WI0400527_DEEMED FILES_20191107

Deft/ma w it-Oo,2F
North Carolina Department of Environmental Quality—Division of Water Resources
INJECTION EVENT RECORD (L ER)
Permit Number WI0400527
1. Permit Information Were any wells abandoned during this injection
event?
7474 caiun auiuuiuns. inc. ® Yes ❑ No
Permittee
If yes,please provide the following information:
it Former Cotton Mill Square Site
Facility Name Number of Monitoring Wells
801 Merritt Drive,Greensboro,NC 27407(Guilford Number of Injection Wells _
County) Please include a copy of the GW-30 for each well
Facility Address(include County) abandoned See Attachment B.
2. Injection Contractor Information 4. Injectant Information
Weston Solution;. CATI00''by Remediation Products,Inc.(RPI]
Injection Contractor/Company Name Injectant(s)Type(can use separate additional sheets
if necessary
Street Address 100 Weston Way
Concentration Injected as slurry composed of
Found of CAT100'"per�allon of water
West Chester Pennsylvania 19380
City State Zip Code If the injectant is diluted please indicate the source
6l 0 . dilution fluid.City of Greensboro potable water-fire
( ) 7D].3079 uop auol Ot euo,!. - hydrant
Area code—Phone number Ailenti.teteffi
Total Volume Injected(gal)2,900 gallons(2.000 Ibs)
3. Well Information 610z L 0 A O N
Volume Injected per well(gal)see Table l attached
Number of wells used for injection:
5. Injection History
Well IDs:TP-01 through IP-08
Injection date(s) 1-10/3/19
Were any new wells installed during this injection.
event? Injection number(e.g.3 of 5) 1 of I
® Yes ❑ No 2019 Is this the last injection at this site?
NOV ® ® Yes ❑ No
If yes,please provide the following information:
WaterQuaGty DO HEREBY CERTIFY THAT Number of Monitoring Wells gional Operations S•
INFORMATION ON THIS FORM IS COALLRRECT TOTHE
Number of Injection Wells THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LtID THE PERMIT.
Type of Well Installed•(Check applicable type): , r
❑ Bored ® Drilled ®Direct-Push %IN y
❑ Hand-Augured ❑ Other(specify) SIGNATURE OF INJECTION CONTRACTOR DATE
Please include a copy of the GW-1 form for each PAVE C.4i?ivy
well installed See Attachment A. PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection. Form UIC-IER
Attn:UIC Program, 1636 Mail Service Center,Raleigh,NC 27699-1636,Phone No.919-807-6464 Rev.3-1-2016

Table 1
CAT woe Injection Details
Injection Permit Number W10400527
Nokia-Lucent Former Cotton Mill Site
Greensboro, NC
Injection Injection Slurry Injected CAT1 DOe Injected
Date Point 1D Depth (ft bgs) (gallons) (pounds)
10/1/2019 IP-03 25-36 210 210
1P-04 26-36.5 175 175
IP-08 26-34.75 150 150
IP-07 25-34 150 150
IP-06 26-34 125 125
1P-05 25-34 150 150
10/2/2019 IP-02 26-60 605 605 -- -
10/3/2019 1P-01 61-93 435 435
Totals: 2000 2000
ft bgs =feet below ground surface
Appendix F-WESTON-COTTON MILL;NJ TAMLE.edsxNCDEO-Strtdllal

L=.
Mtkyr
ATTACHMENT A
WELL CONSTRUCTION RECORDS-FORM GW-1

WE IL CONSTRUCTION RECORD For Internal Ilse ONLY:
This form cart he used for metric or pnikipk wells
1.Well C'oalrador Information:
-
KEN NY SARGENT I`WATER'ANFS
FROM To DESCRIPTION
Well Coratancr Name II. n
-A-4226 rt. r.
NC Well Contractor Certification Number
tx'Tslt CASING(tear mtlFa ea.aa wells)OR LINE t a,�snws)
IRON TO _ DIAMETER .1 ]1 THIERNESS A'IFduAI,
GEOLOGIC EXPLORATION, INC n. u.
Company Nam Id-INNER CASING Olt TUBING tae°Ilert arl eleserLhaio)
FROM TO _ DIAMETER Tine t sa MATERIAL.
2.Well t'aust:recliod Permit IS: 0.0 n. 30.0 n. 2.0 h` SCH 40 PVC
Liai all rrylphroble well ronskneflau permits fl.e.Comics;Slate.l eriuxce.We., R. R.
I
3.Well Use(check well me): 't7.SCREE.
Water Supply Weil: soon , TO DlAsrt:ILR , PI.OTSIPE Tmr't:Nt:s, MATERIAL.
DAgricultusal ❑Municipal/Public 30.0 11' 35.0 R- 20 11 .010 SCH 40 PVC
OGeothel(Mating/Cooling Supply) ❑Residential Water Supply(single) n' n' I`
tma
❑IndusttialiCo ms ercial ClRctidcntial Water Supply(shared) IB.GROUT
luau To _ MATERIAL ExtrtACEMErr station a.Uloi m*'
❑irrigation ~0.0 ^' 25.0 p' SLURRY
romaeoserewsf
Non-Water Supply Weil: n. n.
t2}Monitorinp ❑Recur ery
Injection Veen n. It. 1
OAquifcr Recharge O(.imundwater Rcmcdiation 19.SANDIGRAVFJ.PACK Sif apailahiel
FROM TO MATERIAL EMILACEMrME1MOD
OAquifar Storage and RecoveryRSaliniry Barrier28 0 n. 35.0 A. 1 NT 20-40 FINE SILICA SAND
O Aquifcr Test 13Stonnwatm Drainage
It ft.
❑}xperittleatal Technology RStrhsidatcn Control 20.DRILLING LOG(attach addletaal greets If aeasaanr)
OGeothermal(Mood Loup) ❑Tracer most TO Mar'aRtlo".(eebr,>r.ra..rro riVr eltt,.a.,soda am.ova
❑Geuthennal(IIeatirtg Cooling Return) ❑Other(explain under#21 Remarks], 0.0 n• 1.0 A. GRASS/TOPSOIL
4.Dale Wks)Completed: Weil Heil ID# SMW-1 1.0 A. 28.0 A. BROWN CLAY
28.0 R• 35.0 A. GRAY SILT
Se.Well Location: n. it.
COTTON MILL SQUARE n. I,
Facility Owns Name Facihtr ILIa(if applicable) - - '
801 MERRITT DRIVE GREENSBORO 27407 tt.
Ph)sicaI Adda s.City,sad lip it.REMARKS
GUILFORD BENTONITE SEAL FROM 25.0 TO 28.0 FEET
County Parcel Identification No.(PIN)
•
Sh.Latitude and Longitude in degrceshninutrslserouds or decimal degrees: 22.certification:
(if-well field,one taeloag is suiliciem)
36*03'32.19" N 79° 51' 11.49" WoilveAti... 10108r19
Sir true oIC'I:MEied WenCanuactor Date
6.is(are)the wdi(a): 6dPcrmaueot or ❑Tempurery Hy signing this fain,,haat-nerfilfi•,Mu the Wiles/IOU fame)comsinncrerl in aeriarkwxr
with I5.4 1CAC 02C.0100 or 154 hit SIC a2C.02200 iron Cossmretlon Smadltrds end that a
7.is this a repair to an existing well: ❑Yes or ®Na ropy of Mk pecatlhas been prai'k dro the nWl owner.
Obis is a rrpal_Pilore humor well CORI17,71a011 Inforwmkiarr and explain the wave of Ike
repair under 112/remarks sector or or the bark cif Mir farm. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site dads or well
R.Number of wells caa:tructed: cuosttuelion details. You may also attach additional pages if necessary.
For nothiple Weak*or taan-wrier sitsop&wells ONII'wiA shesante C.adiParti era ape ran
rtrhtnir oars form- SIJBMITFAL LN^STU(TIONS
9.Total well depth below Mod surface: 35.0 (to 24a. For All Wear Submit this foam within 30 days of completion of well
Far radiiple wells list all depths ifdi(lerent teuaiajdc-3@ 2011'and Nil lot!) construction to the following:
to.Static water level below lap of casing: 17.0 (ft.) Division of Water Duality.Iafonuatloa Processing fall.
{/wrier!net is abaex easing,our"r" 1617 Mall Service Center,Raleigh,NC 27699-1617
11.Borehole diameter. 6.0 ()a.) 24b.for laiestion Walk: In addition to sending the form to the address in 24u
SONIC shove. also submit a copy of this form within 30 days of completion of well
12.Well construction medial: construction to the following:
(I.e.auger.scary.cable.direct rash.etc.)
Division of Linter Quality,Ieedergrouad Ia}ectloa Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield();pm) Method of test: 24c.for Water Sunitdv&%tertina Weil,: ID addition to sending the farm to
the addecss(cs) above, also submit one copy of this farm within 30 days of
13b.Disinfection ape: Amount: completion of well construction to the county health department of the county
tdlcre ccosttticteld.
Form(iW-I Nash C•aralmu Depanmcnt of Finimnment and Natural Renames Dieisin°of Water Qualm lb:N.iacd Jan.2013

WELL CONSTRUCTION RECORD Fat[ataasl Use ONLY:
This farm ram be used far single or multiple wells
1.Well Contractor Information:
KENNY SARGENT 14.WATER ZONES
FROM To DESCRIPTION
Well Caaaaetot Name n. n.
A-4226 n• f.
NC Well Contractor Cartinewioa Number IS.OUTER CASING[Tar muB.tared wells OR LINER III )
FROM TO ' DIAMETER TIIICIasiSS atATrausi.
GEOLOGIC EXPLORATION, INC n. n• I..
Company Name 10.INNER CASING OR TUBING(arother'mal load-[oap)
FROM TO MAMMA TnlCkNCSS ' MATERIAL.
L Well Construction Permit 4: 0.0 tL 45.0 R- 2.0 i°' SCH 40 PVC
Liar allay)rlicnhle well ronstrucNon permits(i,e.Conan;Sarre.Var'krace etc.) R. •
3.Well Use(check well use): '
17.SCREEN
Water Supply Well: FROM TO RIAMETRR SLOT SIM _ TUICb:NF;9s MATER/AL
OAgricultutal ❑Municipal/Public 45.0 rt. , 55.0 n. 2.0 I'' .010 SCH 40 PVC
D6eutheemal(Heating/Cooling Supply) DResidenlial Water Supply(single) R. n. -
❑lnduslrial/Onnnte vial ❑Residential Water Supply(shared) IS.GR01rf
FROM TO _ MATERIAL. EMPLACEMENT METHOD a AMOV-r
DImifatiOT 0.0 h' 40.0 it. °j°'""°' 2"7'°1° SLURRY
Non-Water Supply Well: n. ft.
63Monitoring ❑Recovery
Injection Weil: n. i n•
❑Aquifer Recharge ❑Groundwater Reno:dialion It SAND/CRAV£I.PACK rapplkable)
°Aquifer Storage mid Recovery ❑Salinity Barrier FROM TO MATERIAL FMFLACr.MFYT i1TET1t00
°Aquifer Test ❑Slarrmvater Drainage. `43.0 n• 55_0 n• 20-40 FINE SILICA SAND
n. n.
OF..x[x:rimatal Technology ❑Subsidence.Control
18.DRILLING LOG latlach addissaal.costa Irata y)
❑Geothermal(Closed Loop) °Tracer must (0 ULSCR1P1 ton trot,.,barrio ,1d4erek trim arsls gm,are)
ClGeothermal(Iieatine Cooling Return) R(hher(explain under a2I Remarks)_ 0,0 n• 1.0 d ASPHALT/GRAVEL
4.Date Well(s)Completed: Well Well WO TZMW-1 to N• 28.0 n• BROWN CLAY
28.0 It42.0 n•_ GRAY SILT
Soh.Well Location: 42.0 n. 55.0 It GRAY SILTY PWRIROCK
COTTON MILL SQUARE n R. •
Facility/Owner Name Facility IDLY(if applicable)
IL R.
801 MERRITT DRIVE GREENSBORO 27407 n. R.
Physical Address,City.and Zip ' -
GUILFORD t.REMARKS
BENTONITE SEAL FROM 40.0 TO 43.0 FEET
County Parcel(demifieation Na.(PIN)
5b.Latitude and Longitude In degrees/minutes/seconds or decimal degrees:
(,!well field.one kWoag is sufhciear) 22.[:I:rtilicatloa:
36° 03'32.19" N 79°51' 11.49" �� "4-04.- Tr 10/08I19
Sigma=of Certified Well Contractor Dale
6.Is(are)the svei(s): 10Permanent or ❑1'ernporar}'
lh'sgrrnYg Mu Arm,I hereby ern*that the twigs)was Avers/c'aresuucretl na onrnxlantr
with ISA NCAC 02C.0100 or 15.4 NCAC OW.0200 Weil ContUsMrla,Srmaderets and the;a
7.is this a repair to an existing well: Oyes or ®Na copy aphis record has been provided to the well owner.
!Phis(e a repalr•j►N ow hump well ccastmetion information anon aylalu the nature of the
'yak ender s21 remarks sernan or GM the bark tarriasform,. 23.Site diagram or additional well details:
You may use the hack of this page to provide additional well site details or well
B.Number of welts constructed: construction details. You may also attach additional pages if necessary.
For mslityle Hyocrlon or non-sneersirPplp wells ONLY with thesane eeasa eetioo.ow con
rshmh onefarm. SUBMITTAL INSTUCTIONS
9.Total well depth below hind%urine: 55'0 (ft.) 24a. For Ali Welk Submit this farm within 30 days of completion of well
For erelliyk welds do all delalts{fd{Qerant(rxa,aple-3[°200'and II100) construction to the following:
10.State water level below top of+slog: 17.0 (D•) Divisioo of Water Quality,Information Processing Unit,
(f inter later!la°bore noshtg.use•"r" 1617 Mall Service Center,Weigh,NC'27699-1617
11.Borehole diameter: 6.0 (In.) 2db.Fur Inlection Wells: In addition to sending the fonn to the address in 24a
SONIC above. also submit a copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,sable,direct push.me.)
Division of Wxkr Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method Of test: 24e.For Water Sunnlv&lriection Wells: In addition in sanding the form in
the address(es)above,also submit one copy of this form within 30 days of
I3b Disinfection type:_ Amount: completion of well construction to the county health dc[m imern of the county
- A411ere constructed.
(corm GW-I Noah Carolina Department a[kinvironmcat rod Natural l eswacin-nivisian of water Oddity Revised Jan.2013

WELL CONSTRUCTION RECORD re,linernal Ilse MA'
This form con be used for single or multiple wells
1.Well('wlrrcinr information:
CARL CARPENTER II.WATER ZONES
FROM TO rrescarrnoN
Wei Carwactoe Nane n. n.
A-4475 A- n•
NC Well runniest Certification Number t'�.OVTE[CASING(for aft[used Welk}OR LINER lit Me)
FROM 70 OIAMETFR THICKNESS 31ATFRL7L
GEOLOGIC EXPLORATION, INC rt. n. M.
Company Name 16.th•NEI(CAsiNG OR 7't'•RING ImessOnsionl drd-1wi)
FROM _ TO DIAMETER THICKNESS is:sS ATERL 1.
2.Nell Contraction Permit 1Y: 0_0 n• 66.0 it2.0 SCH 40 PVC
Lfsr on applicable well comrrue:on pecans lie.roomy:stale.rodonee,oral - in.
1
3.Well Ilse(check well me): I7.SCREEN
Water Supply Well: FROM TO DIAMFERR soon'SINE Tt[WCKNESS mamas,.
OAgricultural DMunieipal/Public 66.0 n' 86.0 n• 2.0 In- .010 SCH 40 PVC
OGeuther:mil(lleatingaC'ooling Supply) I:Residential Water Supply(single) * n 1`
Dhiduslrial/Comuic rial DResideulial Water Supply(shared) la GROUT
FROM TO MATERIAL EMPLACEMENT METHOD 6 AMOr.17
'
❑irrigation 0.0 D• 6Q.0 n• "a■r'"aa*n°"'e SLURRY
Non-Water Supply Well: n. n
OMouituurrnin� DRccuvery - n, R.
Injection'i(rll:
DAquifer Recharge OCirmundwater Rcinedia lion 19.SA/NDiGRAVE:I.PACK DI applicable)
FROM 10 MATERIAL _ EMPI4CE 1FYT METHOD
t7Aquifer Storage and Recovery DSalinity Barrier 64.0 n.-86 0 n. 20-40 FINE SILICA SAND
CLlquifer Test ❑Swmtwater Drainage
n. n.
arxpe:t;iaK,atallbclmnitrgy ❑Suhsidtatect'anrot 1a.DRILLING LOG(Mach.ddlllma Dank If..ee.ar3)
DOcothermal(Closed Loup) ❑Tn►eer root to , DESCRIPTION(n6rl,hartlentk rllh.cle tpm train elk,etc.)
DGco(hemtal(lleatiog Coding Return) ❑Other(explain under l2 I Remarks) 0,0 n. 93.0 R. RED SILTY CLAY
09/30119 BMW-01 ft. n
4.Date Weil's)Completed: Well IDN
n. H.
Sa.Weil I+acatlna: IL. r n.
COTTON MILL SQUARE n. a.
Facility Owns Naow Facility 1t)d(if applicable) R. It.
801 MERRITT DRIVE GREENSBORO 27407 ,( -
R.
Physical Address,tit,'.and Zip •
• M.REMARKS
GUILFORD BENTONITE SEAL FROM 60.0 TO 64.0 FEET
County Parcel Identification No.(PIN)
5b.Latitude and Longitude is degnn•almiautrslaecnnds or decimal degrees: 22.Certlflenlion:
(data field.one tat tan is sutjiciemy
36°03'32.19" N 79° 51' 11.49" �� ioro8/19
Sianalure of('ertifkd Well Contractor Date
6.Is(arc)the we!(s): 121Pertnanent or ❑Temporary yh-signing this form 1 haulm eriil&thin the myths;sun tome,monomial in arrrnrlowe'
with 154 XCACO2C.0100 or 15,1:v'C 4C 02C.0200 Orel Canrmnrllan Stondarthe and that is
7.is this a repair to au esislfag well: OYes or ff3No copy elks record ken been provided to the well owner.
IIf rhis is o reperr:fill as lnaxn wellcaneu'tx'lion laafooaamiae and explain the nature of the
repair mutter 421 reworks'section won the back orders form. 23.Site diagram or additional wed details:
You may use the bock of this page to provide additional well site details or well
H.Number of wells constructed:_ 1 construction details. YOU may also attach additional pages if necessary,
Fee'multiple injection ornon-.rorer'2aryrp&wells ONLY with the SOW nassrxcdain.you eon
sithmit are rase. SUBMITTAL INSTUCTIONS
86
9.Total well depth below load surface: ' (IT.) 24a. for All Welk: Submit this limn within 30 days of completion of well
Far nrnhfple awls lii,[/Irk i k'(rdiJfdrenr laample-3(d200•end 2111007 CO(I5tteelial to the following'.
10.Sta de water level belowtop of casing: 30.0 (ft.) Dh islan of Water Quality,Information Processing Unit,
Ortarter(erei is shorn caring.use'•t" 1617 Mall Service("eater,Raleigh,NC 27699-1617
11.RnreholedimarNer: 6.0 OM 24b.for lalectiva Wells: In addition to sending the fain to the address in 24a
above, also s'ubcnit a copy of this (Ono within 3t1 days of completion of well
12.Well rnastrucllon method: AIR construction to the following:
(ix.auger,rowan'.cable_direct push.die.)
Division of Water Qaa lt►,underground Injection Control Program,
•FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service('enter,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test: 24c.Far Water Suovh.di Iniectina Welk In addition to sending the limn to
the address(es)above, also submit one copy of this fmm within 30 days of
13b.1INsiatcrtloa type: Amount: cc.npktinn of well ccrostruclion io the county health department of the county
r where constructed.
From(ill'-I hash['mutiny D ianmemi of Erwin-Iowal.and Natural Iicsoureot Division of Wilier Qualify' Revised yen.2013

WELL CONSTRUCTION RECORD For lam nal IJte ONLY:
This form can be used for single or niulsiple wails
ll.Well Contractor Infortaalian:
KENNY SARGENT 1e.WATER$ONRs
' FTGWI TO DESCRIPTION
Well Contmator Nisnr n. n.
A-4226 II. rt.
NC loon Contractor Certification Number 15.OUTER CASING(for mrtn-c..ed tree. OR t . MelRttre)
GEOLOGIC EXPLORATION, INC 0.0 TM• 61.0 rt 6.0 TO 1e TER I"-� SCM TRIERN0 MATERIAL PVC
Cam.Name M.INNER CASING OR T1URING(geothermal elosed.lsap) ,
FROM TI) DIAMETER TIRCRITESS MATERIAL
2.Well Construction Permit#: FL n. W.
Lett all aim/Irnhfa well construction partite fie.Cooney.Sate Yearns ere)
R. ft. ie.
3.Well Use(check well use): ri.SCREEN `
,Water Supply Welk ", most , TO DIAMETER I SLOTSIM TRIMNESS , MATERIAL ,
n°Agricultural °Municipal/Public II. IV. 1a
l7Geoihermal(Heating/Cooling Supply) °Residential Water Supply(single) n rt. la
,
°industrialtmCo ercial DRowidentiai Water Supply(shared) 11.GROVI
FROM TO i MATERIAL PMPLACE.1I %TM€T1IO1&AMOUNT
°irrigation 0.0 n• 61.0 n• .can.rotarnaiarie SLURRY
Non-Water Supply Well:
n. n.
o Moniloring ❑Racove►y
Injection Well: n. R.
o Aquifer Recharge RlCrroutdttmcr Remediatian 19.WANDiGRAVEL PACK llspplleabk)
FROM TO MATERIAL EmrLACEMF$11METHOD
°Aquifer Storage and Recovery risolinity Barrier
R. R.
o Aquifer Test DStormwatcr I3rairmge
n. n.
°Experimental'Technology °Subsidence Control .
Hsi.DRILLING LOG(Much adaideaal sheets If woes.ars)
°Geothermal(Closed Loop) °Ttatsr Fauber _'In DESCRIPI ION t.a6r.hard.....crones n.t.r.arsia.In e1F0 ,
DGeothennal(Flenting:Cooling Return) °Other(explain under#21 Remarks) 0.0 n• 1.0 A. GRASS/TOPSOiL
4.Date Well(s)Completed: Weil wet!Mal 1.0 iL 9.0 ri• BROWN SILTY CLAY
9.0 n• 48.0 n• GRAY SILTY PWRIROCK
Sm.Well Location: 48.0 R. 93.0 n' GRAY ROCK
COTTON MiLL SQUARE n. n.
Eacitity/Own'r Nome misty tIM(if appbcablc)
n. n.
801 MERRITT DRIVE GREENSBORO 27407 n.' n.'
Physical Arldrrss,City.and Zip ' n.REMARKS -
GUILFORD OPEN HOLE
County Parcel Identification No.(PIN)
Sb.Latitude and Longitude I.degrees/minutes/seconds or dee3otal degrees:
'C:rlYlfieatfon:
(if well bald,one lat/bng is sufficient)
36°03'32.19" N 79°51 a 11.49" W 4w.. 1010e/19
Signature of Certified WcII Contractor Cate
6.Is(arc)the well(s): l l'crnuenent or °Temporary as signing this farm,a bomb•terrifh dud the so )mix(Scary ern namelei!I.earralrarcr
with 1 SANCACO!C.0100 or 114 NCAC OW.0100 Well t onstn,cil..,Standards and*et a
7.Is this a repair to an existing well: ID Yes or EC1No copy of Oar record hos beenprnmhd to the wrl ouster.
!f Mir is a repah: ill ore kniow.i tneI construction information and etplain►be sterner of the
repair:le er n2/remedis section or on the bock of this form23.Site diagram or additional well details:
You may use the bock of this page to provide additional well site details or well
0.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple infariian or non-miter supply urns ONLY Nth the some eonslree#oe,you can
submit one farm SUBMITTAL INSTUCTIONS
9.Total well depth below land surface:_ 93 Q _(R) 24n. For All We1k: Submit this foam within 30 clays of completion of well
For multiple mulls list all depths ifdi eremi fereerule-s@r,2o0'and 1 f..Iocr) construction to the following:
10.Steele water level below top of casing: 20.0 ((..) Division of Water Quality,information Processing Unit,
If-water knot is abovecasin.use--I" 1617 Mall Service Center,Raleigh,NC:27609-1617
11.Borehole diameter: 55-875 (DO 24b.For Infection Welch: In addition to sending the form to the address in 24o
SONIC/AIR ROTARY above. also submit a copy Fas of this o within 30 days of coinpiction of'Atli
12.Well construction method: construction to the following:
(i.e.auger,rotary.cable;direct push,etc.)
Disislan of Water()utility,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center,Raleigh,NC 276994636
13a Yield(gym) Method of test: 24c.For Water Sunnis,&ialectiea Wells: in addition to sending the form to
the addeess(cs)above,also submit one copy of this form within 30 days of
13b.Disinfection type: Amount: completion of welt construction to the county health department of the county
ahem constructed.
farm OW-1 Womb t'arolina Deportment of Invsmnmant and Natural Resources- I)is ktion of Wince Quality Reviled/an.2013

