WI0300371_DEEMED FILES_20180217

Permit Number
Program Category
Deemed Ground Water
Permit Type
WI0300371
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Frances Gibson Property
Location Address
114 W 1st St
Conover NC 28613
Owner
Owner Name
Ncdeq State Lead Program Mooresvile Regional Office
Dates/Events
Orig Issue
2/14/2018
App Received
2/1/2018
Reg ulated Activities
Groundwater remediation
Outfall
Waterbody Name
Draft Initiated
Scheduled
Issuance Public Notice
Central Files : APS SWP
2/14/2018
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Afflllation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Government -State
Owner AfflllaUon
Jake Whittle
Region
Mooresville
County
Catawba
7606 Whitehall Executive Center Dr
Charlotte NC
Issue
2/14/2018
Effective
2/14/2018
28273
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasln
ATC
ENVIRONMENTAL • &EUTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
7606 Whitehall Executive Center Drive
Suite 800
Charlotte, NC 28273
Tel: [phone]
Fax: [phone]
www. atcgro u pservices. com
N.C. Engineering License No. C-1598
ti { :CE VED'NCDED(OW ..
January 31, 2018
'tar Quality Reg►onal
Ms. Shristi Shrestha -
��nne Section
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section, UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Reference: Notice of Intent to Construct or Operate Injection Wells
Frances Gibson Property
114 West 15` Street
Conover, Catawba County, North Carolina
NCDEQ Incident #23265
Dear Ms. Shrestha:
ATC Associates of North Carolina, P.C. (ATC) has prepared the enclosed Notice of Intent to
Construct or Operate Injection Wells on behalf of the NC DEQ State Lead UST Cleanup
Program. The permit application covers injection of ambient air through an existing monitoring
well network concurrent with aggressive fluid -vapor recovery (AFVR) and subsequent
installation of down well Advent -us oxygen releasing remedial socks to promote natural
degradation of petroleum impact in groundwater at the site.
If you have questions or require additional information, please contact our office at [phone].
Sincerely,
Asssicia�ftec�t�� North Carolina, P.C.
I
Whittle
Project Manager
Attachments

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 of 15A NCAC 02C .0200. This form 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 O5A NCAC 02C .0225 ) or TRACER WELLS {15A NCAC 02C .0229 ):
1) Passive Injection S ystems -In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small-Scale Injection O p erations -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 Injection 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: January 31 ,2018_ PERMIT NO. V\/1030 031'( (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1)
(2)
(3)
=X~_~Air Injection Well ...................................... Complete sections B through F, K, N
___ Aquifer Test Well. ...................................... Complete sections B throughF, K, N
=X~_~Passive Injection System ............................... Complete sections B through F, H-N
(4) ___ Small-Scale Injection Operation ...................... Complete sectio(\~ ,, .N~~-:ctEQ/DWR
(5) ___ Pilot Test ................................................. Complete sections B through N
. . · F'="R -1 2018 (6) ___ Tracer lnJectlon Well ................................... Complete sectrnns B th'rottgh N
Water Quality Regional
B. STATUS OF WELL OWNER: Choose an item. Oper?.tions Section
C. WELL OWNER(S)-State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): North Carolina Department of Environmental Quality (NCDEO) -State Lead Program
Mooresville Ree ional Office
Mailing Address: --~6~1~0=E=a=st~C~e=n=te=r~A~v~e=. =S~w=·te~30~1~------------------
City: -------=-M=o=o=r""es~v=il=le~_ State: _ NC_ Zip Code: __ ~2=8=1~1~5 ____ County:~Ir=e=d=e=ll ___ _
Day Tele No.: 704-663-1699 CellNo.: __________ _
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page 1
EMAIL Address: _____________ _ FaxNo.: ___________ _
D. PROPERTY OWNER(S) (if different than well owner)
Name and Title: ___ C=on=o"-v,_,e=r-"'P~ro""'p"-'e=rt=i=es=-----------------------------
Mailing Address: --~5~0'-9_5_th_A_v_e~n~u_e_N_E _________________ _
City: ------'C'-'o=n=o~ve=r ______ State:_NC_ZipCode: 28613 County: Catawba
Day Tele No.: 828-234-6418 Cell No.:
EMAIL Address: _____________ _ FaxNo.: ___________ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: -----'J=ak=e--'Wh'-'-=1=·tt=le=.""P""r""'o""je=ct.a..M=a=n=a=ge=r ___________________ _
Company Name ___ Aa.=T-=C'-A"-='ss=o'-=c=ia=t=es=------------------------------
Mailing Address: __ ___,_7-"6-=-0-=--6 _,Wh--'--=i=te=h=a=ll'-'E=x=e=c=ut=iv-'-e"'--"'C""'en=t=e-=--r =D=r'-. S=-u=i=te'-8=-0~0=-------------------
City: _C_h_ar_l_ott_e _______ _ State: _NC_ Zip Code: 28273 County: Mecklenburg
Day Tele No.: 704-529-3200 Cell No.:. ___________ _
EMAIL Address: jason.whittle@ atcassociates.com Fax No.: ------------
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: ---~Fr=an~ce=s~G-=--1=·b~so=n-=--P~r'-'o_._p-'-e rty~---------------
l14 West pt St.
City: ___ C=-o=n=o'--'v""'e""'r _________ County: Catawba Zip Code: __ 2=8~6~13~
(2) Geographic Coordinates: Latitude**: 0 "or 35 °._7~0~6~69~8~--
Longitude**: 0 __ "or -81 ° 218658
Reference Datum: _______ ~Accuracy: ________ _
Method of Collection: _________________ _
**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: Localized Im pact* square feet
Land surface area ofinj. well network: <10 .000 ft2 __ square feet ts 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: NI A (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 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 Permitted GW Remediation NOI Rev. 8-28-2017 Page2
I. DESCRIPTION OF PROPOSED INJECTION ACTMTIES -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.
Concurrent with an 8 hour Aggressive Fluid-Vapor Recove rv (AFVR) event with extraction from source
area well MW-3 , ATC will perform air s parge at shallow monitoring wells MW-1. MW-2 , and MW-4. which
surround MW-3. A downwell air s parne stinger pi pe will be installed in these wells with a bladder installed
above the end of the spare:e stin e.er to promote s parn:e influence into the groundwater column below the well
screen. Adventus dissolved oxyg en release sleeve (remedial socks ) will be installed in each well (3 OSOXS in
each well-12 total) a pproximately 30 day s after the AFVR. followin g ernundwater sam ple collection.
