WI0300353_DEEMED FILES_20170512

Perm;t N umber
Program Category
Deemed Ground Water
Permit Type
WI0300353
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi .shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Carolina Fast Mart #2
Location Address
5104 Hwy 49 N
Concord
Owner
Owner Name
Carolina Oil Company
Dates/Events
NC
Orig Issue
5/12/2017
App Received
5/5/2017
Re g ulated Activities
Groundwater monitoring
Outfall
Waterbody Name
28025
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
5/12/2017
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Mooresville
County
Cabarrus
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
Robbie Barber
PO Box 5010
Concord
Issue
5/12/2017
Effective
5/12/2017
NC 28027501
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
Shrestha, Shristi R
From:
Sent:
To:
Cc:
Subject:
Shrestha, Shristi R
Friday, May 12, 2017 11:39 AM
'[e-mail]'
Basinger, Corey; Pitner, Andrew
WI0300353 NOi Carolina Fast Mart #2
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells (NOi) for the above referenced
site.
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 (ori ginals 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 Comments/Remarks section of form. These forms can be found on our website
at.
http ://de q .nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch /ground-water-
protection /g round-water-re portin g-forms
2) Injection Event Records (IER). All injections, including air and passive systems require an IER. The IER 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 me at Shristi.shrestha @ncdenr.gov or via regular mail to address
below. When submitting the above forms, you will need to enter the nine-digit alpha-numeric number on the form
(i.e., WI0XXXXXX) that has been assigned to the injection activity at this site. This notification has been given the
deemed permit number WI0300353. This number is also referenced in the subject line of this email. You may if you
wish, scan and send back as attachments in re p ly to this emai l, as it will already have the assigned deemed permit
number in the subject line.
Shristi
Shristi R. Shrestha
Hydrogeologist
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shrestha@ ncdenr.gov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to the
North Carolina Pubiic Records Law and may be disclosed to third parties.
Shrestha. Shristi R
From:
Sent:
To:
Subject:
Attachments:
Please find the attached NOi.
Shristi
Shristi R. Shrestha
Hydrogeologist
Shrestha, Shristi R
Friday, May 12, 2017 11:38 AM
Basinger, Corey; Pitner, Andrew
WI0300353 NOI Carolina Fast Mart #2
NOI.pdf; maps.pdf
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shrestha@ ncdenr.g ov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to fhird parties.
North Carolina Department of Environmental Quality -Division of Water Resources
NOTIFICATION OF INTENT (NOi) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of15A NCAC 02C .0200. This fo rm shall be submitted at least 2 WEEKS prior to iniection.
AQUIFER TEST WELLS '15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (ISA NCAC 02C .0225 ) or TRACER WELLS (ISA NCAC 02c .0229 ):
1) Passive In jection S v stems -In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small-Scale In jection O perations -Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests -Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells 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: ~M=a-v-3~--~ 2017 PERMIT NO. V\J :I. 0 3 0 03 53 (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERA TED
B.
C.
(1)
(2)
(3)
--~Air Injection Well ...................................... Complete sections B through F, K, N
--~Aquifer Test Well ....................................... Complete sections B through F, K, N
~X~_~Passive Injection System ............................... Complete sections B through F, H-N
(4) ___ Small-Scale Injection Operation ...................... Complete sections B through N
(5) ___ .Pilot Test ................................................. Complete sections B through N
(6) ___ Tracer Injection Well ................................... Complete section RE~~~CDt.aJO'NR
ST A TUS OF WELL OWNER: Business/Organization MA'< 5 20\?
\\~ Reg\ona\
WELL OWNER(S) -State name of Business/Agency, and Name and Title of person\M-iB~~n
sign on behalf of the business or agency: Qper
Name(s): Carolina Oil Compan y. Robert Barbour/President
Mailing Address: ~P_,__,.O"-'.'-"B=o=x"-'5=0"--'l'-"0 __________________________ _
City: Concord State: NC Zip Code: _28~2_0_7 ____ County: Cabarrus
Day Tele No.: (7 04 ) 782-3196 Cell No.:
EMAIL Address: Fax No.: __________ _
Deemed Permitted GW Remediation NOi Rev. 3-1-2016 Page I
D. PROPERTY OWNER(S) (if different than well owner)
Name and Title: ~S~am=e~a=s~o~wn~e~r ___________________________ _
Company Name:---------------------------------
Mailing Address:
City: Lexington ____________ State:-~-Zip Code: ___ County: _____ _
Day Tele No.: ____________ _ Cell Nb.: __________ _
EMAIL Address: _____________ _ Fax No.: ___________ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Matthew Smith, Staff Scientist
Company Name Shield En gineerin g, Inc.
