WI0600190_DEEMED FILES_20171121

North Carolina Department of Environmental Quality -Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number WI0600190
Were any wells abandoned during this injection
I. Permit Information event?
M.M. Fowler. Inc.
Permittee
Caroco#2
Facility Name
503 Gilles pie Street, Fa yetteville, NC Cumberland
County 2830 I
Facility Address (include County)
2. Injection Contractor Information
EMS Environmental. Inc. ------Injection Contractor/ Company Name
Street Address 117 S. Hoover Road
Durham NC
City State
(_____2li_) 596-0470
Area code -Phone number
3. Well Information
27703
Zip Code
RECEIVED!NCDEQIDWR
NOV 21 2017
. WaterQuafity
Number of wells used for inje bl'r8W0 <(00otfr;ltb ns 5 .
ect1on
WeHIDs MW-3
Were any new wells installed during this injection
event?
0 Yes ~ No
If yes, please provide the following information:
Number of Monitoring Wells __ N"-"/=A'----
Number of htjection Wells ___ ___;.N-"-/"'"'A=----
Type of Well Installed (Check applicable type):
0 Bored D DriUed D Direct-Push
D Hand-Augured D Other (specify) NIA
Please i11c/11de a copy oftlte GW-1 form for each
well installed.
D Yes 181 No
If yes, please provide the following infonnation:
Number of Monitoring Wells __ """N--"-/=A,__ __
Number of Injection Wells. ___ _,cN~l~A"'----
P/e(lj'e iltcltuie a copy of tlte GW-30 for eaclt well
ahmulo11e<l.
4. Injectant lnfo1·mation
ORC Advanced
lnjectant(s) Type (can use separate additional sheets
if necessary)
Concentration Calcium hydroxide oxide = > 85%
Calcium h droxide = < 15%
Di potassium phos 12hate = < 5%
Mono potassium phos phate = < 5%
If the injectant is diluted please indicate the source
dilution fluid. __ .e-N.,_,_/Ac__:__ _______ _
Total Volume Injected (gal),_...;.3,_s=o=c=ks,,_ __ _
Volume Injected per well (gal)-'3"'--"'so=c=k=s ~---
5. Injection History
Injection date(s) _-"-1~1/-=2=0/=2~0~17'-------
Injection number (e.g. 3 of 5). _ _,.,1_,o=f-=T-=B=D"---
Is this the last injection at this site?
Yes X No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID q__uT IN THE PERMIT .
(Z___ l) _.A--11/H1/17
SIONA TORE OF INJECTION CONTRACTOR TIA TE
~s--rx.,J t\6~t.lA E M.s_
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Fo1m UIC-IER
Rev. 3-1-2016
Permit Number
Program Category
Deemed Ground Water
Permit Type
WI0600190
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Car_oco #2
Location Address
503 Gillepsie St
Fayetteville
Owner
Owner Name
M
Dates/Events
Orig Issue
11/13/2017
NC
M
App Received
11/2/2017
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
28301
Fowler
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
11/13/2017
Permit Tracking Slip
Status
Active
Version
1.00 ,
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Fayetteville
County
Cumberland
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
MM. Fowler
Owner Property
4220 Neal Dr
Dumam
Issue
11/13/2017
Effective
11/13/2017
NC 27705
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
Shrestha, Shristi R
From:
Sent:
To:
Cc:
Subject:
Shrestha, Shristi R
Monday, November 13, 20171:43 PM
'[e-mail]'; [e-mail]'
Allen, Trent
CORRECTED NUMBER WI0600190 NOi Caroco#2
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells (NOQ for the above referenced
site.
Please remember to submit the following regarding this injection activity:
1) Well Construction Records (GW-1) and Abandonment Records (GW-30) when completed. Please provide
copies of the GW-ls and GW-30s if not already submitted (originals go the address printed on the
form). NOTE: Direct push or Geoprobe wells are considered wells and require construction (GW-1) and
abandonment forms (GW-30). Ifwe11 construction/abandonment information is the same for the wells, only one form
needs to be completed-just indicate total number of injection points in the Comments/Remarks section of
form. These forms can be found on our website at
h ttp://deq .nc.gov/about/ divisions/water-resources/water-resources-permits/wastewater-branch/ ground-water-
protection/ ground-water-rep orting-forms
2) . Injection Event Records (IER). All injections, including air and passive systems require an IER. The IER can be
modified for air sparge wells (e.g., air flow 'continuous' for date or rate of injection, etc.).
You can scan and send these forms directly to me at [e-mail] or via regular mail to address
below. When submitting the above forms, you will need to enter the nine-digit alpha-numeric number on the form
(i.e., WI0XXXXXX) that has been assigned to the injection activity at this site. This notification has been given the
deemed permit number WI0600190. This number is also referenced in the subject line of this email. You may if you
wish, scan and send back as attachments in r epl y to this email, as it will already have the assigned deemed permit
number in the subject line.
Shristi
Shrlstl R. Shrestha
Hydrogeologist
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi .shrestha @ ncdenr.g ov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Shrestha, Shristi R
From:
Sent:
To:
Subject:
Attachments:
Please find the attached NOi.
Shristi
Shristi R. Shrestha
Hydrogeologist
Shrestha, Shristi R
Monday, November 13, 2017 1:53 PM
Allen, Trent
WI0600190 NOi Caroco #2
NOI.pdf
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shrestha @ ncdenr.oov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
r7115
ENVIRONMENTAL
emsenv.corn
October 18, 2017
DWR — UIC Program
Mr. Thomas Slusser, TUIC Program Manager
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
RECENED1NCOEQJDWR
NOV 02 Z017
Water Ouatity Regional
Operations Section
Subject: Notification of Intent: Passive Injection ORC
Caroco #2
503 Gillespie Street, Fayetteville, NC 28301
NCDEQ Incident #29065
Risk Classification: Intermediate
Dear Mr. Slusser,
Please find attached a notification of intent to operate a passive injection system consisting
of ORC Socks at the above referenced site. Please review the notification and contact me
at [phone] if you have any questions or comments.
Sincerely,
EMS Environmental, Inc,
James J. Dodson, L.G.
