not available.
Iaratoqeolcity
Not available.
Specific target organ toxicity (single exposure)
Not available.
Specific target organ toxicity (repeated exposure)
Not available.
Aspiration hazard
Not available.
Information on the likely Not available.
routes of exposure
Potential acute b11ltb effects
Eye contact Contact with rapidly expanding gas may cause bums or frostbite.
Inhalation No known significant effects or critical hazards.
Skin contact Contact with rapidly expanding gas may cause bums or frostbite.
Ingestion As this product is a gas, refer to the inhalation section.
symptoms refated to the physjca1, chemical and tox;cotogicat characterjstjcs
Eye contact No specific data.
Inhalation
Skin contact
Ingestion
No specific data.
No specific data.
No specific data.
Delayed and immediate effects and also chronic effects from short and tong term exposure
Short tenn exposure
Potential immediate
effects
Potential delayed effects
Long tenn exposure
Potential immediate
affects
Potential delayed effects
Not available.
Not available.
Not available.
Not available.
potential chronic health effects
Not available.
General
Carcinogenicity
Mutagenlclty
Teratogenlclty
Developmental effects
Fertility effects
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
Date of lnuelDate of revision : 10/15/2014. Date of previous Issue : 10/2/2014. Version :0.02
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7112
Section 11. Toxicological information
N jcai measures of toxlcitx
Acute toxicity estiipatel
Not available.
Section 12. Ecological information
Toxicity
Not available.
Evals,tenckandslegradability
Not available.
Blceccumuiative potentia[
Not available.
Mobility In soil
Salliwater partition
coefficient (Koc)
Not available.
Other adverse effects : No known significant effects or critical hazards.
Section 13. Disposal considerations
Disposal methods
The generation of waste should be avoided or minimized wherever possible. Disposal
of this product, solutions and any by-products should at ail times comply with the
requirements of environmental protection and waste disposal legislation and any
regional local authority requirements. Dispose of surplus and non -recyclable products
via a licensed waste disposal contractor. Waste should not be disposed of untreated to
the sewer unless fully compliant with the requirements of all authorities with jurisdiction.
Empty Airgas-owned pressure vessels should be returned to Airgas_ Waste packaging
should be recycled. Incineration or landfill should only be considered when recycling is
not feasible. This material and its container must be disposed of in a safe way. Empty
containers or liners may retain some product residues. Do not puncture or incinerate
container.
r --
LSection 14. Transport information
DOT
TOG Mexico
UN number
UN1049
UN proper
shipping name
Transport
hazard class(es)
Packing group
Environment
HYDROGEN,
COMPRESSED
2,1
UN1049
IMDG
IATA
HYDROGEN,
COMPRESSED
2.1
No.
UN1049
HYDROGEN
COMPRESSED
No
UN1049
UN1049
HYDROGEN,
COMPRESSED
2.1
HYDROGEN,
COMPRESSED
No.
2.1
A
No.
Gate of issue/Dee of reriswn
: 16W5 14. Date of previous issue-10Y21014. Version :0.02 P1f2
Pau/bred by !HS

Hydrogen
Section 14. Transport information
Addition al l.lmflml IIUIO&lilt ~~.J.!.mJ!.i'.rut --easaene1t 1nd ~mg
Yes . Llmlt!HI g111oltw lmll! &llimflQuantlty Information 0.125 Hmltation : 0 Forbidden
eackaglng Instruction Cargo Alr:mft Qnb!
Passenger aircraft EBAelDIIU Quantityllmltatlon: 150
Quantity limitation : 3000 kg
Forbidden.
filHDIIII: ~DJllUII
Cargo aircraft 3b1Plodex
Quantity limitation : 150 Forbidden
kg
eaa•an111E ~IDJIIJII
BSllsl ac BIii fndax
Forbidden
"Refer to CFR 49 (or authority having jurisdiction) to determine the information required for shipment of the
product"
Special precautions for user Transport within user's premises: always transport in closed containers that are
upright and secure. Ensure that persons transporting the product know what to do in the
event of an accident or spillage.
Transport In bulk according Not available
to Annex II of MARPOL
73f18 and the IBC Code
!Section 15. Regulatory information
U.S. Federal regulations TSCA 8(a) CDR Exempt/Partial exemption: This material is listed or exempted .
United States inventory (TSCA 8b): This material is listed or exempted.
Clean Air Act (CAA} 112 regulated flammable substances: hydrogen
Clean Air Act Section 112
(b) Hazardous Air
Pollutants (HAPs)
Clean Air Act Section 602
Class I Substances
Clean Air Act Section 602
Class II Substances
DEA List I Chemicals
(Precursor Chemicals)
DEA List II Chemicals
(Essential Chemicals)
SARA 3021304
Not listed
Not listed
Not listed
Not listed
Not listed
Composition/fntormatjon on ingredients
No products were found.
SARA304RQ
SARA 311/312
Classification
Not applicable.
Fire hazard
Sudden release of pressure
Comoosmon/jnformation on ingredients
Date of luue/Date of r&vl$/on · 10/15/2014. Dateofp,evlous/Ssue 10/2/2014. Version : 0 02
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HYdragen
Section 15. Regulatory information
Name
hydrogen
Stale remotions
Massachusetts
New York
New Jersey
Pennsylvania
Canada Inventory
International regulations
International lists
Chemical Weapons
Convention List Schedule
I Chemicals
Chemical Weapons
Convention List Schedule
!I Chemicals
Chemical Weapons
Convention List Schedule
III Chemicals
WHMIS (Canada}
1 DO
Fire
hazard
Yes.
Sudden
release of
pressure
Yes.
Reactive
Na.
Immediate
(acute)
health
hazard
Delayed
(chronic)
health
hazard
No. No.
This material is listed.
: This material is not listed.
This material is listed.
This material is listed.
This material is listed or exempted.
Australia inventory (AICS): This material is listed or exempted.
China inventory (IECSC): This material is listed or exempted.
Japan Inventory: Not determined.
Korea inventory: This material is listed or exempted.
Malaysia Inventory (EHS Register): This material is listed or exempted.
New Zealand Inventory of Chemicals (NZloC): This material is listed or exempted.
Philippines inventory (PICCS): This material is listed or exempted.
Taiwan inventory (CSNN): Not determined.
Not listed
: Not listed
• Not listed
Class A: Compressed gas.
Class B-1: Flammable gas.
CEPA Toxic substances: This material is not listed,
Canadian ARET: This material is not listed.
Canadian NPRI: This material is not listed.
Alberta Designated Substances: This material is not listed.
Ontario Designated Substances: This material is not listed
Quebec Designated Substances: This materiel is not listed.
Section 16. Other information
Canada Label requirements :
Hazardous Material Information
,Health
Flammability
Physical hazards
Class A: Compressed gas.
Class B-1: Flammable gas.
System tU,S.A.I
Q
4
Date of katt 1lDai8 of revision
: 1a►'1512014. Date of previous issue
i402i2014.
Version :0.02 1042
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HYdrogon
Section 16. Other information
Caution: HMIS® ratings are based on a 0-4 rating scale, with 0 representing minimal hazards or risks, and 4
representing significant hazards or risks Although HMIS® ratings are not required on SO5s under 29 CFR 1910.