Mailing Address: 4301 Taggart Creek Road
City: Charlotte State: NC Zip Code: 28208 County: Mecklenburrr
Day Tele No.: ('"""7-=-04"'"')'"""3"""9""""4--=-6"'-9""'13=--------------
EMAIL Address: msmith @shielderni ineerin g.com
F. PHYSICAL LOCATION OF WELL SITE
Cell No.: (828 ) 228-3881
Fax No.: [phone]
(1) Facility Name & Address: -=--5=10"----4'----U=S---=-H=i.egh=w=av'--------'-'49=----=S=ou=t=h~ _______________ _
City: Concord County: Cabarrus Zip Code: 28025
(2) Geographic Coordinates: Latitude**: 0
__ " or .l.i_0
• _3_88_8_3 _____ _
Longitude**: 0
__ " or -80 °._4_9_2_77 _____ _
Reference Datum: ________ Accuracy: ________ _
Method of Collection: ____ G~oo~g--'l~e~E~arth~~----------
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: _______ square feet
Land surface area ofinj. well network: square feet(~ 10,000 tt2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be~ 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS -Attach the following to the notification. (Figures 1, 2, and 3)
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(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) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus
existing and proposed wells.
Deemed Pennitted GW Remediation NOi Rev. 3-1-2016 Page2
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.
There was a possible release from a UST system consistin g of three I 0 .000-galJon g asoline USTs. The
quantit y of fuel release is unknown. Dissolved phase petroleum constituent com pounds in the fHoundwater
from the sam ple area are detected in concentrations above the 15A NCAC 2L .0202 groundwater quality
standards in monitor wells MW-4 and MW-5. The use ofORC Advanced Socks in wells MW-4 and MW-5 is
planned to enhance the de gradation of petroleum contaminant levels in the groundwater. A pp roximatelv 7
pounds of ox vg en release com pound are pro posed to be added to each well in the form of self-contained
"socks". The ORC is desi gned to slowl y release ox vg en and are antici pated to last for u p to one year. The
ORC socks will be re placed in monitorin g wells MW-4 and MW-5 on an annual basis. as needed, be ginning in
Mav 2018.
J. APPROVED INJECT ANTS -Provide a MSDS for each injectant. Attach additional sheets if necessary.
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at htt1 ://deq .nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/l!round-water-protection/ground-water-a pp roved-in jectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info
(919-807-6496).
Injectant: Calcium H droxide Oxide in solid form . b v sock of chemical in monitor wells, for oxyg en
Volume ofinjectant: Varies. bv diffusion.
Concentration at point of injection: A pproximatel v 7 pounds will be added to each well. ORC socks
are antici pated to last for u p to one vear.
Percent if in a mixture with other injectants: Calcium h ydroxide oxide >85%, Calcium H droxide
<15%. Di potassium Phos phate <5%, Mono potassium Phos phate <5%
Injectant:
Volume of injectant:
Concentration at point of injection: ________________________ _
Percent if in a mixture with other injectants: ____________________ _
Injectant:
Volume ofinjectant: _____________________________ _
Concentration at point of injection: ________________________ _
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA
(I) Number of injection wells: _____ Proposed __ ~2~ __ Existing (provide GW-ls) (A
(2) For Proposed wells or Existing wells not having GW-1 s, 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
Deemed Pennitted GW Remediation NOi Rev. 3-1-2016 Page3
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a)
(b)
(c)
Well type as permanent, Geaprcrhe/DPT, or subsurface distribution infiltration gallery
Depth below land surface of casing, each grout type and depth, screen, and sand pack
Well contractor name and certification number
Well
Type
Grout
(ft-bls)
Screen
(ft bls)
Sand Pack
(ft-b]s)
Casing -
Length
(ft-bls)