Senior Project Manager
cc: 7357 file
M.M. Fowler, Inc. (electronic)
NEW YOFIK
PENNSYLVANIA NORTH CAROLINA
EM5 ENVIRONMENTAL INC. • 117 South Hoover Road • Durham, NC 27703-3350 • {office] 919.596.0470 • [fax] 919.596.0579

North Carolina Department of Environmental Quality-Division of Water Resources
NOTIFICATION OF INTENT (NOi) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are ''permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C .0200. This fo rm shall be submitted at least 2 WEEKS prior to in jection.
AQUIFER TEST WELLS (1 5A NCAC 02c .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (1 5A NCAC 02c .022 5) or TRACER WELLS (1 5A NCAC 02C .0229 ):
1) Passive In jection S y stems -In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small-Scale In jection O perations -Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests -Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air In jection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
VV10600lqO
DATE: July 14 , 2016_ PERMIT NO. ~ (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
B.
(1) ___ Air Injection Well ...................................... Complete sections B through F, K, N
(2) ___ Aquifer Test Well ....................................... Complete sections B through F, K, N
(3) X __ Passive Injection System ............................... Complete sections B through F, H-N
(4) ___ Small-Scale Injection Operation ...................... Complete sections B through N
(5) __ Pilot Test ................................................. Complete sectio1Rro~~COEOIDWR
(6) ___ Tracer Injection Well ................................... Complete sections B t~~lf"r 2 Z017
STATUS OF WELL OWNER: Municipal Government Water Quality Reg.ional
Operations Section
C. WELL OWNER(S) -State name of Business/ Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name: M.M. Fowler. Inc.
Mailing Address: """'42=2"""0'""'N~ea=l"""R=o=a=d ______________________ _
City: Durham State: ~ Zip Code:~2~7~70~3~ ___ County: Durham
Day Tele No.: (919 ) 390-2925 Cell No.: __________ _
EMAIL Address: lbarnes@ famil fareconveniencestores.com Fax No.: _____ _
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 1
D. PROPERTY OWNER(S) (if different than well owner)
Name and Title:
Company Name ---------------------------------
Mailing Address:---------------------------------
City: ____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: ____________ _ Cell No.:
EMAIL Address: _____________ _ Fax No.: ___________ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name: -----=J-=am=e-=--s -=D'----'o=d=so=n"'---=E=M=S--=E=n=v'---"ir'--"o=nm=e=n=ta=l ___________________ _
Mailing Address: --~1~1"""7~S~o~u=th=-=H=o--=o-'-v=er'""'R"-=-oa=d"-----------------------
City: Durham State: _lli;;_ Zip Code:27703 County: Durham
Day Tele No.: 919-596-0470 Cell No.: 919-201-0463
Fax No.: 919-596-0578 EMAIL Address: jdodson(@.emsenv.com ------------
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Caroco #2 . 503 Gilles pie Street. Favetteville . NC 28301
(N CDEQ Incident #29065 )
City: ___ F_a~y_et_te_v_il_le ________ County_: ___ C_u_m_b_e_rl_a_n_d __ Zip Code: ___ 2_8_3_0 _1 _
(2) Geographic Coordinates: Latitude**: ___ 0 ____ " or 0
Longitude**: " "or 0
Reference Datum: ________ Accuracy: ________ _
Method of Collection: __________________ _
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: AF ACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: _______ .square feet
Land surface area of inj. well network: square feet(.'.:: 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be.'.:: 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS -Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page2
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration
of injection over time.
Due to the exceedances of the NCAC 2L e.ro undwater standards and 10 X NCAC 2B surface water quali ty
standards in the area re presented by MW-3 . ORC socks will be installed in MW-3 to increase dissolved oxygen
level for the stimulation of aerobic microbial processes that will assist natural attenuation and dissolved phase
petroleum h ydrocarbon plume size and concentration reduction.
J. APPROVED INJECT ANTS -Provide a MSDS for each injectant. Attach additional sheets if necessary.
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at h ttp ://deq.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/2.:round-water-protection/e:round-water-a pproved-in jectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info (919-
807-6496).
lnjectant: ___ O_R_C_S_o_c_k~s _________________________ _
Volume of injectant: __ 1_2_-_in_c_h_l~o_n~g~X_2_-i_n_c_h~d_iam __ et_e_r ________________ _
Concentration at point of injection: ------=--10-=---0=---o/c'-'o'-------------------------
Percent if in a mixture with other injectants: NIA
Injectant: --------------------------------
Volume ofinjectant: _____________________________ _
Concentration at point of injection: _______________________ _
Percent if in a mixture with other injectants: ____________________ _
Injectant: ----------------------------------
Volume ofinjectant: _____________________________ _
Concentration at point of injection: _______________________ _
Percent if in a mixture with other injectants: ____________________ _
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: ___ O ___ Proposed ___ l ___ Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as-built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page 3
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Upon completion of the UIC Notification Form. the ORC Socks will be immediately installed in the proposed
well location. MW-3 is inplace and existing. The process may be periodically performed quarterly/semiannually
from the initial injection date for a total of four events_
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 021, result from the injection activity.
All monitorinc wells on site will be sampled on a semi-annual basis to monitor chances in water quaky,
subseeuent to the installation of the ORC Socks. Laboraton analysis of Groundwater from each well will be
performed by EPA Method 6200B.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, under penalty of law, that 1 am familiar with the information submitted in this
document and all attachments thereto and that, based on my inquiry of those individuals immediately responsible
for obtaining said information, I believe that the information is true, accurate and complete. I am aware that
there are significant penalties, including the possibility of fines and imprisonment, for submitting false
information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurte s in accordance with the 1 ,4 , C.AC 02C 0200 Rules."
1k!(�W M.L. Barnes_ Jr. President
Signature of Applicant 0 Print or Type Full Name and Title
PROPERTY OWNER (if the property is not owned by the permit applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A NCAC 02C .0200,"
"Owner" means any person who holds the fee or other property rights in. the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the land owner, in the
absence of contrary agreement in writing.