1200, the preparer may choose to provide them. HMIS® ratings are to be used with a fully implemented HMIS®
program. HMIS® is a registered mark of the National Paint & Coatings Association (NPCA). HMIS® materials
may be purchased exclusively from J. J. Keller [phone].
The customer is responsible for determining the PPE code for this material.
fictional Fire Protection Assoriiation (U.S.A.1
Flammability
Health 0 InstabllltylReactivity
Special
Reprinted with permission from NFPA 704-2001, identification of the Hazards of Materials for Emergency
Response Copyright ©1997, National Fire Protection Association, Quincy, MA 02269. This reprinted material is
not the complete and official position of the National Fire protection Association, on the referenced subject
which is represented only by the standard in its entirety.
Copyright ©2001, National Fire Protection Association, Quincy, MA 02269. This warning system is intended to
be interpreted and applied only by properly trained individuals to identify fire, health and reactivity hazards of
chemicals. The user is referred to certain limited number of chemicals with recommended classifications in
NFPA 49 and NFPA 325, which would be used as a guideline only. Whether the chemicals are classified by NFPA
or not, anyone using the 704 systems to classify chemicals does so at their own risk.
wry
Date of printing
Date of IssuelDate of
revision
Date of previous Issue
Version
Key to abbreviations
10/15/2014
10/15/2014.
: 10/2I2014.
: 0.02
ATE = Acute Toxicity Estimate
BCF = Bioconcentration Factor
GHS = Globally Harmonized System of Classification and Labelling of Chemicals
IATA = International Air Transport Association
IBC = Intermediate Bulk Container
IMDG = International Maritime Dangerous Goods
LogPow = logarithm of the octanol/water partition coefficient
MARPOL 73178 = International Convention for the Prevention of Pollution From Ships,
1973 as modified by the Protocol of 1978, ("Marpol" = marine pollution)
UN = United NationsACGIH — American Conference of Governmental Industrial
Hygienists
AIHA — American Industrial Hygiene Association
CAS — Chemical Abstract Services
CEPA — Canadian Environmental Protection Act
CERCLA — Comprehensive Environmental Response, Compensation, and Liability Act
(EPA)
CFR — United States Code of Federal Regulations
CPR — Controlled Products Regulations
DSL — Domestic Substances List
GWP — Global Warming Potential
IARC — International Agency for Research on Cancer
ICAO — International Civil Aviation Organisation
Inh— Inhalation
LC — Lethal concentration
LD — Lethal dosage
NDSL Non -Domestic Substances List
NIOSH — National Institute for Occupational Safety and Health
DM M issuettes or ►evisfon
fa'15/2014. Dare of prsvrous issue 1Or 14.
0 02 11fl2

1::ion 16. Other information
References
TOG -Canadian Transportation of Dangerous Goods Act and Regulations
TL V -Threshold Limit Value
TSCA -Toxic Substances Control Act
WEEL -Workplace Environmental Exposure Level
WHMIS -Canadian Workplace Hazardous Material Information System
Not available.
Indicates Information that has changed from previously issued version.
Notice to reader
To the best of our knowledge, the information contained herein is accurate. However, neither the above-named
supplier, nor any of Its subsidiaries, assumes any liability whatsoever for the accuracy or completeness of the
Information contained herein.
Final determination of suitability of any material is the sole responsibility of the user. All materials may present
unknown hazards and should be used with caution. Although certain hazards are described herein, we cannot
guarantee that these are the only hazards that exist.
Date of Issue/Date of revision : 10/15/2014. Date of previous issue : 10/2/2014. Version :0.02 12/12
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PASSIVE HYDROGEN INJECTION SYSTEM DIAGRAM
tJ ID 1
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells (N01) at the
Former Cemex Ready Plant. This facility is located at 4206 Unionville -Indian Trail Road Indian Trail, NC
28079. We received your complete NOI on June 18, 2015.
Please remember to submit the following regarding this injection activity:
1) Well Construction Records (GW-1) and Abandonment Records (GW-30) when completed. Please
provide copies of the GW-ls and GW-30s if not already submitted (originals go the address printed
on the form). NOTE: Direct push or Geoprobe wells are considered wells and require construction
(GW-1) and abandonment forms (GW-30). If well construction/abandonment information is the
same for the wells, only one form needs to be completed- just indicate total number of injection
points in the CommentsjRernarks section of form. These forms can be found on our website at
httn l/Lsnrtal,rirdenr orpJweb/wq/anslhwprojreporting-forme.
2) Injection Event Records (IER). All injections, including air and passive systems require an fER. The
[ER can be modified for air sparge wells (e.g., air flow `continuous' for date or rate of injection, etc.).
You can scan and send these forms directly to meat -i rr:hael,r0gersgi@ncde-,r send by fax to my
attention at 919-807-6406, or via regular mail to address bellow- When submitting the above forms, you
will need to enter the nine -digit alpha -numeric number on the form (i.e., WIOXXXXXX) that has been
assigned to the injection activity at this site. This notification has been given the deemed permit
number WI0300290. This number is also referenced in the subject line of this email. You may if you
wish, scan and send back as attachments in reply to this email, as it wilt already have the assigned
deemed permit number in the subject line.
Thank you for your cooperation.
Michael Rogers, P.G. (NC & FL)
Hydrogeologist
NCDENR - DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6406

Shire, Ebonee
From:
Sent:
To:
Cc:
Subject:
Attachments:
Follow Up Flag:
Flag Status:
Shire, Ebonee
Thursday, June 18, 2015 12:16 PM
'[e-mail]'
Parker, Michael; Pitner, Andrew; '[e-mail]'
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells
Thank you for submitting the Notice of Intent to Construct or Operate Injection
Wells.pdf
Follow up
Completed
1
EF
Environmental Services
June 2, 2015
Mr. Mike Rogers
Division of Water Resources
1611 Mail Service Center
Raleigh, North Carolina 27699-1611
0, I06
' Neer 4uetlty Reenel
rypecat1on
Reference: Notification of Intent to Construct or Operate Injection Wells
Former Cemex Ready Mix Plant
4206 Unionville -Indian Trail Road
Indian Trail, North Carolina
NCDENR IHSB Site #NONCD0002395
Dear Mr, Rogers:
EnviroTrac is pleased to submit the enclosed Notification of Intent to Install or Construct Injection
Wells, The purpose of this corrective action is to target the localized area of elevated
trichloroethylene concentrations in monitoring well MW-40 at the site Installing a passive
hydrogen injection device in the well would increase the degradation rate of chlorinated
hydrocarbons but still allow the well to be used as a monitoring point.
Should you have any questions regarding this notification or require additional information, please
contact the undersigned_
Very truly yours,
ENVIROTRAC LTD.
CraigDK-4
. Neil, P.G.
Senior Project Manager
[e-mail]
Attachments: Notification of Intent to Install or Construct Injection Wells
Cc: Ms. Denise Corrales, Cemex
€1330 Vanstory Drive, Fruntersville, NC 28078I Office: [phone] I Fax: [phone]
www.envirotrac.com

t
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT 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. This form shall be submitted at least 2 weeks prior to iniection.