WELL COpISTRUCTIQN RECORD I For Inlerrtsi Use ONLY:
This farm ran be used for single or mrtriple wens
I.Well Contactor Information: - -
DAVID HALL i4.WATER ZONES
mono Ter I nescRIPTION
Wen Condor Name ft. n.
A-4459 • rt. + ft
NC Well Centateter Certification Number IS OUTER CASING lEer utidii.raaed weld OR LINER Woo Ski
FROM TO DIAMETER THICKNESS JII MATERIAL
GEOLOGIC EXPLORATION, INC R. it lei
Cempaey Name N.INNER CASING OR TUBING teletberaad deesd-Iar�l
PROM _TO DIAMETER TnlciviEas , MATERIAL
2.Well CQI,trattioa Permit k: R ft. ha
Cis,all applirabfe well naus'rnuc*Nw peruatr Ae Cumet.Sean,Farlancs.tree) R. in.
3.Well Use(cheek well tee): 17.SCREEN
'Water Supply Welk _mom TO DIAMETER SLOTSIZE Tificaueas MATERIAL,
❑Agrieahem' ❑Municipal/Public D. ft IN.
❑Gecrthemlal(Heating/Cooling Supply) ❑Residential Water Supply(single) TM' *' Is
°industrial/Commercial ❑Residential Water Supply(shared) la.GROUT
avM TO MATERIAL EMPLACEMEPrT METHOD A AMOUNT
❑1rriitatiun R. ft.
Non-Water Supply Well: R
❑Monitoring °Recovery
Injection Well: R' h.
❑Aquiter Recharge °Groundwater Remediation 19.SAND/GRAVEL PACtiiriypiic.Ikl
❑Aquifer Storage and Recovery °Salinity Barrier FROM TO MATERIAL PJNPL,ICBMPNiT IdEIkIOD
❑Aquifer Test ❑Stormwaler Drainage R. r -I•t - --
°Earperimental Technology ❑Subsidence Control 20.DRILLINC LOG twaarh idd stood AM ON LT liftman)
,Geothermal(Closed Loop) °Tracer FROM To DliSCRIPTIONEnkr.bardanr,nNreek W0.0e10 Gins NW.)
°Geothermal(Keating/Cooling Return ElUther(explain under 021 Remarks) 0.0 Ti. 60.0 D' DIRECT PUSH
10/01/19 IP-02 ft. "-
4.Date Well(s)Completed: Well 1DN '
R. ft
Sa.Well Lora lion: B. R
COTTON MILL SQUARE a fte "
Facility/OwnerName Facility ma(irapplieable)
3612 HEWITT STREET GREENSBORO 27407 it. rt.
Physical Watts,City.and Zip -
GUILFORD 21.REMARKS
INJECTION POINT-ABANDONED
County Parcel Identification No(PIN)
tt,,Latitude sad Longitude in degrees/minutes/seconds or decimal degrees:
72•Certinratisn:
(if well raid.oat Iaeg.arn io ainieati
36°03'32.19" N 79° 85'14.29" w � �o/Oaii9
signature orrenified Wan Contractor Date
6.I.(art)the wel(sj ❑Pernaaent or I Temporary Hy swing de(wne.I hereby rumOr sheen the we0(x)was(were)r+onrmawd Or arrrrnkn"v
with ISA Nt Al'&'C.WOO or ISA N'AC S2C,O2fQ Well r oasseuerean Ihundanls wed ohm IN
7.Is this a repair to on existing well: Mew or 83No crtpy of llen rerun,ho,hem p►arhkd In the well owner
IJ llrlr 4 a repair.Jill oar brawn wen erinxfnxrrrur ethic hur and explain the maim al the
r■potr roxkr:21 rdwrarls newton or arc the lame rgl'rhis(Uree 23.Site diagram or additional well details;
You may use the back of this page to provide additional well site details or well
8.Number of wells consiruettd: 1 construction details. You may also attach additional pages if necessary.
14w mulerrrle irOrrlanormummer supple wells ONLY wkk*ramie construction.yat awe
,ptbndt nnaJitrai. SUBMITTAL INSTUGTIONS
9-Total well depth below land surfeet: 60.0 (to 24a. For Al Wells: Submit this form within 30 days of completion of well
1Eareueduple nvlis Ilan all dnprhs IfOttawa(example-3BNM1-and WOO) construction to the following:
10.Static water level below lop of casing: (R,) Division of Weber Quality,Information Prorating Unit,
(!'w(er lend is above maw,are" 1617 Mail Service Center,Raleigh,NC 27699-1617
II.Borehole diameter. 2-25 Cm) 24b.For Iniecitlalt.Welk: in addition to sending the form to the address in 24a
DPT RODS above, also submit a ropy of this form within 30 days of completion of well
12.Well cunsfraction method: - construction to the following:
(i.e.auger.ralary,rsbk,direst push,etc.)
_ Division sr Wikr Quality,Underground Injectio.Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center,Raleigh,NC 27699-1636
13a Yield(gent) Method of test: 2dr.Far Water Supply&[election Wells; In addition to sending the form to
the address(es)above,also submit one copy of this form within 30 days id
13b Disiaketion completion of well construction to the county health department of the county
type- Amoaolr where constructed.
Form OW-I North Caroline Deprnmear of Environment end Natural Resources—Division,of Waver Qoatiry Revised Jon.2013

WELL CONSTRUCTION RECORD For fmergel Use ONLY:
This formats be used tee single or multiple wells
I.Weil Coctraetor Irfortttetios: •
DAVID HALL 14.WATEI ZONES
PROM r 70 -DESCaQTION
Well Commutes Neale IL D.
A-4459 ft. ' Il-
NC Well Contractor Certification Number 15.OUTER CASING(for rrukf.ce ed wells)OR LINER Llf C Ike
FROM TO DIAMETER t THICENRES MATERIAL
GEOLOGIC EXPLORATION. INC n. Ip. rit.
Company Name I6.INNER CASING OR TUBING Itsethwallel churl-IO,PI
!MOM TO DIAMETER THICI(N S MATERIAL
2.Well Cantlrretion Permit#: fR tl. de.
rka ors atvrllsobre well exunrruwtanpnmhs fie.rnon%Suite.Variance.err)
ft. it. Ia.
3.Well Use(chuck well use): I7.saughl
Water Supply Well- _PROM TO DIAM6rER SWTSIZE -gar-sNPSS -MATaRUI.
DAgricultural ❑Municipal/Publ lc R. fi• In.
IL
D0eothermal(Heating/Cooling Supply) DResidential Water Supply(single) In
Dlnduslriel/Cummereial ❑Residential Water Supply(shared) II.GROUT
FROM TO MATIRNI, rMPLaCEMFarr MLTHOD&AMOUNT
DlrriRation ft, n.
Non-Water Supply Well:
Ps. It
DMonitUring [!Recovery
Injection Well: IL tr.
DAquit'er Recharge ge ❑Grrmndwater Remediation 19,SANWGRAVEL PACK f tyrailrablel
(Aquifer Storage and Recovery ❑Salinity Barrier FROMT4 MATERIAL _EREPEACEMENT Mt ruub
ft. It.
❑Aquifer Test ❑Stonuwater Drainage fL • R.
h7Ekpt rtmental Technology C]Subsldeilce Control 1o.Diu LUNG LOG laIlmb eddllw u nef flees iraereseTJ
rn DOeathearl(Closed Loop) OTracer III DM 7O - ILSCRtPT1ON!velar,t,creacw,rrdrreclt ryar,erale ur,en)
DGaothermal(license/Cooling Return) E101her(explain under*21 Remadcs) 0,0 it- 36.0 R• DIRECT PUSH
10/01/19 IP-03 n' it..1.Dile Well(s)Completed: Well IDE II. n.
SA.Well Loralion: It. ft. -4
COTTON MILL SQUARE n. - FL
Facility/0wpm Name Facility 100(if applicable) ft. ft. •
3612 HEWITT STREET GREENSBORO 27407 ft. ft.
Physical Address,City,and Zip al.RERtARILS -,
GUILFORD INJECTION POINT-ABANDONED
Comity Fans(I dentition ion No.(PIN)
Sb.Li Elude and Longitude in degreealmiuutes/seeonds or decimal degrees:
(if well field,one luNleas is sufficient} zz Cenlrkagan:
36°03'32.19" N 79°85' 14.29" W - 10/08/19
Sigaanaa of Cen ified welt Cell/NNtor Dale
6.is(are)the well(e): DPermaneul or RI'remporary
By elgnAtIg rlrIN'roger,I homey aenaF that she well(s)war peen}cwrssirmcted In acrankrrrre
,rhh 03A NIAC NNC.0/Ni OP i3A N(AC WC_0200 Well r'rltntrortkrn&cedardr oil dot a
7.Ic Miss repair to an retain well: DYes or MNo coley of flex MOH'haw been provided to the yell owner.
Ohl"cr a repair,fill aw known well a awsruenon l+41WRation and uYlrfdrh Ike ensure lithe
rejwar mile b71 remo tt shirr or on the bark tfrhir.lixws% 23.Site diagram or addhiouul well details:
'You may use the hair of this page to provide additional well site details tic well
8.Number(Wwelh constructed: construction details. You may also attach additional pages if necessary.
14w aruldprr iejrrtiwr grown-water ONLY with h the some l.witsu•w.akia.tern max+
rtrluailwleplrer. SUBMITTAL INSTUCTIONS
9.Total well depth belowlcod surface: 6'a (!t.) 24a- Far MI Wells: Submit this form within 30 days of completion of well
ear aro/rlp/e me No all depeke Uri{irtin frionapre-)(WOW and 2,(JW'1 construction to the falluorine
10.Static water level below top Greasing: (R,) Division of Water Quality,Information Processing Unit,
If mier level is°ba,r eyeing,rue••.- 1617 Mail Service Center,Raleigh,NC 27699-1617
I I.Borehole diameter: 2.25 (ice.) 246.Far injection Wells: In addition to sending the form to the address in 24a
DPT RODS above.also submit a copy of this form within 30 days of completion of wall
IZ.Well coastructioa method: construction to the following:
(i.e.auger.rotary,cable,direct push,etc.)
Division of Water Quality,Underground injection Control Progrinm,
FOR WATER SUPPLY WELLS ONLY: 163E Mail Service Center,Raleigh,NC 27699-1636
13a.Yield($pm) Method of tech 24e.For Water Styluly&telethon Wens: In addition to sending the form to
the address(a)above, also submit one copy of this form within 30 days of
13b Ilisiaferllor type: Atnorot: completion of wall construction to the canny health department of the county
where constructed.
Form G W-1 North Carol tea Department of Environment sad Noland Resomome-Diviafon of wirer°uglily Revised Jan.2017,

WELL CONSTRUCTION RECORD Far macron)Use ONLY:
This form can he used Far simple or amWuple walls
I.Well Contramor Infarteatiom
DAVID HALL 14.WATER ZONES
FROM TO _ DESCRIPTION
Well Contractor Name H. n.
A-4459 lr.- R.
NC Well Contractor Cerlifialion Number _13.(fU'rER CASING 1„rrr maUFebsed weft)OR LINER(ifro,pseaai<I
FROM TO BUM UTTER r THICKNESS MATERIAL
GEOLOGIC EXPLORATION, INC ft. ft Ia.
Company Name 14.INNER CASINC OR TUBING olherm al dosed-leap)
FROM TO DIAMETER THICKNESS MATERIAL
2.Well Construction Permit ff: TI. al. M.
Lire off applicable o tb roerfrorfiail premiss(i.e,Crsono%Store.Karroo*.rite) n R. is
3.Well Use(check well we): ' IT.SCREEN
Water Supply Will: PROM - TO DIAMETER 1 SLO15rLB T1i1L'IIN _ MATERIAL
❑Agriculturist ❑MunieipaltPublic n ft. in.
°Geothermal(Heating(Caoling Supply) ❑Residential Water Supply(single) R R. in
(lndustrial/Commerciat ❑Residential Water Supply(shared) JLCRO1Tf
PROM TO MATERAA. elanAcg)w erMLTRODS AMOuWr
°Irrigation ft, ft.
Non-Water Simply Well: - -
ft.
DMonitoring ❑Recovery n.
Injection Well: n. R.
C}Aquifia-Recharge °Groundwater Remediation 19.SANEWGRAVEL PACK titrnnolleablel '
❑Aquifer Stofage and Recovery' ❑Salinity Battier FROM TO MATERIAL t1aF1.kCEMiNr11IS]H00
It R
❑Aquifer Test ❑Storm►otcr Drainage
It R.
❑Experimental Technology ❑Subsidence Control .
20.URILWNC WC(attach edditlaaal sheets ifrittuarr)
❑Geothermal(Closed Loop) ❑Tracsr FROM I TO BCICRIPTION Wile,aeMareal,ealFreek leer,Dist skit.ecr.n ,
❑Geothcmral(Hesting1Caoling Return) OUther[explain under 121 Remarks) 0.0 n. 36.5 n- DIRECT PUSH
1(1/01/19 IP-04 "' R.
4.Dote Well(s)Completed: Well Ifin R. R.
Sa.Well Location: It. it.
COTTON MILL SQUARE R R.
Facility/Owner Nana Facility 104(if applicable) n n
3612 HEWITT STREET GREENSBORO 27407 n • R
Physical Address,[Sty,and 7.ip 21.REMARKS
GUILFORD INJECTION POINT-ABANDONED
County Pima'Identile:anon No.(PIN)
4b.Latitude and Loagitwle in degtees/alioatesfseconds or decimal degrees: 22.Crrtifleatiou:
(if well rreld.one ImSove is sullicionI)
36°03'32.19" N 79°85'14.29" �y 10/08/19
Stermure of Certified Well canvacloe Dew
6.Is(are)the well(s): ❑Permanent or IBTemporary
Hy,u,lvrrn fi rho man.!hereby rurv(Jy Thor the wrG(s)was ileum)rrursrrocrrrl it,errrunkuarr'
11,7141 IJA He A!'ow.0100 or 15A Nt'At'02f .0200 Well f'r+nsoler:um Slanehvrh aml that u
7.Is this a repair to an existing well: ❑Yes or FEN ropy grants ream!has bows providedm Ii a sell owner
O bis ix a rem:,fill ow Enure well omerrucswi arflwswnton andrrplaw the norwe u/'rde
repair raider.i1 remarks Jargon or MP the bar,[of We Jaen 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
3.Number of wells constructed: 1 construction details You any also attach additional pages if necessary,
t•irr wulitphe mjrction ortrwr-watee supply wells ONLY with the reuse coomerstos.)err mu
5 about onejomr. SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: 36.5 (it) 24a. For All Wells: Submit this Form within 30 days of completion of well
l•i+rnralgple Mk her oil rkpilex if or frrew(eras:pie-3@200'ar,S I@Itkl'► construction to the following:
10.Static miler level below top of casing: (K) llivison of Wiser Qauliryf lafarmetion Processtag Unit.
If water/wet is above caring!We - 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole die auger: 2.25 (ix,) 24b.For lnietr(pp)Vells: In addition to sending the form to the address in 24a
DPT RODS above,also submit a copy of this form within 30 days of completion of well
II.Well construction method: construction to the following:
(i.e.sugar,rotary,cable,direct push,Mc.) - --
Division of Water Quality,Urdergrourd Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Britingh,NC 27699-1636
13r.yield(gpm) Method of leaf: 24c.For Water Supply&laiectipn Wells: Ip addition to sending the form to
the address(es)above,also submit one copy of this form within 30 days or
13b.Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Fmrn OW-1 North Cnmtina DepaRmeot or Emmental and Narutel Resources-Diviriva of Maw Quality Revised Jan,3013

WELL CONSTRUCTION RECORD For internal Use ONLY:
This furor can be used for single at multiple wells
I.Well Contractor Information:
DAV I D HALL sr.WATER ZONES
FROM TO DESCRIPTION _
Well Conlinetor Name R D.
A-4459 IR n
NC Weil Contractor Certification Humber 13.OUTER CASING filar multi-clued walks OR LlNE4 of opphcrbkl
FROM TO DIAMETER THICK ESS f MATERIAL
GEOLOGIC EXPLORATION,INC ft. ft. la. ` i
"
Company Name 16.INNER CARING OR TUBING ipestarxll elosee-loapl.
FROM 7iO DIAMETER TRICILNESs MATERIAL
2.Well Constriction Permit N: I4. ft-
1.La aft oy fknblr mall rannnurNnn pdrmits(!a r'watr t Siam.Variannr,vie.) + •
IS. fa. la
3.Well Use(chuck well use): 17.SCREEN _
Water Supply Weil: ' nom TO DIAMETER _SLOTSISE— THICKNESS MATERIAL
°Agricultural ❑Municipal/Public n id .
❑Geothermal[Heating/Cooling Supply) ❑Residential Water Supply(single) ft. ft. '9
°Industrial/Commercial °Residential Waler Supply[shared) Ill'Tilt FROM TO MATERIAL 1 EMPLACEMENT METHOD&.* IQ(JNT•
❑initiation ft. R.
Non-Water Supply Well: —
❑Monitoring °Recovery ,.
injection Wen: ft, I
°Aquifer Recharge °Ground►>,ater Remediation 19.SAND/GRAV EL PACT:il1'anr)acaak}
❑Aquifer Storage and Recovery °Salinity Barrier M MATERIALr1HPLAf7MFNTM6Zt1OA
1a. re.
❑Aquifer Test ❑Stormwater Drainage 1
R. ft.
❑Experi merit al Technology QSuhsidenca Control 10.'MULLING LOG(M i sch additional'hush if neca'ar=1
❑Geothermat(Closed Loop) °Tracer most To 1 DESCRIrtraS i rein..i.Minrw,oiling f.tie..f wlnram.nr.I
DC'redthcrmal(Heating/Ca6Gng Return! 0O her(explain under Sill Remarks) 0.0 ft' 34.0 R• I DIRECT PUSH
10/01/19 IP-05 ft. R' }f
4.Date Wells)Completed! Well Iqq ft. ft.
Sa.Well Location: D. - A.
COTTON MILL SQUARE - II. ft. .
Facility/Owner Name Fecilicy!Dal ifapplicat.le) ft.3612 HEWITT STREET GREENSBORO 27407 It ix t
Physical Address,City,and Lip 2i.REMARKS
GUILFORD INJECTION POINT-ABANDONED
County Parcel Identification No.(PIN)
Sb.Latitude and Longitude in degrreslminutrslseconds or decimal degrees: n emu-miaow
(itweell field.one hrriioag is auiTiaicall rr�� 85pc q r�
36°03'32.19" 79° � 14.2 /9H 0/08✓19
NW
SignarureofCertified Well Cornactor Dole
6.is(are)the well(s): ❑Permanent or °Temporary By signing this four.I hereby rterrtlj,that the welliN)uvr(awry)cars rrur+orl in arraNtarre
with ISA M Ar 02C'.0101 OP ISA MAC 02r'.00P Writ a nsinrc iwi Standards and Mar n
7,Is Ibis a repair to an existing well: °Yes or BINo ropy alibis record hunt been pwn kfse1 en the well rncwrr.
If thlx ix a repair,fill rwr knns.n mill cantlrncmtn Iyitrntwiurr and explain the rotors al'he
r yktir a n er`Si remarks%eril.a nr an ihr hack e.f thine firm. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
S.Number ufwells constructed: construction details. You may also attach additional pages if necessary.
fart aitr/Nplr hejsrtlnu nr 0171-i1,71dr.0/01I'irons ONLY with ow Awn r:+.a.urrµik+a,you rare
.vuhmferuir liirnr, SUBMITTAL INSTUC.'i7ON5
9.Total well depth below land surface: 34.D (ft,) 24a. For All Wells: Submit this than within 30 days of completion of well
Far mulllirlo n•rilx Ilst all depths 11] .flerene(example,3@2to and 2 r@10i1') construction to the following:
10.Static water level below lop cleating: (p,) Division of Wrier Quality,Information Processing Unit,
f/liwecr le.'rf is 4frn•r caring.rare 1617 Mall Service Center,Raleigh,NC 27699-1617
I I.Borehole diameter. 2.25 (in.) Z4b.r or Injection Wells; In addition to sending the form to the address in 24s
DPT RODS above, also submit a copy of this form within 30 days of completion or well
12 Well construction method; conSlruction to the following:
(ine.auger,rotary,cable,direct posh,ate)
Division of Water Quality,Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Maii Service Center,Raleigh,NC 276994636
13tI.Yield[grim) Method of rest: 24c.For Water Suaoly&lnirctioa Wells: In addition to sending the form to
the address(m) above, also submit one copy or this farm within 30 days of
13b Disinfection type __ Amount: completion of well construction to the county health department of the county
where constructed.
Form GW 1 Noah Carolina Department ofEnvirvnmeni and Natural Resources—Division 0f Water finality Reviled San 2013

WELL CONSTRUCTION RECORD Far Internet Use ONLY:
Twin Wu as be.used for single or multiple wells
I.Well Coatructor lafarTawttlea:
DAVID HALL IL WATER WNW;
FROM TO _DESCRi1I1)N
Well Contractor Name - R. ft.
A-4459 n. n.
NC Weil Contractor Certification Number 15.OUTER CASING(Tee ralii-eased*elect OR LiNen Mae • el
FROM TO DIAMICT6lk I THICHNIMIS JI MATERIAL
GEOLOGIC EXPLORATION, INC fL n .. h —
Company Name le.1NN=CASING OR TURING IEertheriod dined laael
FROM TO DIAMETER THICILNESS , MATERIAL
2.Well Contraction Permit St ft. ft. in.
Lai oil alipli ahIe knell rorreirurlion iinraifin tie Cooney,Siam,,Varlwtea.err./ ,
fr ft. In.
3.Well Use(check well use): Iy XCk$Brr-
Water Supply Well: FROM TO OL{METER SLOT SIZE 1001198 ' MATERIAL
❑Agricultural ❑MutiicipallPublic rt. It iw -
R. R. In.
❑Geothermal(Heat ing/CoolingSupply) ❑Residential Water Supply(single) _
❑Industnat/Commercial CIResidential Water Supply(shared) IR.GROUT
FROM TO MATERIAL E Mpr+cEMENf MRTHOD&MIlOtNYr
❑Irrigation it. TL
Noir-Wa1er&apply Well:
R. f.
❑Monitoring ❑Recovery
injection Well: RL R.
Li Aquifer Recharge OGroundwater Reined iation Ie.SAND/GRAVEL PACK tira,piieabki
❑Aquifer Storage and Recovery ❑Salinity Barrier -FROM TO MATERIAL EMPLAC1rNENTs1ElHOD
t1. fr.
❑Aquifer Test OSlormwwrfleeDrainage ft. R.
C1Fxpuimcrdal Technology ❑Subsidence Control 20.DRILLING LOC Iailacli additonal thee,if rrcesMr21
°Geothermal(Closed Luop) OTracer fxoM To mourners Icon..wawa.lemma sysit..min ill.ek.1 _
❑Geothermal(Heating/Cooling Return) LiQther(explain under N21 Remarks) 0_0 it- 34.0 R• DIRECT PUSH
10/01/19 IP-06 °. R•
a,pate lYcli(s)Completed: Well lDN rt. ft. -
5a.Well Location: R. ' ft.
COTTON MILL SQUARE ft. ft. '
Facility/Owner Name Facility Ios(if applicabk) rt. R
3612 HEWITT STREET GREENSBORO 27407 it.
- re.
Physical Atllress.City,sent Zip
GUILFORD 31.REMARKS _
INJECTION POINT-ABANDONED
Conroy Parcel Identification No.(PIN)
Sb.Latitude and Longilade in degrees/minutes/seconds or decimal!degrees: 22.Ccrlifiration
Orwell field,one Wane is sarriciwa)
36° 03'32.19" N 79'85' 14.29" W /a-ef.e 10/08/19
Signature of Certified Well Conira os Date
6.Is(are)the well(s): ❑Peratanral or 12ffernpurary By rilirainl;this fnraa.I hereby serf&that Ore irrl4s)me(were)cr errata l In acevraianee
whip FSA Nr'AC'OR'.G11t0Oar ISA lit'At'rW.0201l Well raw traranua.taairkttA MIS&toa
7,Is Ibis*repair to an existing wet: DYes or ONo ropy((Phu recarr/has hean p tIr*/iel to Ihr us/l wrier
Ifrhis is a repair,Jill end ixunri well crsearnrnen illfiftlfallioli awl esplaph the norm of the
repair mkt'=2t renianteMika or on Ma hank rflhas Jii n. 23.Site diagram or Additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
liar iraih/pre lnfdrriara or rain-amen wpply wells OJNI.I'rah she mime rnsiidrncten.yarn mar
strhwfr wee foam. SUBMITTAL INSTUCTIONS
34
9.Total well depth below land surface: '0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
Fur malrip/e uirllar liar oil ukpi::Ifrlrprrriu fexaaapio-.1 a nt'and 2@!0Y) construction to the talkiwing:
10.Static water level below top of easing: (4) Division of Water Quality,Information Processing Unit.
Ifnroar Intel is obrnw coo tar" " f 617 Mail Service Center,Raleigh,NC 27699-1617
IL Burehuk diameter: 2.25 (in.) 246.Foram,Ie;S•on Wstls: In addition to sending the form to the address in 24a
DPT RODS above,also submit a copy of this fbrm within 30 days of completion of well
I2.Well roastriretioa method: construction to the following;
ti.e.anger,rotary,Goble,direct push,etc I
Division of Water Quality,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699.1636
Z4r.for Witter Sault'&lnjyrtiou Wells: Jai addition to sending.the form to
131.Yield(gpm) Method retest the address(es)above, also submit one copy of this form within 30 days of
13k.Disinfection type. Amount completion of well construction to the county health department of the county
e where constructed.
Fatal(1 W-1 Nome Carolina Department ofEaviroalmneul and Natural Resaaces—Division or Water Quality Knitted Jim 2013