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Submit the completed notification package to:
DWR—UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone; [phone]
Deemed Permitted GW Rernediation NO1 Rev, 3-1-2016 Page 4

*
MN 'GN
7a 1°22'
500
1,500
0
1,000
SCALE (FEET)
CONTOUR INTERVAL 10 FEET
2,000
PORTION OF THE FAYETTEVILLE, NC USGS 7.5 MINUTE QUADRANGLE MAP
USGS, 1957, PHOTOREVISED IN 1907
FIGURE 1: SITE AND VICINITY TOPOGRAPHIC MAP
CARACO #2
503 GILLESPIE STREET
FAYETTEVILLE, NORTH CAROLINA
MODIFIED BY: JJD
DATE: 7106/2017
EMS PROJECT # 7357

MATLOCK MEMORIAL
AFRICAN METHODIST
EPISCOPAL ZIONIST CHURC
NOTES:
�. ALL SAMPLES COLLECTED ON 512712017
2. DEEP WELL MW6O NOT USED IN MAP PRE
]. ''NO" DENOTES NOT DETECTED.
7111M
ENVIRONMENTAL
ARATION.
WILLIES AUTOMOTIVE
STATION
BUILDING
CHURCH
FIGURE 2: ❑RC WELL LOCATION AND BENZENE ISOCONCENTRATION MAP
CAROCO #2
503 GILLESPIE ST., FAYETTEVILLE, CUMBERLAND COUNTY, NC
APPROXIMATE SCALE
�a s ao 0
IN FEET
LEGEND
MONITOR WELLL.00ATEON
BENZENE CON CENTRATION i IIOIL)
ENZ£NE ISOCONTOVN
(DASHED WHERE INFERRED)
ORC WELL LOCATION
PROJECT NO.7357
DRAWN BY: JJD
DATE: 7106/2017

MATLOCK MEMORIAL i
AFRICAN METHODIST
EPISCOPAL ZIONIST CHURL I
PARKING LOT
NOTES
t I DATA COLLECTED CN S#i7q.
i Y 0! WE - eW-so NOT LLITET) I'l'AAP PRERN AT1TJ
r=1EI
(NVIf1(1NMt N fAt
GILLESPIE STREET
WILLIES AUTOMOTIVE
1,1414,3
* CA MOP`.
MW7
POND STREET
MWJ
STATION
BUILDING
Mw30 NW 1
CHURCH
APPROXIMATE SCALE
Qr rti� 30 40 50 sa
IN FEET
Mwa
P
94.7
LEGEND
MONITOR WELL LOCATION
GROLI .T]NA7 ER aEPAOON I F>l
FLOW ❑!RE.CTiON
GROUNDWATER CONTOt
4TEgSAL =2 FEE
FIGURE 3. SHALLOW WATER TABLE GRADIENT MAP
CAROCO #2
503 GILLESPIE ST., FAYETTEVILLE, CUMBERLAND COUNTY, NC
PROJECT NO.7357
DRAWN BY! JJD
DATE: 7/06/2017

WEST TO EAST CROSS SECTION
w MW-3 MW-4 E
J.-2.5
--¥-----~------------------··--· ------···-· .,_,. ___ .--------····-~------------,;,.,._ -------------4-
PVC CASING
PVC SCREEN INTERVAL
7.5
12.5
l--15
1--17.5 8=970
T=ND E=130
X=110
MTBE=ND
WATER TABLE
~ ELEVATION
•• ..i;i ... DASHED WHERE
INFERRED
I ::.I ", Lj I h
E NV IRO NM E NTAL
N
1-7.5
I-10
1-12.5
1--15
1-1?.5 8=970
T=ND
E=130
20 X=110
. ----·---
-- --
- - - -·-- - -
~-~ =-__[]
NORTH TO SOUTH CROSS SECTION
MW-3 MW-2 S
----: _,._,---~-----------------------------------·----------
t
---· J.
;-
-· ~ .f 8=110
T=30
E=15
X=41
MTBE=12
MTBE=ND
GROUNDWATER RESULTS IN UG/L
B= BENZENE
~ : i~INl:~fNZENE
X; XYLENES
MlBE = METHYL-T-BUTYL-ETHER
ND = NOT DETECTED
J = ESTIMATED
(1.0 5.0 10.0 101[1 30.0
HORIZONTAL SCALE (FEET)
NOTES: 1) CROSS SECTION LOCATIONS ON FIGURE 2.
2) WELL DIAMETERS NOT TO SCALE.
3) ALL GROUNDWATER DATA FROM 5/27/2017.
GEOLOGIC CROSS SECTIONS
CAROCO#2
B=ND
T=ND
E=ND
X=ND
MTBE=0.93 J
REDO<SHBROWN c--. -1 ctAYE'T'SILT
&FINE SAND
503 GILLESPIE STREET, FAYETTEVILLE, CUMBERLAND COUNTY, NORTH CAROLINA
EMS PROJECT 7357
DATE DRAWN: 10/17/2017
DRAWN BY: JJD
L
I•inen Caroiina - Departnient of Envinneneta and Natu.A1 Rest - Division of Water ity - Crsoundwater Section
W . CONTRACTOR OR OID %±DZ.AL) ;s?Ai 4S ;prier? ,L"f= f"i ' `- A'0'`'•+•"-' =--' ClenTir.CAMON i#:?
CONTRACTOR CiOR COMPA N ' NAMM --7;,,id... CAA 4— Pi40NZ J e .
STATE WIrLL COtignUCTION PERMIT ASSOCIATED WQ PJ 1MITt
if a iic.ablg if idle Ie
I. WELL USE (Ciseclt Applicable Eox): Residential 0 Maknicipal/PW41ic 0 Industrial 0 Agricultural 0
Monitoring) Recovery I:3 He Pump Water Injectioh 0 Other 0 If Other, List Use 3
2. WELL LOCATI N:
Nearest Town: Pfrig ?I1 tit I. L Coca e
503 Gt 11t e. S�. F e4i-evt hip .:
tr� ;•lama NuratbenCommunity, $ltibdi La o. CecEe
t5 t, ry, 1'i+daa, , Zip)
3. OWNER: M r Lh C
Address Lin.[ •
1-7(-)5
Cry or Town Stan Zip Cede
Mont number
4. DATE DRILLED 6'5
3. TOTAL DEPTH: •d
6. DOES WELL REPLACE EXISTING WELL? YES Ir] NO 63
7. STATIC WATERLEVEL &IOW Top of Casing:.?•)
tUaa "-6" if Above Top of C nx)
1. TOP OF CASING IS '" • . FT. Above Land Surrsce
'Top of cuing turns{ndtad aYor 8niary Wad nutlet requires
►seiaaes is taoirduca with ISA PNC tC 2C .01I3.
