WI0600207_DEEMED FILES_20181019

ENVIRONMENTAL • GEDTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
October 9, 2018
Ms. Shristi Shrestha
North Carolina Department of Environmental Quality
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
Division of Water Quality-Aquifer Protection Section, UIC Program
1636 Mail Service Center
,t:CEIVED/NCDEQ/DW1
OCT : 9 2018
Water Quality RegionA 1
Ooerations-'S~ct,~r
Raleigh, North Carolina 27699-1636
Reference: Injection Event Record -WI0600207
Betty Lucas Property
Intersection of Red Hill Church Road and Ashe A venue
Dunn, Harnett County, North Carolina
NCDEQ Incident# 3359
Dear Ms. Shrestha:
ATC Associates of North Carolina, P.C. (ATC) is submitting an Injection Event Record for the
Betty Lucas Property on behalf of the North Carolina Department of Environmental Quality State
Lead Program. The record documents the installation of one Provect ORS sleeve in monitoring
well MW-1 associated with the above referenced site
If you have questions or require additional information, please contact our office at [phone] .
Sincerely,
ATC Associates of North Carolina, P.C.
Ashley M. Winkelman, P.G.
Senior Project Manager
cc: Hassan Osman, Hydrogeologist for NCDEQ
Attachments
Injection Event Record
Betty Lucas Pro pe rty. Dunn. North Carolina
INJECTION EVENT RECORD
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EfMRDIIIIENTll • ;E1R.CHNICAL
HIUJJIG HIEICES • IUTERlill lE5TIH
North Carolina Department of Environmental Quality-Division of Water Resources
INJECTION EVENT RECORD {IER)
Permit Number WI0600207
1. Permit Information
NCDE Q
Permittee
Betty Lucas Pro pe rty
Facility Name
1217 Red Hill Church Road, Dunn, Hfrir r~H ffJ .~ ~nM EO/ }V
Facility Address (include County)
OCT : 9 2018
2. Injection Contractor Information
Nater Quality Reg <,
·Jl")Cr~ 4,onc:-~.C,"~ • ATC Associates ofNC. P.C . · •· 01· •· •• ·, · •
Injection Contractor I Company Name
Street Address 2725 E. Millbrook Road, Ste 121
Raleigh
City
[phone]
NC
State
Area code -Phone number
3 . Well Information
27604
Zip Code
Number of wells used for injection.~1 ____ _
Well IDs_~M~W~-~1 _________ _
Were any new wells installed during this injection
event?
D Yes ~ No
If yes, please provide the following information:
Number of Monitoring Wells __ _;.N~A'=-----
Number of Injection Wells NA ---------
Type of Well Installed (Check applicable type):
D Bored D Drilled D Direct-Push
D Hand-Augured D Other (specify) __ _
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
D Yes ~ No
If yes, please provide the following information:
Number of Monitoring Wells _ _,N,_,_A,,_,,_ ____ _
Number of Injection Wells. ___ N~A::.-___ _
Please include a copy of the GW-30for each well
abandoned.
4 . Injectant Information
Provect ORS sleeve
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration ---'-7-"'-5....,-8<-=5'-'-o/c-"-o ________ _
If the injectant is diluted please indicate the source
dilution fluid. Not A pplicable
Total Volume Injected (gal) 346 in3-sleeve volume
Volume Injected per well (gal) 346 in3-sleeve vol.
5 . Injection History
Injection date(s) Se ptember 10 . 2018
Injection number ( e.g. 3 of 5)._.=c..1 _,,_o.=c..f .ec._1 ____ _
Is this the last injection at this site?
D Yes rzl 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 OUT IN THE PERMIT.
/0 'i 1¥:
SIGNATURE OF INJECTION CONTRACTOR DAT ·
ATC Associates of North Carolina, P.C.