MW-4
Permanent
Monitoring
Well
0-2f1
Concrete
2-3ft
Bentonite
5-l5ft
3-15ft
tin PVC
0-5ft
MW-5
Permanent
Monitoring
Weil
0-1.5ft
Concrete
1.5-2ft
Bentonite
3-13ft
2-13ft
tin PVC
0-3ft
L. SCHEDULES— Briefly describe the schedule for well construction and injection activities.
Advanced ORC Sacks. will . be placed into the existing, wells 1vIW-4 . and MW 5. in early to: nnithiViav 2017,
following receipt of the notification permit number from the NCDEQ. The ORC sockwill be replaced in
rnofitorinl wells MW-4 and MW-5 on anannual basis, as needed, beginning in May 2018_ _
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 Subchapter 02L result from the injection activity.
The injection of oxygen is not expected to result in violations of the 2L Standards. The monitor wells will be
sampled on a regular basis. This will be followed bv. post-retnediatioti sampiine without oxygen. infusion to
check for rebound of contaminant levels_
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 information is true, accurate and complete. I am
aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false inform: i. I agree to construct, operate, maintain, repair, and f applicable, abandon the injection well
and all r appur renatt • .* r a 'coo -dance with the I5A NCAC 02C 0000 Rules." r
J e. ■i ?re5tdeii
7f
Si f attire of Applicant Print or Type Full Name and Title
PROPERTY OWNER (if the property is not awned by the permit. applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, 1 hereby consent
to allow the applicant to construct each injection well as outlined in this application and agree that it shall be
the responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction
Standards (15A NCAC 02C .0.200). "
Deemed Pcnnitled GW Remediation NO1 Rev. 3-I-2016 Page 4

"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 and Title
*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:
Deemed Pennitted GW Remediation NOi Rev. 3-1-2016
DWR -UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Page 5
4 REGENES1S SAFETY DATA SHEET
Technology -Based Solutions for the Environment
1. Identification
Product identifier
Other means of identification
Recommended use
Recommended restrictions
Oxygen Release Compound Advanced (ORC Advanced®)
None.
Soil and Groundwater Remediation.
None known.
Manufacturerlimporter1Supplier!Distributor information
Company Nance
Address
Telephone
E-mail
Emergency phone number
2. Hazard(s) identification
Physical hazards
Health hazards
OSHA defined hazards
Label elements
Signal word
Hazard statement
Precautionary statement
Prevention
Response
Storage
Disposal
Hazard(s) not otherwise
classified (HNOC)
Regenesis
1011 Calle Sombre
San Clemente, CA 92673
949-366-8000
[e-mail]
CHEMTRECB at 1-800-424-9300 (International)
Oxidizing solids
Skin corrosion/irritation
Serious eye damage/eye irritation
Not classified.
Category 2
Category 1
Category 1
Danger
May intensify fire; oxidizer. Causes skin irritation. Causes serious eye damage.
Keep away from heat. Keep/Store away from clothing and other combustible materials. Take any
precaution to avoid mixing with combustibles. Wash thoroughly after handling. Wear protective
gloves/eye protection/face protection.
if on skin: Wash with plenty of water. If in eyes. Rinse cautiously with water for several minutes.
Remove contact lenses, if present and easy to do. Continue rinsing. Immediately call a poison
center/doctor. If skin irritation occurs: Get medical advice/attention. Take off contaminated
clothing and wash before reuse. In case of fire: Use appropriate media to extinguish.
Store away from incompatible materials.
Dispose of contents/container in accordance with local/regional/national/international regulations.
None known.
3. Composition/information on ingredients
Mixtures
Chemical name
Calcium hydroxide oxide
CAS number
682334-66-3 ?85
Calcium hydroxide
1305-62-0 15
Dipotassium Phosphate
7758-11-4 <5
Monnpotassium Phosphate
7778-77-0 <5
Composition comments
All concentrations are in percent by weight unless otherwise indicated.