AQUIFER TEST WELLS (I SA NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION <l SA NCAC 02C .0225) or TRACER WELLS (f SA NCAC 02C .0229):
1) Passive In jection S ystems -In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small-Scale Injection O perations -Injection wells located within a land surface area not to exceed l0,000
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 are 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 In jection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater,
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: _Jun_e_2 __ ~• 2015 PERMIT NO. \\)\(>2,()0'2,.G\() (t-0 be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERA TED
(1)
(2)
(3)
(4)
(5)
(6)
___ Air Injection Well .................................... ,.Complete sections B-F, K, N
___ Aquifer Test Well.. ..................................... Complete sections B-F, K, N
~X __ Passive fujection System ...................... u•••,; .. Complete sections B-F, H-N
___ Small-Scale Injection Operation ........... ,,.., ....... Complete sections B-N
____ Pilot Test ..............................•.•.. ; ........ ,, ... Complete sections B-N
___ Tracer Injection Well .................................. _ •. Complete sections B-N
B. ST A TUS OF WELL OWNER: Choose an item.
C. WE LL OWNER -State name of entity and name of person delegated authority to sign on behalf of the business
or agency:
Name: ______ C~e=m __ e=x-=M=s~. =D~e=m""·s ... e_C..,o ... rra ...... le ... s _______________________ _
Mailing Address: 3820 Northdale Blvd. Suite 100B
City: Tampa State: FL Zip Code:_3=3~6=24~ ___ County: Hillsborough
Day Tele No.: (813 )269.,1035
EMAIL Address: deni~[e-mail]=m~----
UIC//n Situ Remed. Notification (Revised 3/2/2015)
Cell No.: ----------"""---
Fax No.: --~<8~1~31~2 ..... 6 ..... 9-~l-"-03"-'0'----
Page I
D. PROPERTY OWNER (if different than well owner)
Name: -----------------------------------
Mailing Address:--------------------------------
City:-· ____________ State: _ZipCode: _________ County: _____ _
Day Tele No.: _____________ .....,..., Cell No.: __________ _
EMAIL Address:--'-----------------Fax No.: __________ _
E. PROJECT CONT ACT -Person who can answer technical questions about the proposed injection project.
Name: Crai e Neil. EmriroTrac Ltd.
Mailing Address: ----=-1=13=3,_,0,_V"""-.=an=st=o:cory..s..=D=r_,,_iv'--"e'--____________________ _
City: Huntersville State: NC Zip Code: __ 2_80_7_8 ____ County: Mecklenburg
Day Tele No.: [phone] Cell No.: __ __.{=33=6=)=40=7,_-4=5=t=S __ _
EMAIL Addresst __ -=c=ra=i""gn""@=e::.:nv""'ir,:..o:::..:tr::..:a=-=cc:..:.c::..::oc.::.:mc:..._ __ _ Fax No.: -----------
F. PHYSICAL LOCATION OF WELL SITE
(l) Physical Address: ___ 4~2~0~6~U~m=·o~n_vi=ll=e-~I=n~di~a=n ~T~ra=i ...... l ~R ...... ci~ad~(F~i ... gur~e_l-) __________ _
_______________________ County:.,...U.,..D....,io .... n ...... • ______ ___
City: Indian Trai.l State: NC Zip Code: --=2=-80"""'7-"-9 _____ _
(2) Geographic Coordinates: Latitude**: ---
0
--__ " or =35"--_0 -~0~7~5~0~9 ...... 1 __ _
Longitude**: ______ 0 __ ,, or ~0 634504
Reference Datum: ........ _______ Accuracy: _______ _
Method of Collection: http :/ /itouchmap.com/latlong.htm l
--
** 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 p lume: ______ 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 5% ofph.11ne for pilot test injections)
H. INJECTION ZONE MAPS -Attach the following to the notification.
(I) Contaminant plume map(s) with isoconcehtration 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
Figure 2 shows the site layout and existing monitoring well locations. Figure 3 shows the
horizontal extent of impacted groundwater. The passive hydrogen injection system is proposed to
be installed into MW-4D.
UICI In Situ Remed. Notification (Revised 3/2/2015) Page2
(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.
Figure 4 shows the location of the cross section A-A'. Figure 5 shows the cross section with
projected vertical extent of impacted groundwater that exceed the NCGS 2L Standard.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
Figure 6 is the potentiometric surface map showing the rate and direction of groundwater
move!)lent based on data collected during the February 2015 sampl!ng ~vent.
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration
of injection over time.
The in iec tio n activities arc intended to irn.prove trichloroeth ylene (TCE) concentrations. Results of the Feb ruary
201,5 sam plin g eventSm.!ge st TCE im pacted groundwat\ir is. limi ted and 011I MW-4D e,chibits TCE and d aughter
products,auioncen.trationsthat exceed the groundwater reme diati on goal s, Monttor ing well MW-40wiU have
a passive h dro 1Hin deliverv svstem installed inside the monitorin g well. This systernwill allow h ydrogen to be.
in jected ihto the g_rourtdwater affectin g a lotalized area. The p~rforrnanc~ of this svstcrn will be monitored
uarterl .
J. INJECT ANTS-Provide a MSDS and the following for each injectant. Attach additional sheets ifnecessacy.
NOTE: Approved injectants (tracers and remediation additives) can be found online at
http://portal.ncdenr.orglweblwqlapslgwpro, All other substances must be reviewed by the Division of Public
Health, Department of Health and Human Services. Contact the U/C Program for more info (919-807-6496).
Injectant: --~H~y-dr=o-g=e=n~-~M,e=-S=D~S~a=tta~ch~e~d~-------------------
Volume ofinjectant: continuous release of hydrogen gas at one cubic foot per day
Concentration at point of injection: MW-4D will range from 2.4 to 2.5 ppm (based on 16 to 19 feet of
submergence). The hydr.qgen concentrations .are. estimated based on a saturated hydrogen contt!11t of
1.6 ppm per atmos phere.
Percent if in a mixture with other injectants: __ ._.N .... A_.. •-----------------
Injectant: ______________________________ _
Volumeofinjectant: ____________________________ _
Concentration at point of injection: ----------------------------
Percent if in a mixture with other injectants: --------------------~
Injectant: ---------------------------------
Volume of injectant ____________________________ _
Concentration at point of injection: _______________________ _
Percent if in a mixture with other injectants: ____________________ _
UICI In Situ Remed. Notification (Revised 3/2/2015) Page3
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: -----'Proposed'--------=1 __ • _Existing
(2) 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:
(a) well type as permanent, direct-push, or subsurface distribution system (infiltration gallery)
(b) depth below land surface of grout, screen, and casing intervals
(c) well contractor name and cer:tification number
A passive hydrogen injection system diagram with well construction details for MW-4D is
attached. The well contractor name and certification number are unknown.
L. SCHEDULES -Briefly d(;!scribe the schedule for well construction and injection activities.
Enviro.trac wIHtravel to the site and install the delivery system upon recei pt of the permit · The .h dro gen will
b e iniecfed con tinuousl y and th content of th hvdrogcn cvl inde and tie.Id parnnieter will ht, monitored.
monthl.
M. MONITORING PLAN -Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified inSubehaptg02L result from the injection activity.
Groundwater samples wHI b -collected from MW~4D quarterl y. · The perfonnance of the passive hydrogen
deliverv S)'5 ten, will be evaluated following three months of operation.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "l hereby certify, under penalty of law, that lam 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, l 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. l agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
({\ r. elate_dupptttf1c,rlce!i in acco0dance with the lSA N.(' tc 2l' 200 Rules."(\ .