Groundwater contaminant concentrations are illustrated in the attached Figure 1 and are summarized in the
Groundwater Analytical Data table also attached.
J. APPROVED INJECTANTS-Provide a MSDS for each injectant. Attach additional sheets ifnecessary.
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be irifected. Approved injectants can be found online at http://deg.nc.gov/about/divisions/water-
rcsources/water-resources-pennits/wastewater-branch/ground-water-protection/ground-water-ap proved-in iectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UJC Program for more info (919-
807-6496).
Injectant: --~A~d~ve=n=tu~s-"d=is=s~o~lv....:e=d~o=x=v .... g=e=n=r~el=e=a~se~sl=e~ev~e~(r __ e=m=e=d=ia=l .... s __ o=ck=s~) __ O_·_-_S_O_)l' ___ _
Volume of injectant: 12 remedial socks @ 20.86 in.3 ; Total Volume= 250.32 in.3
Concentration at point of injection: --~9'-0~o/c~o~-------------------
Percent if in a mixture with other injectants: --~N~/=A~-----------------
Injectant: __ ....:Am~=b=ie=n"'"t "-'A=ir'--=A=ir=-=S=p=ar"'-g'""e'""'d=ur=1=·n=e:"""AF~VR...a..=..'-----------------
Volume of injectant: _....:Nc...c/_c_A"---------
Concentration at point of injection: 100% Ambient Air
Percent if in a mixture with other injectants: ___ N_/_A _________________ _
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: _Q_Proposed 4 MWs (MW-I through MW-4 ) Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as-built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page3
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
The AFVR with enhanced Air Sparoe event will take place in February 2018. 30 days following the event,
groundwater will be sampled from monitoring wells MW-1 through MW-4. The 0-SOX will be installed
immediately after sampling each monitoring well.
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.
Site monitorinc wells MW-1 through MW4 will be sampled 30 dais after the AFVR/Air Snare event to
evaluate the effectiveness of the remediation effort. The 0-SOX will be installed during the groundwater
sampline event and the wells will be sampled again approximately 6 months following the remedial socks
treatment.
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 baased on my inquiry of those individuals immediately responsible
for obtaining said inform ion, I believe that the information is true, accurate and complete. I am aware that
the r e sigylrftca it hies, including the possibility of fines and imprisonment for submitting false
infrlrnuOion. 9 agr to tract operate, maintain, repair, and if applicable, abandon the injection well and
all irela ed aiii utter anc s Ecordance with the 15A NCAC 02C 0200 Rules."
15ygoimili/FJ4i
a are of Applicant / Print or Type Fall Name and Title
PROPERTY OWNER Of thepropem is not owned by the permit applicantj:
"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
VISA NCAC 02C.020Mj, "
£ram
"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 forms •
Please send this NOI electronically to Sltristi.Shrestha,ti ncdenr.uov AND one hard copy to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted OW Remediarian NOI Rev, 8-28-2017
Page 4

TABLE 1
MONITORING WELL CONSTRUCTION
Frances Gibson Property
114 1st Street West
Conover, Catawba County, North Carolina 28115
NCDEQincident #23265
Well Screen Well Diameter Depth of.Well Well ID Date Installed Interval (in) (Feet) (Feet)
MW-I 10/30/2007 2 45 30-45
MW-2 9/28/2011 2 50 25-50
MW-3 9/28/2011 2 50 25-50
MW-4 9/28/2011 2 50 25-50
NM = Not Measured
TOC Elevation
(Feet)
NM
NM
NM
NM
Gauging Well ID Date
1/5/2015
MW-1 8/7/2015
9/22/2016
1/5/2015
MW-2 8/7/2015
9/22/2016
1/5/2015
MW-3 8/7/2015
9/22/2016
1/5/2015
MW-4 8/7/2015
9/22/2016
NM = Not Measured
NA = Not Applicable
TABLE2
GROUNDWATER ELEVATION DATA
Frances Gibson Property
114 1st Street West
Conover, Catawba County, North Carolina 28115
NCDEQ Incident #23265
Depth to Depth To Product Groundwater
(feet) Product (feet) Thickness (feet)
33.95 NA NA
34.47 NA NA
34.31 NA NA
33.81 NA NA
34.43 NA NA
34.31 NA NA
33.14 NA NA
33.76 NA NA
32.43 NA NA
33.17 NA NA
33.79 NA NA
33.01 NA NA
TOC Groundwater
Elevation Elevation
(feet) (feet)
NM NA
NM NA
NM NA
NM NA
NM NA
NM NA
NM NA
NM NA
NM NA
NM NA
NM NA
NM NA
Well ID Sample Date .. !:l .. = ~ = = .!:! .!:! .. .. ~ .. .. ;! 5 = t .. " .e -; .c
= .c -Q, .. ~ .. " l:Q ~ ... z
Analytical Procedure
1/5 /2014 820 2,500 480 3,280 <6.0
MW -I
9/22/201 6 640 1,000 280 2 ,040 140
1/5/2015 660 3,500 940 5,300 690
MW-2
9/22/2016 750 3,500 1,100 6,700 480
1/5 /2015 4,300 35,000 3,300 18,300 1,300
MW-3 8/7/2015 4,720 23,400 2,810 14,300 519
9/22/2016 5.400 37,000 2,900 17,100 440
1/5 /201 4
MW-4
280 2,900 750 4,500 <12
9/2 2/201 6 560 4,700 1,200 7,600 240
2L Standard (ug/1) l 600 600 500 6
GCL(ug/1) 5,000 260,000 84,500 85,500 6,000
Notes:
"<" = Not Detected at or above the laboratory detection limit
Concentrations are reported in micrograms per liter (ug/1) = parts per billion (ppb)
TABLE3
GROUNDWATER ANALYTICAL DATA
Frances Gibson Property
114 1st Street West
Conover, Catawba County, North Carolina 28115
NCDEQ Incident #23265
$'
A .. ..