9. YIELD (gpmn): MOOD OF TEST
10. WATER ZONES (depth):
11. D1S NFE'CT1ON: Type Amount
12. CASING; Weir This
Fr orrre.5 T� .� , th Ft_ I a or eigi,trt ;ai
From __ To Ft. '�d
Fromm To Ft
13. GROUT: Depth
Frost_ Tog • FL
Froarcd_To_ . Ft.
14. SCRW Depth Slat Size
FioutrC , To f 8• _ in. Cisn F'c
Flom To Ft in. in.
13. SAND/GRr .VEL PACK:
netith Matte
From'V� To / Ft.,.__._ .•
F, om To Ft.
Topogr hcILand setting
DRidge ®Slope `7Vailey OF1at
(tteekappropriae J
Latitude/longitude of well location
(de poesholnutai+seoonais)
Latitude/longitude source: DGPSOTopograpbic amp
(check box)
� G LOQ
i:vOcr Description
DEPTH
From To
— Arc
Sbow direction and distance in nrilee from at least
two State Roads or County Roads. Include the read
numbers and common road names,
It REMARKS.
I DO ire.REBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC ORDA -IC2 WITH ISA NCAC 2C, WELL
CCMRUC'TION STANDARDS, AND THAT A COPY OF 110- -« BEEN PROVIDED TO THE W LL WIER
Sl ` r TIME OF PERSOI COMIRVC:lNG a r ILL DA =
Submit the original to the Division of Water Quality, Groundwater Section, 16 6 Mali Service Crater - (Raleigh, NC
7�a 1Anorm
on4 No. [phone], wlthia 30 clays. w. i V. o oo
rt
•
R pi

ORC A [I v. TECHNICAL B U L LET I N 1. 1- 1
ORC Advanced®
Compatibility with Underground Storage Structures and Pipes
The use of ORC Advanced in proximity to underground tanks and pipes is not a concern.
Underground tanks and pipes are installed to meet the relatively corrosive conditions of wet soil, Also,
the advent of Fiberglass Reinforced Plastics (FRPs) has greatly diminished the overall concerns in this
area. Both metal and FRP installations are normally exposed to fairly wide ranges of pH, oxygen
saturated water and even corrosive mineral contents. The biggest threat to system failure lies in poor
installation and not in the presence of materials such as ORC Advanced.
Interactions with metals and plastics are an extremely complicated phenomenon that is dependent on
time, temperature and concentrations. Given enough time, oxidizers and caustic solutions will slowly
react with certain metals and plastics. ORC Advanced will produce oxic conditions, but oxygen levels
are typically within the range of naturally aerobic groundwater, so the environment is not considered
"highly oxidizing." In many cases, ORC Advanced simply restores oxygen levels in the aquifer that
had been depleted as a result of contamination. ORC Advanced does has the potential to raise
groundwater pH in aquifers with low buffering capacity, but the pH increase is generally localized
within a few feet of the injection point. Furthermore, the pH increase is temporary and pH conditions
will return to ambient levels once ORC Advanced is completely consumed. ORC Advanced will not
affect most subsurface structures near the treatment zone. A detailed discussion of materials
compatibility follows.
Metals
After ORC Advanced application, a pH increase is sometimes observed in monitoring wells located
near the injection points. Theoretically, in beaker of unbuffered water, the pH of an ORC Advanced
solution can reach a pH as high as 11. Whether or not the pH will actually increase in the field is
highly dependent on the natural buffering capacity of the aquifer and dilution effects. Iron corrosion
rates drop at high pH (10-12), so a high pH may actually inhibit iron corrosion. However, as pH
increases, corrosion rates increase for aluminum and zinc. If the pH remains high for an extended
period of time, this may have implications for buried electrical conduit which are frequently zinc
coated iron or aluminum
In order to summarize all the factors that may lead to metal corrosion, it is customary to use a grading
system as an overall guide. In a corrosion index (Table 28-2) in the Chemical Engineer's Handbook
(edited by Perry and Green), one category applies to ORC Advanced: alkaline solutions. This index is
graded from 0-6 with a rating of 4-6 being good to excellent in terms of compatibility. A summary of
the relevant information from this table is shown in Table 1 below. Materials rated a 4 or higher with
alkaline solutions include cast iron, ductile iron, mild steel, stainless steel, Incoloy 825 nickel -iron -
chromium alloy, hastelloy alloy C-276 and Incone1 600. Caustic conditions may cause problems with
silicon iron, aluminum, aluminum brass, nickel -aluminum bronze, lead, titanium and zirconium.
1
Regenesis ORC Advanced Tech Bulletin #1.1.1

Table 1. General Corrosion Properties of Some Metals and Alloys (from Perry's Chemical
Engineers Handbook, Table 28-2)
Plastics
Materials
Cast iron
Ductile iron
Mild Steel
Ni-Resist corrosion cast iron
Stainless steel
14% Silicon iron
Incoloy 825 nickel-iron-chromium alloy
Hastelloy alloyC-276
Hastelloy alloy B-2
Inconel 600
Copper-nickel alloys up to 3 0% nickel
Mone! 400 nickel-copper alloy
Nickel
Copper and silicon bronze
Aluminum brass
Nickel-aluminum bronze
Bronze
Aluminum and its alloys
Lead
Silver
Titanium
Zirconium
Alkaline Solutions
Caustic and mild alkalies
4
4
4
5
4-5
2
5
5
4
6
5
6
6
4
2
2
4
0
2
6
2
2
A wide range of plastics and pipes or Fiberglass Reinforced Plastics (FRPs) may be used in
underground service. Each type of plastic will have its own characteristic definition profile. These
tanks and pipes are replacing metals due to their greater chemical resistance to corrosion. In many
cases plastics can withstand significant concentrations of caustic chemicals. Overall, FRPs withstand
a variety of harsh outdoor conditions where they are subjected to high temperatures, ozone and UV
over long periods of time.