Oxygen Release Compound Advanced (ORC Advanced'
925597 Version #: 01 Revision date: - issue date:02-April-2015
505 US
118

4. First-aid measures
Inhalation
Skin contact
Eye contact
Ingestion
Most important
symptoms/effects, acute and
delayed
Indication of immediate
medical attention and special
treatment needed
General information
5. Fire-fighting measures
Suitable extinguishing media
Unsuitable extinguishing
media
Specific hazards arising from
the chemical
Special protective equipment
and precautions for firefighters
Fire fighting
equipment/instructions
Specific methods
General fire hazards
Move to fresh air. Call a physician if symptoms develop or persist.
IF ON CLOTHING: rinse immediately contaminated clothing and skin with plenty of water before
removing clothes. Rinse skin with water/shower. If skin irritation occurs: Get medical
advice/attention. Wash contaminated clothing before reuse.
Do not rub eyes. Immediately flush eyes with plenty of water for at least 15 minutes. Remove
contact lenses, if present and easy to do. Continue rinsing. Get medical attention immediately.
Never give anything by mouth to a victim who is unconscious or is having convulsions. Rinse
mouth. Do not induce vomiting. If vomiting occurs, keep head low so that stomach content doesn't
get into the lungs. Get medical attention if symptoms occur.
Severe eye irritation. Symptoms may include stinging, tearing, redness, swelling, and blurred
vision. Permanent eye damage including blindness could result. Dusts may irritate the respiratory
tract, skin and eyes. Skin irritation. May cause redness and pain.
Provide general supportive measures and treat symptomatically. Keep victim under observation.
Symptoms may be delayed.
Take off all contaminated clothing immediately. Contact with combustible material may cause fire.
Ensure that medical personnel are aware of the material(s) involved, and take precautions to
protect themselves. Wash contaminated clothing before reuse.
Water spray, fog (flooding amounts). Foam. Dry chemical powder. Carbon dioxide (CO2).
None known.
Greatly increases the burning rate of combustible materials. Containers may explode when
heated. During fire, gases hazardous to health may be formed. Combustion products may include:
metal oxides.
Self-contained breathing apparatus and full protective clothing must be worn in case of fire.
In case of fire and/or explosion do not breathe fumes. Move containers from fire area if you can do
so without risk. Use water spray to cool unopened containers.
Cool containers exposed to flames with water until well after the fire is out.
May intensify fire; oxidizer. Contact with combustible material may cause fire.
6. Accidental release measures
Personal precautions,
protective equipment and
emergency procedures
Methods and materials for
containment and cleaning up
Environmental precautions
Keep unnecessary personnel away. Keep people away from and upwind of spill/leak. Keep away
from clothing and other combustible materials. Wear appropriate protective equipment and
clothing during clean-up. Use a NIOSH/MSHA approved respirator if there is a risk of exposure to
dusUfume at levels exceeding the exposure limits. Do not touch damaged containers or spilled
material unless wearing appropriate protective clothing. Ensure adequate ventilation. Local
authorities should be advised if significant spillages cannot be contained. For personal protection,
see section 8 of the SOS.
Eliminate all ignition sources (no smoking, flares, sparks, or flames in immediate area). Collect
dust using a vacuum cleaner equipped with HEPA filter. Keep combustibles (wood, paper, oil, etc.)
away from spilled material. Ventilate the contaminated area. Stop the flow of material, if this is
without risk. Absorb in vermiculite, dry sand or earth and place into containers.
Large Spills: Sweep up or vacuum up spillage and collect in suitable container for disposal. Shovel
the material into waste container. Minimize dust generation and accumulation. Avoid the
generation of dusts during clean-up. Following product recovery, flush area with water.
Small Spills: Wipe up with absorbent material (e.g. cloth, fleece). Clean surface thoroughly to
remove residual contamination.
Never return spills to original containers for re-use. Place all material into loosely covered plastic
containers for later disposal. For waste disposal, see section 13 of the SOS. Wear appropriate
protective equipment and clothing during clean-up.
Avoid discharge into drains, water courses or onto the ground.