[::, = Cl .. .. .. " " 5 Cl Cl .. .. .. Cl .. ::9 .Q .c .. ~ = ... ;:. ';:i = .. .. " .c .c .,
::I i 5 ';:i ';:i e ., i ;:. .Q e -~ ... ;:. ·.: .. p "" :9 e Q, ~-';' = Q ~ 9 = .. "l l:Q "" ~ N Q "'i <"'!, " ... = ~ < .. ..
EPA METHOD 6200B
44 <2.7 22 J 50 J 630 140 <2500
27 15 28 51 410 160 160
41 93 40 110 1,200 300 <2500
36 42 110 140 1,500 380 <5000
330 190 76 290 2,300 560 <5000
352 67 87 296 1,880 537 na
270 34 90 200 1,800 420 560
<8.9 160J 48 J 160 1,200 280 <5000
<50 81 320 290 2,100 550 <5000
O.o2 70 70 70 400 400 6000
50 6,900 25,000 30,000 28,500 25,000 6,000,000
Concentrations in BOLD print equal or exceed the NCDEQ ISA 2L NCAC Groundwater Quality Standards (2L Standards).
GCL = Gross Contamination Level
Concentration underlined and in BOLD and italicized print exceed the GCLs
J = Estimated value below metho d reporting limit
NE = Not Established
na-Not Avail able
I fZ' ~ .. .. Cl e, Cl ~ ., .. ~ Cl .. .. Cl .. ~ .. Cl
Cl .. "" ~ ! .. .. .. .c e ;! = ';:i .. 0 ::I "" ';'-ja;l e e .. .t: .. .. = ~ ;:. ... .Q .s .s = ., "" "" E, .c .c Q = ;:. e e = = ~ .S:! .f!
., .c "" "" .. ';:i ~ A = .. Q Q
"l. l:Q ~ ~ ., i " "'i :c .. ' .;. A ., .. .. N N
<25 <25 <25 <500 <2500 <1000 <25 <25
3 .5 30 7.6 66 <5 .0 <5.0 3 .6 3 ,3
<25 <25 <25 <50 0 <2500 <1000 <25 <25
lOJ 32 7.8J 220 120J 41J <12 6.51
<50 <50 <50 <1000 <5000 <2000 <50 <50
16 83 na na na na 13 8
9 51 37 280 <50 <50 <5.0 4 .I J
<50 <50 <50 <1000 <5000 <2000 <50 <50
25J <50 <50 <50 0 <500 <500 <50 <50
70 0.4 0.6 4000 40 100 70 25
8,500 400 600 4,000,000 40,000 100,000 700,000 11,700
ADVENTUS
Proven Soil, Sediment and Groundwater
Remedfa don Technologies
Safety Data
MATERIAL SAFETY DATA SHEET:
O-SOXTM Page: 1 of 6
1. PRODUCT IDENTIFICATION: 0-S0)04
PRODUCT USE: Soil and water treatment.
MANUFACTURER: EMERGENCY PHONE:
Adventus Americas Inc.
2871 W. Forest Rd., Suite 2
Freeport, IL
61032
Office Hours: 815-235-3503
After Hours: 815-235-3506
TRANSPORTATION OF DANGEROUS GOOD CLASSIFICATION:
Oxidizing Solid, n.o.s. (Calcium Peroxide), Class 5.1, PG II, HN1479
WHMIS CLASSIFICATION:
Oxidizer
2. COMPOSITION/INFORMATION ON INGREDIENTS
Ingredients Chemical Formula CAS No. Percentage
Calcium Peroxide CaO2 1305-79-9 45%-70%
Calcium Hydroxide Ca(OH)2 1305-62-0 10%-20%
3. PHYSICAL DATA
Appearance White & brown granules
Physical state Solid
Odor threshold �_-• None
Bulk Density 500-650g/L
Solubility in Water Insoluble
PH -11
Decomposition Temperature _ Self -accelerating decomposition with oxygen release starting from 275
degrees Celsius
4. HAZARDS IDENTIFICATION
Emergency overview
Oxidizing agent, contact with other material may cause fire. Under fire conditions this material may
decompose and release oxygen that intensifies fire. This product also contains crystalline silica. Long tern
exposure to hazardous levels of silica dusts can cause lung disease (silicosis). The World Health
Organization had indicated that there is limited evidence that crystalline silica is carcinogenic to humans,
but the NTP and OSHA have not classified this ingredient as carcinogenic.
Potential health Effects:
General _ Irritating to mucous membrane and eyes.

(A)ADVENTUS
JFawn, 5ait Seaimenc and Gruundwata
fiemed ration Technologies
Safety 111hData
-71:11
MATERIAL SAFETY DATA SHEET:
0-SOX" Page: 2 of 6
• Inhalation Irritating to respiratory tract. Long term inhalation of elevated levels
may cause lung disease (silicosis).
• Eye contact May cause irritation to the eyes; Risks of serious or permanent eye
lesions.
• Skin contact May cause skin irritation.
• Ingestion Irritation of the mouth and throat with nausea and vomiting.
5. FIRST AID MEASURES
• Inhalation Remove affected person to fresh air. Seek medical attention if effects
persist.
• Eye contact__w_,________. Flush eyes with running water for at least I5 minutes with eyelids
held open. Seek specialist advice.