Reference
Perry's Chemical Engineer's Handbook, Seventh Edition. 1997 . Editors: Perry, R.H.; D .W . Green,
J.0. Maloney. McGraw-Hill Publishing.
2 Regenesis ORC Advanced Tech Bulletin #1.1.1
Filtel' Socks -Ol'iginal ORC and ORC Advanced
-di RfEGENESIS
1:-' ::. '• II ' ' !
Page 1 of2
Search I Monday; February 24, 2014
F(nd 0/ Follow us on mJ W ~
Advanced ·T·echnologies for Conta111inated Site r~e111ediation
company Woi-ldwldo Services
Orig1nal OR(: aild ORC AdVi!f\~ Filler Socks/Canislers
Prodilcl
Wilen Ol!)'gen Release Compound (ORO®) was firs\
cqmmerclallzed some 15 years ago, II was designed io be
emplaced ln!o g1oundl'la\er\•1eU& us!rig Regenesls ORC Filter
Socks (filter socks). FIiter socks ere permeable, rabrlc sleeves
liUed with pure ORC Of ORC A<Nanced!l ~terlai, Each filler
soci< Is Inserted Into II colored, Nallex"' Flex-Guard rot maximum
durability. Wien hydrated, ftttersocks produce 00ntro1fed-releaS11,
moleeolar oxygen ror perio<l11 of up to 12 months on a single
application. The abundanl Oll}'get1 Is 111011. readily avaftable to
llcsourcos Bloo
facilitate the ptoven and cost-effective, enhanced aerobic blodegradeUon process.
Purpose .
Filler socks ere designed lei deliver coritrolied Original ORC FIiter Sock Schematic
release oxygen Into a specif IC well or treatment
ere11 with the purpose or creaUn9 a ve,Y
loceffze(I l)ut errectiVe (li(ygenated zone \·1here
a.ccelerated aerolllc blodegrada_tlon can ocwr.
Upon exhaustion QI their oxygen wpp"J ·
(anywhere from 9-1~ months) lhe socks can ba
remov.ed end/or nipla~.
Functiolla~ty
Filler sock, ere avsilaf!le In 2•. 4" end 6"
diameters and can be replil~ to restore the
OJtYgen supply and maintain aerobic c:~ck to lnta,g•
b!ocl•eradatlon es needed.
filter socks are easily laced togelher using Ilia
pre-measured/ pre-eut rope that Is supplied with each ord.er (Figures 1, 2, 3 and 4). Fnter
socks can elso be Inserted Into Regenesls, l\ppllcallon -Tlme-Saver Canisters (usually for
deeper appli~Uons to avoid lodging the socks within the well} as required.
Consltuctlori · ·
ORC and ORC Advanced Fffter Socks are hand-made. permeab:e fabric steeves, filled
wllh pure ORC or more recently ORC Alfvarn:e<I. They are epproxlmalely i2• long and
designed to fit 2·, 4• or 6' diameter wells. ·
AeX-Guard Ourebtily · ·
All sizes or Reganests ORC 11nd ORC Advanced Filter Socks Include a faolory Installed,
colored, Nal!eii"' Rex-Guard (green = 2', yehov, "4• and orange= 6'). Tlils coi:nponenl Is
deslgne<I to prevent rips or tears lri the ai;lual gock mat11rlat assuring durability during the
lnstallalion ilnd removal process.
Appltcatlon Consklerallons
• Eld$iin9 aer~!o or anaerob!c ~lions
• Cotilam~ l)'F• end inau
• SubsurfilCIO llll<l!ogy (di1lllbution)
• Depth lo g,ounct,Yale,
• GIOUIICINelef 11<r11 rat~•
• Competing •lK!rotl a«•ptora (o><W•n 1inl<s)
• Free product r.r ,,.-.10111 ca11 'R~nes1s ledl servlc:es lo 6scun opllcris)
Availalffl'i . .
Regenests ORC end ORC Advanced Fnter Socks are always In stocll encl av,allab!e ror
deliVery worldwide.
Plea~ cad 1-949-366-8000 for current p!iclng and. detans.
Vapor lntri,slon Otder
/\ddlllonnl lnformaitoo
B rner~u,sos
Contact
D Fdler SN:k App~:a1 ,.,,.. ln!IM;lit.;,s
D F~cr So<:Hlro.hute
0 ~1~~ S,te Ewl\.1~110:, ,,n Cos, rs1;.:,ia!,1
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Free Consullalion, Design
sncf Cosl Esl1rnatc!
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!low did y011 !lear abo.u\ us?:
: Please sele,1
Request
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9.-.y~rn Rt::t•tt· C~mi~nd
Mvart.~~ (OIIC M;•.,.•~•1
http://www.regenesis.com/contaminated-site-re111ediation-products/enhanced~aerobic-biote ... 2/24/2014
REGENESIIS
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4 REGENESIS SAFETY DATA SHEET
Technology -eased Solutions for the Environment
1. Identification
Product identifier
Other means of identification
Recommended use
Recommended restrictions
Oxygen Release Compound Advanced (ORC Advanced®)
None.
Soil and Groundwater Remediation.
None known.
Manufacturer/importer/Supplier/Distributor information
Company Name
Address
Telephone
E-mail
Emergency phone number
2. Hazard(s) identification
Physical hazards
Health hazards
OSHA defined hazards
Label elements
Signal word
Hazard statement
Precautionary statement
Prevention
Response
Storage
Disposal
Hazard(s) not otherwise
classified (HNOC)
Regenesis
1011 Calle Sombra
San Clemente, CA 92673
949-366-8000
C usto mer5e rvice@ regene sis.com
CHEMTREC° at 1-800-424-9300 (international)
Oxidizing solids
Skin corrosion/irritation
Serious eye damage/eye irritation
Not classified.
Category 2
Category 1
Category 1
Danger
May intensify fire; oxidizer. Causes skin irritation. Causes serious eye damage.
Keep away from heat. Keep/Store away from clothing and other combustible materials. Take any
precaution to avoid mixing with combustibles. Wash thoroughly after handling. Wear protective
gloves/eye protection/face protection.
if on skin: Wash with plenty of water. If in eyes: Rinse cautiously with water for several minutes.