Oxygen Release Compound Advanced (ORC Advanced®) SDSUS
2/8 925597 Version#: 01 Revision date: -Issue date: 02-April-2015
7. Handling and storage
Precautions for safe handling
Conditions for safe storage,
including any incompatibilities
Minimize dust generation and accumulation. Routine housekeeping should be instituted to ensure
that dusts do not accumulate on surfaces. Keep away from heat. Provide appropriate exhaust
ventilation at places where dust is formed. Keep away from clothing and other combustible
materials. Take any precaution to avoid mixing with combustibles. Avoid contact with water and
moisture. Do not get this material in contact with eyes. Avoid contact with eyes, skin, and clothing.
Avoid prolonged exposure. Wear appropriate personal protective equipment. Observe good
industrial hygiene practices.
Keep away from heat. Store in a cool, dry place out of direct sunlight. Store in original tightly
closed container. Store in a well-ventilated place. Do not store near combustible materials. Store
away from incompatible materials (see Section 10 of the SDS).
8. Exposure controls/personal protection
Occupational exposure limits
US. OSHA Table Z-1 Limits for Air Contaminants (29 CFR 1910.1000)
Components
Calcium hydroxide (CAS
1305-62-0)
Type
PEL
Value
5 mg/m3
15 mg/m3
Form
Respirable fraction.
Total dust.
US. ACGIH Threshold Limit Values
Components Type Value
Calcium hydroxide (CAS TWA 5 mg/m3
1305-62-0)
US. NIOSH: Pocket Guide to Chemical Hazards
Components
Calcium hydroxide (CAS
1305-62-0)
Biological limit values
Appropriate engineering
controls
Type Value
TWA 5 mg/m3
No biological exposure limits noted for the ingredient(s).
Good general ventilation (typically 10 air changes per hour) should be used. Ventilation rates
should be matched to conditions. If applicable, use process enclosures, local exhaust ventilation,
or other engineering controls to maintain airborne levels below recommended exposure limits. If
exposure limits have not been established, maintain airborne levels to an acceptable level. If
engineering measures are not sufficient to maintain concentrations of dust particulates below the
Occupational Exposure Limit (OEL), suitable respiratory protection must be worn. If material is
ground, cut, or used in any operation which may generate dusts, use appropriate local exhaust
ventilation to keep exposures below the recommended exposure limits. Eye wash facilities and
emergency shower must be available when handling this product.
Individual protection measures, such as personal protective equipment
Eye/face protection Use dust-tight, unvented chemical safety goggles when there is potential for eye contact.
Skin protection
Hand protection
Other
Respiratory protection
Thermal hazards
General hygiene
considerations
Wear appropriate chemical resistant gloves. Frequent change is advisable. Recommended gloves
include rubber, neoprene, nitrile or viton.
Wear appropriate chemical resistant clothing.
If engineering controls do not maintain airborne concentrations below recommended exposure
limits (where applicable) or to an acceptable level (in countries where exposure limits have not
been established), an approved respirator must be worn. Recommended use: Wear respirator with
dust filter.
Wear appropriate thermal protective clothing, when necessary.
Keep from contact with clothing and other combustible materials. Remove and wash contaminated
clothing promptly. Always observe good personal hygiene measures, such as washing after
handling the material and before eating, drinking, and/or smoking. Routinely wash work clothing
and protective equipment to remove contaminants.
9. Physical and chemical properties
Appearance
Physical state
Form
Color
Solid.
Powder.
White to pale yellow.
Oxygen Release Compound Advanced (ORC Advanced®)
925597 Version#: 01 Revision date: -Issue date: 02-April-2015
sos us
3/8
Odor Odorless.
Odor threshold Not available.
pH 12.5 (3% suspension/water)
Melting point/freezing point Not available.
Initial boiling point and boiling Not available.
range
Flash point Not available.
Evaporation rate Not available.
Flammability (solid, gas) Oxidizer.
Upper/lower flammability or explosive limits
Flammability limit -lower Not available.
(%)
Flammability limit -upper Not available.
(%)
Explosive limit -lower(%) Not available.
Explosive limit -upper(%) Not available.
Vapor pressure Not available.
Vapor density Not available.
Relative density Not available.
Solubility(ies)
Solubility (water) Slightly soluble
Partition coefficient Not available.
(n-octanol/water)
Auto-ignition temperature Not available.