• Skin contact Wash affected skin with soap and mild detergent and large amounts of
water.
• Ingestion , If the person is conscious and not convulsing, give 2-4 cupfuls of
water to dilute the chemical and seek medical attention immediately.
Do not induce vomiting.
6. FIRE FIGHTING MEASURE
Flash Point
• Not applicable
Flammability
• Not applicable
Ignition Temperature
• Not applicable
Danger of Explosion
• Non -explosive
Extinguishing Media
• Water
Fire Hazards
• Oxidizer. Storage vessels involved in a fire may vent gas or rupture due to internal pressure.
Damp material may decompose exothermically and ignite combustibles. Oxygen release due to
exothermic decomposition may support combustion_ May ignite other combustible materials,
Avoid contact with incompatible materials such as heavy metals, reducing agents, acids, bases,

riit`) ADVENTUS
liar Proven Soil Sedimenr and Grourrdwvater
kemeaiatron technotagies
Safety Data
.4.i
MATERIAL SAFETY DATA SHEET:
❑-SOX Page: 3 of 6
combustible (wood, papers, cloths etc.) Thermal decomposition releases oxygen and heat.
Pressure bursts may occur due to gas evolution. Pressurization if confined when heated or
decomposing. Containers may burst violently.
Fire Fighting Measures
• Evacuate all non -essential personnel
• Wear protective clothing and self-contained breathing apparatus.
• Remain upwind of fire to avoid hazardous vapors and decomposition products.
• Use water spray to cool fire- exposed containers.
7. ACCIDENTAL RELEASE MEASURES
Spill Clean-up Procedure
• Oxidizer. Eliminate all sources of ignition. Evacuate unprotected personnel from equipment
recommendations found in Section 9. Never exceed any occupational exposure limit,
• Shovel or sweep material into plastic bags or vented containers for disposal. Do nor return spilled
or contaminated material to inventory. Avoid making dust.
• Flush remaining area with water to remove trace residue and dispose of properly. Avoid direct
discharge to sewers and surface waters. Notify authorities if entry occurs.
• Do not touch or walk through spilled material, Keep away from combustibles (wood, paper, oils,
etc.). Do not return product to container because of risk of contamination.
S. HANDLING AND STORAGE
Storage
• Oxidizer. Store in a cool, well -ventilated area away from all source of ignition and out of direct
sunlight. Store in a dry location away from heat.
• Keep away from incompatible materials. Keep containers tightly closed. Do not store in
unlabeled or mislabeled containers.
• Protect from moisture. Do not store near combustible materials. Keep containers well sealed.
Ensure pressure relief and adequate ventilation.
• Store separately from organics and reducing materials. Avoid contamination that may lead to
decomposition.
Handling
• Avoid contact with eyes, skin, and clothing. Use with adequate ventilation.
• Do not swallow. Avoid breathing vapors, mists, or dust. Do not eat, drink, or smoke in work
arca.
• Prevent contact with combustible or organic materials.
• Labe! containers and keep them tightly closed when not in use.
• Wash thoroughly after handling.
9. EXPOSURE CONTROLS/PERSONAL PROTECTION

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

(A) ADVENTUS
Proven Soh, 5edimert4 and Ground ter
Remedi t]on Technologies
Safety Data
..
MATERIAL SAFETY DATA SHEET:
o SOXTM
Page: 5 of 6
• LD50 Oral: Min.2000 mg/kg, rat
• LD50 Dermal: Min. 2000mg/kg, rat
• LD50 Inhalation: Min. 4580 mg/kg, rat
12. ECOLOGICAL INFORMATION
Ecotoxicological Information
• Hazards for the environment is limited due to the product properties of no bioaccumulation, weak
solubility and precipitation in aquatic environment.
Chemical Fate Information
• As indicated by chemical properties oxygen is released into the environment.
13. DLSPOSAL CONSIDERATIONS
Waste Treatment
• Dispose of in an approved waste facility operated by an authorized contractor in compliance with
local regulations.
Package Treatment
• The empty and clean containers are to be recycled or disposed of in conformity with local
regulations.
14. TRANSPORT INFORMATION
• Proper Shipping Name: EHC-O
• Hazard Class: 5.1
• Labels: 5.1 (Oxidizer)
• Packing Group: If
15. REGULATORY INFORMATION
• SARA Section Yes
• SARA (313) Chemicals No
• EPA TSCA Inventory Appears
• Canadian WHMIS Classification C, D2B
• Canadian DSLAppears
• ELNECS Inventory Appears
16. PREPARATION INFORMATION
Prepared By: Kerry Bolanos-Shaw
Adventus Remediation Technologies
1345 Fewster Drive
Mississauga, Ontario
L4W 2A5
Date Prep./Rev:
Print Date:
Phone:
Fax:
113107
1/3/07
905-273-5374
905-273-4367

FROM :RANS[ER ENVDR[LUNG INC FAX NO. :9102350686 Nov. 06 2007 08:42AM P2
Non Residential Well Construction Record
Not1tt Caralina Deparlment atEnYll'Onlllenl and Nahnl ~ ril'NlilM QuaJitJ
WELL CONTIU.CTOR CERTIFICAT10N fl 2&01
1. WELL CONTRACTOR: cf. TOP OF CASI NG IS --0.2 FTNwwelalll-
Michael Ransier-"T0t,dq1U1V~a/orbeloWllnd8IJl'lacamayn,qun
Well Co~ (Individual) Name a llal'a-c:ev. ......,..ice WIii UiA NCAC 2C .0118.