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
Form UIC-IER
Rev. 3-1-2016
Permit Number
Program Category
Deemed Ground Water
Permit Type
WI0600207
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted . Flow
Facility
Facility Name
Betty Luca Property (currently Barefoot Automotive)
Location Address
1217 Red Hill Church Rd
Dunn
Owner
Owner Name
Ncdeq Ust Section
Dates/Events
NC
Orig Issue
8/24/2018
App Received
8/14/2018
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
28334
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
8/24/2018
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Hassan Osman
1646 Mail Service Ctr
Raleigh
Owner Type
Government -State
Owner Affiliation
Hassan Osman
1646 Mail Service Ctr
Raleigh
Region
Fayetteville
County
Hamett
NC
NC
Issue
8/24/2018
Effective
8/24/2018
27699
27699
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupsetvices.com
N. C. Engineering License No. C-1598
----------------------------------··
August 9, 2018
Ms. Shristi Shrestha
North Carolina Department of Environmental Quality
Division of Water Quality -Aquifer Protection Section, UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Reference: Notice of Intent to Construct or Operate Injection Wells
Betty Lucas Property
Intersection of Red Hill Church Road and Ashe A venue
Dunn, Harnett County, North Carolina
NCDEQ Incident# 3359
Dear Ms. Shrestha:
ATC Associates of North Carolina, P.C. (ATC) has prepared the enclosed Notice of Intent to
Construct or Operate Injection Wells on behalf of the North Carolina Department of
Environmental Quality State Lead Program. The permit application covers the performance of
passive remediation in two monitoring wells associated with the above referenced site
If you have questions or require additional information, please contact our office at [phone] .
Sincerely,
ATC Associates of North Carolina, P.C.
AshleyM. Winkelman, P.G.
Senior Project Manager
cc: Hassan Osman, Hydrogeologist for NCDEQ
Attachments
,tCENEOl~COE.UID~ \
AUG : 4 2018
I\Jater Quality Re~j~r
·~,')~f::'1\0'"' -C' ,:,('
Notice of Intent to Construct or Operate Injection Wells
Don Lee Auto Sales . Willow S prin gs, North Carolina
NOTICE OF INTENT FORM
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UVIRDKIIENTAl • SEDTEt~NltAL
BUllDIHSCJENCE!•IIATERI AlSTESTIH
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 iection.
AQUIFER TEST WELLS (ISA NCAC 02C .0220 }
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (ISA NCAC 02C .0225) or TRACER WELLS (ISA NCAC 02C .0229):
1) Passive In jection Sy stems -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 In jection O p erations -Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests -Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Iniection 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 9, 20_18_ PERMIT NO. vV 10 G O O 2.. Df: (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
B.
(1)
(2)
(3)
(4)
(5)
(6)
___ .Air Injection Well. ..................................... Complete sections B through F, K, N
--~Aquifer Test Well ....................................... Complete sections B through F, K, N
X Passive Injection System ............................... Complete sections B through F, H-N
___ Small-Scale Injection Operation ...................... Complete sections B through N
-~_.Pilot Test ................................................. Complete sections B through N
___ Tracer Injection Well ................................... Complete sections B tqr.,o ugbN 0/NCDE.Q/b'w
STATUS OF WELL OWNER: State Government AUG ~ 4 2018
n.Ja er Qu~lity
C. WELL OWNER(S)-State name of Business/Agency, and Name and Title of person delegat e& ~i'.i'thi rity to
sign on behalf of the business or agency:
Name: Hassan Osman - H vdro geolog ist. North Carolina De partment of Environmental Q uali tv
Mailing Address: ---------'1"""'6'""'4-"-6-"M=ai=l """S""'e=-rv=ic=e=-C==en=t=e=-r ____________________ _
City: Raleigh State: NC Zip Code: ____ 2~7~6=9~9~-1"""'6~4~6 __ County:~W~ak=e ___ _
Day Tele No.: 919-707-8167 Cell No.: --~N~o_t _A~v~ai=la~b~le~---
EMAIL Address: hassan.osman@ ncdenr.gov Fax No.: Not Available ---------------
Deemed Permitted GW Remediation NOi Rev. 8-28-2017 Page 1
D. PROPERTY OWNER(S) (if different than well owner)
Name and Title: ___ D_onru_·_e_P_r _ic_e _________________________ _
Company Name ---=B=ar=e=£-=-oo""t"""A""u=t=o=m=o"""t1=·v"""e ______________________ _