WELL CONSTRUCTION RECORD 'Fur Internal Use ONLY:
This form can he used for slaps or multiple welb
I.Well Contractor Information:
DAVID HALL M.WATER ZONES
, FROM To DFRCatatr1Oer _
Well Cuutranor Name ft. n.
A-4459 t.� IL
NC well Connector Cal Motion Number 15.OUTER CASING(far wulikaeed wells)OR LINER(lap Nei
FROM TO DIAMETER Ta11COOMEI MATIrn1AL
GEOLOGIC EXPLORATION, INC n. ' n ie.
. 1
Company Name 16 INNER CASING OR TUBING Itio hermat qI 41aD1
_FROM TO IMAM cm THIOINOM MATEIWL
2.Well Construction Permit#: R. ft. IA—
Llor ell applkrbk well crulrerutafup penults(Le.f%Carry.Seeor.Yetrismee.ere) . —
R ft id.
3-Well Use(check well use): 1
17.8CRE>rN ,
Water Supply Well: FROM Tel Mamma ' SLOTMMEE mamma MATERiA4
❑Agricultural ❑Municipal/Public h. It to.
ft ft
°Geothermal(Heating/Coaling Supply) °Residential Water Supply(single) hi.
Ofndusriaucwn nescial ❑Residential Water Supply(shared) IL GROUT
TRUSS TO I,MATERIAL EMILA EMa2rTMETROb A AMOUNT
°Irigation ft. ri.
Non-Water Supply Weil:
ft. ft.
❑Monitoring °Recovery
Injerlien Well: ft. ft.
o Aquifer Recharge ❑Groundwater Remediation 19.SANONGRAVEL PACE Iif applicable) _
FRODAquit~r Storage and Recovery ❑Salinity Barrier
10 MATFiW amet.Acraiscr mereon
R. ft.
❑Aquifer Test RSlurmwater Drainage n. IL
❑Experimental Technology ❑Subsiderice Control
l7Gl:otht rater(Closed 29.DRILLING LOCSattach addidooat sheets if aeceseary)
Loop) ❑Tracer tom To DzS( IMOON Inter,Inaleetr.niorark type.gnaw the.esr.i
❑Geothermal(Healing/Cooling Return) OOther(explain under#2I Remarks) 0.0 R• 34.0 n. DIRECT PUSH
10/01/19 I P-07 ft. R'
4.Dale Well(s)Completed: Well 10111 Ii. ft.
5a.Well Lorafioa: r. n.
COTTON MILL SQUARE
FaciNty1LhreerName Facility IDIlifapplinhlel R. n
3612 HEWITT STREET GREENSBORO 27407 ft. ft. '
Physical Address,City,eat tip
21.REMARKS
GUILFORD INJECTION POINT-ABANDONED
County Penal Ideutilisation No.(PIN)
5h,Latitude mod Leagitade in degreeslmineiteslaecoads or decimal degrees: 22 certil-nation:
(Orwell field one lrerlony is sufficient)
36°03'32.19" N 79°85' 14.29" W .a..... / -i . i0108/19
Signature of Certified Well Coatrador pate
6.Is(ore)Ike well(s): ❑Prrmaneel or 121Temporary
illy s4peuR rMs Trion.!hereby crrrgry them the 9re11(s)nos(weer.)rortseesrcird In omerrhnrra
with 15.1 NI 4(•OW_ON1O or ISA Nt.AC'W .own Weil Construction 1i'are1src c um)char a
7.is this a repair to so existing writ: ❑Yes or f0No Crgrj aphis recordhet hero provided M the well arrrter.
Ohm.I.r a reptile,fill elk kmsnv r°JI rvxtrteustknr hifrrntaeirue rant explain the nature reshe
runner valet-Il rrnuerts seam neon she hock of Jar final, 23.Site diagram or additioaal well details.
You may use the beck of this page to provide additional well site details or well
S.Number of walk constructed: 1 construction details. You may also attach additional pages if necessary.
Fortardripk ie{(aeilnn nrano-uwrersupply wells ONLY with she swne oukoruicuan•you non
suharlr one„llama SUBMITTAL 1NSTUCTIONS
9.Total well depth below bad surface: 34.0 (((,) 244. Far All Wells: Submit this form within 30 days of completion of well
Mir man*IrCIJ&Iese aft ukpet.i�drgireae ksaarple.3432llll.MI70100.1 construction to the following:
it Shtic water level below top of using: (R.) Division of Water Quality,Information Processing Unit,
ry•wferkrel krahmr[minx,ins"-. 1617 Mail Service Crater,Raleigh,NC 27699-16J7
11.Borehole diameter: 2.25 (in.) 24b.for Infection Wes: In addition to sending the form to the address in 24a
DPT RODS above,also subunit a copy of this farm within 30 days of completion of well
12.Well rontruction method: construction to the following;
fie_miser,rotary,cabk,diem push,ate.)
Division of Water Quality,Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
lie.Yield(gum)__ Method of tag: 24c.For Water Smash 4 Inlet-hen Wens: in addition to sending the form to
the address(es) shove, also submit one copy of this form within 30 days of
13b Disiufrttioa type: Amount: completion of well construction III the county health department of the county
where constructed.
Fonu GO/-I North Caroline t]eparlmeru of Environment and Natural Rasowces-Division of Waiter Quality Revised Jan.21113

WELL CONSTRUCTiON RgCORD For lraenol Use ONLY:
This form one Or used for snag*or muhipk walls
I.Well CunInelor Inforaialloas
DAVID HALL IL WATER ZONES
PROM -TO DESCRIPTION
Well Comtamor Nano ft. IL
A-4459 ft. n,
I .OUTER CASING'kr mu1Ncac- sd wen)OR L7W orsppncatle/
NC Well Contractor Crrtifiariea Number FROM TO ( immerse 'THICKNESS MATERIAL
GEOLOGIC EXPLORATION, INC e. R. In.
Cvmwny New I INNER CASING OR TVOINC feeoldernsrl elete4-Ioep)
PRQM To DIAMETER THICKNESS MATERIAL
2.Well Construction Permit k: N. A. In.
IN nil r,pvhcabk well comma-ikon"ruing ale_Crrvefy,OuAe.Variance our.) --
re. ft in.
3.Well Use(cluck well use): 17.SCREEN
Water Supply Well: _FROM TO DIAMETER SLOTMMEE THICKNESS MATERIAL
❑Agricuituial 0Murticipal/Public in
❑Geothenml Heati R. rt. h'( nglCoolirl$Supply) OResitiendal Water Supply(single)
❑Industrial/Commercial OResidenlial Water Supply(shared) IS GROUT
ID Irrigation OM TO n• MATERIAL EMPLACEMENT METHOD a AMOUNT
ft.Non-Water Supply Well: ,
R. ft.
❑Monitoring CIRecorery .—
Injection Well: ft. ft.
❑AquiferRecharge ❑CjroundwaterRemediation 19.SAND/GIIAVELPACKyraspl)ealslaJ
FROM : TO MATERIAL ` ERIPUCEMENTMETHOa
IDAquifet Storage and Recovery ❑Salinity Barrier n, n.
DAquifor Test ❑Stormwater Drainage
ff. ft.
DExperimettal Technology ❑Subsidence Control
2E DRILLING LOG Iattoeb rddit iiel thee.if recrnsarr)
DGeothermal(Closed Loop) DTtacer Frost TO 1 DESCRIPTIONtrenn krerdeert.milinck yam tuna au.ekj
❑Geothonnal(Healing/Ccolin.Return) eOiher(explain under#21 Remarks) 0.0 It• 34.75 ft• DIRECT PUSH
10/01/19 IP-08 ft R.
4.Dale Well(s)Completed: Well Ifs# .
n• n.
5o.wen Lotilioo: N A.
COTTON MILL SQUARE n. n•
Facilily/Owner Name Fneilily IDS(if applicable)
R. it.
3612 HEWITT STREET GREENSBORO 27407
Physical Address City,and Zip 2s.REMA14I0
GUILFORD INJECTION POINT-ABANDONED
County Parcel Identification No IPINJ
5b.Latitude and Longitude in degrees/minoleshneeorda or derhml degrees: 22.t::erlifallon:
Of well field.one liUlong is sulTwientl
36°03'32.19" N 79°85' 14.29" �, i o/o8/i 9
Sigpaftae ofC ejtifled Well Conlreaor Date
6.Is(are)the well(s): ❑Permanent or lnemporary
Hy a+i@it/inJr Ilk frrvx.I hereby rrrf(ry that the wrrrdJ was(u'e+e1 comma-red ix ocrrrrrlancr
efrh ISA N(`.+N'/t24'.DI00 or 1SA NOW OX'.020U We Cnnrrrurrirxr MernrAona and chat u
7.Is this a repair to an existing well: ❑Yes or PJNo ropy WNW.record Ms/Nen prnr/dodw the well name
(frhtreta rerpatr,fill ma known wen roogirnniot rnfornnkhwn tad erp/airr the neiure of the
repair rtiakr+ill rcxuwM sac/ma or WI doe bark of this form 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or swell
S.Number orwrlu constructed: 1 construction details. You may also attach additions./pages if necessary.
Per aexhiple mferrion or lNm uwurntgiply wells ONLY wish Ire x4rre aewrrrarltwc.you eon
aribrn/r one Arm. SURMI.ITAL INSTUCTIONS
9.Total well depth below lend surface: 34.75 (p,) 24o. For All We Jg: Submit this farm within 30 days of completion of wel l
Far Muhiple rd/,r Ito off&pi&V&peros,remaiiyuk.lej,201r And l@itWr1 construction to the r1111owing:
II.Slide water level below lop of casing: (IL) Division or Water Quality,Intrno.lion Processing Unit,
Oyler/reel ix above rewrap,ore•'•" 1617 Mail Service Center,Raleigh,NC 27699-1617
I I.Borehole diameter; 2.25 (in-) 24b.For Inlection Wells: In addition to sending the form to the address in 24n
OPT RODS above,also submit a copy of this form within 30 days of completion of well
12.Well construction melted: construction to the following:
(i.e.top.rotary,able,direct push,etc.)
Division or Water Quality,Ursdergrourld InjectionControl Program,
'FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Coder,Raleigh,NC 27699-1636
13s.Yield(gpm) Method of teat: 24c.Tor WAN.Sopigh&Infection Wells: In addition to sending the form to
the address(es)above, also submit one copy of this form within 30 days of
136 Disinfection type: Amount: completion of well construction to the county health department of the county
where construed.
Farm GW-I North Carolina Departmes ofEnriramuenl end Floral Rawuraes+-Division of Warm Quality Revised Lair.2013

ATTACHMENT B
WELL ABANDONMENT RECORDS - FORM GW,30

WELL ABANDONMENT RECORD Far treernal Use ONLY:
This form can be used for single or multiple wells
I.Well Contractor Information: WELL ABAN.QO1IMENTDETg
DAVID HALL 7n.Number of wells being abandoned: 1
Well Contractor Name(or well owner palatially abandoning.cIl on hisncm property) Far rumple injection VP rum-inner eiq my eellx ONLY Irak the iewv
eYnmrvcmean abnrokanment.you eon ahpndr am forcer.
A-4459
7b.Approximate volume of triter remaining in well(.); (6214
NC wen Contractor Certification Number
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant rued:
2.Well Construction Permit k:
?ma opptioatde awntratxavxrian perevhr h.e.County,Starr.Yalloaar,err.)if Ammar 7d.Amount of disinfectant used:
3.Well RN(cheek well we):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
t7Geotherrnal(Heating/Cooling Supply) ❑Residential Water supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commercisl ❑Residential Water Supply(shared) ❑Concrete Grout 0 Drill Cunings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide arrtonnt of materials used:
❑Aquifer Recharge °Groundwater Remediation 1.0 GALLON
DAquifer Storage and Recovery ❑Salinity Barrier
°Aquifer Test DStormwater Drainage
Cl xperimnental Technology °Subsidence Control 7g.Provide a brief description of the abandonment procedure
°Geothermal(Closed Loop) °Tracer INJECTION POINT-ABANDONED
,°Geothermal(Heating/Cooling Return) mother(explain under 7g)
4.Date welt(s)abandoned: 10/02/19
Si.Well location:
COTTON MILL SQUARE
Fad lirylOwaar Name Facility IDed tit applicable) &Certification
3612 HEWITT STREET GREENSBORO 27407 10/08/19
Physical Address,Cory,soul Zip Signature of Certified Wdl Contractor or Well Owner Dale
GUILFORD By signing this farm. F hereby certify that the Welt(s)was(here)abandoned In
County Pineal Idaniifeation No.(PIN) accordance with ISA NCAC 02C.0100 or 2C.0200 Weil Construction Standards
and that o copy of this rearm/has been provided to the well owner:
5b.Latitade and longitude is degrees/minutes/seconds or decimal degrees:
Orwell held,one laulong to wittciem) 9.Site diagram or additional wall details:
36°03'32.19" 79° 85' 14.29" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTIQ VAILS OF WELL/St BEING ABANDONEQ SUBMITTAL INSTRUCTIONS
.4rwd ad/cute nnncvrwe reenrd(i))f ail/ohle. lie multiple fn/eadan ar non-urner turpedy
uxNx ONLY with the xorai mown...Moo oo abamlumen r,l,you Mil suborn one fan i. 10a. For Alt Was: Submit this form within 30 days of completion of well
6a.Well IN: I P-02 abandonment to the following;
Division of WeierQuality,Information Processing Unit,
6b.Total well depth 60.0 (ry,) 1617 Mail Service Center,Raleigh,NC 27699-1617
'Ob. For Infection Wellg: In addition to sending the brim to the address in !Oa
2.25 above,also submit one copy of this form within 30 days of completion of well
6r.Borehole diameter (in) abandonment to the following;
6d.Water level below ground surface: {ft.) Division of Water Qaality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh.NC 27699-1636
6e.0uler eosins length(if known): ( } IOc.For Water Snonly&Infection Wells: In addition to sending the form to
the address(es)above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E toner casing/tnbing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Fonn OW-30 North Carolina Demonism of Environment and Houmal Resource,-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY_
This form can be used for single or multiple wells
1.well Contractor Infori aahon: WELL AtIANDONKENTPETAIJA
DAVID HALL 7a.Number of wells being abandoned:
Well Connector Name(or well owner personally a6andoaing wen an hitlherproperty) For aiuII pie lyrrlion or erur-nwer r:goply wells ONLY with the roan
remove:ion odondanntrtr you coo rubeuU one front
A-4459
NC Welt Crmtndoccrrtiflcarion Number 7b.Approximate volume of wafer remaining is weli(a): WE/
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company None 7c.Type of disinfectant mad:
2.Wen Coaairuction Permit 4:
Lin allgyilkoble writ aim-woolen permlra(!a Coxr+Iye Slate,Variance,err)trknowt 7d.Amount of disinfectant used:
3.Welt use(check well ase): -
Water Supply Well: 7e.Sealing materials used(check all that apply):
°Agricultural ❑Murdcipal/Public el Neat Cement Grout L]Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) °Residential Water Supply(single) °Send Cement Grout 0 Dry Clay
Olyduslrial/Commerciai ❑Residential Water Supply(shared) °Concrete Grout 0 Drill Cuttings
❑Irrimtion 4 Specialty Grout 0 Gravel
Non-Water Supply Well: °Bemonite Slurry Cl Other(explain under 7g)
❑Monitoring °Recovery
Injection Well: 7f.For each materiel selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remedialian 1.0 GALLON
❑Aquitbr Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
°Experimental Technology °Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) °Tracer INJECTION POINT-ABANDONED
❑Geothermal(Healing/Cooling Return) °Other(explain under 7g)
4.Date wells)abandoned: 1 OID2119
So.Well location.
COTTON MILL SQUARE
Fecinty&Owner Nance Facility loa(ifapplieable) S.Certification:
3612 HEWITT STREET GREENSBORO 27407 ' -' ° 10/08/19
Physical Address,City,and Zip Signature of Certified Well Connecter or Well Owner Dam
GUILFORD ay signing this form.1 hereby certify that the well(s)was(Were)abandoned in
County Panel Idenlik.Itioa No.(PIN) accordance with ISA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy ofMls record has been provided to the well owner.
Sb.Latitude and Ioagltrde in degrees/minutes/seconds or decimal degrees:
(if well field,one Iollies%is sulfides° 9,Site diagram or additional well details.
36"03'32.19" 79"85' 14.29" You may use the back of this page to provide additional well site details or well
lV W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION WAILS OF WELL(S)BEING ABANDONEIT' SUBMITTAL INSTRUCTIONS
Attach se rnrtrtrnrrkuv reraraVy Ifavailable Mw andripfr l,{]reNrm or nup.emerr s yyply
rush ON♦!Y,rok'heArm rcaunt+ecvinnahaadnrunetu,yyoucooxubntllnueform. 10a.for MI Wells: Submit this form within 30 days of completion of well
6s Well IDft: I P-03 abendanmentto the following:
Division of Water Quality,lnfarraalion Processing Unit,
6b Total wdl depth: 36.0 (DJ Mall Servke Center.Raleigh,NC 27699.1617
10b.for Injection Wells: In addition to sending the form to the address in IOa
6c.Borehole diameter: 2.25 (in.) above,also submit one copy of this font within 30 days of completion of well
abandonment to the following:
6d Water level below ground surface: (It) Division of Water Quality,Underground Injection Control Program.
1636 Mail Service Center.Raleigh,NC 27699-1636
6e.Outer casing length(If known): {it y Mc.For Water Sansdv&lniecfiop Welk: In addition to sending the form to
the addresses?above, also submit one copy of this firm within 30 days of
completion of well abandonment to the county health department of the county
61.inner casingf ubing length(if known): (It.) udtere abandoned.
•
6g.Screen length(if known): (ft.)
Fenn GW-30 North Carolina Deparinneat of Environment and Natural Resources—Division of Wane Quality Revised March 2013

WELL ABANDONMENT RECORD FarlrllemalUae ONLY
:
This Cam can be used fbr single or multiple wells
1_Well Contractor Information: WELL ABAND }NMENT DETAILS
DAVID HALL 7a,Number ofleelis being abandoned:
Well Contractor Name(or well owner personally abandoning well on Ms/het property) hit nwlriptu !loam,' or nrr-wolnr supply was ONLY loth the .some
cruufrudlim aboushomenl,you Coll submil ono fo m
A-4459
NC Well Con[racltxCerttfication Number 7b.Approximate veining of water remaining In welt* (gnL)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Cos .uayName 7r,Type ordisfafectsnt used:
2.Well Construction Permit q:
LW ail cyydM4hle well m,eorWWon mamas r e.Comfy.Starer.Ycr omv.etc..)iflnall'n 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials vied(check all that apply):
❑Agricultural ❑Munioipal/Pubhc rE Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industriel/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout 0 Drill Cuttings
Dlrrigation ❑Specialty Grout ❑Gravel
Non-Water Sapply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Reoavcry
Iajectioe Well: 7f For each material selected above,provide amount of materials used:
❑Aquifer Recharge °Groundwater Remediation 1.0 GALLON
°Aquifer Storage and Recovery °Salinity Barrier
o Aquifer Test DStorm►titer Drainage
—
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer INJECTION POINT-ABANDONED
❑Geothermal(Heating/Cooling Return) EIOther(explain under 7g)
4.Date well(s)abandoned: 10/02/19
02'1
5a.Well location:
COTTON MILL SQUARE
Foci laylOwner Name Feciliry IDI(if applicable) B.Certification:
3612 HEWITT STREET GREENSBORO 27407 10/08/19
Physical Address,Ciry,and Zip Signature of Cenified Well Continuos or Well Owner Date
GUILFORD 8y signing this form I hereby certify that the wars)was(were)abandoned in
County Pace/Identification No.(PINT ucrpvdprrce with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
anti that a copy(Phis record has been provided to the well owner.
Sb.Latitude and longitude In degreee/minntes/secoads or decimal degrees:
(if well Sell one larliong is sufficient) 9.Site diagram or additional well details:
36a 03'32.19" N 79a 85' 14.29" W You may use the beck of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary,
CONSTRUCTION DETAILLQF WELUSI BEING ABANDONED $UBiM1TTALINSTRU5T19N$
Amok ad!ntavrrrrlrnn recw•d(.$)Carartahle. him multiple hyarnrar ar,anti-uvrr ripply
meld•ONLY rrnH the same canansearso abarnk+ltmenl,yOu ton.ralratr one form 10a.for Ali Wills: Submit this form within 30 days of completion of Will
6s Well lilt: IP-04 abandonment to the Following:
Division of Witter Quality,lnlormalion Processing Unit,
36,5 1617 Mail Service Center,Raleigh,NC 27699.1617
ib.Total well depth:
10b_Far Infection Welly In addition to sending the tbrm to the address in 10a
ie.Borehole diameter: (in.)(in.) above,also submit tine copy of this form within 30 days of completion of well
abandonment to the following
6d Water level below ground surface:_ ;fL) Division of Water Quality,Underground lajecelan Control Program,
1636 Hail Service Center,Raleigh,NC 27699-1636
10c.Fir Water Snook&Infection Welbp In addition to sending the form to
6e.Outer casing length(if known): (hJ the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6I Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (f.)
Form t3W-10 North Carolina Department of Environment and Na ursl Resources-Division of Water Duality Revised March 20r3