Ransler Environmental Orill ina. Inc. a. YIELD (1pm) METHOD OF TEST
Well Conlractot Company ~me f. DISINFECTION:Tn-Amount
STREET ADDRESS 1 Pinev Point 9. WATER ZONES (deplh);
WhisoerillQ Pines NC 28327 Frum To ___ Front__To
Cll:yotTOWl'I State ZipCodl1 From To ___ FRlffl ___ To
910 949--4555 From To From_To
Areaeode Phone Number I.CASING: Thk:kneS5
2. WELL INFORMATION: DepCh Diamtltar Weight Material
Sile Well ID iJ ("If appfk::able) MWM1 From~To ...!2..Ft. X' sdl40 PYO
STA TE WELL PERMIT# (if epplicable) na From_ To R --D\IVQ or OTHER PERMIT• (if applk:ablt na From To Fl -WELLUSE (Clat Applicable) Maniloring X MunlPubl"IC 7.GROUT: Dapd'I Maferfal ~
Muslria~ Agiicl.ll1ural ~ lnjadian Fn:,rn 0.5 To ~A. portland u.nmi&
krignan Olher (Listi.Jee) From To R. -Datlt Drilled 10/300/2007 From_ To A. -Time complet8d 4:00 AM PM X 8. SCREEN: Depttt Diameter Slot ... rial
3. WELL LOCATION: From ~ To 45 Ft. 1!' 0.01 PVO
Cl1Y Conover COUNTY catawba From _To Ft. --1141 st Street West From_ To ·A. --~ Name, Humt,eis, Communi1.Y, Lot No., Pmml, Zip Code) 9. SAND/GRAVEL PACK:
TOPOGRAPHIC I LAND SETTING DepUt Size Ma1erial
Slope Veley Aatx Ridge Olhat From 28 To 45 R medium quartz --(dleak appupriafa) FIQffl To Fl --LATTilJDE 35 42.406 IN., t,v Ill CleglwS, min;, From To R. --LONGlnJD81 13.119 I eaca.orin.-10. DRIWNG LOG:
l.ati\Qdell.Oogitude $0Ul'C&: GPS X TopofflaP From To FonnationDaacfiption
(laca6on of WOii must be shDWn on• USGS tvPO map end 0 1 asohaltlfill
aaactled fQ .. form if nal using GPS) 1 45 red/broWn silt
4.FM:11..RY ilh11111Mt:lthe~'Ml8nrlhll_l8_
FACILITY ID fl (If applicable)
NAME OF FACILITY Gibson P rooertv
STREET ADDRESS 1141 stSb-eetWest
Conover NC
CltyotTown Slate ZipCoda
OONTACT PERSON Scott Ball 11. REMARKS;
MAILING ADDRESS 2301 Crown Pt Exeo. Or.
Charlotte NC 28227
Cityar TIMI! stda Zlpeod8
704 845--4010 I DOHEREIIYCIRIFl'ntolT"IMBWB.1.-CDNSTRUDTBIIN-
Almcode Numb« Wffl41541CAC&WB1.-GTNCWa)SMD~TA
6. Wl!LL DETAILS: 00IJl'l'CFltll8MiOOIIOi-.lllEIN~TO-nEWBJ.OWIBt.
a. TOTAL DEPTH: 46 10131/2007
b. DOES WELL REPLACE EXISTING WELL NO SIGNITURE OF camFteO \NEU. CONTRACTOR DATE
c. WATERl.EVEL Beloo,Tllp tJI ~ 37 Michael Ransier
(UM VII IMJQ\<e lllp t1f CINlf'OJ PRIN1ED NAME OF PERSON CONEmWCTlNG WEU
SU!lmilarignal la Div. alW...Quaily wllhh30 ia,o. Nin:. Wcmmlian Mgt. 1617 Mllil SeAkzt C-~ l«;~W.7 Pr.-(9111)~7016 mtMa
Geological Resources, Inc. Phone: [phone]
Fax: (704)84,5.4{}12 2301-F Crown Point Executive Drive
Charlotte, NC 28227
Project
Address
Boring Number
Sample Method
Completion Details
Driller
Depth
0 ----2 --
--4 ----6 - -
--8 ----10 ----12 ----14 --
--16 ----18 ----20 ----22 ,_ ---24 ---26 -
----28 ----30
I--
--32 --- -34 ----36 ---38 -----40
SUBSURFACE LOG
Gibson Pro oertv NCDENR Incident No . 23265
114 1st Street West, Conover, Catawba Coun tv
_M_W_-_1 _____________ Date Drilled __ 1..;..;0/...;..30/0;;..;..;;..7'--____ -l
1
..;.M..;..;a;.;;c""roco=r-"-e"""sa""mc;..:;pc;..;l=er'--_________ Drilling Method Direct Push
Well comoleted at 45' with 15 feet of screen
__ M_ic"""h;...a_el_R_a.;..n.:;.;si..:.cer'--"""N.;..;C"-L""ice.;..;;.;.;nc:.se;:,,.;,,.:N..:..;o . ...::2:..:.5.:..01'--___ Log By Hollis Keech
Lab
Sample
MW-1-30'
Sample
lnterval(ft)
OVA
ppm LITHOLOGY/COMMENTS
Asphalt, Concrete and Gravel
Dark Redish-Brown Silts and Mica
Brown Silts and Mica
Well drilling terminated at 45 feet
• Measured depth to water on 10/30/07 was 34.46 feet
.. -·-· J
Geological Resources, Inc.