Decomposition temperature 527 °F (275 °C)
Viscosity Not available.
Other information
Bulk density 0.5 -0.9 g/ml
Explosive limit Non-explosive.
10. Stability and reactivity
Reactivity
Chemical stability
Possibility of hazardous
reactions
Greatly increases the burning rate of combustible materials.
Decomposes on heating. Product may be unstable at temperatures above: 275°C/527°F.
Reacts slowly with water.
Conditions to avoid Heat. Moisture. Avoid temperatures exceeding the decomposition temperature. Contact with
incompatible materials.
Incompatible materials
Hazardous decomposition
products
Acids. Bases. Salts of heavy metals. Reducing agents. Combustible material.
Oxygen. Hydrogen peroxide (H2O2). Steam. Heat.
11. Toxicological information
Information on likely routes of exposure
Inhalation Dust may irritate respiratory system. Prolonged inhalation may be harmful.
Skin contact
Eye contact
Ingestion
Causes skin irritation.
Causes serious eye damage.
Ingestion may cause irritation and malaise.
Symptoms related to the
physical, chemical and
toxicological characteristics
Severe eye irritation. Symptoms may include stinging, tearing, redness, swelling, and blurred
vision. Permanent eye damage including blindness could result. Dusts may irritate the respiratory
tract, skin and eyes. Skin irritation. May cause redness and pain.
Information on toxicological effects
Acute toxicity
Oxygen Release Compound Advanced (ORC Advanced®)
925597 Version#: 01 Revision date: -Issue date: 02-April-2015
sos us
4/8
Components Species
Calcium hydroxide (CAS 1305-62-0)
Acute
Oral
LD50 Rat
Skin corrosion/irritation
Serious eye damage/eye
irritation
Respiratory or skin sensitization
Respiratory sensitization
Causes skin irritation.
Causes serious eye damage.
Not a respiratory sensitizer.
Test Results
7340 mg/kg
Skin sensitization This product is not expected to cause skin sensitization.
Germ cell mutagenicity No data available to indicate product or any components present at greater than 0.1 % are
mutagenic or genotoxic.
Carcinogenicity This product is not considered to be a carcinogen by IARC, ACGIH, NTP, or OSHA.
OSHA Specifically Regulated Substances (29 CFR 1910.1001-1050)
Not listed.
Reproductive toxicity This product is not expected to cause reproductive or developmental effects.
Specific target organ toxicity -Not classified.
single exposure
Specific target organ toxicity -Not classified.
repeated exposure
Aspiration hazard Due to the physical form of the product it is not expected to be an aspiration hazard.
Chronic effects Prolonged inhalation may be harmful.
12. Ecological information
Ecotoxicity The product is not classified as environmentally hazardous. However, this does not exclude the
possibility that large or frequent spills can have a harmful or damaging effect on the environment.
Components Species Test Results
Calcium hydroxide (CAS 1305-62-0)
Aquatic
Fish
Persistence and degradability
Bioaccumulative potential
Mobility in soil
Other adverse effects
LC50 Zambezi barbel (Clarias gariepinus) 33.8844 mg/I, 96 hours
Decomposes in the presence of water. The product contains inorganic compounds which are not
biodegradable.
The product does not contain any substances expected to be bioaccumulating.
This substance has very low solubility in water and low mobility in the environment.
None known.
13. Disposal considerations
Disposal instructions
Local disposal regulations
Hazardous waste code
Waste from residues / unused
products
Contaminated packaging
14. Transport information
DOT
UN number
UN proper shipping name
Collect and reclaim or dispose in sealed containers at licensed waste disposal site. Dispose of
contents/container in accordance with local/regional/national/international regulations.
Dispose in accordance with all applicable regulations.
The waste code should be assigned in discussion between the user, the producer and the waste
disposal company.
Dispose of in accordance with local regulations. Empty containers or liners may retain some
product residues. This material and its container must be disposed of in a safe manner (see:
Disposal instructions).
Empty containers should be taken to an approved waste handling site for recycling or disposal.
Since emptied containers may retain product residue, follow label warnings even after container is
emptied.