· 'iQ. J(\ -~""'-x....D. -<:.A-/ l\1!;1·e. LDY'rcr..le
~lgna7ttcorApplicant · .
\)~ff t-tcJ{ Gr\Vi fbf\"t ~-%t,°"A _;f._,
Print or Type Full Name
PROPERTY OWNER (if the pro pertv is not owned by the permit a pp licant):
"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 i~jection 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
(J 5A NCAC 02C .0200). "
UIC/Jn Situ Remed. Notification (Revised 3/2/2015) Page4
"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.
Signature* of Property Owner (if different from applicant) · Print or Type Full Name
* An access agreement between the app/icam and property owner may be submitted in lieu of a signature on this form.
Submit the completed notification package to:
UICI In Situ Remed. Notification (Revised 3/2/2015)
DWR -UIC Program
1636 Mail Service. Center
Raleigh, NC 27699-1636
Telephone: [phone]
Page 5
FIGURES
6/1/2015 1:49 PM BY: annarnarie blause
lndisnTrails_-figures 1 dwg
4'a CIR
44
1
oit
ss1
fir
N.
\DLIN
i w
TRAIL
lake Park
fM oormL prowl' mt. Ro yy
ti
stturrue
e
goo' gfr
SOURCE: IJSGS Topographic map Matthews Quadrangle.
tirivirTo lira
Environmental Services
T
PROJECT NO. 11AAL1�21Ad
DRAWN BY: AS
CHECKED BY: CON
DATE: 2/27/2015
REVISED:
IGO
Red
I
tj
R
OGY rig
eel
0
etcfr
2000
57
osib
HAD
•
4000
SCALE: I" = 2000' SCALE IN FEET
SITE LOCATION MAP
FORMER READY MIX PLANT
UNIONVILLE-INDIAN TRAIL ROAD
INDIAN TRAIL, NORTH CAROLINA
FIGURE
1
ENVIRRTARAC-11330 VANSTORY DRIVE I HUNTERSVILLE, NC I PI-11 704.897,0707 I FAX! 704.897.0486 I www.envIrotrac.corl

�rniro ra
Environmental 9arvlwc Environmental Services
1133D VAMSORAV DRAR
1 inch = 75 f t. "" `C ' ORI t"" ,r
" NV1ROTRAC - 11330 VANSTORY DRIVE.! HUNTERSVILLE, NC ! PH' 704.897.0707 I FAX! 704,897.0486 I www.envlrairar.ron
M�Approximate Groundwater Monitoring
8 l Location
DAME: O2 2 ' aws
CRAYON MI As
FIGURE 2
SITE MAP
FORMER READY MIX PLANT
UNIONVILLE-TRAIL ROAD
INDIAN TRAIL, NORTH CAROLINA
APPROVED IV:
CDM
win 1.. 7.
imago- ow: U99:021 0

UW-9
•
'1
•
0,4
•
Approxim- a▪ te
Loeatlon of
the Sump
1 inch = 75 ft.
r 'A Vr--•
,1 •
4
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:141k. It
,r
a
i
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Environmental
Environm.ntal Services
SUM W latYOWE
NIINTSASSALLE, NGPM PAOUNA
PNOMC: 1PWI 191'OIO7
:ENVIREJTRAC - 11330 VANSTURY DRIVE.' HUNTERSVILLE, NC I PHI 704.897,0707 I FAX' 704,897.0486 1 www.envIrotrac,com
LEGEND
APPROXIMATE GROUNDWATER
MONITORING ,AEU. LCCATIGN
r'� AFYRU7CMA+`� EAuETr r C�
C-DCE r CIS-1,2•-01CI'ILORGETHE]IE
TCE . TRiGillOROEETH w
VC r VIM CHLORIDE
NOTES
ALL CONCENTRATIONS IN MICROGRAMS PER
LITER. ONLY CONCENTRATIONS GREATER
THAN SL STANDARDS SHOWN.
Glatt o atILI 11i
WAWA Dr OSA
FIGURE 3
GROUNDWATER EXCEEDANCE MAP
FORMER READY MIX PLANT
UNIONVILLE-TRAIL ROAD
INOIANTRAIL, NORTH CAROLINA
AMwavrD srf
CON
SCALE A Q WWM
recast MRlieg:M LO

c
0 37.5 75
1 inch = 75 ft.
viro ra
Emrironmantal SafylC6i
11110WIKSODE EWA
HIRCIERWIL LE, NORM OLROLNA
PHEW: DIM u 7a707
t GELD
MW-8
MW-2
APPROXIMATE GROUNDWATER
MONITORING WELL LOCATION
APPROXIMATE ARANb0NED
MONITORING WELL LOCATION
..-- CROSS SECTION LOCATION
FIGURE4
CROSS SECTION LOCATION MAP
FORMER HEADY MIX PLANT
UNION VILLE-TRAIL ROAD
I NOIAN TRAIL, N ORTN CAROUNA
DAM: s/m/lms
(PAWNO'l: 61OH
APPROVED Er:
CAE
SCAM 1,6511.7NN
PROPERN0; 11.94001LG0
. NVIRDTRAC - 11330 VANSTORY DRIVE,' HUNTERSVILLE, NC I PHI 704,897,0707 I FAX; 704,897,0486 I www,envIro±rac,Com

a
M W-4D
C-D w 453 f
TCE =116
0 VC=4.2
100
OWN:W ER CvA1N
DATA TOM Zi IIIARCH 1993
— 90
GROUNDWATER ELEVATION
DATA FROM FEB 2015
MOMENTS CLAY
A
GRAVEL -ROCK
11
SMYT
YOH ROCK> CLA� 90
{MW--21 I.taw 1
s g 1 4, 0 6 t Mw-4D 6 p
III�F
-
lii
iTCLAY WITH '1
1 \ : 1 '' '(
ROCK FRA rNTT NAM arroirtm &� \ . r! '............... .... • '.-. 100 -- sN \ I ir /
PWR
70--
8EL WCOC ', :TAB-MARCO< Arm
LIP HIRLI51VES
HORIZONTAL SCALE
0 15
1
VERTICAL SCALE EXAGGERATED BY 3.
NOTES:
BASED ON EA ENGINEERING, SCIENCE, AND
TECHNOLOGY, MC. PROJECT NO.,1241S.01. FIGURE9,
DATED5/1993.
AU. CONCENTRATIONS SHOWN IN MICROGRAMS PER
LITER.
ONLY CONCENTRATIONS GREATER THAN IL
STANDARDS SHOWN.
LEGEND
MW-40
C-DLE
TCE
VL
80
70
130
APPROXIMATE GROUNDWATER MONITORING
WELL LOCATION
APPROXIMATE APANIDONED
MONfr0RING WELL LOCAT]ON
APPROXMATE EXTENT OF GROUNDWATER
EXCEEo NCES(HISTORICy
APPROXIMATE EXTENT Of GROUNDWATER
EXCEEOANCES(CURRENT]
= CIS-!, 2•DI CH LOROELHENE
TRICHIOROETHENE
= VINYL CHLORIDE
I1 r p%%WartMY!