Remove contact lenses, if present and easy to do. Continue rinsing. Immediately call a poison
center/doctor. if skin irritation occurs: Get medical advice/attention. Take off contaminated
clothing and wash before reuse, in case of fire: Use appropriate media to extinguish.
Store away from incompatible materials.
Dispose of contents/container in accordance with local/regional/national/international regulations,
None known.
3. Composition/information on Ingredients
Mixtures
Chemical name
CAS number
Calcium hydroxide oxide
682334-66-3 ?85
Cai ium hydroxide
1305-62-0 s15
Dipotassium Phosphate
7758-11-4 <5
Monopotassium Phosphate
7778-77-0 <5
Composition comments
All concentrations are in percent by weight unless otherwise indicated.
Oxygen Release Compound Advanced {ORC Advanced`)
925597 Version fi: 01 Revision date:- issue date: 02-April-2015
505 US
1/8

4. First-aid measures
Inhalation
Skin contact
Eye contact
Ingestion
Most important
symptoms/effects, acute and
delayed
Indication of immediate
medical attention and special
treatment needed
General information
5. Fire-fighting measures
Suitable extinguishing media
Unsuitable extinguishing
media
Specific hazards arising from
the chemical
Special protective equipment
and precautions for firefighters
Fire fighting
equipment/instructions
Specific methods
General fire hazards
Move to fresh air. Call a physician if symptoms develop or persist.
IF ON CLOTHING: rinse immediately contaminated clothing and skin with plenty of water before
removing clothes. Rinse skin with water/shower. If skin irritation occurs: Get medical
advice/attention. Wash contaminated clothing before reuse.
Do not rub eyes. Immediately flush eyes with plenty of water for at least 15 minutes. Remove
contact lenses, if present and easy to do. Continue rinsing. Get medical attention immediately.
Never give anything by mouth to a victim who is unconscious or is having convulsions. Rinse
mouth. Do not induce vomiting. If vomiting occurs, keep head low so that stomach content doesn't
get into the lungs. Get medical attention if symptoms occur.
Severe eye irritation. Symptoms may include stinging, tearing, redness, swelling, and blurred
vision. Permanent eye damage including blindness could result. Dusts may irritate the respiratory
tract, skin and eyes. Skin irritation. May cause redness and pain.
Provide general supportive measures and treat symptomatically. Keep victim under observation.
Symptoms may be delayed.
Take off all contaminated clothing immediately. Contact with combustible material may cause fire.
Ensure that medical personnel are aware of the material(s) involved, and take precautions to
protect themselves. Wash contaminated clothing before reuse.
Water spray, fog (flooding amounts). Foam. Dry chemical powder. Carbon dioxide (CO2).
None known.
Greatly increases the burning rate of combustible materials. Containers may explode when
heated. During fire, gases hazardous to health may be formed. Combustion products may include:
metal oxides.
Self-contained breathing apparatus and full protective clothing must be worn in case of fire.
In case of fire and/or explosion do not breathe fumes. Move containers from fire area if you can do
so without risk. Use water spray to cool unopened containers.
Cool containers exposed to flames with water until well after the fire is out.
May intensify fire; oxidizer. Contact with combustible material may cause fire.
6. Accidental release measures
Personal precautions,
protective equipment and
emergency procedures
Methods and materials for
containment and cleaning up
Environmental precautions
Keep unnecessary personnel away. Keep people away from and upwind of spill/leak. Keep away
from clothing and other combustible materials. Wear appropriate protective equipment and
clothing during clean-up. Use a NIOSH/MSHA approved respirator if there is a risk of exposure to
dust/fume at levels exceeding the exposure limits. Do not touch damaged containers or spilled
material unless wearing appropriate protective clothing. Ensure adequate ventilation. Local
authorities should be advised if significant spillages cannot be contained. For personal protection,
see section 8 of the SOS.
Eliminate all ignition sources (no smoking, flares, sparks, or flames in immediate area). Collect
dust using a vacuum cleaner equipped with HEPA filter. Keep combustibles (wood, paper, oil, etc.)
away from spilled material. Ventilate the contaminated area. Stop the flow of material, if this is
without risk. Absorb in vermiculite, dry sand or earth and place into containers.
Large Spills: Sweep up or vacuum up spillage and collect in suitable container for disposal. Shovel
the material into waste container. Minimize dust generation and accumulation. Avoid the
generation of dusts during clean-up. Following product recovery, flush area with water.
Small Spills: Wipe up with absorbent material (e.g. cloth, fleece). Clean surface thoroughly to
remove residual contamination.
Never return spills to original containers for re-use. Place all material into loosely covered plastic
containers for later disposal. For waste disposal, see section 13 of the SOS. Wear appropriate
protective equipment and clothing during clean-up.
Avoid discharge into drains, water courses or onto the ground.
Oxygen Release Compound Advanced (ORC Advanced®) SDS US
2/8 925597 Version#: 01 Revision date: -Issue date: 02-April-2015
7. Handling and storage
Precautions for safe handling
Conditions for safe storage,
including any incompatibilities
Minimize dust generation and accumulation. Routine housekeeping should be instituted to ensure
that dusts do not accumulate on surfaces. Keep away from heat. Provide appropriate exhaust
ventilation at places where dust is formed. Keep away from clothing and other combustible
materials. Take any precaution to avoid mixing with combustibles. Avoid contact with water and
moisture. Do not get this material in contact with eyes. Avoid contact with eyes, skin, and clothing.
Avoid prolonged exposure. Wear appropriate personal protective equipment. Observe good
industrial hygiene practices.
Keep away from heat. Store in a cool, dry place out of direct sunlight. Store in original tightly
closed container. Store in a well-ventilated place. Do not store near combustible materials. Store
away from incompatible materials (see Section 10 of the SDS).
8. Exposure controls/personal protection
Occupational exposure limits
US. OSHA Table Z-1 Limits for Air Contaminants (29 CFR 1910.1000)
Components
Calcium hydroxide (CAS
1305-62-0)
Type
PEL
Value
5 mg/m3
15 mg/m3
Form
Respirable fraction.
Total dust.