UN1479
Oxidizing solid, n.o.s. (Calcium hydroxide oxide)
Oxygen Release Compound Advanced (ORC Advanced®) SDSUS
5/8 925597 Version#: 01 Revision date: -Issue date: 02-April-2015
Transport hazard class(es)
Class 5.1
Subsidiary risk
Label{s) 5.1
Packing group II
Environmental hazards
Marine pollutant No
Special precautions for user Read safety instructions, SOS and emergency procedures before handling.
Special provisions 62, 1B8, IP2, IP4, T3, TP33
Packaging exceptions 152
Packaging non bulk 212
Packaging bulk 240
IATA
UN number UN1479
UN proper shipping name Oxidizing solid, n.o.s. (Calcium hydroxide oxide)
Transport hazard class(es)
Class 5.1
Subsidiary risk
Packing group II
Environmental hazards No
ERG Code SL
Special precautions for user Read safety instructions, SOS and emergency procedures before handling.
IMDG
UN number
UN proper shipping name
Transport hazard class(es)
Class
Subsidiary risk
Packing group
Environmental hazards
Marine pollutant
EmS
UN1479
OXIDIZING SOLID, N.O.S. (Calcium hydroxide oxide)
5.1
II
No
F-A, S-Q
Special precautions for user Read safety instructions, SOS and emergency procedures before handling.
Transport in bulk according to Not applicable.
Annex II of MARPOL 73/78 and
the IBC Code
15. Regulatory information
US federal regulations This product is a "Hazardous Chemical" as defined by the OSHA Hazard Communication
Standard, 29 CFR 1910.1200.
All components are on the U.S. EPA TSCA Inventory List.
TSCA Section 12(b) Export Notification (40 CFR 707, Subpt. D)
Not regulated.
OSHA Specifically Regulated Substances (29 CFR 1910.1001-1050)
Not listed.
CERCLA Hazardous Substance List (40 CFR 302.4)
Not listed.
Superfund Amendments and Reauthorization Act of 1986 (SARA)
Hazard categories Immediate Hazard -Yes
Delayed Hazard -No
Fire Hazard -Yes
Pressure Hazard -No
Reactivity Hazard -Yes
SARA 302 Extremely hazardous substance
Not listed.
SARA 311/312 Hazardous Yes
chemical
Oxygen Release Compound Advanced (ORC Advanced®)
925597 Version#: 01 Revision date: -Issue date: 02-April-2015
sos us
6/8
SARA 313 (TRI reporting)
Not regulated.
Other federal regulations
Clean Air Act (CAA) Section 112 Hazardous Air Pollutants (NAPS) List
Not regulated.
Clean Air Act (CAA) Section 112(r) Accidental Release Prevention (40 CFR 68.130)
Nat regulated.
Safe Drinking Water Act Not regulated.
(SDWA)
US state regulations
US. Massachusetts RTK - Substance List
Calcium hydroxide (CAS 1305-62-0)
US. New Jersey Worker and Community Right -to -Know Act
Calcium hydroxide (CAS 1305-62-0)
Calcium hydroxide oxide (CAS 682334-66-3)
US. Pennsylvania Worker and Community Right -to -Know Law
Calcium hydroxide (CAS 1305-62-0)
IIS. Rhode Island RTK
Not regulated.
US. California Proposition 65
California Safe Drinking Water and Toxic Enforcement Act of 1986 (Proposition 65): This material is not known to contain
any chemicals currently listed as carcinogens or reproductive toxins.
International Inventories
Country(s) or region Inventory name On inventory (yes/no)'
Australia Australian Inventory of Chemical Substances (AICS) Yes
Canada Domestic Substances List (DSL) Yes
Canada Non -Domestic Substances List (NDSL) No
China Inventory of Existing Chemical Substances in China (IECSC) Yes
Europe European Inventory of Existing Commercial Chemical Yes
Substances (EINECS)
Europe European List of Notified Chemical Substances (ELINCS) No
Japan Inventory of Existing and New Chemical Substances (ENCS) Yes
Korea Existing Chemicals List (ECL) Yes
New Zealand New Zealand Inventory Yes
Philippines Philippine Inventory of Chemicals and Chemical Substances Yes
(PICCS)
United States & Puerto Rico Toxic Substances Control Act (TSCA) Inventory Yes
'A' Yes" indicates this product complies with the inventory requirements administered by the governing country{sy.