..ARIAP IC Nano COMM
rnaN[: Frw)I107{1Z,
FIGURE 5
CROSS SECTION A -AI
FORMER READY NO% PLANT
UNIOiVI LLE-TRAIL ROAD
IND+AN TRAIL, NO5114CARO INA
CATT1 0002,02015
ORASVrir•rr•14
APPAOPLO
ma
scxc: ►s EPnrwr
mac op: union in
L
4&NVIR[]TRAC - 11330 VANSTURY DRIVE,I
HUNTERSVILI.E. NC I PH. 704.897.0707 I FAX+ 704.897,04136
wW*.e nvlrokra r.con

75
■t•
Approximate't
Location of __ 1
the Sump
57,$ 75
viro ra
Environmental Services
11330 VANSEORE MIME
1 inch = 75 it IfinfWOKE EEPPPALLE.COMM
l a97-007
ENV1REITARAE — 11330 VANSTIJRY DRIVE,I HUNTERSVILLE, NCI PHI 704,897.0707 I FA* 704.897.0486 I www.erkvIrotracron
LEGEND
0 APPRPXO,ATE GROUNDWATER
M>M-8 AION€TARING WELL LOCATION
APPROXIMATE GROUNDWATER
(64030) ELEVATION CONTOURS (ft)
GROUNDWATER CONTOUR LINE
GROUNDWATER FLOW DIRECTION
FIGURE 6
GROUNDWATER POTENT{OMETIi1C SURFACE MAP
FORMER READY MIX PLANT
UN ION VI LIE -TRAIL ROAD
!WAN TRA14 NORTH CAROUNA
DATE WED112015
DIRR1Nk RE: M
APPROVED BY:
C9x
SEAIL 1•,75•
PREVECT1101 1i 99007E00

HYDROGEN MSDS
SAFETY DATA SHEET
Airgas
Hydrogen
1Se ction 1. identification
GHS product identifier
Chemical name
Other means of
identification
Product use
Synonym
SOS #
Supplier's details
Emergency telephone
number (with hours of
operation)
: Hydrogen
: hydrogen
Dihydrogen; a -Hydrogen; p-Hydrogen Molecular hydrogen; H2; UN 1049
: Synthetic/Analytical chemistry.
: Dihydrogen; a -Hydrogen; p-Hydrogen; Molecular hydrogen; H2; UN 1049
: 001026
Airgas USA, LLC and its affiliates
259 North Radnor -Chester Road
Suite 100
Radnor, PA 19087-5283
1-610-687-5253
1-866-734-3438
Section 2. Hazards identification
OSHAIHCS status
Classification of the
substance or mixture
GHQ label elements
Hazard pictograms
Signal word
Hazard statements
Precautionary statements
General
Prevention
Response
Storage
Disposal
: This material is considered hazardous by the OSHA Hazard Communication Standard
(29 CFR 1910.1200).
: FLAMMABLE GASES - Category 1
GASES UNDER PRESSURE - Compressed gas
: Danger
Extremely flammable gas.
Contains gas under pressure; may explode if heated
Burns with invisible flame.
May displace oxygen and cause rapid suffocation.
Read and follow all Safety Data Sheets (SDS'S) before use. Read label before use.
Keep out of reach of children. If medical advice is needed, have product container or
label at hand. Close valve after each use and when empty. Use equipment rated for
cylinder pressure. Do not open valve until connected to equipment prepared for use.
Use a back flow preventative device in the piping. Use only equipment of compatible
materials of construction. Approach suspected leak area with caution.
: Never Put cylinders into unventilated areas of passenger vehicles. Keep away from
heat, sparks, open flames and hot surfaces. - No smoking. Use and store only outdoors
or in a well ventilated place.
Leaking gas fire; Do not extinguish, unless leak can be stopped safely. Eliminate all
ignition sources if safe to do so.
Protect from sunlight. Protect from sunlight when ambient temperature exceeds
52'C/125°F. Store in a well -ventilated place.
: Not applicable.
Dale of issue/Date of revision
: 10/15/2014. Date of previous issue : 1Oi2_2014, Version :0.02 1112
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Hydrogen
Section 2. Hazards identification
Hazards not otherwise
classified
: In addition to any other important health or physical hazards, this product may displace
oxygen and cause rapid suffocation .
Section 3. Composition/information on ingredients
Substance/mixture
Chemical name
Other means of
identification
CAS number/other Identifiers
<;AS number
Product code
Ingredient name
hydrogen
Substance
hydrogen
Dihydrogen; o-Hydrogen; p-Hydrogen; Molecular hydrogen; H2; UN 1049
1333-74-0
001026
%
100
CAS number
1333-74-0
There are no additional ingredients present which, within the current knowledge of the supplier and in the
concentrations applicable, are classified as hazardous to health or the environment and hence require reporting
in this section.
Occupational exposure limits, if available, are listed in Section 8.
I Section 4. First aid measures
PmriPtkul of neces,wy tirst 1id me,sun:s
Eye contact Immediately flush eyes with plenty of water, occasionally lifting the upper and lower
eyelids. Check for and remove any contact lenses. Continue to rinse for at least 10
minutes. Get medical attention if irritation occurs.
Inhalation Remove victim to fresh air and keep at rest in a position comfortable for breathing. If
not breathing, if breathing is irregular or if respiratory arrest occurs, provide artificial
respiration or oxygen by trained personnel. It may be dangerous to the pers,on providing,
aid to give mouth-to-mouth resuscitation. Get medical attention if adverse health effects
persist or are severe. If unconscious, place in Fecovery position and get medical
attention immediately. Maintain an open airway. Loosen tight clothing such as a collar,
tie, belt or waistband.
Skin contact
Ingestion
Flush contaminated skin with plenty of water. Remove contaminated clothing and
shoes. To avoid the risk of static discharges and gas ignition, soak contaminated
clothing thoroughly with water before removing it. Get medical attention if symptoms
occur. Wash clothing before reuse. Clean shoes thoroughly before reuse.
As this product is a gas, refer to the inhalation section.
Most important &Ytnptomsteffects, acute and· delayed
Pote nt ial acute healt h effec ts
Eye contact
Inhalation
Skin contact
Frostbite
Ingestion
Contact with rapidly expanding gas may cause burns or frostbite,
No known significant effects or critical hazards.
Contact with rapidly expanding gas may cause burns or frostbite,
Try to warm up the frozen tissues and seek medical attention.
As this product is a gas, refer to the inhalation section.
Over-exposure signs/symptoms
Eye contact No specific data.
Inhalation
Skin contact
No specific data.
No specific data.
Date of issue/Date of revision : 10/1512014. Date of previous issue ; 1012/2014. Version : 0.02
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2112
1-" Section 4. First aid measures
Ingestion · ;. No specific data.
Indication. of immediate roedtcat attention and special treatment otided, ff necessary
Notes to physician Treat symptomatically. Contact poison treatment specialist immediately if large
quantities have been ingested or inhaled.
Specific treatments
Protection of first-aiders
No specific treatment. ·
No action shall be taken involving any personal risk or without suitable training . It may
be dangerous to the person providing aid to give mouth-to-mouth resuscitation.
See toxicological information (Section 11)
Section 5. Fire-fightipg measures
Extinguishing media
Suitable extinguishing
media
Unsuitable extinguishing .
media
Specific hazards arising
from the chemical
Hazardous thermal
decomposition products
Special protective actions
for fire-fighters
Use an extinguishing agent suitable for the surrounding fire.