2301-F Crown Point Executive Drive
Charlotte, NC 28227
SUBSURFACE LOG
Project Gibson Prooertv NCDENR Incident No . 23265
Address 1141 st Street West, Conover, Catawba County
Phone: [phone]
Fax: [phone]
Boring Number SB-1 Date Drilled 10/30/07 ---------------------------a
Sample Method Macrocore sampler Drilling Method Direct Push
Completion Details Well completed at 45' with 15 feet of screen
Driller Michael Ransier -NC License No. 2501 log By Hollis Keech
Depth
I-0 --2 -4 --6 --8 -
-10 --12 --14 --16 --18 --20 --22 I--24 --26 --28 --30 --32 --34 --36 --38 --40
---
--------
-
-
-
-
----
----
---
-
--
-
----
-
---
--
Lab
Sample
SB-112'
Sample
lnterval{ft)
OVA
ppm LITHOLOGY/COMMENTS
Asphalt, Concrete and Gravel
Redisfl..Brown Silts
Soil boring terminated at 12 feet
• Measured depth to water on 10/30/07 was 34.46 feet
Project: France Gil -non Property
120 Fayette Street
❑ iirtston-Salem, North Carolina 27101
[phone]
Location: Conover, NC
Date: November 2011
Boring/Well I :
MW-2
Project Manager_ J_ Ricks
doh No.: 151190.001
Stab Date: 9/28/2011
Complete Date: 9/28/2011
Hole Diameter: 6.25"
Casing Diameter: 2"
Drilling Method: SSA
Total Depth: 50.0'
Reim rks: -
Sample
.. ID
Sn
;n
Oil
^i1
3.3
1.4
0,7
on
Geologic Description
Red Slightly Clayey Very Coarse
and Clumpy
Red Soil Very Fine to Medium
Red Soil Very Fine to Fine
1 Sand PYu icles Mi ced 1n
1.9
4.7
56.4
Rai Soil. Clumpy to Medium
" " Sm ll Since
Boring Terminated ( 50 f'eet his
Well Diagram
Su
(25.0') 2'
PVC Casing,
(25.0') 2+.
PVC Screen
Chem Seaman&
10�
Hwaeaaaicn
20 —
30 —1
Quartz Sand
40 —
5
60 —
Geologist:
Page 1 of 1

‘1=111:7'
120 Fayette Street
Winston-Salern, North Carolina 27101
[phone]
Project: Franc ns (bon Property
Location: Conover, NC
Date: November 2011
Boring/Well ID:
MW-3
Project Manager: J. Ricks
Job No.: 151190.001
Start Date: 9/28/2011
Complete Date: 9/28/2011
Hole Diameter: 6.25"
Casing Diameter: 2"
Drilling lViciltorl: SSA
Total Depth: 50.0
Remarks:
10
20
30
40
BI
Sm-ripte
P
5_8
50 -
60
Geologic Description
own/Reddish Clurrim, Medium to
Fine Grains Silty w/ Pet_ Odor
Brown/Reddish Fine to Medium
Csrained wiPet. Odor
Reddish Brown, Fine to i'vleditun
Gamins Silty w/Pctro Odor
ReddislvlArnwn Clayey Fine to Coarse
Grains Clumpy wiPeno Odor
Boring Ternlireoterl C41.50 feet bls
Well Diagram
Grustaul
Surihne
(25_0') 2"
PVC Casing
(25_0') 2"
PVC Sc-et
T
tp Siarfea.
—
13aran -to
20 —
30
<27) t2
tZkeegri.: Sam. i
40
5
60 —
Geologist:
Page 1 of 1

Project: F'mnees Gibson Property
120 Fayette Street
Winston-Salem, North Carolina 27101
[phone]
Location: Conover, NC
Date: November 2011
Boring/Well ID:
MW-di
Project Man2gr J Ricks
Job No.: 151190.001
Start Date: 9/28/2011
Complete Date: 9/28/2011
Hole Diameter: 6 25"
Casivag Diameter: 2"
DrillingIVIethod: SSA
Total Depth: 50.0'
Remarks:
Sample.
ID
2(1
49
50
60
17.8
24.6
66,6
•
1,332
396.9
1 .198
4,537
Geologic Description
Red Clumpy Soil Poled. to Very Coarse
GaLin Silty
Red Silty Soil Clumped Fine to
IVIecL Grains
Reddish Brown Silty Fine to Med.
Grains Slight Petro. Odor
Reddish Brown Silty Pine to Very
Coarse Grins Slight Petro Odcs-
Raddish/Eirenvn Clay ey CaurrAPY
Med. to Vcay Coarse Grins
w/Petro Odor
Boring Terrnittated @ 50 feet bls
Well _Diagram
Ground
.Surlatin
(25.0) 2"
PVC laming
(25.0') 2"
PVC Screen
Oroot to Soak.,
3Ekozoonic.
20 —
30 —
(.27') 4,02
Quartz Sorld
.10
I A_ so
60
Geologist: Page 1 of 1

T
; T.1)
1. WELL CONTRACTOR:
Walter Lea Davis
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTLF CATION €t 3162 .A
Well Contractor (Individual) Herne
3D Environmental Investigations L.L.G
Well Contractor Company Narne
2157 Mocksville Hiahwav
Street Address
statesville NC 28625
City or Town Slate Ziip Code
(704 ) 657-7785
Area cods Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMlT#(if app[karle'
SrTE WELL ID #(lt app lcabie),IW 4 2
3. WELL USE (Check One Box) Monitoring Municipal/Public Q
inclustiallOcovnercial p Agricultural D Recovery Fl Infection ❑
lrrgetlonu Other .] C(list use)
G-
DATE DRILLED I� -..Rir� JI
4. WELL. LOCATION:
r4 legsf j4rct.1--
(Street Name, Number% Cammuntty, Lat ND., Farrel, Zrp Code)
CITY: COUNTY CI ,,, ‘do
TOPOGRAPHIC l LAND SETTING: (check eppropriete bux)
❑ Slope ❑ Valley pat Ridge d Other
LATITUDE ae 3,5"° "I t. • 2I.1 ' " OMS OR 3x.7OCCCOC XX OD
LONGITUDE ,Ai tl ° / 3 ' ■� " DINS OR 7XXXICO of DD
Latitude/longitude source: aPS Dtopographicmap
(location well must be sh on a LJSGS bpo ;nap errdatteched to
this form ff not using GPS)
3. FACILITY (Name of the business where the well is located.)
Facility Name
J», /SIR West` .5ace(ef
Facility IN (if applicable)
Street Address
COO-01ct
C:tylor Town
f' .4,4-5 4PI rfEl-
a
State Zip Code
c Na
x srer
Mnpiljg Address
. Wh.I s(,,i- S41-rive a //13
City or Town State Zp Code
(VC /22-ffrS�
Area code Phone number
O. WELL DETAILS:
a- TOTAL DEPTH: 623
b. DOES lifIELL REPLACE EXISTING WELL?