A No indicates that one or more components of the product are nal listed GI exempt from listing on the inventory administered by the governing
country(s).
16. Other information, including date of preparation or last revision
Issue date
Revision date
Version #
Further information
HMIS® ratings
NFPA ratings
02-April-2015
01
HM1S@ is a registered trade and service mark of the American Coatings Association (ACA).
Health: 3
Flammability_ 0
Physical hazard: 2
Oxygen Release Compound Advanced (CRC Advanced57)
925597 Version #7 01 Revision date - Issue date: 02-April-2015
SDS 05
718

Disclaimer Regenesis cannot anticipate all conditions under which this information and its product, or the
products of other manufacturers in combination with its product, may be used. It is the user's
responsibility to ensure safe conditions for handling, storage and disposal of the product, and to
assume liability for loss, injury, damage or expense due to improper use. The information in the
sheet was written based on the best knowledge and experience currently available.
Oxygen Release Compound Advanced (ORC Advanced®) SDSUS
8/8 925597 Version#: 01 Revision date: -Issue date: 02-April-2015
H:IPROJECTS 1199911990047 CFIWI`2\FIGURESlARMR OWGS 1-16.DWG
4RAR7ACE TTLE
•
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•
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NCDOT RIUHT OF WAY
41 - — — POLE LOCATIONS, OVERHEAD ELECTRrCAL POWER
GASOLINE UST {10,000 GALLONS)
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ABANDONED MONIFOR INc WELL LOCATIOI45
. MANHOLE FOR SANfTARY SEWER
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O
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WuSML1 MICROGRAMS PER LITER
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.�. — NAPHTHALENE ISOCONCENTRATlON LINE
(NO) HOT DETECTED AT OR ABOVE THE
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(Ns) NOT SAMPLED
NOTES:
1- ALL LUCK PONS ARE APPROXIMATE.
Z. GROUNDWATER SAMPLES COLLECTED IN WI11211&
3- CONTOUR INTERVAL AS SHOWN.
GRAPHICSCALE
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SCALE- 1 in. = d0 !L.
SHIELD
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15000NCENTRAT1ON MAP
CAROLINA FAST MART #2
CONCORD, NORTH CAROLINA
SHIELD 11 199004f7
DATE : 01 /09/17 DRAWN BY : RBS
SCALE : AS SHOWN FIGURE : 1

M#21FIGLIRESIA
pOSER SUPPLY TO LIMITS
EDGE OF PAVEMENT
KEROSENE DISPENSER
ORAWACE TILE
SANITARY•
SENEE
MW-9 S
(97.8ay
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UNDTMGROUNO
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NC HIGHWAY 49 EAST
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°l
LEGEND:
�— DRAINAGE FEATURE
— — — NCDOT RIGHT OF WAY
—• -- —0 POLE LOCATIONS, OVERNEAO ELECTRICAL POWER
GASOLINE IIST j12,00f GALLONS
µONIrORING WELLLOCATIONS
PK ABANDONED MONITORING WELL LOCATIONS
. MANHOLE FOR SANITARY SEWER
• SOIL BORINGS
p ATTEMPTED SOIL BDR1NGS
WATER SUPPLY WELL
STREAM SAMPLE LOCATION
{fly FEET
[98.52j GROUNDWATER ELEVATION (1Lj
{NHL NOT MEASURED
NOTES:
1- DEPTHS TO GROUNDWATER MEASURED ON 17112116.
2- ALL LOCATIONS ARE APPROXIMATE_
GRAPHIC SCALE
IO op 10 40
SCALE:1 in. _40ft
SHIELD
ENGINEERING, INC.
4303 rAGGART CREEK ROAE
CHARLOTTE NC 282q
iui39e49f3
7443444999 ry
rfflwA144141.*44444 cam
GROUNDWATER ELEVATION MAP
CAROLINA FAST MART #2
CONCORD, NORTH CAROLINA
SHIELD # 195,0047
DATE: 01/09/17
DRAWN BY : RBS
SCALE : AS SHOWN
FIGURE : 2