: None known.
Conta ins gas under pressure. Extremely flammable gas. In a fire or if heated, a
pressure increase will occur and the container may burst, with the risk of a subsequent
explosion.
• No specific data.
: Promptly isolate the scene by removing all persons from the vicinity of the incident if
there is a fire. No action shall be taken involving any personal risk or without suitable
training. Contact supplier immediately for specialist advice. Move containers from fire
area if this can be done without risk . Use water spray to keep fire-exposed containers
-cool. If involved in fire, shut off flow immediately if it can be done without risk . If this is
impossible, withdraw from area ~nd allow fire to burn. Fight fire from protected location
or maximum possible distance. Eliminate all ignition sources if safe to do so.
Special protective Fire-fighters should wear appropriate protective equipment and self-contained breathing
equipment for fire-fighters apparatus (SCBA) with a full face-piece operated in positive pressure mode.
I Section 6. Accidental release measures
persona• prjcauti2ni. protect.Ive eguip,nem anci emergeruw proeedvres
For non-emergency Accidental releases pose a serious fire or explosion hazard. No action shall be taken
personnel involving any personal risk or without suitable training. Evacuate surrounding areas.
K_eep unnecessaiy and unprotected personnel from entering. Shut off all ignition
sources. No flares, smoking or flames in hazard area . Avoid breathing gas. Provide
adequate ventilation . Wear appropriate respirator when ventilation is inadequate. Put
on appropriate personal protective equipment.
For emergency responders If specialised clothing is required to deal with the spillage, take note of any information
in Section 8 on suitable and unsuitable materials. See also the information in "For non-
emergency personnel".
Environmental precautions Ensure emergency procedures to deal with accidental gas releases are in place to avoid
contamination of the environment. Inform the relevant authorities if the product has
caused environmental pollution (sewers, waterways, soil or air).
MdJorui iJOd roaleriats for @otalnment and clHoing YR
Date of issue/Date of revision : 10/15/2014. Date of previous issue : 10/'l/2014. Version : 0.02 3112
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Hydrogen
Section 6. Accidental release measures
Small spill
Large spill
Immediately contact emergency personnel.
tools and explosion -proof equipment,
: Immediately contact emergency personnel.
tools and explosion -proof equipment. Note:
information and Section 13 for waste dispos
Stop leak If without risk. Use spark -proof
Stop leak if without risk. Lise spark -proof
see Section 1 for emergency contact
al.
Section 7. Handling and storage
Preeeautions for safe handling
Protective measures : Put on appropriate personal protective equipment (see Section 8). Contains gas under
pressure. Avoid contact with eyes, skin and clothing. Avoid breathing gas. Use only
with adequate ventilation. Wear appropriate respirator when ventilation is inadequate.
Do not enter storage areas and confined spaces unless adequately ventilated. Store
and use away from heat, sparks, open flame or any other ignition source. Use
explosion -proof electrical (ventilating, lighting and material handling) equipment. Use
only non -sparking tools. Empty containers retain product residue and can be hazardous.
Do not puncture or incinerate container. Use equipment rated for cylinder pressure.
Close valve after each use and when empty. Protect cylinders from physical damage;
do not drag, roll, slide, or drop. Use a suitable hand truck for cylinder movement.
Advice on general
occupational hygiene
Conditions for safe storage,
including any
incompatibilities
: Eating, drinking and smoking should be prohibited in areas where this material is
handled, stored and processed. Workers should wash hands and face before eating,
drinking and smoking. Remove contaminated clothing and protective equipment before
entering eating areas. See also Section 8 for additional information on hygiene
measures.
Store in accordance with local regulations. Store in a segregated and approved area.
Store away from direct sunlight in a dry, cool and well -ventilated area, away from
incompatible materials (see Section 10). Eliminate ail ignition sources. Keep container
tightly closed and sealed until ready for use. Cylinders should be stored upright, with
valve protection cap in place, and firmly secured to prevent falling or being knocked
over. Cylinder temperatures should not exceed 52 °C (125 °F).
Section 8. Exposure controls/personal protection
Control parameters
OccupatioLnal exposure limits
ingredient name
'Exposure limits
hydrogen
Oxygen Depletion [Asphyxiant)
Appropriate engineering : Use only with adequate ventilation. Use process enclosures, Iocal exhaust ventilation or
controls other engineering controls to keep worker exposure to airborne contaminants below any
recommended or statutory limits. The engineering controls also need to keep gas,
vapor or dust concentrations below any lower explosive limits. Use explosion -proof
ventilation equipment.
Environmental exposure Emissions from ventilation or work process equipment should be checked to ensure
controls they comply with the requirements of environmental protection legislation. In some
cases, fume scrubbers, filters or engineering modifications to the process equipment
will be necessary to reduce emissions to acceptable levels.
Individual protect►en measures
Dale of issue/Date of revision
10/15+2014. Date of previous issue : 1012/2014. Version :0.02 4112
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Hydrogen
Section 8. Exposure controls/personal protection
Hygiene measures
Eye/face protection
Skin protection
Hand protection
Body protection
Wash hands, forearms and face thoroughly after handling chemical products, before
eating, smoking and using the lavatory and at the end of the working period.
Appropriate techniques should be used to remove potentially contaminated clothing .
Wash contaminated clothing before reusing. Ensure that eyewash stations and safety
showers are close to the workstation location.
Safety eyewear complying with an approved standard should be used when a risk
assessment indicates this is necessary to avoid exposure to liquid splashes, m ists,
gases or dusts. If contact is possible, the following protection should be worn, unless
the assessment indicates a higher degree of protection: safety glasses with side-
shields.
• Chemical-resistant, impervious gloves complying with an approved standard should be
worn at all times when handling chemical .products if a risk assessment indicates this is
necessary. Considering the parameters specified by the glove manufacturer, check
during use that the g loves are still retaining their protective properties. It should be
noted that the time to breakthrough for ariy glove material may be different for different
glove manufacturers. In the case of mixtures, consisting of several substances, the
protection time of the gloves cannot be accurately estimated.
Personal protective equipment for the body should be selected based on the task being
performed and the risks involved and should be approved by a specialist before
handling this product. When there is a risk of ignition from static electricity, wear anti-
static protective clothing. For ttie greatest protection from static discharges, clothing
should include anti-static overalls, boots and gloves.
Other skin protection Appropriate footwear and any add itional skin protection measures should be selected
based on the task being performed and the risks involved and should be approved by a
specialist before handling this product.
Respiratory protection Use a properly fitted, air-purifying or air-fed respirator complying with an approved
standard if a risk assessment indicates this is necessary. Respirator selection must be
based on known or anticipated exposure levels, the hazards of the product and the safe
working limits of the selected respirator.
I Section 9. Physical and chemical properties
Appe:arance
Physical state
Color
Molecular weight
Molecular formula
Borling/condensation point
Melting/freezing point
Critical temperature
Odor
Odor threshold
pH
Flash point
Burning time
Burning rate
Evaporation rate
Flammablllty (solid, gas)
Lower and upper explosive
(flammable) limits
Date of issue/Date of revision
,. Gas
.. Colorless.
2.02 g/mole
: H2
.. -253°C (-423.4°F) . -259.15°C (-434.5°F} ..