US. ACGIH Threshold Limit Values
Components Type Value
Calcium hydroxide (CAS TWA 5 mg/m3
1305-62-0)
US. NIOSH: Pocket Guide to Chemical Hazards
Components
Calcium hydroxide (CAS
1305-62-0)
Biological limit values
Appropriate engineering
controls
Type Value
TWA 5 mg/m3
No biological exposure limits noted for the ingredient(s).
Good general ventilation (typically 10 air changes per hour) should be used. Ventilation rates
should be matched to conditions. If applicable, use process enclosures, local exhaust ventilation,
or other engineering controls to maintain airborne levels below recommended exposure limits. If
exposure limits have not been established, maintain airborne levels to an acceptable level. If
engineering measures are not sufficient to maintain concentrations of dust particulates below the
Occupational Exposure Limit (OEL), suitable respiratory protection must be worn. If material is
ground, cut, or used in any operation which may generate dusts, use appropriate local exhaust
ventilation to keep exposures below the recommended exposure limits. Eye wash facilities and
emergency shower must be available when handling this product.
Individual protection measures, such as personal protective equipment
Eye/face protection Use dust-tight, unvented chemical safety goggles when there is potential for eye contact.
Skin protection
Hand protection
Other
Respiratory protection
Thermal hazards
General hygiene
considerations
Wear appropriate chemical resistant gloves. Frequent change is advisable. Recommended gloves
include rubber, neoprene, nitrile or viton.
Wear appropriate chemical resistant clothing.
If engineering controls do not maintain airborne concentrations below recommended exposure
limits (where applicable) or to an acceptable level (in countries where exposure limits have not
been established), an approved respirator must be worn. Recommended use: Wear respirator with
dust filter.
Wear appropriate thermal protective clothing, when necessary.
Keep from contact with clothing and other combustible materials. Remove and wash contaminated
clothing promptly. Always observe good personal hygiene measures, such as washing after
handling the material and before eating, drinking, and/or smoking. Routinely wash work clothing
and protective equipment to remove contaminants.
9. Physical and chemical properties
Appearance
Physical state
Form
Color
Solid.
Powder.
White to pale yellow.
Oxygen Release Compound Advanced (ORC Advanced®)
925597 Version #: 01 Revision date: -Issue date: 02-April-2015
SDSUS
3/8
Odor
Odor threshold
pH
Melting point/freezing point
Initial boiling point and boiling
range
Flash point
Evaporation rate
Flammability (solid, gas)
Odorless.
Not available.
12.5 (3% suspension/water)
Not available.
Not available.
Not available.
Not available.
Oxidizer.
Upper/lower flammability or explosive limits
Flammability limit -lower Not available.
(%)
Flammability limit -upper
(%)
Explosive limit -lower(%)
Explosive limit -upper(%)
Vapor pressure
Vapor density
Relative density
Solubility(ies)
Solubility (water)
Partition coefficient
(n-octanol/water)
Auto-ignition temperature
Decomposition temperature
Viscosity
Other information
Bulk density
Explosive limit
10. Stability and reactivity
Reactivity
Chemical stability
Possibility of hazardous
reactions
Not available.
Not available.
Not available.
Not available.
Not available.
Not available.
Slightly soluble
Not available.
Not available.
527 °F (275 °C)
Not available.
0.5 -0.9 g/ml
Non-explosive.
Greatly increases the burning rate of combustible materials.
Decomposes on heating. Product may be unstable at temperatures above: 275°C/527°F.
Reacts slowly with water.
Conditions to avoid Heat. Moisture. Avoid temperatures exceeding the decomposition temperature. Contact with
incompatible materials.
Incompatible materials
Hazardous decomposition
products
Acids. Bases. Salts of heavy metals. Reducing agents. Combustible material.
Oxygen. Hydrogen peroxide (H2O2). Steam. Heat.
11. Toxicological information
Information on likely routes of exposure
Inhalation
Skin contact
Dust may irritate respiratory system. Prolonged inhalation may be harmful.
Causes skin irritation.
Eye contact Causes serious eye damage.
Ingestion Ingestion may cause irritation and malaise.
Symptoms related to the Severe eye irritation. Symptoms may include stinging, tearing, redness, swelling, and blurred
physical, chemical and vision. Permanent eye damage including blindness could result. Dusts may irritate the respiratory
toxicological characteristics tract, skin and eyes. Skin irritation. May cause redness and pain.
Information on toxicological effects
Acute toxicity
Oxygen Release Compound Advanced (ORC Advanced®)
925597 Version #: 01 Revision date: -Issue date: 02-April-2015
SDS US
4/8
Components Species Test Results
Calcium hydroxide (CAS 1305-62-0)
Acute
Oral
LD50 Rat 7340 mg/kg
Skin corrosion/irritation
Serious eye damage/eye
irritation
Respiratory or skin sensitization
Respiratory sensitization
Skin sensitization
Germ cell mutagenicity
Causes skin irritation.
Causes serious eye damage.
Not a respiratory sensitizer.
This product is not expected to cause skin sensitization.
No data available to indicate product or any components present at greater than 0.1 % are
mutagenic or genotoxic.
Carcinogenicity This product is not considered to be a carcinogen by IARC, ACGIH, NTP, or OSHA.
OSHA Specifically Regulated Substances (29 CFR 1910.1001-1050)
Not listed.
Reproductive toxicity
Specific target organ toxicity -
single exposure
Specific target organ toxicity -
repeated exposure
Aspiration hazard
Chronic effects
12. Ecological information
Ecotoxicity
Components
This product is not expected to cause reproductive or developmental effects.
Not classified.
Not classified.
Due to the physical form of the product it is not expected to be an aspiration hazard.
Prolonged inhalation may be harmful.
The product is not classified as environmentally hazardous. However, this does not exclude the
possibility that large or frequent spills can have a harmful or damaging effect on the environment.
Species Test Results
Calcium hydroxide (CAS 1305-62-0)
Aquatic
Fish
Persistence and degradability
Bioaccumulative potential
Mobility in soil
Other adverse effects
LC50 Zambezi barbel (Clarias gariepinus) 33.8844 mg/I, 96 hours
Decomposes in the presence of water. The product contains inorganic compounds which are not
biodegradable.
The product does not contain any substances expected to be bioaccumulating.