Mailing Address: ___ 4~7~0~D~uk=e~R~oa=d~------------------------
City: Dunn State: _NC_ Zip Code:=2~83~3~4 ____ County:~H=arn=e~tt~--------
Day Tele No.: 910-897-7439 CellNo.: NotAvailable
EMAIL Address: Not Available Fax No.: ___ N_o_t _A_v_ai=·1~ab~l~e ___ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: --~A~sh=l=e.,_y ~W~1=·nk=el=m=an=·=P~.G~. -_S~e=ru=·-=-or~P~r=oc.,..ie=c=t =M=an=a=g=er~------------
Company Name ___ A~T~C~A~ss~o~c~ia~t~es~o~f~N~ort=h~C~ar~o=l=in=a~P~.C=·~---------------
Mailing Address: ___ 2 _72_5_E_. M_il_lb_r_o_ok_R_o_ad~._S_u_it_e _1_2_1 ________________ _
City: Ralei gh State: _NC_ Zip Code: 27604 County:_W_ak_e ___ _
Day Tele No.: 919-871-0999 Cell No.: 919-830-3576
EMAIL Address: ashlev.winkelman@ atcassociates.com Fax No.: ---'-7-=-37-'---=2-=-07'-----=82=--=6c.--=.1 ___ _
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: ____ B_e_tt~y_L_u_c_as_P_ro~p_e_r-ry~(_c_urr_en_t_lv~B_ar_e_fo~o~t_A_u~t~o~m=o~ti=v~e_._) __
1217 Red Hill Church Road
City: --~D~unn=~ ______ County: Hamett Zip Code: __ 2=8=3-=3-'---4 -
(2) Geographic Coordinates: Latitude**: 3 5 ° -----1.Q' ____]]_" or 0
Longitude**: 78° ~, ------12_" or 0
Reference Datum: ___ W_G_S_8_4 ___ Accuracy: ___ 1_0_-m_et_e_r __ _
Method of Collection: DOQ -Acme Mapp er 2.2
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
·G. TREATMENT AREA
Land surface area of contaminant plume: _______ square feet
Land surface area of inj. well network: square feet (:s 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; See Figure 1 for the horizontal extent of groundwater contamination and
all monitoring wells associated with the site. There are no proposed wells. Recent soil sampling
activities have not been performed for the site.
(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; and -Cross-sections have not been
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page2
prepared for this site during previous assessment activities. There are no deep wells associated with
this site, therefore the vertical extent of contamination is unknown.
(3) Potentiometric surface map( s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells. -Please see Figure 2.
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. ·
ATC will install one Provect ORS sleeve in monitorin1r wells MW-1 and MW-3 in order to aide in natural
attenuation and reduce compounds concentrations to below the North Carolina Groundwater Q uality Standards
(2L Standards). Based on the most recent sam plinQ. event performed in March 2018 , the followin g com pounds
exceeded the 2L Standards: benzene at 29.4 micro grams per liter {µg/L) and methvl tert-buty l ether at 121 µQ/L.
The sleeves come in 3-foot sections. ATC will install one 3-foot section at the base of each well. across the well
screen. The socks will release oxidizing solids into the g.roundwater for a pp roximate! 6 months . at which point
the chemicals in the socks will have"-"'-de=l=et.,_,e'""d"-. ____ _
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 ://deg .nc.eov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/e:round-water-protection/ernund-water-a pp roved-in jectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UJC Program for more info (919-
807-6496).
Injectant: Provect ORS sleeves
Volume ofinjectant: 346 in3 -volume of socks
Concentration at point of injection: ___ 7~5~-~8~5~o/c~o __________________ _
Percent if in a mixture with other injectants: ___ N~o_t_A_,_p.._pl_ic_a_b_le _____________ _
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: _____ Proposed __ -=2'-__ Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-1 s, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well cohstruction 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
See Appendix B for well construction details.
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page 3
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
'Two weeks after submittirw this NOI,ATC will install the Provect ORS sleeves in monitoring well MW-1 and
MW-3.
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.
ATC will collect ►xoundwater samples ajroximately 6 months after the installation of the Provect ORS sleeves
(August 2018_ with saniplin2 to occur Februar, 2019 L_ Durinc the samplinv event. ATC will collect samples
from monitorintl wells MW-1 and MW-3 for analysis of volatile organic compounds by E1'A Method 6200B.