-240.15°C (-400.3°F)
Odorless.
Not available.
Not available.
Not available.
Not applicable.
Not applicable.
Not available.
Extremely flammable in the presence of the following materials or conditions: oxidizing
materials.
• Lower: 4%
Upper: 76%
: 10/15/2014. Date of previous issue : 1012/2014 . Version : 0.02 5112
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Hydrogen
Section 9. Physical and chemical properties
Vapor pressure
Vapor density
Specific Volume (ft 3/lb)
Gas Density (lb/ft 3)
Relative density
Solubility
Solubility In water
Partition coefficient: n-
octanol/water
Not available.
0.07 (Air= 1)
: 191.9386
0.00521
Not applicable.
Not available.
Not available.
Not available.
Liquid Density@BP: 4 .43 lb/ft3 (70.96 kg/m3)
Auto-ignition temperature 500 to 571°C (932 to 1059.8°F)
Decomposition temperature Not available.
SADT Not available.
Viscosity Not applicable.
[section 10. Stability and reactivity
Reactivity
Chemical stability
Possibility of hazardous
reactions
Conditions to avoid
Incompatibility with various
substances
No specific test data related to reactivity available for this product or its ingredients,
The product is stable .·
Under normal conditions of storage and use, hazardous reactions will not occu r::
: Avoid all possible sources of ignition (spark or flame). Do not pressurize, cut, weld,
braze, solder, drill, grind or expose· containers to heat or sources of ignition.
Extremely reactive or incompatible with the following materials: oxidizing materials.
Hazardous decomposition
products
: Under normal conditions of storage and use, hazardous decomposition products should
not be produced.
Hazardous polymerization : Under normal conditions ofstorage and use, hazardous polymerization will not occur.
!sectio-n-11. Toxicological information
Information 20 toxicologic al effecbl
Acute toxicity
Not available.
lrritation/Corrosjon
Not available.
Sensitization
Not available.
Mutagentcitv
Not available.
carcinogenicity
Date of issue/Date of revision : 10/1512.014. Date of previous issue : 101'212014. Version : 0,02
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6/12
Hydrogen
Section 11. Toxicological information
Not available.
Reproductive toxicity
Not available.
Ieratogenicity
Not available.
Specific target oman toxicity tsiqgle expmu:tl
Not available.
Specific targ,rt organ toxicity (re_peated exposure)
Not available.
Aspiration hazard
Not available.
Information on the likely
routes of exposure
Potential acute health effects
Eye contact
Inhalation
Skin contact
Ingestion
: Not available,.
Contact with rapidly expanding gas may cause burns or frostbite.
No known significant effects or critical hazards.
Contact with rapidly expanding gas may cause burns or frostbite ;
As this product is a gas, refer to the inhalation section.
$Ymptoms related to the physical, ehernig;l and toxicological characteristics
Eye contact No specific data.
Inhalation
Skin contact
Ingestion
No specific data.
No specifiG data.
.No specific data.
peflYed and immedl,lte effects and also chronic effects from short and tonq term exposure
Short term exposure
Potential Immediate
effects
Potential delayed effects
Long term exposure
Potential immediate
effects
Potential delayed effects
Potential chronic health effects
Not available.
General
Carcinogenicity
Mutagenlclty
Teratogenlcity
Developmental effects
Fertility effects
Not available.
Not available.
Not available.
Not available.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
Date of issue/Date of revision : 10/15/2014. Date of previous issue ; 10/2/2014. Version : 0. 02
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7112
Hydrogen
Section 11. Toxicological information
Numerical measures of toxicity
Acute toxicity est;mates
Not available.
!Section 12. Ecological information
Toxicity
Not available.
Persi$nceanddeg,:adabifity .
Not available.
Bioaccumulatjye potential
Not available.
Mobility in soil
Soil/water partition
coefficient (Koc)
Not available.
Other adverse effects : No known significant effects or critical hazards.
I Section 13. Disposal considerations
Disposal methods The generation of waste should be avoided or minimized wherever possible. Disposal
of this product, solutions and any by-products should at all times comply with the
requirements of environmental protection and waste disposal legislation and any
regional local authority requirements. Dispose of surplus and non-recyclable products
via a licensed waste disposal contractor. Waste·should not be disposed of untreated to
the sewer unless fully compliant with the requirements of all authorties with jurisdiction.
Empty Airgas-owned pressure vessels should be returned to Airgas. Waste packaging
should be recycled. Incineration or landfill should only be considered when recycling is
not feasible. This material and its container must be disposed of in a safe way. Empty
containers or liners may retain some product residues. Do not puncture or incinerate
container.
I section 14. Tra-nsp·ort information
DOT TOG Mexico IMDG IATA
UN number UN1049 UN1049 UN1049 UN1049 UN1049
UN proper HYDROGEN . HYDROGEN, HYDROGEN HYDROGEN, HYDROGEN,
shipping name COMPRESSED COMPRESSED COMPRESSED COMPRESSED COMPRESSED
Transport 2.1 2.1 2.1 2.1 2.1
hazard class(es) ♦ ♦ ♦ ♦ ♦
Packing group ·-.-.-··--
Environment No. No . No. No. No.
I Date of issue/Date of revision :101151'2014. Date of previous issue : 1012/2014. Version :0.02 8/12 1
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---·---Hydrogen
Section 14. Transport information
Additionel !.lmttld au1atib: ila:llsm!m Llmll lml . . P1i1&1!Hli[ IDd !a!llg
!.1mllld Qianlft¥ Ir.ult& Yes. A!w:lflQuanlity Information Q.1 ~· .......... limitation: o Forbidden
eai;lsiglog IDBD.ICtis:tD ~egg Alcctd Qalir:
Passenger aircraft ERAPlndax Quantity limitation: 150
Quantity limitation: 3000 kg
Forbidden .
e11111oggc CiWJIDSI
Cargo aircraft Ship lode.x
Quantity limitation : 150 .Forbidden
kg
enlillSIIC~IEDdllU
Bgad SJ[ Biil lodu
Forbidden
"Refer to CFR 49 (or aothorlty having jurisdiction) to determine the information required for shipment of the
product."
Special precautions for user Transport within user's premises: always transport in closed containers that are
upright and secure. Ensure that persons transporting the product know what to do in the
event of an accident or spillage.
Transport in bulk according Not available.
to Annex II of MARPOL
73n8 and the IBC Code
!Section 15. Regulatory information
U.S. Federal regulations TSCA 8(a) CDR Exempt/Partial exemption: This material is listed or exempted.
United States inventory (TSCA Sb): This material is listed or exempted.
Clean Air Act (CAA) 112 regulated flammable substances: hydrogen
Clean Air Act Section 1_12
(b} Hazardous Air
Pollutants (HAPs)
Clean Air Act Section 602
Class I Substances
Clean Air Act Section 602
Class II Substances
DEA List I Chemicals
(Precursor Chemicals)
DEA List II Chemicals
(Essential Chemicals)
SARA 302/304
: Not listed
Not listed
Not listed
Not listed
Not listed
~903itiQnlinform,tt® Qn _ 1,ig,:.edi~nw
No products were found .
SARA304RQ
SARA 311/312
Not applicable.