WELL ABANDONMENT RECORD For Ireemel Use ONLY:
This farm can be used for single or multiple wells
I.Well Contractor Information; WELL ABAFIDONMENT DETAIL$
DAVID HALL 7a.Nnmber of wells being abandoned: 1
Well Contractor Name Car well owner pernatally atandonieg welt on his/her properly) For e,i it* Werilan or nan'^atrr cw.yaly a.vtin ONLY Uirp the rams
A-4459 rwrrrrxrrranabavndwmenyaaurea'Windt assArm
NC Well Contractor Certification Number 7b.Approximate voiame of water remaining in we11(s): (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company tie 7c.Type of did a triant used:
2.Wall Construetioo Permit
Lot all apptikable moil ranrlrueian psrerla O.r.r:nuny:SSase.Yarrauev,eat:)irb teen 7d.Amount of dislafectaal need:
3.Well use(check well use):
Water Supply Welk le.Sealing materials used(check all that apply):
O Agricultural °Mwucipal/Public 0 Neat Cement Grout ❑ Bcmonite Chips or Pellets
f Gecthermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
❑IndustriallCommercial ❑Residential Water Supply(shared) ❑Cancrete Grout CI Drill Cuttings
Dlrrigatian 0 Specialty Grout 0 Grave)
Non-Water Supply WNI: ❑Bentonite Slimy 0 Other(explain under 7g)
❑Monitoring ['Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
°Aquifer Recharge ❑Groundwater Remeduation 1.0 GALLON
❑Aquifer Storage and Recovery °Salinity Barrier
DAquiferTest ❑Stormrrmter Drainage
❑Experimental Technology ❑Subsidertce Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer INJECTION POINT-ABANDONED
(]Geothermal(Heating/Cooling Return) Other(explain under)
4.Date well(a)abandoned: 10/02/19
Sa.Well location:
COTTON MILL SQUARE
Faelliy/OwtearName Facility IDrifirappticabk) 8.Certifieatiorr:
3612 HEWITT STREET GREENSBORO 27407 10/48/19
Physical Address.City.and Zip Signature of Cori ified Wdl Coeirector or Well Owner Date
GUILFORD
By signing this free", 1 hereby cerrIA than the well(:)war(tars)abandoned in
C°umy Parcel Identification No.(PIN) accordance with 1SA NCAC 02C.0100 or 7C.0700 Well Ccrsrtr ucifaii Standards
and that a can;of this record inns been provided to the well owner,
Sb latitude end longitude la degrees/minutes/seconds or decimal degrees:
(if well field,one lean s sufficient) 9.Ste diagram or additional well details:
36°03'32.19" 79°85'14.29" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTI(UCTIOIY D$TAII,S QF WgLL(§)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Mrarh wv/i rartrnt crlan recantp)limwlahle. Fur rnnh*hyrerlon ay.twit-vane+ryrp&Y
tenth ONLY mint the more ronr471eviretabandonment,you am submit one IOa.For Al Welk: Submit this form within 30 days of completion of weal
6a well lap: IP-05 abandonment to the following:
Division of Water Quality,Information Processing Unit,
34.0 1617 Mail Service Center,Raleigh,NC 2 7699-1 6 1 7
lib.Total well depth: (Ii.)
lOb.For Infection Wells: In addition to sending the fbrm to the address in 10a
6c.Borehole tliarneter: 2.25 (;a,) above,also submit one copy of this(bra within 30 days of completion of well
abandonment to the following;
6d.Water level below ground solace: (�) Division of Water Quality,Underground Islet lion Control Program,
1636 Mall Service Center,Raleigh,NC 27699-1636
6e Oa1er earning length(If karma) {ff) 10e.For Water Sheol%&Injection Wells: In additi0n to sending the form to
the addresa(ss)above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f.tamer caaing/lubiag ieaglb(if known): (h)
6g.Screen length Of known): (t.)
Form CW-30 North Carolina Depathneot ofEnviroement and Natural Rescreees—Division of Water Quality Revised march 2013

WELL ABANDONMENT RECORD For Internal Use ONLY
This form can be used for single or multiple wells
I.Well Contractor lnformaliont W$L,4ABiNDONMENT l3ETA1L$
DAVID HALL 1
7a,Number of wells being abandoned: _
Wen Contractor Name[or well owner personally abandoning well on his/hor properly) liar awhiplr iajrenan or non-uouer supply ins/b ONLY with the _WNW
ranrtruavmn eMaatdstrarrre,you can sw6mir owe Prot
A-4459
NC Well Caruraeror Certification Nteanher lb.Approshaate volume of water remaining In well(s): (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
ConWrty Name 7e.Type of disinfectant used:
2.Well Construction Permit#:
Orr oil opplrnahle tall errxrtrvrOno prsNiu tie.romp..Sore,Yorionrs,err)(lYueranp 7d.Amount of disinfectant used:
3.Well use(cheek well use):
Water Supply Well: 7t.SeeNmg materiels used(cheek all that apply):
❑Agricultural 0 Municipal/Public GD Neal Cement Grout 0 Bentonite Chips or Pellets
°Geothermal(Healing/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
CIindustrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout. 0 Drill Cuttings
Qtmgation O Specialty Grout 0 Gravel
Non-Water Supply Well: ❑Bentonite Slurry ❑Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material ideated above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 1.0 GALLON
ClAquifer Storage and Recovery ❑Salinity Barrier
°Aquifer Test OStormwater Drainage
°Experimental Technology °Subsidence Control 7g.provide a brief description of the abandonment procedure:
°Geothermal(Closed Loop) 0Traoer INJECTION POINT-ABANDONED
°Geothermal(Healing/Cooling Return) i17Other(explain under 7gf
4.Date well(s)abandoned: 10/02/19
Sa.Well location:
COTTON MILL SQUARE
Facility4DwnerName Facility lDt(irapplicable} &Certi6eallant
3612 HEWITT STREET GREENSBORO 27407 / ' 10/08/19
Physical Address.City,and Zip signatrm oofCertifed Well Convenor or Well Owner tare
GUILFORD By signing this b rat. l hereby Geri 5 that the well(s)was(were)abandoned in
Canary Panel Identification No.(PIN) accordance with 15A NCAC 02C.0/00 or 2C.0200 Weil Construction Standiards
and that a copy of this record has been provided to the used owner.
Sb.Latitude sod longitude in degrees/minutes/seconds or decimal degrees:
(if wall fcld,ono hunag is nufeeient} 9.Site diagram or additional well details:
36°03'32.19" N 79°85' 14.29" W You may use the back of this page to provide additional well site details or well
abandonment details. You may also roach additional pages if necessary.
CONSTRUCTION QETA1fS OF WELLISI BEING ABANDONED S IRMITTAL INSTRUCT IONS
Arrorii u n/f u tnrwnvi mr recon1(s)!f arath b/r. Par auddptr rnjerdaro or aaw>_"atrr supply
rrlir ONLY with the sans rnnreraruan ohoroloorxrnr,yene ran tubaa'r.me j►rnr. 10a.for All Web: Submit this form within 30 days or completion of n,reil
61.Well 1THt: IP-06 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b Total well depth: 34.0 (ff) 1617 Mail Service Center,Raleigh,NC 27699-1617
1011 For Injection Weill: In addition to sending the harm to the address in 1pa
6e.Borehole diameter. 2.25 (ire.) above,also submit one copy of this form within 30 days of completion or well
abandonment to the following:
6d Water level below ground surfaeel (It) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 2 7699-1 636
6r.0utercasing length(!f known): (n j 10e,for Water SumGv do[election Welk: In addition to sending the form to
the address(es)above, also submit one copy of this form within 30 days of
completion of wall abandonment to the county health department of the county
6f.Inner casing/tubing length(If known): (ft.) where abandoned.
6g.Screen length(if knowa)t (R.)
Form a W-30 Norlh Carolina Deprrtmeni o r Enviroa mail and Nuurat Resources—Division of Water Quality Revised March 2013

WELL ABANDONMENT A RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor lnformaiore: WELL ABANDONMENT DETAILS
DAVID HALL 7a.Number of wells being abandoned: 1
Well Uttar Name(Or well ownerpersmmlty ebandmriag well on AiW1=property) blur IWO& lofeerlott or near+rarer .supply welt ONLY with site .vane
canerracvfaa aborxlbnwenr,pm can sehrali one fora+.
A-4459
NC wen ComractmCertification Number 7b.Approximate volume of water remainlag in weIl(s):
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7e.Type of disieracism'used:
2.Well Construction Permit*:
1Jxn vI1 applhohle a rN evmrrrmwux perinio rya.t wllrij%Mow,Variance.erej rfkrarrrr 7d.Amount of disinfectant used:
3.Well use(cheek well user
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 03 Neat Cement Grout 0 Bentonite Chips or Pellets
OGcolhermal(Heeling/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Gaut ❑Drill Cuttings
CI irrigation CI Specialty Grout CI Gravel
Non-Water Supply Well: °Demonize Slurry ❑Other(explain under 7g)
(]Monitoring ❑Recovery
Isdeciivn Well: 7E For encit material selected above,provide amount of materials used:
°Aquifer Recharge ❑Groundwater Relnedituion 1.0 GALLON
❑A(wirer Storage end Recovery °Salinity Barrier
❑Aquifer Tell °Storm water Drainage
❑Experimernnl Technology °Subsidence Control 7g.Provide a brief demriptiaa of the abandonment proredure:
❑Geothermal(Closed Loop) °Tracer INJECTION POINT-ABANDONED
❑Geothermal(HeatiapCoaling Return) Blether(explain under 7g)
4.Date wells)abandoned: 10/02J19
Sa.Well Meadow
COTTON MILL SQUARE
Facility/OwnerName Facility IDs(ifeeplicable) &Certification:
3612 HEW(TT STREET GREENSBORO 27407 - 1OIO8/19
Physir.s1 Address.City.tad Zip signature ofcanned Well Contractor or well Owner Date
GUILFORO
By signing this farm. 1 kartrby cerrlJy 14o1 the well(s)was(were)abandoned/a
County Parcel identification Na(PIN) accordance with l5A NCAC 07C.0100 or 2C.0200 Well Construction Standards
and deal a copy o/skis record hos been provided to the well owner.
5b.Latitude and longitude in degrees/minsles/seconds or decimal degrees.
(if well field,one latftoag is sulncisel) 9.Site diagrams or additional well details:
36°03'32.19" 79°85'14.29" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLISI BEING ABANDONED S)OM1'(TAL INSTRUCTIONS
Arknch well Commie:frut r aord{r)if ar'osraMe. 1•irr&whittle Wargo'or nuns-waver ripply
evils dNLYWith the same rmsurnalanebonekrntneto you emrsr knit one lea. For All Wells: Submit this form within 30 days of completion of well
6a.Well Ida: IP-O7 abandonment to the following:
Division of Water Quality,Information Processing Unit,
(h.)6b.Total well depth:
34.0 1617 Mail Serviee Center.Raleigh,NC 27699-1617
10b.Far Micelles Wells: In addition to sending the that to the address in 10a
6e.Borehole diameter; 2.25 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: rn) Division of Water Quality,Underground Injection Central Program,
1636 Mail Service Center,Raleigh,NC 27699.1636
6e.Oaten easing length(if known): fry) 10e.For Water Sunnly&Infection Wells: In addition to sending the fonn to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6E loner essingttebine length(if known): (IL)
6g.Screen length(if known); (R)
Furtrt G W-30 North Carolina Department of Fnviron meet and Natural Resources—Division or Water Quality Reinsert March 2013

WELL ABANDONMENT RECORD Fat Internal Use ONLY:
This Fenn can be used for single or multiple wells
1.Well Contraclor Information: WELL ABANDONMENT IIFTAIt S5
DAVID HALL 7a.Number of wells being abandoned: 1
Well Comranroe Name Of will coats personalty abandoning well on Weibel'prvparty) For multiple injennon or o n•,rafer ,rapply maid! ONLY with fire .,dine
A—4459 conrerudlenAwn/ammo,n yan can submit one flour.
NC Well Co Cestificarion Number7b.Approximate volume of wale!remaining in welt(s): (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit at
list all aryiplirable well construction panic(l.c.('angry,Aye.Yarlunrr.rlc.)iflrlmwal 7d.Amount of disinfectant used:
3.Well use{check well use):
Wafer Supply Well: 7e.Sealing materials need(check sill thus apply):
[]Agricultural ❑Mun[eipalfPublic 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Hcating/Cooting Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑lndttstriet/Commcrciel OResidtntial Water Supply(Ousted) 0 Concrete Grout ❑ Drill Cuttings
❑Irrielion ❑Specialty Grout o Gravel
Non-Water Supply Well: Li Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ['Recovery
injection Well: 7f For each material selected shove,provide amount of materials used:
❑Aquifer Recharge 0Groundwater Remedintion 1.0 GALLON
['Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Tess ❑Strnmwater Drainage —
❑Experimensal Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer INJECTION POINT-ABANDONED
❑Geothermal(Heating oolint_Retum't MOrher(explain under 7g)
4.Date wells)abandoned: 1 Da{Q2/1
9
5a.Well location:
COTTON MILL SQUARE
Facility/0watt Name Facility(Da{if applicable) S.Certification:
3612 HEWITT STREET GREENSBORO 27407 - 10/08/19
Physical Address,Ciry,and Zip Siswutare ofCertifed Well Contractor or Well Owner Date
GUILFORD By signing this foru7. 1 hereby terrify that the wells/was(were)abandoned in
County Parcel[dent ficatisn No.(PIN) accordance with 15.1 NCtC 02C.OIPO or 2C.OIOI Well Construction Si,mdatxls
and that a copy of this record has been provided to the well ouner-
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
fir wen field.out larllang is sufficient) 9.Site diagram or additional well details:
36°03'32.19" 79a 85' 14.29" You may use the beck of this page to provide additional well site details or well
N W abandonment details- You may also auach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLIS}BEING ABANDONED yLIIh11TTAL INSTRUCTIONS
Mulch well r ntealrucnon s en,&fsf it arm/able. Pot mutup1e injection re tour-water Aunt/
wells ONLY reah the saute cnnsmtciliin oharulntuvrerin yner con ruhnrlr rare Jones 10a- For All Wells: Submit this form within 30 days of completion of well
ha.Well!DC IP-08 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gh.Total well depth: 34.75 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
[Ob.for Injection Weft: In addition to sending the form to the address in(On
2.26 above,also submit one copy of this form within 30 days of completion of well
fir.Borehole diameter: (in.( abandonment to the following:
ed_Witter level below ground surface (R•) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10e.For Water Sunnlv&injection Weill: In addition to sending the form to
lie.Outer casing length(if known): (IL) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f.Inner easing/tubing length(if known): _ (ft.)
6g.Screen length(if known):_ _.(ft.)
FonnGW-30 North Carolina Dep.artinen[of Fnvironuw;nt and Na[ural Rcseturccs—Division of Water Quality Revised Marcel Mil

Central Files: APS SWP
9/19/2019
Permit Number WI0400527 Permit Tracking Slip
Program Category Status Project Type
Deemed Ground Water Active NeW Project
Permit Type Version Permit Classification
Injection Deemed In-situ Groundwater Remediation Well 1.00 individual
Primary Reviewer Permit Contact Affiliation
shristi,shrestha
Coastal SWRuIe
Permitted Flow
Facility
Facility Name MajoriMinor Region
Cotton Mill Square Facility Minor Winston-Salem
Location Address County
801 Meritt Dr Guilford
Facility Contact Affiliation
Greensboro NC 27407
Owner
Owner Name . Owner Type
Nokia of America Corporation Non-Government
Owner Affiliation
Gary M.Fisher
600 Mountain Ave
Dates/Events New Providence NJ 07974207
Scheduled
Orlg Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
91 812019 9l412019 9/18/2019 9/18/2019
Regulated Activities Requested!Received Events
Groundwater remediatian
Outfa II
Waterbody Name Streamindex Number Current Class Subbasln

wEcraN
It, k Letter of Transmittal
1 400 Weston Way
West.Chester,PA 19380
TO: DWR—UIC Program Date: August 30,2019 Job No.: 11621.043.009
1636 Mail Service Center
Raleigh, NC 27699-1636
[phone]
RE: Nokia-Lucent Cotton Mill Square Site, Greensboro
NC—NOI to Construct or Operate Injection Wells
WE ARE SENDING YOU:
X Attached Under Separate Cover
Drawings Affidavit of Compliance Sample(s)
Manuals Schedule Change Order
Report X Other(Work Scope)
Transmittal Copies Date Submittal Description
No. No.
1 1 08/30/19 - NOI to Construct or Operate Injection Wells, Nokia-Lucent
Cotton Mill Square Site, Greensboro NC
WE ARE TRANSMITTING as checked below:
X For Approval For Your Use Copies for Approval
As Requested Returned After Loan to Us Copies for Distribution
X For Review and Comment Other(explain) Corrected Prints
Signed: C Date: 08/30/2019
-
Weston Solutions, Inc.
REMARKS:
Please find attached a NOI to Construct or Operate Injection Wells in Greensboro NC associated with Lucent-Nokia
Cotton Mill Site.
Please do not hesitate to contact me with any questions you may have. Best Regards,
Best Regards -David Kane-t610) 701-3079 David.Kane©WestonSolutions.com
6,4)40.0 4 2019
Wear CutiltY
Regional Dperailona Sedkla

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 1 SA NCAC 02C.0200(NOTE:This form must be received at least 14 DAYS prior to injection)
AQUIFER TEST WELLS(15A NCAC 02C.0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITUREMEDIATION (15A NCAC 02C.0225)or TRACER WELLS LISA NCAC 02C A229):
1) Passive Injection Systems - In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks,iSOC systems,and other gas infusion methods(Note: Injection Event Records(IER)do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small-Scale Injection Operations—Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests-Preliminary studies conducted for the purpose of evaluating the technical feasibility ofa
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 Re Returned As Incomplete.
DATE: August 29 ,20_19 PERMIT NO. (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well Complete sections B through F, K,N
(2) Aquifer Test Well Complete sections B through F, K,N
(3) Passive injection System .Complete sections B through F,H-N
(4) Small-Scale Injection Operation Complete sections B through N
(5) X Pilot Test Complete sections B through N
(6) _ Tracer Injection Well Complete sections B through N
B. STATUS OF WELL OWNER: Business/Organization
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): Gary Fisher(Nokia)
Mailing Address: 600 Mountain Avenue
City: Murray Hill State: NJ_Zip Code: 07974 County:
Day Tele No,: 908-516-3255 Cell No,: 908-358-7475
EMAIL Address: Garv.Fisherrimokiacom Fax No.:
Deemed Permitted OW Remediation NOI Rev.3-21-2018 Page 1

Li
► T Letter of Transmittal
1400 Weston Way
West Chester, PA 19380
TO: DWR—UIC Program Date: August 30, 2019 Job No.: 11621.043.009
1636 Mail Service Center
Raleigh, NC 27699-1636
[phone]
RE: Nokia-Lucent Cotton Mill Square Site, Greensboro
NC—NOI to Construct or Operate Injection Wells
WE ARE SENDING YOU:
X Attached Under Separate Cover
Drawings Affidavit of Compliance Sample(s)
Manuals Schedule Change Order
Report X Other(Work Scope)
Transmittal Copies Date Submittal Description
No. No.
1 1 08/30/19 - NOI to Construct or Operate Injection Wells, Nokia-Lucent
Cotton Mill Square Site, Greensboro NC
WE ARE TRANSMITTING as checked below:
X For Approval For Your Use Copies for Approval
As Requested Returned After Loan to Us Copies for Distribution
X For Review and Comment Other(explain) Corrected Prints
Signed: r f' Date: 08/30/2019
Weston Solutions, Inc.
REMARKS:
Please find attached a NOI to Construct or Operate Injection Wells in Greensboro NC associated with Lucent-Nokia
Cotton Mill Site.
Please do not hesitate to contact me with any questions you may have. Best Regards,
Best Regards -David Kane- [phone] [e-mail]

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(NOTE: This form must be received at least 14 DAYS prior to injection)
AQUIFER TEST WELLS (15A NCAC 02C.0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION(15A NCAC 02C.0225) or TRACER WELLS(15A NCAC 02C.0229):
1) Passive Injection Systems - In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems,and other gas infusion methods(Note: Injection Event Records(IER)do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small-Scale Injection Operations—Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests -Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation,and where the
surface area of the injection zone wells 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: August 29 ,20_19_ PERMIT NO. (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well ....Complete sections B through F,K,N
(2) Aquifer Test Well .Complete sections B through F,K,N
(3) Passive Injection System Complete sections B through F,H-N
(4) Small-Scale Injection Operation Complete sections B through N
(5) X Pilot Test Complete sections B through N
(6) Tracer Injection Well Complete sections B through N
B. STATUS OF WELL OWNER: Business/Organization
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): Gary Fisher(Nokia)
Mailing Address: 600 Mountain Avenue
City: Murray Hill State:_NJ_Zip Code: 07974 County:
Day Tele No.: 908-516-3256 Cell No.: 908-358-7475
EMAIL Address: [e-mail] Fax No.:
Deemed Permitted GW Remediation NOI Rev.3-21-2018 Page 1

D. PROPERTY OWNER(S)(if different than well owner/applicant)
Name and Title: Angie Sutton Area Manager
Company Name Burkely Communities
Mailing Address: 1515 West Cornwallis, Suite 204
City: Greensboro State:_NC_Zip Code: 27408 County: Guilford
Day Tele No.: 336-285-9300 Cell No.:
EMAIL Address:[e-mail] Fax No.: 336-285-9990
E. PROJECT CONTACT(Typically Environmental Engineering Firm)
Name and Title: David Cairns Project Manager
Company Name Weston Solutions
Mailing Address: 1400 Weston Way
City: West Chester State: PA Zip Code: 19380 County:
Day Tele No.: 610-701-3676 Cell No.: 484-888-8268
EMAIL Address: [e-mail] Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name&Address: 801 Merritt Drive
City: Greensboro County:Guilford Zip Code: 27407
(2) Geographic Coordinates: Latitude**: 36° 3' 27.24"or °.
Longitude**: 79° 51' 12.91"or °.
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: TBD square feet
Land surface area of inj.well network: TBD square feet(< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: TBD (must be<5%of plume for pilot test injections)
The purpose of the pilot test is to determine the effectiveness of the CAT100®injectant under site conditions. The total
area of the contaminant plume and percentage of the contaminant plume to be treated will be included in the full-scale
design.
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.
Deemed Permitted GW Remediation NOI Rev.3-21-2018 Page 2

(3) Potentiometric surface map(s)indicating the rate and direction of groundwater movement,plus existing
and proposed wells.
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.
See attachment.
J. APPROVED INJECTANTS—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 http://deq.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/ground-water-protection/ground-water-approved-inj ectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info(919-
807-6496).
Injectant: CAT100® by Remediation Products,Inc. (RPI)
Volume of injectant: Approximately 3,600 lbs of CAT100®will be injected during the pilot test
activities.
Concentration at point of injection: The CAT100®is injected as a slurry that is composed of 1
to 2 pounds of CAT100®per gallon of water.
Percent if in a mixture with other injectants: CAT100®is manufactured by combining RPI's
BOS100®technology with microorganisms. CAT100®consists of BOS100®,various blends of
microorganisms,high molecular weight substrate food(starch),and low sodium yeast extract.
Injectant:
Volume of injectant:
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:
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: 8+3 MWs Proposed 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
Deemed Permitted GW Remediation NOI Rev.3-21-2018 Page 3

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
Well ID: Well Existing/Proposed Contractor: Well Permanent/Temporary:
Depth: Contractor
Certification
Number:
IP-1 80 ft Proposed Geologic 2332-A Permanent
Exploration
IP-2 40 ft Proposed Geologic 2332-A Permanent
Exploration
IP-3 30 ft Proposed Geologic 2332-A Geoprobe/DPT
Exploration
IP-4 30 ft Proposed Geologic 2332-A Geoprobe/DPT
Exploration
IP-5 30 ft Proposed Geologic 2332-A Geoprobe/DPT
Exploration
IP-6 30 ft Proposed Geologic 2332-A Geoprobe/DPT
Exploration
IP-7 30 ft Proposed Geologic 2332-A Geoprobe/DPT
Exploration
IP-8 30 ft Proposed Geologic 2332-A Geoprobe/DPT
Exploration
SMW-1 30 ft Proposed Geologic 2332-A Permanent
Exploration Monitoring well
TZMW-1 40 ft Proposed Geologic 2332-A Permanent
Exploration Monitoring well
BMW-1 80 ft Proposed Geologic 2332-A Permanent
Exploration Monitoring well
L. SCHEDULES—Briefly describe the schedule for well construction and injection activities.
Week of 9/9/19: Start of installation of injection points;
Week of 9/16/19: Finish installation of injection points and collect background samples;
Week of 9/30/19: Start and complete injection activities.
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.
Following completion of the CAT100®injections,groundwater samples and water level measurements
will be collected from IP-1 (provided the open bedrock borehole at IP-1 is accessible after injections),the three
new monitoring wells (BMW-1,TZMW-1 and SMW-1)and existing well EW-504. The collected groundwater
samples will be analyzed for the parameters listed in Tables 1 and 2. Post-injection groundwater monitoring is
expected to be performed one month and three months after completing the CATION) injections. A subset of
the Post-injection samples will also be analyzed by a NC-Certified laboratory for the VOCs.
Deemed Permitted GW Remediation NOI Rev.3-21-2018 Page 4