This substance has very low solubility in water and low mobility in the environment.
None known.
13. Disposal considerations
Disposal instructions
Local disposal regulations
Hazardous waste code
Waste from residues / unused
products
Contaminated packaging
14. Transporfinformation
DOT
Collect and reclaim or dispose in sealed containers at licensed waste disposal site. Dispose of
contents/container in accordance with local/regional/national/international regulations.
Dispose in accordance with all applicable regulations.
The waste code should be assigned in discussion between the user, the producer and the waste
disposal company.
Dispose of in accordance with local regulations. Empty containers or liners may retain some
product residues. This material and its container must be disposed of in a safe manner (see:
Disposal instructions).
Empty containers should be taken to an approved waste handling site for recycling or disposal.
Since emptied containers may retain product residue, follow label warnings even after container is
emptied.
UN number UN1479
UN proper shipping name Oxidizing solid, n.o.s. (Calcium hydroxide oxide)
Oxygen Release Compound Advanced (ORC Advanced®)
925597 Version #: 01 Revision date: -Issue date: 02-April-2015
sos us
5/8
Transport hazard class(es)
Class 5.1
Subsidiary risk
Label(s) 5.1
Packing group II
Environmental hazards
Marine pollutant No
Special precautions for user Read safety instructions, SDS and emergency procedures before handling.
Special provisions 62, 188, IP2, IP4, T3, TP33
Packaging exceptions 152
Packaging non bulk 212
Packaging bulk 240
IATA
UN number UN1479
UN proper shipping name Oxidizing solid, n.o.s. (Calcium hydroxide oxide)
Transport hazard class(es)
Class 5.1
Subsidiary risk
Packing group II
Environmental hazards No
ERG Code 5L
Special precautions for user Read safety instructions, SDS and emergency procedures before handling.
IMDG
UN number
UN proper shipping name
Transport hazard class(es)
Class
Subsidiary risk
Packing group
Environmental hazards
Marine pollutant
Ems
UN1479
OXIDIZING SOLID, N.O.S. (Calcium hydroxide oxide)
5.1
II
No
F-A, S-Q
Special precautions for user Read safety instructions, SDS and emergency procedures before handling.
Transport in bulk according to Not applicable.
Annex II of MARPOL 73/78 and
the IBC Code
15. Regulatory information
US federal regulations This product is a "Hazardous Chemical" as defined by the OSHA Hazard Communication
Standard, 29 CFR 1910.1200.
All components are on the U.S. EPA TSCA Inventory List.
TSCA Section 12(b) Export Notification (40 CFR 707, Subpt. D)
Not regulated.
OSHA Specifically Regulated Substances (29 CFR 1910.1001-1050)
Not listed.
CERCLA Hazardous Substance List (40 CFR 302.4)
Not listed.
Superfund Amendments and Reauthorization Act of 1986 (SARA)
Hazard categories Immediate Hazard -Yes
Delayed Hazard -No
Fire Hazard -Yes
Pressure Hazard -No
Reactivity Hazard -Yes
SARA 302 Extremely hazardous substance
Not listed.
SARA 311/312 Hazardous Yes
chemical
Oxygen Release Compound Advanced (ORC Advanced®)
925597 Version#: 01 Revision date: -Issue date: 02-April-2015
SDS US
6/8
SARA 313 (TR' reporting)
Not regulated.
Other federal regulations
Clean Air Act (CAA) Section 112 Hazardous Air Pollutants (HAPs) List
Not regulated.
Clean Air Act (CAA) Section 112(r) Accidental Release Prevention (40 CFR 68.130)
Not regulated.
Safe Drinking Water Act Not regulated.
(SDWA)
US state regulations
US. Massachusetts RTK - Substance List
Calcium hydroxide (CAS 1305-62-0)
US. New Jersey Worker and Community Right -to -Know Act
Ca€cium hydroxide (CAS 1305-62-0)
Calcium hydroxide oxide (CAS 682334-66-3)
US. Pennsylvania Worker and Community Right -to -Know Law
Calcium hydroxide (CAS 1305-62-0)
US. Rhode Island RTK
Not regulated.
US. California Proposition 65
California Safe prinking Water and Toxic Enforcement Act of 1986 (Proposition 65): This material is not known to contain
any chemicals currently listed as carcinogens or reproductive toxins.
International inventories
Country(s) or region inventory name On inventory (yes/nor
Australia Australian Inventory of Chemical Substances (AICS) Yes
Canada Domestic Substances List (DSL) Yes
Canada Non -Domestic Substances List (NDSL) No
China inventory of Existing Chemical Substances in China (IECSC) Yes
Europe European Inventory of Existing Commercial Chemical Yes
Substances (EINECS)
Europe European List of Notified Chemical Substances (EL1NCS) No
Japan Inventory of Existing and New Chemical Substances (ENCS) Yes
Korea Existing Chemicals List (ECL) Yes
New Zealand New Zealand Inventory Yes
Philippines Philippine Inventory of Chemicals and Chemical Substances Yes
(PICCS)
United States & Puerta Rico Toxic Substances Control Act (TSCA) Inventory Yes
'A "Yes" indicates this product complies with the inventory requirements administered by the governing country(s).
A No indicates that one or more components of the product are not listed or exempt from listing on the inventory administered by the governing
country(s).
16. Other information, including date of preparation or last revision
Issue date
Revision date
Version #
Further information
HMISi ratings
NFPA ratings
02-April-2015
01
HMISO is a registered trade and service mark of the American Coatings Association (ACA).
Health: 3
Flammability: 0
Physical hazard' 2
Oxygen Release Compound Advanced (ORC Advanced®)
925597 Version #: 41 Revision date: - Issue date: 02-April-2015
SDS US
T16

Disclaimer Regenesis cannot anticipate all conditions under which this information and its product, or the
products of other manufacturers in combination with its product, may be used. It is the user's
responsibility to ensure safe conditions for handling, storage and disposal of the product, and to
assume liability for loss, injury, damage or expense due to improper use. The information in the
sheet was written based on the best knowledge and experience currently available.
Oxygen Release Compound Advanced (ORC Advanced®) SDSUS
8/8 925597 Version#: 01 Revision date: -Issue date: 02-April-2015