YES ❑ NO V
c. WATER LEVEL Below Top of Casing: FT.
(Use '+' if Above Top of Casing)
d. TOP OF CASING 1S C) FT. AborLadd Surface"
'Top of casing terminated at/or below land surface may require
a vananoe in accordance with 15A NCAC 2C .4118.
e. YIELD (gpm): ME HOC OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Schur Too Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness!
7. CASING: Depth Diameter Weight Material
Top a Bottom 01 R .2 31qet
Top Bottom FL
Top Bottom Ft.
B. GROUT: Depth
Top Q Bottom /I R
Top Bottom Ft
Top Bottoms Fl.
Material
9. SCREEN: Depth
Top c2S Boftnm So
Top Bottom
Top Bottom
Method
/1411,
Dtarneter Slot Size Material
Ft..2 in. do in. 6-
In.
Ft, in. _ in. _
Ft.
10_ SAND/GRAVEL PACK:
Depth Sdme Matet'lai
Top .23 Bottom - FL 44- 2 Sod
Top_ Bottom_ Ft.
Top Bottom R.
11, DRILLING LOG
Top Bottom
1
1
1
1
1
1
1
1
1
1
12, REMARKS:
Formation Description
t Dv FERESY CERTIFY THAT THIS WEt. was ocwSTRUCTD IN ACCORDANCE WITH
16A NCAC ❑N ST Are' THAT A COPY OF THIS
RL OWNER.
� ?
SIGNATURE OF CERTIFIED V4(ELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of compiet ipn to: Division of Water Quality.-- information Processing,
1617 Mall Service Center, Raleigh. NG 27609-761; Phone : [phone]
Form GW-Ib
Rev. 2/09

1. WELL CONTRACTOR:
Walter Lea Davis
Well Contractor (Individual) Name
3D Environmental Investiaatians L.LC
Well Contractor Company Name
2157 Mocksville Hiahwav
Street Add mess
statesville - NC 28625
City or Town State Zip Code
(704 ) 857-7785
Area code Phona number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT
OTHER ASSOCIATED PERMIT#(IFTp4xebie)
SfTE WELL ID m1r a mace te) 1'11W A`.3
3. WELL USE (Check One Box) Monitoring 0/Municipal/Public D
Industrialleco rnercral ❑ Agricultural ❑ Recovery D Injecton 0
Irrigation❑ Other ] (list use)
DATE DRY I+ t 1I
4. WELL LOCATION:
1�✓ 1s1L Wei�ffrt�'
(Street Name, Numbers, Community, Subigeslnn, Lot Na., Parcel, Lp Code)
C17Y. �D►}Ia►rGl� COUNTY Cledso61
TOPOGRAPHIC 1 LAND SETTING: (shook aparocriale hour)
❑Slope fl Valley Fiat ❑ Ridge G Other
LATITUDE 35 5r2' 2 Y. L� " DMs OR 3iL)000003OOt DO
LONGTUDE 711$ ° r ' a'], 1 ° " DMS OR 7Zt.MCODX0c OD
Labtuderlongituda saunas: P.IpPS Qropogrephic map
(location of well mull be sirbin on USGS Lupo map andstfhed to
this farm if not using GPS)
5. FACILITY (Name of the business where the wall is located.)
vv�r M. yn LL1
Facility Nam Facility It1# (if applicable)
1/tf /s( west 51+'ec-f--
Street Address
C_Gvi/aJct NC 2r / 3
or Town tt State Zip Cade
ref";G-�lv.'sC ! 3 /iSdre)
Con ct Name
sW
Mailing Address
.r .1. Sifr .. e a '1/3
City or Town State Zip Code
(,.576i 1.22^fly�f
Area code Phone number,
5. WELL DETAILS:
a. TOTAL. DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES t7 NO PrF
c. WATER LEVEL Below Top of Casing: FT.
(Use •+• if Alvve Top of Casing)
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Euvironateat and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTLFICATION # 3162-A
d. TOP OF CASING IS O FT. Above Land Surface`
'Top of casing terminated aUer below land surface may require
a variance in aaccndance with 15A NCAC 2C .4118
e YIELD (gpm)- METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Tap Bottom
Top Bottom Top Bottom
Top Bottom Top 8oltorn _
Thickness!
T. CASING: Depth Diameter Weight Material
Top e) Bottom of Ft...2 54'fo �Ir'
Top Bottom FL
Top Bottom Ft,
9. GROUT: Depth Malarial
TopC Bottom %r Ft_ eeastatee
Top Bottom Ft
Top Bottom FL
Method
9. SCREEN Depth Diameter Slot Sire Matisriel
Top pis 6ottnm 517 Ft. .2 in. 6 r/o in. I re —
Top Bottom FL in.
Top Bottom Ft. in.
in.
In.
10. SAND/GRAVEL PACK:
Depth Stu Material
Top .23 Bottom - Pt, '2 And
Top Bottom Ft.
Top Bottom FL
11. DRILLING LOG
Top Bottom
1
1
1
1
1
,r
1
1
1
1
1 Z REMARKS:
Porrnatton Description
I Da HERESY CERTIFY niAT THIS WELL WAS DONSTRIJD ] IN ACCORDANCE wmi
15A MACc g :ION STANDARDS. AND THAT ACOPY OF THIS
RECC+iiw ■ PR ❑ THE' Eli DWNEi. ?
TURE OF CERTIFIED LL CONTRACTOR DATE
W, t.c
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days - of completion to: Division Of Water Quality - Information Processing.