N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well 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 information. I agree to construct, operate,maintain,repair, and if applicable,abandon the
injectio ated appurtenances in accordance with the 15A NCAC 02C 0200 Rules."
..�•---^� )A1,/e.)/ �� r 12 -r/ otivA&E7Z.
Signature of Applicant Print or Type Full Name and Title
Property Owner(if the property is not owned by the Well Owner/Applicant}:
"As owner of the property on which the injection well(s)are to be constructed and operated,Thereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A NCAC 02C_0200). "
"Owner"means any person who holds the fee or other property rights in the well being constructed.A well
is real ro rty and its construction on land shall be deemed to vest ownership in the land owner, in the
Sign Here absence f contrary agreement in writing.
art NM aria V.
Sig ature*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.
Please send I (one)hard color copy of his NOI along with a copy on an attached CD or Flash Drive at least
two(2)weeks prior to injection to:
•
DWR—UIC Program
1636 Mail Service Center
Raleigh,NC 27699--1636
Telephone:[phone]
•
Deemed Permitted OW Remediation NO1 Rev.3-21-2018 Page 5

1:1 O
7�
N
ME 1'i
Cir:31:::;;-:402
_T Lail 00
0�0� •
M W-02-s •
849.27 ' C
i'l °'° '❑��� MW-20-is Y� ' �J
.�,�� - Iw-210/
W-01-d1 IW-205 \ _ I111
'-- IW-403 IW-407 IW-206
IW-405IW-404 IW-409 IW-4061---
\m":4w3w:01-410;85;--/idw_51.1134.d2_2;4,3_1.141_s• IW-408 _ �
DW-06-d 1 �
�MW16 -jEW-512tiIW-201I M -os s MW-3a-
8533 �C�..\:w_3:24121-42.11'
DW-07-i 1
DW-02-d1 /MW-13-s 1
1 DW-17-d2 � � Q�6/ 843.68
EW-508 EW-509 1
DW-09-d1 IW-203 4�`�
W-204 1
DW-10-d1 �p`� 1
`O, j DW-03-d1 MW-28-s
�837-.02 c. 1
....____ now EW-510 EW-511 ?).,0 .'2) i '
ill. 0\-------
� IW-208 IW-209 $3H 834.6�
' IW=2 � JI
s Li
EW-507
1 W �. EW-506 /
u C Mw- csj EW-505 \ Mw-72-s
�/ wl 10 s 5 i1 %' A4/
1/_ MW-JPi /
00 EW-503 EW-504
i so
0 EW-502 ,MW-44-d1
Q ❑EW-501
13
IW-304 -43-s
CI I1 w-as-i
7' /4� MW-42-4 DW-11-d1
L MW-45-10
f� " DW-12-d1 DW-15-d1
IW-302 \ IW-303 IW-306
IW-305
DW-13-d1
DW-16-d2 IW-307
IW-301
DW-19-d1
DW-18-i
MW-600 -47-d2
MW-601
* Legend
E. Injection Well
FI Extraction Well
Saprolite Monitor Well
MW-50-i 9
4 Transition Zone Monitor Well
Bedrock Monitor Well
Offsite Shallow Monitoring
Well Locations
I MW-49-ice Abandoned Saprolite Monitor Well
i + MW-603 MW-602 Abandoned Transition Zone
*� * `aIli € Monitor Well
Abandoned Bedrock Monitor Well
— . Cotton Mill Square Boundary
,,MW-604
Buildings/Roads
f\lik MW-605 —84o—Groundwater Elevation Contour
1111/- (feet above mean sea level)
834.67 Groundwater Elevation (Feet)
MW-606
MW-607 * Scale in Feet
M51-i 0 200 400
Feet
1 inch = 200 Feet
Figure 2
c Groundwater Elevation Contour Map
October 2017
I\ -11,- Saprolite Unit
TP
Cotton Mill Square Facility
Greensboro, North Carolina
File:Y:\CMS\MXD\October2017_GW_Contour_Saprolite.mxd, 8/2/2018 2:09:10 PM, johna

4LybO L-.5-7-70
1,:n N
00ME 00- -- (i-j-- - - li-j-- -- - ' " - - -- -- - - -, _
+E
I it] 0 .�
0�0°:().+
MW02s
�0 (�(— 1 S
❑L II � 20s 1
1 i
I — IW-210
DW-01-d1 IW-205 \ — I
���H IW-403 IW-407 / IW-206
V� M -21-i 11 V IW-405
IW-401 IW-404 \ IW-409 i- MW-18-i r
fW402 IW-406 846.24
r
IW-408 DW-05-d1
DW-14-d2
1 ' DW-06-d1
EW-513 MW-16- —j
IW-201 EW-512 Mw-3a-
/
MW-36-s i IW-202 �� MW-04-s 1
\•� I /\ MW-29-i 1
r
1 '� MW-37-s MW-g-s 4. `�•�MW-22-s 1
C/\ DW-07-i i MW-14-s
De,
M 4.10
I DW-50 4 s 7 844.10
EW-508 ''''����JJTT EW-509 1
7
DW-09-d1 IW-203
IW-204 1
1. DW-10-d1 - _ 1
D W-03-d 1 MW-28-s
84EW4.511 1
MW-39-s nw-z, EW-51o� F-3---I 1
— /34'. 84405 I
ri El
_ ,� I
842 Mw-o3 j
IW-207IW-209
IW-208 1
• EW-507
:in E W-505
W 840 838:79 El EW-506
ZMW MW-12-s ,,
C /
-� 836 838 DW-08-i �•i
CD
3 836\ ' • I /'
i
EW-504L 1 --
836.99 '
EW-503-
�834.9� MW-44-di
g,.32834
'a -502
�EW83 321• �-
H EW-501 -
% -830 ••
4+MW-,6-s C� ` •
MW-46-i �' i w-43-s
830.57 p �1 W-45-i W-3o4'
i��/ MW-42-4 DW-11-d1
L MW-45-\I
f� " DW-12-d1 DW-15-d1
IW-302 , CIW-303 IW-306
DW-13-d1 IW-305
828 DW-16-d2
IW-307
IW-301
826 r
DW-18-i DW-19-d1
` \ 824.49 / I
A \ MW-600 -47-d2
824 ,
822- -
MW-601
Legend
820 C•, Injection Well
HI Extraction Well
MW-50-i
818.04 + Saprolite Monitor Well
s$ - Transition Zone Monitor Well
...0,9:ill
816 — —4 Bedrock Monitor Well
Abandoned Saprolite Monitor Well
1a Mw-49-i Abandoned Transition Zone
'� 813.95
• MW-603 MW-602 - 7-' Monitor Well
812 ♦ 1 " �i
T 4 Abandoned Bedrock Monitor Well
810 Offsite Shallow Monitoring
Well Locations
Mw- 8 Cotton Mill Square Boundary
AMW-605 Buildings/Roads
sos —sao—Groundwater Elevation Contour
(feet above mean sea level)
/2\
� , ao 1.99 Groundwater Elevation (Feet)
MW-51-i
802 801.99 W-606
M W-607
Scale in Feet
0 200 I
400
'Feet
1 inch = 200 Feet
Figure 3
\ —h- Groundwater Elevation Contour Map
October 2017
Transition Zone
Cotton Mill Square Facility
Greensboro, North Carolina
T-1
File:Y:\CMS\MXD\October2017GW_Contour_Intermediate.mxd, 8/2/2018 2:09:52 PM, johna

1111. I, 00 ❑ - 7 - -
- - _ _ _ _ N
•
•
CJIDED +E
O❑n00 I
•
•
MW-02-s
��� _ + •
` S
1
f� (j .2o..
IW_210 1
6
DW-01-d1 IW-205s` 6a 1
Mw-vs-s / IW-403 IW-407 1 IW-206 1
M�{j'21-i i I IW-405 \ W-vs s��$R6 _ 1
IW-001 IW-404 IW-409 MW-18=i
IW-402 IW-406 �D847 421 II1I
IW-408
DW-14-d2 DW-06-d1
I 1 _ 844.67 843.48 1
V EW-513 A 1
1-1
��MW-16-s
MW-36-s IW-201 00 s EW-512 JJ,, /6R Mw-30-i 1
850.35 IW-202 MW-04-Y
1
1 MW-37-s MW"3-s �•+\MW-22s I MW-29-i ;
I II /� DW-02-d1 DW-07-i/ MW-14-s
`� 848.18 T 842 I
1 DW-17-d2 N ,� 4-s J MW-13-s/ 1
7
1 EW-508 EW-509 I'' 1
DW-09-d1 IW-203 I I ga0 L I
Fill
W-204
DW-10=d1 84/�.98/1 " � _ iiii
MW-28-s 1
849.21 MW39-�6a� 6a6" - _ 1
- EW=510 EW-511 ' i,
1
iIJ
6aa� 1
Mw-17-
MW-03-s I
IW=207 •'IW-209 • '
111�111 r IW+208 •
'
1 L J w �Z $Q L EW�507 1
63a
r Mw -EhEW,506
1 Z `•+ EW-505 + 0 MW-12-s P
1 - Dv908-i ��
�W503 -504 1
1 _ -
1 636 1 830
1 EW-502 - -
/
' MW-44-d1
828
% O EW-501 i , ,....
s� � i .• •1 g26
<, Fps
�.� p� ��R 62a
6gA MW-43-
O Mw-as-i IW-304'•
�' i•�i / Mw-az- /• DW-11-d1 622 DW-15-d1
—0 MW-45-s, O.
IW-302 6 DW-12-d1
30IW-303 �IW-306
MW-41-1
DW-13-d16 �626 /IW-305
830.71 DW-16-d2
IW-301 g26 IW-307
62A 622
20
g16
616 DW19-d1
61a 811.59
%iiiDW-18-i% $12
MW-600 N-47-d2
/ MW-6o1
♦ Legend
Injection Well
Extraction Well
Saprolite Monitor Well
MW-50-i
Transition Zone Monitor Well
Bedrock Monitor Well
\ Abandoned Saprolite Monitor Well
J Abandoned Transition Zone
Monitor Well
M W-49-i
MW-6034- Mw-602 `±w- , • Abandoned Bedrock Monitor Well
Offsite Shallow Monitoring
Well Locations
Cotton Mill Square Boundary
MW-604 Buildings/Roads
♦ —840—Groundwater Elevation Contour
MW-605
♦ (feet above mean sea level)
851.91 Groundwater Elevation (Feet)
MW-51-i MW-606 Scale in Feet
MW-607
0 200 400
1 Feet
1 inch = 200 Feet
l
Figure 4
Groundwater Elevation Contour Map
October 2017
Bedrock Unit
Cotton Mill Square Facility
Greensboro, North Carolina
Ea
VIIF •►
• --SOLUTIONS
File:Y:\CMS\MXD\October2017GW_Contour_Bedrock.mxd, 8/2/2018 2:10:37 PM, johna

1, CITT0 ... .., - .., 7�
_ _
N
' �o - _ _ _ _
-
00 00 . , ,
a
�� �1W_U2:s 1 V
I\^/1 N D '
11 D M BU ING Rl o. �� _ '0 1
30 _ I
IW-205 W-206
IW=40:
07 �IW-403 IW_4o5 - WYO� ``\ 1
IWc40, .DW-�.-d1/O 0 BMW-151-s I�DO�DW-05--d1 ` 1
n 7 _
10 I W-404 11w-406 O4o7 mw_18111r 'PMW-02 7O
100 TMfN-1 l 8,853 1
M IL ING(B ICK) 0 23,1b5T -, Dw-os-d,
IW-201 Ei
Ew-s,z Ew-s,3 1
11! M W-36-s �M W 04 S 1
163 IW-202 w-zs�
MW�37-s 6�565 0 3,922 o 0 0
ES
71,797 Z e DW-02-d1 DW-07MW-14-s
LDW01 FO MER o `13 I1
-n-d2 ��0� EW-509 AU OR 11
\.
EW-508 1
�0-ow-oy,d, OQ j MW-13-s o
p iw-2oa 73 1
Dw-,o-d, r�0'
/.j Dw-03 d^ Zone-2 — MW-28-s 1
.1 eti 'L71 �� N D 1
i � Ew-51 o_ o EW-51A
�r�� oo K
ne 4 1
o 1
! Li c ■1, ■ o�� MW-03-s
il \ i 17
1 ,
11
HEWI 10111* t k -505
0.
I I 11 EEW-504 1 / / i i
1 Oa
' ❑EW-503 1
EW-502 Z ' ' I �..--' / MW
❑EW-501
%�� , Zone 6
1-'P • o0
O O IW-3040+ -15-d1
100 10 ow-,2-d, DW-11-d1
2
IW-303
/ 4_IW-302 ® IW-306
W-13-d IW-305 0
D
+DW-16-d2 IW-307
10 e-
IW-301
oDW-19-d1
W D -1r +
-410- MW-600
MW
r-. --------------
-50-i Le g e n d
L. Extraction Well
c Injection Well
O
Recharge Well
e _49> o Saprolite Monitor Well
0 *MW-603 *MW-602 -4- Intermediate Zone Monitor Well
Bedrock Monitor Well
16\
Offslite Shallow Monitoring
C\'.
Well Locations
*Mw-soa Inferred Total cVOC
— Concentration Contour
A._ MW-605 Cotton Mill Square Boundary
32.9 Total cVOC concentration (ug/L)
MW-51-i
MW-606
* MW-s07
Scale in Feet
C 0 200 400
Feet
I
1 inch = 200 Feet
Figure 5
Approximate Total cVOC
. \ VIIF
Distribution in Groundwater
October 2017
Saprolite Unit
Cotton Mill Square Facility
;; Greensboro, North Carolina
` SOLUTIONS
File:Y:\CMS\MXD\October2017_GW_Saprolite.mxd, 8/2/2018 2:06:52 PM, johna

1 0 — — —
oo - - _
❑0 ❑
1n00 --.----____________
�„ -
_ i
ET-DEJ00
C_____ s
w00
•
n10�
MAIN BUI DIL JG RIfSK>_J 100 0660
\\\ IW'205 P
IW-402 IW=403 I`206
PM W=
-�all in_ O O 0 0� 0'405 IW-4F7 � I
�(� IW-404 IC—
j� Iw,i / +W-18-i
one
��op0 \ Iw�aoa '-� �_,12 I. �
pr ' GAIN B ING(B' oo�EW-512 ' O DW=06=d
/ Iw-zo` 1E9
�`? 1581011 E4-513 nn-'s
v-36_s `100;000°56454j
o OIw-zoz
O 71.5 i ��
I o I / 71.5 Mw-,a-s
L. -___________J
o - 1
DW-17-a
A-MOR 11MW-13-s , M I
ew-so9 R •AIR
EW-508
DW-09-d1 J_ S OP 0 '
O -d1 W/4 O
�� jDWO3d1
Zone MW-28-s
MW-23-i . '
11111k� il
EW-510 ®W`1J
I. C:13 I
12,923
Li �O. MW-03-s
IBOO(14 -507 OIi-
o
' 1� 11 1 I8 '
I10;000
1 "EW-506 \ �Imo, 1 LI,,EW-505
1 ao2,565
EW-504� p �//
c EW-503 3,671 I `��
tri
/-,
o I 4 i I /
.�' `® Zop,e�5
EW-50� / ROPE
t1 00 ® ' 473 �N� N?' o
E 598 • OV
6-s� f0� �598 • s Zone 6,,
0
j.=
MW-46-i • i .14
U ow-,s-d,
1.2 W-11-d1 T1
/ IW-302 IW-303
((yy+�� IW-306
DW-13-d{ IW-305 0
0 +DW-16-d2 e
� 0
W-301
o O
0
D W-18-i D W-19-d1
5,513 +
''' c- \ 4_MW-600
O00
1111111111111
/Al- MW-601
o0
M W-50-i
. ,moo
ND /
Legend
..-- Extraction Well
;,:- --
+ Injection Well
MW-49-i
p. 279 Recharge Well
--MW-603 T MW-602 Saprolite Monitor Well
Intermediate Zone Monitor Well
, 7
_______) L
Bedrock Monitor Well
MW-604 Offsite Shallow Monitoring
o Well Locations
0
,�o� Cotton Mill Square Boundary
Inferred Total cVOC
MW� !ns.—,.......•"'L------- _\\ / — Concentration Contour
51-i_ MW 606 Boa Total cVOC concentration (ug/L)
77l7
* MW-607 Scale in Feet
0 200 400
I I I 1
I Feet
1 inch = 200 Feet
Figure 6
'o
Approximate Total cVOC
Distribution in Groundwater
October 2017
Intermediate Unit
Cotton Mill Square Facility
y Ea
:; Greensboro, North Carolina
` +--SOLUTIONS
File:Y:\CMS\MXD\October2017gw_Intermediate.mxd, 8/2/2018 2:07:43 PM, johna

1, ❑
N
IIIIIIIII 0-...frni - .. .. _ _ _ _ _ _ - _ _ r--___
.. _
❑ ,0
1,,- 1 E
0 �� �,CLIFTON ROAD �0 O ♦
❑ MW-02-s ft • N
I V
�❑ 10
�Op 1C)1-11
�10-7
.}._____
DIW-402 o{IW-405PMW IW-2(IW-401 DI-oi� `_4oa n 1
\/ IW-407 PMVIr/\ W-05-d1DW-06-d1
10,370 01.8
II it°1
ri [ I
_
wII -2o1 DW-14=d2
MW-36 s +IW-202 1°° 88,206 �Nlbv-�i...
I p vIW=37s 07-{MW-29-,
W-07-DW-02-d11,616MW13 -1sI'
LI 'o
o509-� Ll00 DW09d1DW-10-d1 1
12 , , DW-03-d1 Zone 2
HEWITT STREET \ 5,70a `,p0o c ;""-za-s '
o
_L
0
III 11\1.11I s
1$ unci]o_
o E
i:00
�
OEW=506-
\ '1
lli
/ s DEW-504 -1
LJ '
I
EW-503 ♦ /
I
EW-502 Z05 /
1 10 ti",.•
10p0°0
I.
. •
Zone 6 DW-11-d1
MW-46-i 1 :
��f +DW-15-d1
L +DW-12-d1 )�
IW-302 1W-303
DW-13-d Iw-306 v
o
73 � ���,zit�' o
o /
Op DW-16-d2
116
D W�19-d 1
/1,416
DW-18-I�
17000
Q� MW-600
o0
100
+MW-601
V
iiii ^.
MW-50-i
.,•,, 111111‘...k
+ Legend
, VIP Extraction Well
+ Injection Well
Ole
Recharge Well
W 49 i�
0Saprolite Monitor Well
*BMW 603 *MW 602C .
Intermediate Zone Monitor Well
Bedrock Monitor Well
Offsite Shallow Monitoring
*MW-604 Well Locations
o
A._ MW-605 Inferred Total cVOC
Concentration Contour
Property Boundary
MW,51-; 392 Total cVOC concentration (ug/L)
MW-606
* Mw-607 Scale in Feet
0 200 400
I I I Feet
1 inch = 200 Feet
Figure 7
Approximate Total cVOC
Distribution in Groundwater
October 2017
Bedrock Unit
Cotton Mill Square Facility
;; Greensboro, North Carolina
SOLUTIONS
/ \
File:Y:\CMS\MXD\October2017_GW_Bedrock.mxd, 8/2/2018 2:08:18 PM, johna

E Parking Lot > I
New Monitoring
Well Cluster
I
IP-3 through IP-8 ob` �.
Apartment `Q `Q^ ��, . A,
Building Sidewalk y 'C 0
Clayey Silt with
o Trace Sand o
20- — -20
;, so I _ _ — - 30 0
, Transition Zone/
Weathered Bedrock = _
- m
g 40- M -40 'Y.
0 0 o "'"`k
o
50- -50
d =
w a
H
H �
O.
w Legend °;
p 60- _ -60 CD
Injection Well
Red line is
I Water Table Bedrock=Gabbto
Injection Zone. _ =
Nletamorphosed=Granite
70 Notes: - _ = —70
•EW-504 is an existing monitoring well.
•lP-1 through IP-8 are injection wells.
80- •New monitoring well cluster SMW-1, TZMW-1 and -80
BMW-1 will be installed prior to injection activity.
•CVOCs present throughout water column.
90- -90
118P-0462-1
CROSS-SECTION SCHEMATIC
PILOT TEST INJECTION AREA

Item I: Description of Proposed Injection Activities
Purpose and Goal
A remedial technology pilot test involving the injection of a reactive treatment media into
targeted groundwater zones will be conducted at an on-site location near the southern
(downgradient) property boundary of the CMS Site.This pilot test will also include remedial
design characterization activities to help support the development of the final design for the
future implementation of the PRB treatment curtain option.
Scope
Pre-Injection Support
Three monitoring wells will be installed on-site and immediately downgradient of the CAT100®
pilot test injection points (see monitoring well and injection point layout in Figure 4).The well
and injection point locations shown in the figure are approximate and may be adjusted in the
field based on accessibility, utility clearance and subsurface conditions encountered.
The new onsite wells will be installed as part of the pilot test to monitor groundwater conditions
in upper bedrock,the transition zone (TZ)overlying bedrock and the saprolite. We have
assumed the following approximate depths for the new monitoring wells: bedrock well 80 feet
below ground surface (ft bgs),transition zone well 40 ft bgs, and saprolite well 30 ft bgs.
Rotosonic cores will be collected continuously from overburden to the top of bedrock.The
Rotosonic cores will be logged and screened with a photoionization detector(PID) in the field by
the WESTON geologist. During the air rotary drilling, logging of bedrock drilling cuttings will be
conducted. Any soil samples from the overburden that exhibit PID readings above
ambient/background will be analyzed in accordance with Method 8260B at RPI's laboratory in
Golden, Colorado.These laboratory analytical data are for remedial design purposes only and
not for regulatory compliance hence a NCDEQ certified laboratory is not warranted as part of
this task. Soil CVOC mass,along with CVOC mass flux in groundwater, will be used to determine
CAT100® loadings for the final remedial design.The soil CVOC data may also provide indication
of impacted groundwater migration in the saprolite and TZ.
Prior to commencement of the CAT100® injections, newly installed monitoring wells SMW-1 and
TZMW-1, and existing well EW-504(see well location in Figure 1;this well is screened across the
TZ and upper bedrock)will be low-flow sampled for the CVOC,anion and the dissolved gas
parameters listed in Table 1.As stated above,these laboratory analyses are for remedial design
use only.Additionally, pre-injection groundwater samples will also be collected from the new
monitoring wells and existing well EW-504 and submitted to Microbial Insights for analysis of
the microbial parameters listed (Table 2)to establish baseline microbial conditions.
Injection Point Installation
Two injection points will be installed to perform CAT100® injections in the saprolite,TZ and
upper bedrock zones.The locations of these injection points are shown in Figure 1. One
injection point(IP-1)will be installed in the same manner as the open bedrock borehole at

BMW-1.This will allow CAT100®to be injected into upper bedrock at the IP-1 location, provided
such injections are feasible.
The second injection point(IP-2)will be constructed by advancing a rotosonic casing from
ground surface to the base of the TZ(i.e.,top of bedrock). Soil cores will be collected at the IP-2
location for logging and PID screening purposes and for possible soil CVOC analysis, as described
above. After the rotosonic casing reaches the base of the TZ, injection point IP-2 will be
constructed by backfilling this borehole with hydrated bentonite pellets as the casing is
gradually extracted.This bentonite-backfilled borehole will be used to inject CAT100® into the
saturated saprolite and TZ,as described in Task 6.
Borehole Geophysics and Downhole Camera
Geophysical tools will be used to log the open bedrock borehole at IP-1 and BMW-1 using
caliper,temperature,fluid conductivity, optical or acoustic imaging and downhole camera tools.
The collected geophysical information and camera images will be used to identify stratigraphic
features,fractures and areas of preferential groundwater flow.
Straddle-Packer Discrete Bedrock Sampling
The drilling, borehole geophysics and downhole camera information will be evaluated to identify
bedrock fractures for possible groundwater sample collection. Straddle-packers will be used to
isolate fractures identified during the borehole geophysics at IP-1 and the open bedrock
borehole at BMW-1 for vertical profile sampling of the upper bedrock zone. We have assumed
that a maximum of three to five water-bearing fractures per borehole would be sampled,
provided this number of water-bearing fractures is encountered at BMW-1 and IP-1.The actual
number of zones tested will vary based upon the geophysical results and may be less. During
this sampling effort,the surrounding monitoring wells screened partially or fully in upper
bedrock will be monitored for water level changes using transducers to assess fracture
connectivity. Pressure transducers in the straddle-packer assembly will monitor pressures within
the sampled zone, and above and below this zone to help confirm the discreteness of the
collected sample or identify areas of vertical permeability within upper bedrock.The
groundwater samples collected using the straddle-packer will be submitted to the RPI laboratory
for analysis of the CVOC parameters listed in Table 1.
Following completion of the aforementioned vertical profile sampling, BMW-1 will be completed
as a 2-inch diameter monitoring well.After developing well BMW-1, it will be low-flow sampled
prior to CAT100® injection and the collected groundwater samples analyzed for the parameters
listed in Tables 1 and 2.The Microbial Insights analysis highlighted in Table 2 is proposed in
order to establish baseline microbial conditions in the proposed injection/treatment area, assess
the presence and/or relative degree reductive bacteria,their functional genetic makeup and
propensity for reduction/dechlorination and/or the need for amendments to facilitate during
future scale-up activities.