Classification Fire hazard
Sudden release of pressure
Composit;onlintormatiQn 20 ingredients
Date of issue/Date of revision : 10/15/2014. Date of previous issue : 10/2/2014. Version : 0.02
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9112
'Hydrogen
Section 15. Regulatory information
Name
hydrogen
State regulations
Massachusetts
New York
New Jersey
Pennsylvania
Canada Inventory
lntematjonal regulations
International lists
% Fire
hazard
100 Yes .
This material is listed.
: This material is not listed.
:. This material is listed.
This material is listed.
Sudden
release of
pressure
Yes.
This material is listed or exempted.
Reactive lmmec:llate
(acute)
health
hazard
No. No.
Australia inventory (AICS): This material is listed or exempted.
China inventory (IECSC): This material is listed or exempted.
Japan inventory: Not determined.
Korea inventory: This material is listed or exempted.
Delayed
(chronic)
health
hazard
No.
Malaysia Inventory (EHS Register): This material is listed or exempted.
New Zealand Inventory of Chemicals (NZloC): This material is listed or exempted.
Philippines inventory (PICCS): This material is listed or exempted.
Chemical Weapons
Convention List Schedule
I Chemicals
Chemical Weapons
Convention List Schedule
II Chemicals
Chemical Weapons
Convention List Schedule
Ill Chemicals
Canada
WHMIS (Canada)
Taiwan inventory (CSNN): Not determined.
!-: Not listed
Not listed
: Not listed
Class A: Compressed gas.
Class B-1: Flammable gas.
CEPA Toxic substances: This material is not listed.
Canadian ARET: This material is not listed.
Canadian NPRI: This material is not listed.
Alberta Designated Substances: This material is not listed.
Ontario Designated Substances: This material is not listed,
Quebec Designated Substances: This material is not listed.
I Section 16. Other information
Canada Label requirements : Class A: Compressed gas .
Class B-1: Flammable gas.
Hazardous Material mtormati<>nSystem (U.S.A.) . ., 0
ealt
Flammability
ehys,cal hazarcis
Date of Issue/Date of revision
4
3
: 10/1512014. Date of previous issue : 10/2/2014. Version :0.02
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10/12
Hydrogen
Section 16. Other information
Caution; HMIS® ratings are based on a 0-4 rating scale, with 0 representing minimal hazards or risks, and 4
representing significant hazards or risks Although HMIS® ratings are not required on SDSs under 29 CFR 1910.
1200, the preparer may choose to provide them. HMIS® ratings are to be used with a fully implemented HMIS®
program. HMIS® is a registered mark of the National Paint & Coatings Association (NPCA). HMIS® materials
may be purchased exclusively from J. J. Keller [phone].
The customer is responsible for determining the PPE code for this material.
National Fire Prote tion Association fl1,S.A.1
Flammability
Health 0\> Instability/Reactivity
Special
Reprinted with permission from NFPA 704-2001, Identification of the Hazards of Materials for Emergency
Response Copyright 01997, National Fire Protection Association, Quincy, MA 02269. This reprinted material is
not the complete and official position of the National Fire Protection Association, on the referenced subject
which is represented only by the standard in its entirety.
Copyright 02001, National Fire Protection Association, Quincy, MA 02269. This warning system is intended to
be interpreted and applied only by properly trained individuals to identify fire, health and reactivity hazards of
chemicals. The user is referred to certain limited number of chemicals with recommended classifications in
NFPA 49 and NFPA 325, which would be used as a guideline only. Whether the chemicals are classified by NFPA
or not, anyone using the 704 Systems to classify chemicals does so at their own risk.
History
Date of printing : 10/15/2014.
Date of issue/Date of : 10/15/2014.
revision
Date of previous issue : 10/2/2014,
Version 0.02
Key to abbreviations : ATE = Acute Toxicity Estimate
BCF = Bioconcentration Factor
GHS = Globally Harmonized System of Classification and Labelling of Chemicals
IATA = lnternationarAir Transport Association
IBC = Intermediate Bulk Container
IMDG = International Maritime Dangerous Goods
LogPow = logarithm of the octanollwater partition coefficient
MARPOL 73/78 = International Convention for the Prevention of Pollution From Ships,
1973 as modified by the Protocol of 1978. ("Marpol" = marine pollution)
UN = United NationsACGIH -American Conference of Governmental Industrial
Hygienists
AIHA--American Industrial Hygiene Association
CAS - Chemical Abstract Services
CEPA - Canadian Environmental Protection Act
CERCLA - Comprehensive Environmental Response, Compensation, and Liability Act
(EPA)
CFR - United States Cade of Federal Regulations
CPR - Controlled Products Regulations
DSL - Domestic Substances List
GWP - Global Warming Potential
IARC - international Agency for Research on Cancer
ICAO - International Civil Aviation Organisation
Inh - Inhalation
LC - Lethal concentration
LD - Lethal dosage
NDSL - Non -Domestic Substances List
N1OSH - National Institute for Occupational Safety and Health
Date of issue/Date of revision
: 1011512014. Date of previous issue - f 2/20/4. Version :0.02 11/12
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,----•-___ ...._;. ______ -'-______ -"--___________________________ --...
Hydrogen
Section 16. Other information
TOG -Canadian Transportation of Dangerous Goods Act and Regulations
TLV -Threshold Limit Value
TSCA -Toxic Substances Control Act
WEEL -Workplace Environmental Exposure Level
WHMIS -Canadian Workplace Hazardous Material Information System
References Not available.
· Indicates information that has changed from previously issued version.
Notice to reader
To the best of our knowledge, the information contained herein is accurate. However, neither the above-named
supplier, nor any of its subsidiaries, assumes any liability whatsoever for the accuracy or completeness of the
information contained herein. ,
Final determination of suitability of any material is the sole responsibility of the user. All materials may present
unknown hazards and should be used with caution. Although certain hazards are described herein, we cannot
guarantee that these are the only hazards that exist.
Date of issue/Date of revision : 10/1512014. Date of previous issue : 101212014. Version : 0.02 12112
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PASSIVE HYDROGEN INJECTION SYSTEM DIAGRAM
0 Cemex tndian Ira >445�E:t
�viro ra
Environmental Services Environmental Services
PASSIVE HYDROGEN INJECTION SYSTEM DIAGRAM
PROJECT Former Comex Ready Mix Plant - Indian Trail
DEPTH TO WATER FROM
PROJECT NUMBER 11.090021.00 TOP OF WELL CASING 6.52 feet
WELL NUMBER MW-4D
WATER LEVEL ELEVATION 636.65 feet MSL
ELEVATION OF TOP OF WELL CASING 643.17 feet MSL WATER LEVEL MEASURED ON 02112f2015
HYDROGEN INSTALLED ON June 2015 - Proposed NOTE: DRAWING NOT TO SCALE
GROUNDING
STEEL WELL ROD
VAULT
18.13'
18 13'
23.13'
{
1
SUPPLY LINE
SUPPORT CABLE
TOP OF FILTER PACK
TOP OF SCREEN
HYDROGEN
DIFFUSER
BOTTOM OF WELL
REGULATOR]
PRESSURE
GAUGE
HYDROGEN
CYLINDER
ENVIROTRAC — 7343 W. FRIENDLY AVE., SUITE J I GREENSBORO. NC 1 PH: 336.763.6025 I FAX: [phone] I www.envirptrac.com