1617 Mall Service Confer,' Raleigh, NC 27998-1 S1 Phoei ' 4919) 007 0
Form GW-lb
Rev. 2109

. �'
I, WELL CONTRACTOR:
Walter Lea_Davis
NONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Delman:nit of Envimnmant and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 37624
Welt Contractor (individual) Name)
3D Environmental Investigations L.L.0
Wall Contractor Company Name
2157 Macksviile Hiahwav
Street Address
slatesville • NC 28525
City or Town State Zip Code
(704 ) 657-7785
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#{ilappikatie}
SITE WELL ID Rif epplicahla) r W $ J
3. WELL USE (Check One Box) Monitoring 0/Municipal/Public (�
lndusl iaVCommaroial 0 Agriculture(❑ Recovery In irl;ec on p
Irrigation[] Other 0 (list ust )
DATE DRUM (-- f -
4. WELL LOCATION:
(Street Name, Nrenbere, Comrnunity, & bdNeion, Lot No.. Parcel, Zip Code)
CITY: ( tia"P' COUNTYL.-4...1,,
TOPOGRAPHIC / LAND SETTING: (Phonic epompriate booty
Q Slope 0 Valley 94pFliat ❑ Ridge 0 Other
LATITUDE as y ' Z 4 31 " DMS OR 3XXX0CCOON DD
LONGITUDE 16 4 l ' 13 ' 07. 3? " DiVIs OR 7x.x,o oncoc c DO
LatitudeAongitude source: rroPS Qropographic map
(location of well most be shown on a tISGS top° map arrdattachad to
this roar rinot using GPS)
S. FACILITY (Name of the business where rthe wall is Incalad.)
Facility Name Facility DO {€ applicable)
i Ire;' wr rf ,irte/
Street Address
`atilekPC ( C c2 T l3
Ciao€ Town ` State Zip Code
/ r.S off-0.+r�
Col-7
Name
roc 5a21
Mpiiyn$ AI b
f►�S�sa ,S►ffx,+. Iv1IC a //3
City or Town State Zip Code
a'S ..Wr4'As-
Area code Phone number.
6. WELL DETAILS:
a. TOTAL DEPTH: .5+0
b. DOES WELL REPLACE EILISTING WELL? YES to NO irF
c. WATER LEVEL Below Top of Casing: FT.
(Use `+' if Above Tap of Casing)
d. TOP OF CASING IS t',,r�_ FT. Above Land Surface`
'Top of casing terminated odor below land surface rosy require
a variance iri accordance with 16A NCAC 2C .0118.
a. YIELD (gprn) - - METHOO OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES {depth]:
Top Bottom Top Bottom
Top Bottom Top Bolton)
Top Sodom Top bottom
ThIaknessl
7. CASING: Depth Diameter Weight Material
Top Bottom a2 5 Ft. -2 3i+ fa Yard.
Top Bottom Ft
Top Bolton Ft.
8. GROUT: Depth Material
Tops_ Bottom_ %S Ft. ,CC.h t.
Top Bottom Ft. _ -
Top Bottom Ft. _
Method
/4492
E. SCREEN: Depth Diameter Slot Sham Material
Tap aS Bottom FL 1 in. 6,16 in. 4e-
Top Bottom Ft. in. in.
Top Bottom FL in. in.
10. SAND/GRAVEL PACK
Depth Size &Warta!
Top .23 Bottom - Ft. 44,2
Top Bottom Ft.
Top Bottom Ft
11, DRILLING LOG
Top Bottom
1
J
1
1
1
12. REMARKS:
Format on Description
1 DO teintinf C6471FY T1-tAT THIS WELL WAS CoNSTsuclet, IN ACAORDNICE WITH
I SA NCAC • • NSTRUcrION 8TAwrpNZDs, AND !HATA COPY OF THIS
RECO ] : =? PROVIDE ) THE `F1L GINNER.
r.
SI�FE OF C▪ E▪ RTIFIED LL CONTRAC'iTOFt
DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Subrtttt within 30 days. of tomplslion to: Dlnlelon of Water Quality - information Processing,
1817 Mali Service Centliiimalitigh,P4C ZT .161; Phon i Win 107 00
Form GW-lb
Rev. 2109

ACCESS ROAD
MIN-4
Concentration
[uglL]
2L Standard
GCL
Benzene
560
1
5, 000
Toluene
4,700
600
260,000
Ethylbenzene
1,240
600
84,500
Total Xylenes
7,600
500
85,500
Naphathlene
240
6
6 000
1,2-OIb onoethane lED8
a50
0.02
50
FORMER GIBSON
PROPERTY
MW-4
MW-3
NNV-�
Concentration
(us1L)
2L Standard
GCL
Benzene
750
1
6000
Toluene
3,500
600
260,000
Ethylbenzene
1,100
600
84,500
Total Xylenes
6,700
500
85,500
Naphathlene
480
6
66 000
1,2-Dibrom°ethane (EDB)
36
0.02
50
UN-3(uglL)
Concentration
2L Standard
o L
Benzene
_.
1
5 000
Tduene
37,000
600
2600000
Ethylbenzene
2,900
600
8_5U0
Total Xylenes
17,100
500
85,500
Naphathlene
440
S
6 000
1.2-Dibranoelhane (EDB)
270
0.02
50
MSN- t
Concentration
%giL1
2L Standard
GCL
Benzene
640
1
5 000
Tduene
1,000
600
260.000
Ethylbenzene
280
600
84.500
Total Xjlenes
2,040
500
85,500
Naphathlene
140
6
6.000
1,2-Diaromoethane (EMI)
27
0.02
50
H1. 1ON 3f1N3/\V 1S G
LEGEND
• MONITORING WELL
LOCATION
Source: NC Geospatial
Database
0 10 20 40
rn
Charlotte, North Carolina 28273
TITLE FIGURE 3
tO
0
E
d
07
0
z
Ld
0
z
0
0
0
sn
z
w
z
z
0
0
u7
N
N
h—
uJ
ce
lJ
C)
>---
lJ
CL
CZ)
CL
CO
to
z
0
to
m
APPROXIMATE SCALE IN FAT