Pilot Test CAT100® Infection Related Activities
IP-1 Injections
A straddle packer assembly will be used for the CAT100® injections in IP-1.This injection packer
has an 18-inch isolation interval between packers which permits the injection of CAT100® slurry
at a specific depth interval.The mixing and injection equipment will include:
1. 18-inch interval straddle-packer assembly.
2. Positive displacement pump capable of up to a 250 gallons per minute (gpm)flow rate and a
2,500 pounds per square inch (psi)operating pressure.
3. Water tank with a capacity of 750 gallons.
4. Boom/fork lift to place and position the straddle-packer assembly in the borehole.
5. CAT100® mixing trailer equipped with two 500-gallon mix tanks and a variable speed 300
gpm transfer pump.
6. Hoses, plumbing, manifolds, and charge-pump to connect the CAT100® mixing trailer to
down-hole injection equipment.
7. Plug packers to use as"plugs" if any flowing artesian condition develops at a nearby
monitoring well(s) due to pressure buildup in the subsurface.
During CAT100® injections at IP-1, monitoring wells EW-504, BMW-1,TZMW-1 and SMW-1 will
be equipped with downhole transducers to identify pressure changes indicating the lateral
distribution of CAT100® in the subsurface environment. Field personnel will record other pilot
test observations, such as any visual evidence of CAT100® in the groundwater at the nearby
monitoring wells,and point of injection observations, including pressures, injection rates, and
volumes of injected material.
The IP-1 injections will commence at the bottom of injection point IP-1 and move upward at 2-
foot intervals throughout the targeted zone (i.e., approximately 41 to 80 ft. bgs).At each test
interval,fresh water will be injected initially to determine whether fracture(s) in the packer
interval will accept fluid. If the test interval does not readily accept fresh water, no CAT100®
injection will be conducted at that depth interval. If fluid acceptance is confirmed in the packer
interval, CAT100® slurry will be injected.The injected flow rate of the CAT100® slurry will be
monitored and adjusted to achieve optimal distribution,while minimizing the potential for the
surface expression of the injected CAT100®
We have assumed that IP-1 would receive ten injections, assumed to be approximately every 4-
feet vertically,targeting overall an interval extending from approximately 41 to 80 ft. bgs.
However,the actual number of injection zones will depend on the number of fracture zones
identified during the borehole geophysics. Each injection will consist of approximately 100
pounds (Ibs) of CAT100® mixed with approximately 100 gallons of potable water.This mix ratio
and injected slurry volume may be adjusted in the field based on conditions encountered.
I P-2 Injections
CAT100® injections in the saturated saprolite and TZ will be completed through IP-2. A
Geoprobe rig will be used to drive 2.25-inch diameter injection rods equipped with a basal
injection tip into the hydrated bentonite in the IP-2 borehole. As the Geoprobe rods/basal tip

are advanced with depth, CAT100° slurry will be injected horizontally under pressure at 2-foot
intervals throughout the saturated saprolite and TZ.
We have assumed that the saturated saprolite zone would extend from 10-30 ft bgs.A total of
10 injection intervals are expected to be completed in the saturated saprolite with each
injection consisting of 30 lbs of CAT100° mixed with 30 gallons of potable water. For the TZ,we
have assumed that a total of 5 injections would be completed within the 30-40 ft bgs interval
with each injection consisting of 80 lbs of CAT100° mixed with 80 gallons of potable water.The
aforementioned mix ratios and injected slurry volumes may be adjusted in the field based on
conditions encountered.
Saprolite Direct Push Injections
The pilot test will also evaluate the feasibility of CAT100° application within the saturated
sapolite via Geoprobe direct push injections.This method of treatment media application has
been used at other sites to overcome daylighting issues.These more-closely spaced direct push
injections allow CAT100° slurry to be injected at lower quantities per interval managing the
potential for daylighting.
For the CAT100° pilot test, additional Geoprobe injection points will be completed between and
upgradient of EW-504, IP-1, and IP-2.These injections will be accomplished by driving 2.25-inch
direct push rods directly into the saturated saprolite from the water table to the top of the
transition zone, provided this depth can be achieved without encountering direct push refusal.
These injections will be completed using a grid pattern with two rows of injection points, as
shown in Figure 1. A total of six points are expected to be completed;two points approximately
half-way between EW-504, IP-1, and IP-2, and four points in a row upgradient of IP-1 and IP-2.
The targeted interval for the Geoprobe direct push injections are assumed to be from 10 to 30 ft
bgs and injections will be completed every 2-vertical feet for a total of 10 injections per direct
push point. Each injection interval will receive a slurry comprised of 30 lbs of CAT100° mixed
with 30 gallons of potable water.This mix ratio and injected slurry volumes may be adjusted in
the field based on conditions encountered.

c.7.-
4 ie
• 1 4. 1 pi:, -I . ' 1 MI I I t ir r I 1 li. t i . ,
i I. , .i , , _._, le m ,1 a . . .i..
, .
.. _ 1 1 " .
Win
$ al k%. ..'NNI-.1 4..
,„.: • ....,
1_ _ r - - 1 irl: L.-•'‘..i.r47' Iry
rift 1.1.
:....
t -__...._
_ l
filit ,
•
'IL i
,.. 4 "= r-Z.T..„,.4 - r \:11/:
1111. i• ... ,..
c
ri lr 0 ' �! � :Pi' ; iS
• '4E 6 A l
8 P-2 r ,
c* 1114111PP
+lam 1 �` 'klzbk 1 . mi) ,
• ill, ' I-
Monitoring Well EW-504 -_, gumli .,,,,,, . ....__ ---__ -
, _416,-. _. MihiWii, moimmiovril. ;
New Monitoring Well Cluster
4`
t
i r
p- - Sa rolite Well SMW-1 •
A ';*; -- - Transition Zone Well TZMW-1 tr.. ' FIGURE 1
ji
t - Bedrock Well BMW-1 JI► = 411A.•
• allaiirliVi
-
�t‘ tlr 1 I ;1 •6fir-- CAT 100 Direct Push Injection
!' .�r • � .r � CAT 100 Injection at
Note: Proposed well and injection point locations are approximate and
may be adjusted in the field based on accessibility and utility clearance. Installed Injection Points
18-0462
PILOT TEST LAYOUT
COTTON MILL SQUARE, GREENSBORO, NORTH CAROLINA

Table 1
Parameter List for CAT 100 Pilot Test— RPI Lab
CVOCs Anions Dissolved Gases
Method 8260B Method 300.1 Method RSK 175
Vinyl Chloride Lactate Methane
1,1-Dichloroethene Acetate Ethane
trans-Dichloroethene Propionate Ethylene
1,1-Dichloroethane Formate/Isobutyrate Propane
cis-Dichloroethene Butyrate Propylene
Chloroform Pyruvate Isobutane
1,1,1-Trichloroethane Chloride n-Butane
1,2-Dichloroethane Nitrite Acetylene
Trichloroethene Succinate t-2-Butene
1,1,2-Trichloroethane Nitrate 1-Butene
Tetrachloroethene Sulfate Isobutylene
Phosphate cis-2-Butene
Sulfide 1,3-Butadiene
Methyl Acetylene
Pilot Test Cost Estimate—Cotton Mill Square Site,Revised April 4,2019

Table 2
Microbial Analysis for CAT100 Pilot Test—Microbial Insights Laboratory
Cotton Mill Square Site
Dechlorinating Bacteria
Dehalococcoides
tceA Reductase
BAV1 Vinyl Chloride Reductase
Vinyl Chloride Reductase
Dehalobacter spp.
Functional Genes
Soluble Methane Monooxygenase
Phylogenetic Group
Iron and Sulfate Reducing
Methane Oxidizing Bacteria
Methanogen
Pilot Test Cost Estimate—Cotton Mill Square Site,Revised April 4,2019

Safety Data Sheets
(SDS)

TRAP & TREAT® BOS 100®
Safety Data Sheet
CalgonCarbonr
Issued:05/27/2015
Supersedes:12/30/2011
Version:1.0
SECTION 1: Identification of the Substance/Mixture and of the Company/Undertaking
1.1. Product identifier
Product name : TRAP&TREAT®BOS 100®
Product form : Mixture
Product code : 1271
Synonyms : Activated Carbon
1.2. Relevant identified uses of the substance or mixture and uses advised against
Use of the substance/mixture : Adsorbent
1.3. Details of the supplier of the safety data sheet
Calgon Carbon Corporation
P.O. Box 717
Pittsburgh, PA 15230
412-787-6700
1.4. Emergency telephone number
Emergency number : CHEMTREC(24 HRS): 1-800-424-9300
SECTION 2: Hazards Identification
2.1. Classification of the substance or mixture
GHS-US classification
Combustible Dust H232
Self-heating 1 H251
Not classified as a simple asphyxiant. Product does not displace oxygen in the ambient atmosphere,but slowly adsorbs oxygen from a confined
space when wet. Under conditions of anticipated and recommended use,product does not pose an asphyxiation hazard.
2.2. Label elements
GHS-US labeling
Hazard pictograms(GHS-US) :
GHS02
Signal word(GHS-US) : Warning
Hazard statements(GHS-US) : H232-May form combustible dust concentrations in air
H251 -Self-heating:may catch fire
Precautionary statements(GHS-US) : P235+P410-Keep cool. Protect from sunlight
P280-Wear eye protection, protective gloves
P407-Maintain air gap between stacks/pallets
P413-Store at temperatures not exceeding 140°C/284°F
P420-Store away from other materials
2.3. Other hazards
Other hazards not contributing to the : Wet activated carbon can deplete oxygen from air in enclosed spaces. If use in an enclosed
classification space is required, procedures for work in an oxygen deficient environment should be followed.
2.4. Unknown acute toxicity(GHS US)
No data available
SECTION 3: Composition/Information on Ingredients J
3.1. Substance
Not applicable
3.2. Mixture
Not applicable
05/27/2015 TRAP&TREAT®BOS 100® For Internal Use Only:PR#43 Page 1 of 7
Product Code:1271

TRAP & TREAT® BOS 100®
Product Code: 1271
Safety Data Sheet
Name Product identifier
Activated Carbon (CAS No)7440-44-0 >_75
Zero valent iron (CAS No)7439-89-6 <_25
SECTION 4: First Aid Measures
4.1. Description of first aid measures
First-aid measures general : If exposed or concerned,get medical attention/advice.Show this safety data sheet to the
doctor in attendance.Wash contaminated clothing before re-use. Never give anything to an
unconscious person.
First-aid measures after inhalation : IF INHALED: Remove to fresh air and keep at rest in a comfortable position for breathing.
First-aid measures after skin contact : IF ON SKIN(or clothing): Remove affected clothing and wash all exposed skin with water for at
least 15 minutes.
First-aid measures after eye contact : IF IN EYES: Immediately flush with plenty of water for at least 15 minutes.Remove contact
lenses if present and easy to do so. Continue rinsing.
First-aid measures after ingestion : IF SWALLOWED:Rinse mouth thoroughly. Do not induce vomiting without advice from poison
control center or medical professional.Get medical attention if you feel unwell.
4.2. Most important symptoms and effects, both acute and delayed
Symptoms/injuries : Not expected to present a significant hazard under anticipated conditions of normal use.
However,dust may cause irritation and redness of the eyes,irritation of the skin and respiratory
system.The effects of long-term,low-level exposures to this product have not been
determined.
4.3. Indication of any immediate medical attention and special treatment needed
No additional information available
SECTION 5: Firefighting Measures
5.1. Extinguishing media
Suitable extinguishing media : Water spray.Carbon dioxide. Dry chemical. Foam.Sand.
Unsuitable extinguishing media : None known.
5.2. Special hazards arising from the substance or mixture
Fire hazard : Self-heating;may catch fire. Dust may be combustible under specific conditions. May be ignited
by heat,sparks or flames.
Explosion hazard : Dust may form explosive mixture in air.
Reactivity : Zero valent iron must be kept inert or it may react exothermically.
5.3. Advice for firefighters
Firefighting instructions : Wear NIOSH-approved self-contained breathing apparatus suitable for the surrounding fire.
Use water spray or fog for cooling exposed containers. Evacuate area.
SECTION 6: Accidental Release Measures
6.1. Personal precautions,protective equipment and emergency procedures
General measures : Evacuate area.Keep upwind.Ventilate area.Spill should be handled by trained clean-up crews
properly equipped with respiratory equipment and full chemical protective gear(see Section 8).
6.1.1. For non-emergency personnel
No additional information available
6.1.2. For emergency responders
No additional information available
6.2. Environmental precautions
Prevent entry to sewers and public waters.Avoid release to the environment. Product is not soluble, but can cause particulate emission of
discharged into waterways. Dike all entrances to sewers and drains to avoid introducing material to waterways. Notify authorities if product enters
sewers or public waters.
6.3. Methods and material for containment and cleaning up
For containment : Sweep or shovel spills into appropriate container for disposal. Minimize generation of dust.
Methods for cleaning up : Sweep or shovel spills into appropriate container for disposal. Minimize generation of dust.
Dispose of material in compliance with local,state,and federal regulations.
6.4. Reference to other sections
No additional information available
R
05/27/2015 TRAP&TREAT®BOS 1000 For Internal Use Only:PR#43 2/7
Product Code:1271

TRAP & TREAT® BOS 100®
Product Code: 1271
Safety Data Sheet
SECTION 7: Handling and Storage
7.1. Precautions for safe handling
Precautions for safe handling : Avoid dust formation.Avoid contact with skin,eyes and clothing. Do not handle until all safety
precautions have been read and understood.Wash hands and other exposed areas with mild
soap and water before eating,drinking or smoking and when leaving work. Keep away from
sources of ignition-No smoking.Zero valent iron is highly reactive and must be kept inert or it
may react exothermically.
7.2. Conditions for safe storage,including any incompatibilities
Storage conditions : Keep under inert atmosphere.Keep away from ignition sources.Store in a dry,cool and well-
ventilated place.Store at temperatures not exceeding 140°C/284°F.
SECTION 8: Exposure Controls/Personal Protection
8.1. Control parameters
Activated Carbon(7440-44-0)*
OSHA PEL(TWA)(mg/m3) <_5(Respirable Fraction)
<— 15(Total Dust)
Iron(7439-89-6)
Remark(ACGIH) OELs not established
Remark(OSHA) OELs not established
*Exposure limits are for inert or nuissance dust. No specific exposure limits have been established for this activated carbon product by OSHA or ACGIH.
8.2. Exposure controls
Appropriate engineering controls : Zero valent iron must be kept inert or it may react exothermically. Provide adequate general
and local exhaust ventilation. Use process enclosures, local exhaust ventilation,or other
engineering controls to control airborne levels below recommended exposure limits. Use
explosion-proof equipment with flammable materials. Ensure adequate ventilation,especially in
confined areas.Wet activated carbon can deplete oxygen from air in enclosed spaces. If use in
an enclosed space is required,procedures for work in an oxygen deficient environment should
be followed.
Personal protective equipment : Gloves.Safety glasses. Insufficient ventilation:wear respiratory protection.
11* II ••
Hand protection : Gloves should be classified under Standard EN 374 or ASTM F1296.Suggested glove
materials are: Neoprene, Nitrile/butadiene rubber, Polyethylene,Ethyl vinyl alcohol laminate,
PVC or vinyl.Suitable gloves for this specific application can be recommended by the glove
supplier.
Eye protection : Use eye protection suitable to the environment.Avoid direct contact with eyes.
Skin and body protection : Wear long sleeves,and chemically impervious PPE/coveralls to minimize bodily exposure.
Respiratory protection : Use NIOSH-approved dust/particulate respirator.Where vapor,mist,or dust exceed PELs or
other applicable OELs,use NIOSH-approved respiratory protective equipment.
SECTION 9: Physical and Chemical Properties
9.1. Information on basic physical and chemical properties
Physical state : Solid
Appearance : Granular, powder,or pelletized substance
Color : Black
Odor : Odorless
Odor threshold : No data available
pH : No data available
Relative evaporation rate(butylacetate=1) : Not applicable
Melting point : Not applicable
Freezing point : Not applicable
Boiling point : Not applicable
Flash point : No data available
Auto-ignition temperature : <140°C
Decomposition temperature : No data available
R
05/27/2015 TRAP&TREATO BOS 1000 For Internal Use Only:PR#43 3/7
Product Code:1271

TRAP & TREAT® BOS 100®
Product Code: 1271
Safety Data Sheet
Flammability(solid,gas) : <140°C
Vapor pressure : Not applicable
Relative vapor density at 20°C : Not applicable
Apparent density : 0.4-0.7 g/cc
Solubility : Insoluble.
Log Pow : Not applicable
Log Kow : Not applicable
Viscosity,kinematic : Not applicable
Viscosity,dynamic : Not applicable
Explosive properties : No data available
Oxidising properties : No data available
Explosive limits : No data available
9.2. Other information
No additional information available
SECTION 10: Stability and Reactivity
10.1. Reactivity
Self-heating;may catch fire. Zero valent iron must be kept inert or it may react exothermically.
10.2. Chemical stability
Stable under use and storage conditions as recommended in section 7.
10.3. Possibility of hazardous reactions
No additional information available
10.4. Conditions to avoid
Do not allow contact with air.Avoid dust formation. Heat. Ignition sources.Exposure to high concentrations of organic compounds may cause bed
temperature to rise.
10.5. Incompatible materials
Air.Alkali metals.Strong oxidizing agents.
10.6. Hazardous decomposition products
Carbon monoxide(CO),carbon dioxide(CO2).
SECTION 11: Toxicological Information
11.1. Information on toxicological effects
Acute toxicity : Not classified
Activated Carbon(7440-44-0)
LD50 oral rat >2000 mg/kg
Iron(7439-89-6)
LD50 oral rat 984 mg/kg
Skin corrosion/irritation : Not classified
Serious eye damage/irritation : Not classified
Respiratory or skin sensitisation : Not classified
Germ cell mutagenicity : Not classified
Carcinogenicity : Not classified
Silica: Crystalline,quartz(14808-60-7)
IARC group 1 -Carcinogenic to humans
The International Agency for Research on Cancer(IARC)has classified "silica dust,crystalline,in the form of quartz or cristobalite"as
carcinogenic to humans(group 1). However these warnings refer to crystalline silica dusts and do not apply to solid activated carbon containing
crystalline silica as a naturally occuring, bound impurity.As such,we have not classified this product as a carcinogen in accordance with the US
OSHA Hazard Communication Standard(29 CFR§1910.1200)but recommmend that users avoid inhalation of product in a dust form.
Reproductive toxicity : Not classified
Specific target organ toxicity(single exposure) : Not classified
Specific target organ toxicity(repeated : Not classified
exposure)
R
05/27/2015 TRAP&TREATO BOS 1000 For Internal Use Only:PR#43 4/7
Product Code:1271

TRAP & TREAT® BOS 100®
Product Code: 1271
Safety Data Sheet
Aspiration hazard : Not classified
Symptoms/injuries : Not expected to present a significant hazard under anticipated conditions of normal use.
However,dust may cause irritation and redness of the eyes,irritation of the skin and respiratory
system.The effects of long-term,low-level exposures to this product have not been
determined.
SECTION 12: Ecological Information
12.1. Toxicity
No additional information available
12.2. Persistence and degradability
No additional information available
12.3. Bioaccumulative potential
No additional information available
12.4. Mobility in soil
No additional information available
12.5. Other adverse effects
No additional information available
SECTION 13: Disposal Considerations
13.1. Waste treatment methods
Waste treatment and disposal methods : Vacuum or shovel material into a closed container.Dispose in a safe manner in accordance
with local/national regulations. Do not allow the product to be released into the environment.
Additional information : Activated carbon is an adsorbent media; hazard classification is generally determined by the
adsorbate.Consult U.S. EPA guidelines listed in 40 CFR 261.3 for more information on
hazardous waste disposal.
SECTION 14: Transport Information
14.1.In accordance with DOT
Transport document description : UN3190 Self-heating solid,inorganic,n.o.s.,4.2, II
UN-No.(DOT) : 3190
DOT NA no. : UN3190
Proper Shipping Name(DOT) : Self-heating solid,inorganic,n.o.s.(Contains:Zero Valent Iron)
Department of Transportation(DOT)Hazard : 4.2-Class 4.2-Spontaneously combustible material 49 CFR 173.124
Classes
Hazard labels(DOT) : 4.2-Spontaneously combustible
Packing group(DOT) : II-
14.2.Transport by sea
IMO/IMDG
UN/NA Identification Number : UN3190
UN-Proper Shipping Name :Self-heating solid,inorganic,n.o.s.(Contains:Zero Valent Iron)
Transport Hazard Class :Class 4.2
Packing Group :II
14.3.Air transport
ICAO/IATA
UN/NA No : UN3190
UN-Proper Shipping Name :Self-heating solid,inorganic,n.o.s. (Contains:Zero Valent Iron).
Transport Hazard Class :Class 4.2
Packing Group : II
R
05/27/2015 TRAP&TREATO BOS 1000 For Internal Use Only:PR#43 5/7
Product Code:1271

TRAP & TREAT® BOS 100®
Product Code: 1271
Safety Data Sheet
14.4 Other Information Not recommended for air transport due to material self-heating when exposed to air.
SECTION 15: Regulatory Information
15.1. US Federal regulations
TRAP&TREAT®BOS 100®
All chemical substances in this product are listed in the EPA(Environment Protection Agency)TSCA(Toxic Substances Control Act)Inventory or
are exempt
SARA Section 311/312 Hazard Classes Fire hazard
Cobalt(7440-48-4)*
Listed on the United States TSCA(Toxic Substances Control Act)inventory
Listed on United States SARA Section 313
SARA Section 313-Emission Reporting 0.1 %
*Present below de minimis levels
15.2.International regulations
No additional information available
15.3.US State regulations
California Proposition 65
WARNING:This product contains,or may contain,trace quantities of a substance(s)known to the state of California to cause cancer, birth defects,
or other reproductive harm.
Silica: Crystalline,quartz(14808-60-7)
U.S.-California- U.S.-California- U.S.-California- U.S.-California- No significance risk level
Proposition 65- Proposition 65- Proposition 65- Proposition 65- (NSRL)
Carcinogens List Developmental Toxicity Reproductive Toxicity- Reproductive Toxicity-
Female Male
Yes No No No NA
Cobalt(7440-48-4)
U.S.-California- U.S.-California- U.S.-California- U.S.-California- No significance risk level
Proposition 65- Proposition 65- Proposition 65- Proposition 65- (NSRL)
Carcinogens List Developmental Toxicity Reproductive Toxicity- Reproductive Toxicity-
Female Male
Yes No No No NA
Titanium dioxide(13463-67-7)
U.S.-California- U.S.-California- U.S.-California- U.S.-California- No significance risk level
Proposition 65- Proposition 65- Proposition 65- Proposition 65- (NSRL)
Carcinogens List Developmental Toxicity Reproductive Toxicity- Reproductive Toxicity-
Female Male
Yes No No No NA
Aluminum oxide(1344-28-1)
U.S.-New Jersey-Right to Know Hazardous Substance List
U.S.-Massachusetts-Right to Know List
U.S.-Pennsylvania-RTK(Right to Know)-Environmental Hazard List
Calcium sulfate(7778-18-9)
U.S.-Massachusetts-Right to Know List
U.S.-New Jersey-Right to Know Hazardous Substance List
U.S.-Pennsylvania-RTK(Right to Know) List
Silica: Crystalline,quartz(14808-60-7)
U.S.-New Jersey-Right to Know Hazardous Substance List
U.S.-Pennsylvania-RTK(Right to Know)List
U.S.-Massachusetts-Right to Know List
SECTION 16: Other Information
Indication of changes Revision 1.0: New SDS Created.
Revision Date 05/27/2015
R
05/27/2015 TRAP&TREAT®BOS 1000 For Internal Use Only:PR#43 6/7
Product Code:1271

TRAP & TREAT® BOS 100®
Product Code: 1271
Safety Data Sheet
Other information Author:CJS.
For internal use only PR#43
Prepared according to Federal Register/Vol.77,No.58/Monday,March 26,2012/Rules and Regulations
NFPA health hazard : 0-Exposure under fire conditions would offer no hazard
beyond that of ordinary combustible materials.
NFPA fire hazard : 2-Must be moderately heated or exposed to relatively high
temperature before ignition can occur.
NFPA reactivity : 1 -Normally stable,but can become unstable at elevated
temperatures and pressures or may react with water with +414
some release of energy, but not violently.
HMIS III Rating
Health : 0
Flammability : 2
Physical : 1
This information is based on our current knowledge and is intended to describe the product for the purposes of health, safety and environmental
requirements only. It should not therefore be construed as guaranteeing any specific property of the product. The information is this document
applies to this specific material as supplied. It may not be valid if product is used in combination with other materials. It is the user's responsibility to
determine the suitability and completeness of this information for their particular use.While the information and recommendations set forth herein
are believed to be accurate as of the date hereof,Calgon Carbon Corporation makes no warranty with respect to the same,and disclaims all liability
for reliance thereon.
R
05/27/2015 TRAP&TREATO BOS 1000 For Internal Use Only:PR#43 7/7
Product Code:1271

Biodyne,Inc.
959 Paschal Place
INFO — Safety Data Sheet Biodyn�® 4232-2847
PhoneSarasotd94 3377-6621
Phone [phone]
Environoc® 201 — Liquid Fax [phone]
`1 E-mail [e-mail]
SECTION 1: PRODUCT IDENTIFICATION
01114
Product Name: ENVIRONOC°201 Liquid
Harmonized Tariff Code: 3002 90 10 00
Product Use: Bioremediation agent, industrial wastewater treatment •
enhancer; pesticide & herbicide reduction ,,, B nd%ne
Manufacturer Address: Biodyne,Inc. E�NVIRONOC@201
BerrfiGal Microorganisms
959 Paschal Place
Sarasota, FL 34232-2847 --.
Telephone: [phone]/ infobiodyne-world.com
SECTION 2: HAZARDS IDENTIFICATION
Emergency Overview: This product is not considered to be hazardous to animals, plants, humans or
the environment. The microbes have not been genetically modified.
This product has very low toxicity via ingestion, skin/eye contact or inhalation.
Possible Routes of Entry: Inhalation, ingestion, eyes and skin.
Potential Health Effects from Over-exposure:
Acute:
Skin/Eye Irritation: Direct contact with skin or eyes may cause mild irritation in some individuals.
Ingestion: May cause nausea and diarrhea in some individuals.
Chronic:
Symptoms: Available data does not suggest any long term symptoms from exposure.
Aggravation: Available data does not suggest any aggravation of existing conditions.
Section 2 Notes: In the unlikely event that over-exposure occurs, follow first aid measures in
section 4.
SECTION 3: COMPOSITION / INFORMATION ON INGREDIENTS
Ingredient: CAS No. Percent:
Liquid mixture of microbial Not applicable 4.37% (nominal)
strains
Ferment residue (non-animal) Not applicable 5.8% (nominal)
Section 3 Notes: This preparation contains no hazardous ingredients per Directive
67/548/EEC.
(European Union - Dangerous Goods)
www.biodyne-world.com Page 1 of 4 bd_info_SDS_E201_Liq_2018

INFO—SDS-Environoc®201 —Liquid Biodyne,Inc.
SECTION 4: FIRST AID MEASURES
General: Remove from source of exposure. If irritation or other signs of exposure occur, seek medical
attention.
Eyes: Remove contact lenses if present and flush with water for 15 minutes.
Skin: Remove contaminated clothing. Wash thoroughly with soap and rinse with water.
Ingestion: Do not induce vomiting. Give water if able to swallow.
Note to Physicians and First Aid Providers: This product has low oral, dermal and inhalation toxicity. Direct
contact with eyes may cause temporary irritation. Provide symptomatic and supportive care as necessary.
SECTION 5: FIRE FIGHTING MEASURES
General: Use methods and protective gear that are appropriate for the conditions and size of the
fire.
Extinguishing Use appropriate media for underlying cause and combustibles involved in the fire.
Media:
Special Equipment: Self-contained breathing apparatus and full protective gear according to the conditions
and size of the fire.
Section 5 Notes: This material is not explosive and does not constitute a fire hazard.
SECTION 6: ACCIDENTAL RELEASE MEASURES
Personal Precautions: Wear suitable protective clothing such as long-sleeved shirt, pants, waterproof gloves
and shoes with socks.
Methods for Clean Carefully mop or sweep up spill and place in a closed container for disposal. Rinse area
Up: with water.
Section 6 Notes: Refer to section 8 for personal protection and section 13 for disposal considerations.
SECTION 7: HANDLING AND STORAGE
Handling: Use handling procedures that minimize exposure to the product.
Storage: Store in a refrigerator or alternatively a cool location in original container.
Section 7 Notes: Avoid contact with skin, eyes and clothing. Wash any contamination from skin or
eyes immediately. Wash hands and exposed skin before eating, drinking,
smoking or using the toilet.
www.biodyne-world.com Page 2 of 4 bd_info_SDS_E201_Lici_2018

INFO—SDS-Environoc®201 —Liquid Biodyne,Inc.
SECTION 8: EXPOSURE CONTROLS / PERSONAL PROTECTION
General: Protective clothing should be selected according to the conditions likely to be encountered in
the workplace. Ensure good ventilation. No exposure limits have been established.
Engineering Controls: There are no specific engineering controls for this product.
Personal Protective Equipment:
Respiratory: If liquid is sprayed, use an approved droplet mask.
Eyes and Face: Chemical safety goggles or safety glasses with side shields.
Hands/Skin: Impermeable gloves of neoprene, vinyl, rubber or nitrile may be used to avoid contact.
Other Clothing: Wear suitable protective clothing such as long-sleeve shirt, pants and shoes with socks.
Hygienic Practices: Wash hands and exposed skin before eating, drinking, smoking or using the toilet.
SECTION 9: PHYSICAL AND CHEMICAL PROPERTIES
Appearance: Tan to flesh colored
Form: Liquid
Odor: Creamed corn
Melting Point: Not applicable
Boiling Point: Not applicable
Specific Gravity: 1.00073 g/ml
Solubility in Water: Easily dispersible in water
Incompatibility: None known
SECTION 10: STABILITY AND REACTIVITY
Stability: Stable, material is non-reactive.
Conditions to Avoid: None that are known.
Materials to Avoid: None that are known.
Hazardous Decomposition Products: None that are known.
Hazardous Polymerization: Will not occur.
SECTION 11: TOXICOLOGICAL INFORMATION
Possible Routes of Entry: Eyes and skin.
Potential Health Effects from Over-exposure:
Ingestion May cause nausea and diarrhea in some individuals
Skin/Eye Irritation: Direct contact with skin or eyes may cause slight irritation in some individuals.
Inhalation: N?A
Section 11 Notes: None of the components of this product are listed as carcinogenic by NTP, IARC or OSHA. While
no toxicological studies have been performed on this product, no reports of toxicity have been
reported in over 25 years of use. The microbial components are naturally occurring and are non-
pathogenic for animal and plants. They have not been genetically modified.
www.biodyne-world.com Page 3 of 4 bd_info_SDS_E201_Liq_2018

INFO—SDS-Environoc®201 —Liquid Biodyne,Inc.
SECTION 12: ECOLOGICAL INFORMATION
Ecological Information: With regard to environmental fate and behavior, this product is not expected to impose
any environmental risk. Without continuous application, populations revert to pre-
inoculation numbers with no lasting impact on the environment and indigenous
populations.
Ecotoxicity Information: This product has been in use for over 25 years for surface water, groundwater and land
applications and has never been reported to be toxic to animals or plants.
SECTION 13: DISPOSAL CONSIDERATIONS
Disposal Method: If this product becomes a waste, it does not meet the criteria of a hazardous waste. As a
non-hazardous solid waste, it can be disposed of in an industrial waste landfill in
accordance with government regulations.
Empty Container: The empty container can be disposed of as a non-hazardous solid waste or alternatively
returned to the vendor for recycle.
Section 13 Notes: Regulatory requirements are subject to change and acceptable methods of disposal may
vary by location. The appropriate agencies should be contacted for advisement prior to
disposal.
SECTION 14: TRANSPORT INFORMATION
Land: ADR/ RID Class: European transport of dangerous goods (Road / Rail) Not controlled under ADR
Water: IMDG Class: Transport of hazardous materials by vessel Not controlled under IMDG
Air: IATA—DGR Class: International Air Transport Assoc. (Dangerous Goods) Not controlled under IATA
Other: U. S. DOT: U. S. Department of Transportation Not Regulated
Section 14 Notes: This product may require importation permits in some countries
SECTION 15: REGULATORY INFORMATION
Labeling According to EC Directives:
Symbol: Not Required
R-phrases: Not Required
S Phrases: S 2 Keep out of reach of children
(Recommended) S 20/21 When using do not eat, drink or smoke
U.S. EPA SARA: No acute or chronic health hazards. No fire, release of pressure, or reactivity hazards.
(Title III Classification)
U.S. EPA: No registration required.
SECTION 16: OTHER INFORMATION
User's Responsibility: This safety data sheet provides health and safety information. This product is to be used in applications
consistent with our product literature. Individuals handling this product should be informed of the
recommended safety precautions and should have access to this information. For any other uses,exposures
should be evaluated so that appropriate handling practices and training programs can be established to ensure
safe workplace operations.
Date of last SDS revision: 01 January 2018 Replaces all previous editions
www.biodyne-world.com Page 4 of 4 bd_info_SDS_E201_Lig_2018

Biodyne,Inc.
959 Paschal Place
INFO — Safety Data Sheet jSiiriidj,j) O phon Sarasota,9413377 66247
61
Environoc® 501 — Liquid E- 941@7odyne
`1 yne
E-mail [e-mail]
SECTION 1: PRODUCT IDENTIFICATION
0111114
Product Name: ENVIRONOC®501 Liquid
Harmonized Tariff Code: 3002 90 10 00
Product Use: Enhanced reduction of vegetation thatch and
crop stubble -.... s
Manufacturer Address: Biodyne,Inc. IIENVIRQNO I
959 Paschal Place i t .1
Sarasota, FL 34232-2847
Telephone/Email 1-941-377-6621/ info(a�biodyne-world.com
SECTION 2: HAZARDS IDENTIFICATION
Emergency Overview This product is not considered to be hazardous to animals, plants, humans or the
environment. The microbes have not been genetically modified.
This product has very low toxicity via ingestion, skin/eye contact or inhalation.
Possible Routes of Entry: Ingestion, eyes and skin
Potential Health Effects from Over-exposure:
Acute:
Skin/Eye Irritation: Direct contact with skin or eyes may cause mild irritation in some individuals
Ingestion: May cause nausea and diarrhea in some individuals.
Chronic:
Symptoms Available data does not suggest any long-term symptoms from exposure
Aggravation Available data does not suggest any aggravation of existing conditions
Section 2 Notes: In the unlikely event that over-exposure occurs, follow first aid measures in section 4.
SECTION 3: COMPOSITION / INFORMATION ON INGREDIENTS
Ingredient: CAS No. Percent:
Liquid mixture of Microbial • s Not applicable 4.37%(nominal)
Ferment residue(non-animal) Not applicable 0.2%(nominal)
Water Not applicable 95.43%(nominal)
Section 3 Notes: This preparation contains no hazardous ingredients per Directive 67/548/EEC.
(European Union - Dangerous Goods)
www.biodyne-world.com Page 1 of 4 bd_info_SDS_E501_Lig_2018

r
INFO—SDS-Environoc®501 —Liquid Biodyne,Inc.
SECTION 4: FIRST AID MEASURES
General: Remove from source of exposure. If irritation or other signs of exposure occur, seek medical
attention.
Eyes: Remove contact lenses if present and flush with water for 15 minutes.
Skin: Remove contaminated clothing. Wash thoroughly with soap and rinse with water
Ingestion: Do not induce vomiting. Give water if able to swallow.
Note to Physicians and First Aid Providers: This product has low oral, dermal and inhalation toxicity. Direct
contact with eyes may cause temporary irritation. Provide symptomatic and supportive care as necessary.
SECTION 5: FIRE FIGHTING MEASURES
General: Use methods and protective gear that are appropriate for the conditions and size of the
fire.
Extinguishing Media: Use appropriate media for underlying cause and combustibles involved in the fire.
Special Equipment: Self-contained breathing apparatus and full protective gear according to the conditions and
size of the fire.
Section 5 Notes: This material is not explosive and does not constitute a fire hazard.
SECTION 6: ACCIDENTAL RELEASE MEASURES
Personal Precautions: Wear suitable protective clothing such as long-sleeved shirt, pants, waterproof gloves and
shoes with socks.
Methods of Cleanup: Carefully mop or sweep up spill and place in a closed container for disposal. Rinse area
with water.
Section 6 Notes: Refer to section 8 for personal protection and section 13 for disposal considerations.
SECTION 7: HANDLING AND STORAGE
Handling: Use handling procedures that minimize exposure to the product.
Storage: Stor: : . refrigerator or alternatively a cool location in original container.
Section 7 Notes: • contact with skin, eyes and clothing. Wash any contamination from skin or eyes
immediately. Wash hands and exposed skin before eating, drinking, smoking or using the
toilet.
www.biodyne-world.com Page 2 of 4 bd_info_SDS_E501_Lici_2018

r
INFO—SDS-Environoc®501 —Liquid Biodyne,Inc.
SECTION 8: EXPOSURE CONTROLS/PERSONAL PROTECTION
General: Protective clothing should be selected according to the conditions likely to be encountered
in the workplace. Ensure good ventilation. No exposure limits have been established.
Engineering Controls: There are no specific engineering controls for this product.
Personal Protective Equipment:
Respiratory: If liquid is sprayed, use an approved droplet mask.
Eyes and Face: Chemical safety goggles or safety glasses with side shields
Hands/Skin: Impermeable gloves of neoprene, vinyl, rubber or nitrile may be used to avoid contact.
Other Clothing: Wear suitable protective clothing such as long-sleeve shirt, pants and shoes with socks.
Hygienic Practices: Wash hands and exposed skin before eating, drinking, smoking or using the toilet.
SECTION 9: PHYSICAL AND CHEMICAL PROPERTIES
Appearance: Tan to flesh colored
Form: Liquid
Odor: Creamed corn
Melting Point: Not applicable
Boiling Point: Not applicable
Specific Gravity: 1.00073 glml
Solubility in Water: Easily dispersible in water
Incompatibility: None known
SECTION 10: STABILITY AND REACTIVITY
Stability: Stable, material is non-reactive
Conditions to Avoid: None that are known
Materials to Avoid: None that are known
Hazardous Decomposition Products: None that are known
Hazardous Polymerization: Will not take place
SECTION 11: TOXICOLOGICAL INFORMATION
Possible Routes of Entry: Eyes and Skin
Potential Health Effects fro exposure:
Ingestion: y cause nausea and diarrhea in some individuals
Skin/Eye Irritation: Direct contact with skin or eyes may cause slight irritation in some individuals.
Inhalation: N/A
Section 11 Notes: None of the components of this product are listed as carcinogenic by NTP, IARC or OSHA.
While no toxicological studies have been performed on this product, no reports of toxicity have
been reported in over 25 years of use. The microbial components are naturally occurring and
are non-pathogenic for animal and plants. They have not been genetically modified.
www.biodyne-world.com Page 3 of 4 bd_info_SDS_E501_Lici_2018

INFO—SDS-Environoc®501 —Liquid Biodyne,Inc.
SECTION 12: ECOLOGICAL INFORMATION
Ecological Information Regarding environmental fate and behavior,this product is not expected to impose any environmental
risk. Without continuous application,populations revert to pre-inoculation numbers with no lasting impact
on the environment and indigenous populations.
Ecotoxicity Information This product has been in use for over 25 years for surface water,groundwater and land applications and
has never been reported to be toxic to animals or plants.
SECTION 13: DISPOSAL CONSIDERATIONS
Disposal Method: If this product becomes a waste,it does not meet the criteria of a hazardous waste. As a non-hazardous solid
waste,it can be disposed of in an industrial waste landfill in accordance with government regulations.
Empty Container: The empty container can be disposed of as a non-hazardous solid waste or alternatively returned to the
vendor for recycle.
Section 13 Notes: Regulatory requirements are subject to change and acceptable methods of disposal may vary by location.
The appropriate agencies should be contacted for advisement prior to disposal.
SECTION 14: TRANSPORT INFORMATION
Land: ADR/RID Class European transport of dangerous goods(Road/Rail) Not controlled under ADR
Water: IMDG Class Transport of hazardous materials by vessel Not controlled under IMDG
Air: IATA—DGR Class International Air Transport Assoc. (Dangerous goods) Not controlled under IATA
Other: U.S. DOT U.S. Department of Transportation Not regulated
Section 14 Notes: This product may require importation permits in some countries
SECTION 15: REGULATORY INFORMATION
Labelling According to EC Directives
Symbol Not required
R-phrases Not required
S-phrases S 2 Keep out of reach of children
(Recommended) S 20/21 When using,do not eat,drink or smoke
U.S.EPA SARA No acute or chronic health hazards. No fire,release of pressure or reactivity hazards
(Title III Classification)
U.S.EPA Ns(?).tion required
SECTION 16: OTHER INFORMATION
User Responsibility: This safety data sheet provides health and safety information. This product is to be used in applications
consistent with our product literature. Individuals handling this product should be informed of the recommended
safety precautions and should have access to this information. For any other uses,exposures should be
evaluated so that appropriate handling practices and training programs can be established to ensure safe
workplace operations.
Date of last SDS revision: 01 January 2018 Replaces all previous versions
www.biodyne-world.com Page 4 of 4 bd_info_SDS_E501_Lig_2018

Conforms to Regulation(EC)No. 1907/2006(REACH),Annex II,as amended by Regulation(EU)No.453/2010-Europe
SAFETY DATA SHEET
41:44L DSM
Gistex® LS powder AGGL
SECTION 1: Identification of the substance/mixture and of the company/undertaking
1.1 Product identifier
Product name : Gistex®LS powder AGGL
Internal code : WW15128
Synonyms : Yeast extract.
Chemical formula : Not applicable.
1.2 Relevant identified uses of the substance or mixture and uses advised against
Recommended use : This is a preparation for application in the food and flavour industry.
1.3 Details of the supplier of the safety data sheet
Supplier : DSM Food Specialties B.V.
P.O.Box 1,2600 MA Delft
Alexander Fleminglaan 1,2613 AX Delft
The Netherlands
Telephone no.:[phone]
Fax no.:[phone]
e-mail address of person : [e-mail]
responsible for this SDS
1.4 Emergency telephone number
Emergency telephone : [phone]
number
Remarks : Product code supplier/manufacturer:2435
SECTION 2: Hazards identification
2.1 Classification of the substance or mixture
Product definition : Mixture
Classification according to Regulation(EC)No. 1272/2008[CLP/GHS1
Not classified.
The product is not classified as hazardous according to Regulation(EC)1272/2008 as amended.
Classification according to Directive 1999/45/EC[DPD1
The product is not classified as dangerous according to Directive 1999/45/EC and its amendments.
Classification : Not classified.
2.2 Label elements
Hazard pictograms
Signal word : No signal word.
Hazard statements : No known significant effects or critical hazards.
Supplemental label : Not applicable.
elements
Precautionary statements
Prevention : Not applicable.
Response : Not applicable.
Storage : Not applicable.
Disposal : Not applicable.
Hazardous ingredients
2.3 Other hazards
Other hazards which do : the dust clouds may form explosive mixtures with air. Handling and/or processing of this
not result in classification material may generate a dust which can cause mechanical irritation of the eyes,skin, nose and
throat.
Date of issue/Date of revision:10 April 2015 Version :7.01 Page:1/9

Safety Data Sheet Gistex®LS powder AGGL C DS M
SECTION 3: Composition/information on ingredients
3.1 Substances/3.2 Mixtures : Mixture
Product/ingredient Identifiers % Classification
name
67/548/EEC Regulation(EC)No.
1272/2008[CLP]
Waccharomyces cerevisiae,ext. REACH#: 99- 100 Not classified. Not classified.
01-2119539417-34
EC:283-294-5
CAS:84604-16-0
sodium chloride EC:231-598-3 0-1 Not classified. Not classified.
CAS:7647-14-5
See Section 16 for See Section 16 for the
the full text of the R- full text of the H
phrases declared statements declared
above. above.
SECTION 4: First aid measures
4.1 Description of first 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. Get medical attention if irritation occurs.
Inhalation : Remove victim to fresh air and keep at rest in a position comfortable for breathing. Get medical
attention if symptoms occur.
Skin contact : Flush contaminated skin with plenty of water. Remove contaminated clothing and shoes. Get
medical attention if symptoms occur.
Ingestion : Wash out mouth with water. Remove victim to fresh air and keep at rest in a position
comfortable for breathing. Do not induce vomiting unless directed to do so by medical personnel.
Get medical attention if symptoms occur.
Protection of first-aiders : No action shall be taken involving any personal risk or without suitable training.
4.2 Most important symptoms and effects,both acute and delayed
Potential acute health effects
Eye contact : Exposure to airborne concentrations above statutory or recommended exposure limits may
cause irritation of the eyes.
Inhalation : Exposure to airborne concentrations above statutory or recommended exposure limits may
cause irritation of the nose,throat and lungs.
Skin contact : No known significant effects or critical hazards.
Ingestion : No known significant effects or critical hazards.
Over-exposure sians/svmotoms
Eye contact : Adverse symptoms may include the following:
irritation
redness
Inhalation : Adverse symptoms may include the following:
respiratory tract irritation
coughing
Skin contact : No specific data.
Ingestion : No specific data.
4.3 Indication of any immediate medical attention and special treatment needed
Notes to physician : Treat symptomatically. Contact poison treatment specialist immediately if large quantities have
been ingested or inhaled.
Specific treatments : No specific treatment.
SECTION 5: Firefighting measures
5.1 Extinguishing media
Small fire
Suitable : Use dry chemical or CO2.
Not suitable : Do not use water jet.
Large fire
Date of issue/Date of revision:10 April 2015 Version :7.01 Page:2/9

Safety Data Sheet Gistex®LS powder AGGL C DSM
Suitable : Use extinguishing media suitable for surrounding materials.
Not suitable : Do not use water jet.
5.2 Special hazards arising from the substance or mixture
Hazards from the : Fine dust clouds may form explosive mixtures with air.
substance or mixture
Hazardous combustion : In case of fire, may produce hazardous decomposition products such as carbon monoxide,
products carbon dioxide, nitrogen oxides(NO, Noe etc.),ammonia(NH3),amines.
5.3 Advice for firefighters
Special protective actions : No special measures required.
for fire-fighters
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. Clothing for fire-
fighters(including helmets, protective boots and gloves)conforming to European standard EN
469 will provide a basic level of protection for chemical incidents.
SECTION 6: Accidental release measures
6.1 Personal precautions,protective equipment and emergency procedures
For non-emergency : No action shall be taken involving any personal risk or without suitable training. Evacuate
personnel surrounding areas. Keep unnecessary and unprotected personnel from entering. Do not touch
or walk through spilt material. Shut off all ignition sources. No flares,smoking or flames in
hazard area. Avoid breathing dust. Put on appropriate personal protective equipment.
For emergency : If specialised clothing is required to deal with the spillage,take note of any information in Section
responders 8 on suitable and unsuitable materials. See also the information in"For non-emergency
personnel".
6.2 Environmental : Avoid dispersal of spilt material and runoff and contact with soil,waterways,drains and sewers.
precautions Inform the relevant authorities if the product has caused environmental pollution(sewers,
waterways,soil or air).
6.3 Methods and material for containment and cleaning up
Small spill : Move containers from spill area. Vacuum or sweep up material and place in a designated,
labelled waste container. Use spark-proof tools and explosion-proof equipment. Dispose of via
a licensed waste disposal contractor.
Large spill : Move containers from spill area. Approach the release from upwind. Prevent entry into sewers,
water courses, basements or confined areas. Vacuum or sweep up material and place in a
designated, labelled waste container. Avoid creating dusty conditions and prevent wind
dispersal. Use spark-proof tools and explosion-proof equipment. Dispose of via a licensed
waste disposal contractor. Note:see Section 1 for emergency contact information and Section
13 for waste disposal.
6.4 Reference to other : See Section 1 for emergency contact information.
sections See Section 8 for information on appropriate personal protective equipment.
See Section 13 for additional waste treatment information.
SECTION 7: Handling and storage
The information in this section contains generic advice and guidance.The list of Identified Uses in Section 1 should be consulted
for any available use-specific information provided in the Exposure Scenario(s).
7.1 Precautions for safe handling
Protective measures : Put on appropriate personal protective equipment(see Section 8). 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. Avoid breathing dust. Avoid the
creation of dust when handling and avoid all possible sources of ignition(spark or flame).
Prevent dust accumulation. Use only with adequate ventilation. Wear appropriate respirator
when ventilation is inadequate. Electrical equipment and lighting should be protected to
appropriate standards to prevent dust coming into contact with hot surfaces,sparks or other
ignition sources. Take precautionary measures against electrostatic discharges. To avoid fire or
explosion,dissipate static electricity during transfer by earthing and bonding containers and
equipment before transferring material.
Advice on general : Eating,drinking and smoking should be prohibited in areas where this material is handled,stored
occupational hygiene 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.
Date of issue/Date of revision:10 April 2015 Version :7.01 Page:3/9

Safety Data Sheet Gistex®LS powder AGGL DSM
7.2 Conditions for safe : Store in accordance with local regulations. Store in a segregated and approved area. Store in a
storage, including any dry,cool and well-ventilated area,away from incompatible materials(see Section 10). Eliminate
incompatibilities all ignition sources. Separate from oxidizing materials. Keep container tightly closed and sealed
until ready for use. Containers that have been opened must be carefully resealed and kept
upright to prevent leakage. Do not store in unlabelled containers. Use appropriate containment
to avoid environmental contamination. Store in original container, protected from direct sunlight.
Keep in a cool and dry place. Maximum relative atmospheric humidity 75%. Protect from(sun)
light.
Packaging materials
Suitable : Polyethylene.
7.3 Specific end use(s)
Recommendations : Not available.
Industrial sector specific : Not available.
solutions
SECTION 8: Exposure controls/personal protection
The information in this section contains generic advice and guidance. Information is provided based on typical anticipated uses of
the product. Additional measures might be required for bulk handling or other uses that could significantly increase worker or
exposure or environmental releases.
8.1 Control parameters
Occupational exposure limits
No exposure limit value known.
Recommended monitoring : If this product contains ingredients with exposure limits, personal,workplace atmosphere or
procedures biological monitoring may be required to determine the effectiveness of the ventilation or other
control measures and/or the necessity to use respiratory protective equipment. Reference
should be made to monitoring standards,such as the following: European Standard EN 689
(Workplace atmospheres-Guidance for the assessment of exposure by inhalation to chemical
agents for comparison with limit values and measurement strategy) European Standard EN
14042(Workplace atmospheres-Guide for the application and use of procedures for the
assessment of exposure to chemical and biological agents) European Standard EN 482
(Workplace atmospheres-General requirements for the performance of procedures for the
measurement of chemical agents) Reference to national guidance documents for methods for
the determination of hazardous substances will also be required.
DNELs/DMELs
No DNELs/DMELs available.
PNECs
No PNECs available
8.2 Exposure controls
Appropriate engineering : Use only with adequate ventilation. If user operations generate dust,fumes,gas,vapour or mist,
controls 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,vapour or dust concentrations below any lower explosive limits.
Use explosion-proof ventilation equipment.
Individual protection measures
Hygiene measures : 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.
Eye/face protection : Safety glasses with side shields.
Hand protection : 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. 4-8
hours(breakthrough time): Leather-lined working gloves or latex gloves. Replace damaged
gloves.
Skin and body : Working clothes.
Respiratory protection : Wear dust protection mask P2.
Environmental exposure : Emissions from ventilation or work process equipment should be checked to ensure they comply
controls 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.
Advice on personal protection is applicable for high exposure levels.Select proper personal protection based on a risk
assessment of the actual exposure situation.
Date of issue/Date of revision:10 April 2015 Version :7.01 Page:4/9

Safety Data Sheet Gistex®LS powder AGGL DSM
SECTION 9: Physical and chemical properties
9.1 Information on basic physical and chemical properties
Physical state : Solid.[powder]
Colour : Creamy.
Odour : Characteristic.
Odour threshold : Not available.
pH : 6.5(Concentration 2%)
Melting point/freezing point : Not available.
Initial boiling point and : Not available.
boiling range
Softening range : Not available.
Flash point : Not available.
Evaporation rate : Not available.
Flammability(solid,gas) : Not available.
Upper/lower flammability or : Not available.
explosive limits
Vapour pressure : Not available.
Vapour density : Not available.
Relative density : Not available.
Density(g/cm3) : Not available.
Bulk density : Not available.
Solubility : Soluble in the following materials:cold water.
Solubility in water : Not available.
Partition coefficient:n- : Not available.
octanol/water
Auto-ignition temperature : Not available.
Decomposition temperature : Not available.
Viscosity : Not available.
Explosive properties : dot available.
Oxidising properties : Not available.
9.2 Other information
Minimum ignition : 490°C
temperature
Minimum ignition energy : >1000 mJ
Dust explosion class : 8�1 -moderately explosive.
Remarks : More detailed information on the physical and chemical properties can be requested from the
supplier.
SECTION 10: Stability and reactivity
10.1 Reactivity : No specific test data related to reactivity available for this product or its ingredients.
10.2 Chemical stability : The product is stable.
10.3 Possibility of : Under normal conditions of storage and use, hazardous reactions will not occur.
hazardous reactions
10.4 Conditions to avoid : Avoid the creation of dust when handling and avoid all possible sources of ignition(spark or
flame). Take precautionary measures against electrostatic discharges. To avoid fire or
explosion,dissipate static electricity during transfer by earthing and bonding containers and
equipment before transferring material. Prevent dust accumulation.
Exposure to sources of heat,sources of ignition,open flame. Prevent formation of dust clouds.
10.5 Incompatible materials : Reactive or incompatible with the following materials:
oxidizing materials
Oxidizing substances.
10.6 Hazardous : In case of fire:see section 5.
decomposition products
Date of issue/Date of revision:10 April 2015 Version :7.01 Page:5/9

Safety Data Sheet Gistex®LS powder AGGL DSM
SECTION 11: Toxicological information
11.1 Information on toxicological effects
Acute toxicity
Conclusion/Summary : Not available.
Acute toxicity estimates
Not available.
Irritation/Corrosion
Conclusion/Summary
Eyes : Not available.
Skin : Not available.
Respiratory : Not available.
Sensitisation
Conclusion/Summary
Skin : Not available.
Respiratory : Not available.
Mutagenicity
Conclusion/Summary : Not available.
Carcinogenicity
Conclusion/Summary : Not available.
Reproductive toxicity
Conclusion/Summary : Not available.
Teratogenicity
Conclusion/Summary : Not available.
Specific target organ toxicity(single exposure)
Not available.
Specific target organ toxicity(repeated exposure)
Not available.
Aspiration hazard
Not available.
Potential acute health effects
Eye contact : Exposure to airborne concentrations above statutory or recommended exposure limits may cause
irritation of the eyes.
Inhalation : Exposure to airborne concentrations above statutory or recommended exposure limits may cause
irritation of the nose,throat and lungs.
Skin contact : No known significant effects or critical hazards.
Ingestion : No known significant effects or critical hazards.
Symptoms related to the physical.chemical and toxicological characteristics
Eye contact : Adverse symptoms may include the following:
irritation
redness
Inhalation : Adverse symptoms may include the following:
respiratory tract irritation
coughing
Skin contact : No specific data.
Ingestion : No specific data.
General : Repeated or prolonged inhalation of dust may lead to chronic respiratory irritation.
Carcinogenicity : No known significant effects or critical hazards.
Mutagenicity : No known significant effects or critical hazards.
Teratogenicity : No known significant effects or critical hazards.
Developmental effects : No known significant effects or critical hazards.
Fertility effects : No known significant effects or critical hazards.
Date of issue/Date of revision:10 April 2015 Version :7.01 Page:6/9

Safety Data Sheet Gistex®LS powder AGGL DSM
SECTION 12: Ecological information
12.1 Toxicity
Conclusion/Summary : Not available.
12.2 Persistence and degradability
Conclusion/Summary : Not available.
12.3 Bioaccumulative potential
12.4 Mobility in soil
Soil/water partition : Not available.
coefficient(Koc)
Mobility : Not available.
12.5 Results of PBT and vPvB assessment
PBT : Not applicable.
vPvB : Not applicable.
12.6 Other adverse effects : No known significant effects or critical hazards.
Remarks : The organic fraction is readily biodegradable.
SECTION 13: Disposal considerations
The information in this section contains generic advice and guidance.The list of Identified Uses in Section 1 should be consulted
for any available use-specific information provided in the Exposure Scenario(s).
13.1 Waste treatment methods
Product
Methods of disposal : The generation of waste should be avoided or minimised 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 authorities with jurisdiction. 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. Avoid dispersal of spilt material and runoff and contact with soil,waterways,
drains and sewers.
Hazardous waste : Within the present knowledge of the supplier,this product is not regarded as hazardous waste,as
defined by EU Directive 91/689/EEC.
Packaging
Methods of disposal : The generation of waste should be avoided or minimised wherever possible. Waste packaging
should be recycled. Incineration or landfill should only be considered when recycling is not
feasible.
Special precautions : This material and its container must be disposed of in a safe way. Empty containers or liners
may retain some product residues. Avoid dispersal of spilt material and runoff and contact with
soil,waterways,drains and sewers.
SECTION 14: Transport information
ADR/RID ADN IMDG IATA
14.1 UN number Not regulated. Not regulated. Not regulated. Not regulated.
14.2 UN proper - - - -
shipping name
14.3 Transport - - - -
hazard class(es)
14.4 Packing - - - -
group
Date of issue/Date of revision:10 April 2015 Version :7.01 Page:7/9

Safety Data Sheet Gistex®LS powder AGGL C DSM
14.5 No. No. No. No.
Environmental
hazards
Additional - - - -
information
14.6 Special precautions for : Transport within user's premises:always transport in closed containers that are
user upright and secure. Ensure that persons transporting the product know what to do in
the event of an accident or spillage.
14.7 Transport in bulk : Not available.
according to Annex II of
MARPOL 73/78 and the IBC
Code
SECTION 15: Regulatory information
15.1 Safety, health and environmental regulations/legislation specific for the substance or mixture
EU Regulation(EC)No.1907/2006(REACH)
Annex XIV-List of substances subject to authorisation
Annex XIV
None of the components are listed.
Substances of very high concern
None of the components are listed.
Annex XVII-Restrictions on the manufacture,placing on the market and use of certain dangerous substances,mixtures and
articles
Not applicable.
International regulations
Chemical Weapon Convention List Schedules I.II&Ill Chemicals
Ingredient name List name Status
Not listed.
Montreal Protocol(Annexes A.B.C.E)
Ingredient name List name Status
Not listed.
Stockholm Convention on Persistent Organic Pollutants
Ingredient name List name Status
Not listed.
Rotterdam Convention on Prior Inform Consent(PIC)
Ingredient name List name Status
Not listed.
UNECE Aarhus Protocol on POPs and Heavy Metals
Ingredient name List name Status
Not listed.
15.2 Chemical Safety : No Chemical Safety Assessment has been carried out.
Assessment
SECTION 16: Other information
Procedure used to derive the classification according to Regulation(EC)No. 1272/2008[CLP/GHS]
Classification Justification
Not classified.
Full text of abbreviated H : Not applicable.
statements
Date of issue/Date of revision:10 April 2015 Version :7.01 Page:8/9

Safety Data Sheet Gistex®LS powder AGGL DSM
Full text of classifications : Not applicable.
[CLP/GHS]
Full text of abbreviated R : Not applicable.
phrases
Full text of classifications : Not applicable.
[DSD/DPD]
Alterations compared to the : Alterations compared to the previous version are marked with a little(blue)triangle.
previous version
Abbreviations and acronyms : ATE=Acute Toxicity Estimate
CLP=Classification, Labelling and Packaging Regulation[Regulation(EC)No. 1272/2008]
DMEL=Derived Minimal Effect Level
DNEL=Derived No Effect Level
EUH statement=CLP-specific Hazard statement
PBT=Persistent, Bioaccumulative and Toxic
PNEC=Predicted No Effect Concentration
RRN=REACH Registration Number
vPvB=Very Persistent and Very Bioaccumulative
Sources of key data : Literature data and/or investigation reports are available through the manufacturer.
Internal code : WW15128
Training advice : Before handling this substance/preparation,the personnel involved should be instructed by means
of this safety data sheet.
Notice to reader
The information contained in the Safety Data Sheet is based on our data available on the date of publication.The information is
intended to aid the user in controlling the handling risks;it is not to be construed as a warranty or specification of the product quality.
The information may not be or may not altogether be applicable to combinations of the product with other substances or to particular
applications.
The user is responsible for ensuring that appropriate precautions are taken and for satisfying themselves that the data are suitable
and sufficient for the product's intended purpose.In case of any unclarity we advise consulting the supplier or an expert.
History
Date of printing : 10 April 2015.
Date of issue : 10 April 2015
Version : 7.01
Date of issue/Date of revision:10 April 2015 Version :7.01 Page:9/9

SIGMA-AL D RI C H sigma-aldrich.com
SAFETY DATA SHEET
Version 5.5
Revision Date 01/04/2018
Print Date 11/10/2018
1. PRODUCT AND COMPANY IDENTIFICATION
1.1 Product identifiers
Product name : Starch, from potato
Product Number : S4251
Brand : Sigma-Aldrich
CAS-No. : 9005-25-8
1.2 Relevant identified uses of the substance or mixture and uses advised against
Identified uses : Laboratory chemicals, Synthesis of substances
1.3 Details of the supplier of the safety data sheet
Company : Sigma-Aldrich
3050 Spruce Street
SAINT LOUIS MO 63103
USA
Telephone : [phone]
Fax : [phone]
1.4 Emergency telephone number
Emergency Phone# : [phone] (CHEMTREC)
2. HAZARDS IDENTIFICATION
2.1 Classification of the substance or mixture
GHS Classification in accordance with 29 CFR 1910 (OSHA HCS)
Combustible dust,
For the full text of the H-Statements mentioned in this Section, see Section 16.
2.2 GHS Label elements, including precautionary statements
Pictogram none
Signal word Warning
Hazard statement(s)
May form combustible dust concentrations in air.
Precautionary statement(s) none
2.3 Hazards not otherwise classified (HNOC) or not covered by GHS
Combustible dust
3. COMPOSITION/INFORMATION ON INGREDIENTS
3.1 Substances
CAS-No. : 9005-25-8
EC-No. : 232-679-6
Hazardous components
Component Classification Concentration
High-polymeric carbohydrate material
90 - 100 %
Sigma-Aldrich-S4251 Page 1 of 7

For the full text of the H-Statements mentioned in this Section, see Section 16.
4. FIRST AID MEASURES
4.1 Description of first aid measures
General advice
Consult a physician. Show this safety data sheet to the doctor in attendance.
If inhaled
If breathed in, move person into fresh air. If not breathing, give artificial respiration. Consult a physician.
In case of skin contact
Wash off with soap and plenty of water. Consult a physician.
In case of eye contact
Flush eyes with water as a precaution.
If swallowed
Never give anything by mouth to an unconscious person. Rinse mouth with water. Consult a physician.
4.2 Most important symptoms and effects, both acute and delayed
The most important known symptoms and effects are described in the labelling (see section 2.2)and/or in section 11
4.3 Indication of any immediate medical attention and special treatment needed
No data available
5. FIREFIGHTING MEASURES
5.1 Extinguishing media
Suitable extinguishing media
Use water spray, alcohol-resistant foam, dry chemical or carbon dioxide.
5.2 Special hazards arising from the substance or mixture
No data available
5.3 Advice for firefighters
Wear self-contained breathing apparatus for firefighting if necessary.
5.4 Further information
No data available
6. ACCIDENTAL RELEASE MEASURES
6.1 Personal precautions, protective equipment and emergency procedures
Use personal protective equipment. Avoid dust formation. Avoid breathing vapours, mist or gas. Ensure adequate
ventilation. Avoid breathing dust.
For personal protection see section 8.
6.2 Environmental precautions
Do not let product enter drains.
6.3 Methods and materials for containment and cleaning up
Pick up and arrange disposal without creating dust. Sweep up and shovel. Keep in suitable, closed containers for
disposal.
6.4 Reference to other sections
For disposal see section 13.
7. HANDLING AND STORAGE
7.1 Precautions for safe handling
Further processing of solid materials may result in the formation of combustible dusts. The potential for combustible dust
formation should be taken into consideration before additional processing occurs.
Sigma-Aldrich-S4251 Page 2 of 7

Provide appropriate exhaust ventilation at places where dust is formed.
For precautions see section 2.2.
7.2 Conditions for safe storage, including any incompatibilities
Keep container tightly closed in a dry and well-ventilated place.
Storage class (TRGS 510): 13: Non Combustible Solids
7.3 Specific end use(s)
Apart from the uses mentioned in section 1.2 no other specific uses are stipulated
8. EXPOSURE CONTROLS/PERSONAL PROTECTION
8.1 Control parameters
Components with workplace control parameters
Component CAS-No. Value Control Basis
parameters
High-polymeric 9005-25-8 TWA 10 mg/m3 USA. ACGIH Threshold Limit Values
carbohydrate (TLV)
material
Remarks Dermatitis
Not classifiable as a human carcinogen
TWA 10.000000 USA. ACGIH Threshold Limit Values
mg/m3 (TLV)
Dermatitis
Not classifiable as a human carcinogen
TWA 15.000000 USA. Occupational Exposure Limits
mg/m3 (OSHA)-Table Z-1 Limits for Air
Contaminants
TWA 5.000000 USA. Occupational Exposure Limits
mg/m3 (OSHA)-Table Z-1 Limits for Air
Contaminants
TWA 5.000000 USA. NIOSH Recommended
mg/m3 Exposure Limits
TWA 10.000000 USA. NIOSH Recommended
mg/m3 Exposure Limits
PEL 10 mg/m3 California permissible exposure
limits for chemical contaminants
(Title 8, Article 107)
PEL 5 mg/m3 California permissible exposure
limits for chemical contaminants
(Title 8, Article 107)
8.2 Exposure controls
Appropriate engineering controls
Handle in accordance with good industrial hygiene and safety practice. Wash hands before breaks and at the end of
workday.
Personal protective equipment
Eye/face protection
Safety glasses with side-shields conforming to EN166 Use equipment for eye protection tested and approved
under appropriate government standards such as NIOSH (US) or EN 166(EU).
Skin protection
Handle with gloves. Gloves must be inspected prior to use. Use proper glove removal technique (without
touching glove's outer surface)to avoid skin contact with this product. Dispose of contaminated gloves after
use in accordance with applicable laws and good laboratory practices. Wash and dry hands.
Full contact
Material: Nitrile rubber
Minimum layer thickness: 0.11 mm
Break through time: 480 min
Material tested:Dermatril®(KCL 740/Aldrich Z677272, Size M)
Sigma-Aldrich-S4251 Page 3 of 7

Splash contact
Material: Nitrile rubber
Minimum layer thickness: 0.11 mm
Break through time: 480 min
Material tested:Dermatril®(KCL 740/Aldrich Z677272, Size M)
data source: KCL GmbH, D-36124 Eichenzell, phone [phone], e-mail [e-mail], test method:
EN374
If used in solution, or mixed with other substances, and under conditions which differ from EN 374, contact the
supplier of the CE approved gloves. This recommendation is advisory only and must be evaluated by an
industrial hygienist and safety officer familiar with the specific situation of anticipated use by our customers. It
should not be construed as offering an approval for any specific use scenario.
Body Protection
Choose body protection in relation to its type, to the concentration and amount of dangerous substances, and
to the specific work-place., The type of protective equipment must be selected according to the concentration
and amount of the dangerous substance at the specific workplace.
Respiratory protection
Respiratory protection is not required. Where protection from nuisance levels of dusts are desired, use type
N95 (US)or type P1 (EN 143) dust masks. Use respirators and components tested and approved under
appropriate government standards such as NIOSH (US) or CEN (EU).
Control of environmental exposure
Do not let product enter drains.
9. PHYSICAL AND CHEMICAL PROPERTIES
9.1 Information on basic physical and chemical properties
a) Appearance Form: solid
Colour: white
b) Odour No data available
c) Odour Threshold No data available
d) pH No data available
e) Melting point/freezing No data available
point
f) Initial boiling point and No data available
boiling range
g) Flash point No data available
h) Evaporation rate No data available
i) Flammability(solid, gas) May form combustible dust concentrations in air.
j) Upper/lower No data available
flammability or
explosive limits
k) Vapour pressure No data available
I) Vapour density No data available
m) Relative density No data available
n) Water solubility No data available
o) Partition coefficient: n- No data available
octanol/water
p) Auto-ignition No data available
temperature
q) Decomposition No data available
temperature
r) Viscosity No data available
Sigma-Aldrich-S4251 Page 4 of 7

s) Explosive properties No data available
t) Oxidizing properties No data available
9.2 Other safety information
No data available
10. STABILITY AND REACTIVITY
10.1 Reactivity
No data available
10.2 Chemical stability
Stable under recommended storage conditions.
10.3 Possibility of hazardous reactions
No data available
10.4 Conditions to avoid
No data available
10.5 Incompatible materials
Strong oxidizing agents
10.6 Hazardous decomposition products
Hazardous decomposition products formed under fire conditions. - Carbon oxides
Other decomposition products - No data available
In the event of fire: see section 5
11. TOXICOLOGICAL INFORMATION
11.1 Information on toxicological effects
Acute toxicity
No data available
Inhalation: No data available
Dermal: No data available
LD50 Intraperitoneal - Mouse-6,600 mg/kg
Skin corrosion/irritation
Skin - Human
Result: Mild skin irritation - 3 h
Serious eye damage/eye irritation
No data available
Respiratory or skin sensitisation
No data available
Germ cell mutagenicity
No data available
Carcinogenicity
Reproductive toxicity
No data available
No data available
Specific target organ toxicity -single exposure
No data available
Specific target organ toxicity - repeated exposure
No data available
Aspiration hazard
No data available
Additional Information
RTECS: Not available
Sigma-Aldrich-S4251 Page 5 of 7

To the best of our knowledge, the chemical, physical, and toxicological properties have not been thoroughly investigated.
12. ECOLOGICAL INFORMATION
12.1 Toxicity
No data available
12.2 Persistence and degradability
No data available
12.3 Bioaccumulative potential
No data available
12.4 Mobility in soil
No data available
12.5 Results of PBT and vPvB assessment
PBT/vPvB assessment not available as chemical safety assessment not required/not conducted
12.6 Other adverse effects
No data available
13. DISPOSAL CONSIDERATIONS
13.1 Waste treatment methods
Product
Offer surplus and non-recyclable solutions to a licensed disposal company.
Contaminated packaging
Dispose of as unused product.
14. TRANSPORT INFORMATION
DOT (US)
Not dangerous goods
IMDG
Not dangerous goods
IATA
Not dangerous goods
15. REGULATORY INFORMATION
SARA 302 Components
No chemicals in this material are subject to the reporting requirements of SARA Title III, Section 302.
SARA 313 Components
This material does not contain any chemical components with known CAS numbers that exceed the threshold (De
Minimis) reporting levels established by SARA Title III, Section 313.
SARA 311/312 Hazards
No SARA Hazards
Massachusetts Right To Know Components
CAS-No. Revision Date
High-polymeric carbohydrate material 9005-25-8 1989-08-11
Pennsylvania Right To Know Components
CAS-No. Revision Date
High-polymeric carbohydrate material 9005-25-8 1989-08-11
New Jersey Right To Know Components
CAS-No. Revision Date
High-polymeric carbohydrate material 9005-25-8 1989-08-11
Sigma-Aldrich-S4251 Page 6 of 7

16. OTHER INFORMATION
Full text of H-Statements referred to under sections 2 and 3.
May form combustible dust concentrations in air.
HMIS Rating
Health hazard: 0
Chronic Health Hazard:
Flammability: 0
Physical Hazard 0
NFPA Rating
Health hazard: 0
Fire Hazard: 0
Reactivity Hazard: 0
Further information
Copyright 2016 Sigma-Aldrich Co. LLC. License granted to make unlimited paper copies for internal use only.
The above information is believed to be correct but does not purport to be all inclusive and shall be used only as a
guide. The information in this document is based on the present state of our knowledge and is applicable to the
product with regard to appropriate safety precautions. It does not represent any guarantee of the properties of the
product. Sigma-Aldrich Corporation and its Affiliates shall not be held liable for any damage resulting from handling
or from contact with the above product. See www.sigma-aldrich.com and/or the reverse side of invoice or packing
slip for additional terms and conditions of sale.
Preparation Information
Sigma-Aldrich Corporation
Product Safety—Americas Region
1-800-521-8956
Version: 5.5 Revision Date: 01/04/2018 Print Date: 11/10/2018
Sigma-Aldrich-S4251 Page 7 of 7