The samples will be shipped to Con -Test Laboratory in East Longmeadow. Massachusetts. ATC will also
measure dissolved ougen. conductivity, temperature, pH. and oxveen reduction_potential in MW-3R during the
February 2018 sampling event_
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, under penalty of law, that I am, familiar with the information submitted in this
document and all attachments thereto and that, based on my inquiry ofthose individuals immediately responsible
jor 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
informations. Iagree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the 1 SANCAC 02C 0200 Rules. '
Signature of Applicant
Ashley Winkelman on behalf of Hassan Osman, NCDEQ
tsee next pave for agent authorization)
Print or Type Full Name
PROPERTY OWNER t if thoproperty is not owned b i 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 wells) conform to the Well Construction Standards
(JSANC.. 4C 0.2C .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_
See Appendix C. Donnie Price
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.
Please send this NOI electronically to Shristi.Shrestha lrncdenr,aov AND one hard copy to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 8-282017 Page 4

Ashle y Winkelman
From:
Sent:
Osman, Hassan <[e-mail]>
Tuesday, August 07, 2018 2:33 PM
To: Ashley Winkelman
Subject: RE: [External] FW: #3359 Betty Lucas Agent Authorization
Hi Ashley:
ATC is granted/approved a permission to act as an agent for NCDEQ to sign a notification for UIC permit.
Thanks
Hassan
From: Ashley Winkelman [mailto:[e-mail]]
Sent: Tuesday, August 07, 2018 2:28 PM
To: Osman, Hassan <[e-mail]>
Subject: [External] FW: #3359 Betty Lucas Agent Authorization
CAUTION: External email. Do not click links or op·$n attachments unless verified . Send all suspkious email as an attachment to ·i
; :l~ '. -~ -~''·,it}: L;"d ' ' . . • -. -. .. ... I • _:
Please see below. Thanks!
Ashley M. Winkelman PGI SENIOR PROJECT MANAGER I ATC Group Services LLC
[phone] I [phone] mobile
2725 E. Millbrook Road, Suite 121 I Raleigh, NC 27604
[phone] fax I ashle y .winkelman @atcassociates.com I www.atcq rou pservices.com
This email and its attachments may contain confidential and/or privileged information for the sole use of the intended recipient(s). If you are
not the intended recipient, any use, distribution or copying of the information contained in this email and its attachments is strictly prohibited.
If you have received this email in error, please notify the sender by replying to this message and immediately delete and destroy any copies
of this email and any attachments. The views or opinions expressed are· the author's own and may not reflect the views or opinions of ATC.
From: Ashley Winkelman
Sent: Wednesday, August 01, 2018 2:58 PM
To: 'Osman, Hassan' <hassan.osman @ncdenr.g ov>
Subject: #3359 Betty Lucas Agent Authorization
Hassan,
I'm working on the notification form to install ORS Sleeves in monitoring wells MW-1 and MW-3 at the Betty Lucas site
(Incident #3359). Since ATC is signing the form as an agent for NCDEQ, would you respond to this email giving ATC
permission to act as an agent for NCDEQ? I'll attach it to the Notification Form when I submit it.
Thanks!
1
Ashley M. Winkelman PGI SENIOR PROJECT MANAGER I ATC Group Services LLC
[phone] I [phone] mobile
2725 E. Millbrook Road, Suite 121 I Raleigh, NC 27604
[phone] fax I ashley .winkelman @atcassodates.com I www.atcq rou p services.com
This email and its attachments may contain confidential and/or privileged information for the sole use of the intended recipient(s). If you are
not the intended recipient, any use, distribution or copying of the information contained in this email and its attachments is strictly prohibited.
If you have received this email in error, please notify the sender by replying to this message and immediately delete and destroy any copies
of this email and any attachments. The views or opinions expressed are the author's own and may not reflect the views or opinions of ATC.
2
Notice of Intent to Construct or Operate Injection Welts
Dan Lee Auto Sales. Willow Springs. North Carolina
FIGURES
ATC
rmlrirum - on.Epoiu
161011112100.3. lanCIit 1611lC

WELL
I.D.
DATE
SAMPLED
Benzene
w
F
MW-]
3/23/2018
<0.50
0.81
MW-2
3/23/2018
<0.50
<0.50
MW-3
3/23/2018
29.4
121
FUG O U6N'f •
IANI-1
LEGEND:
m2
FORMER
SOUTHERN RIDERS
MOTORCYCLE CLUB
RESIDENCE
GRASS
2-1,0DO—GALLON
GASOLINE UST
0
GRAVEL
FOR
PUMP IM ND
I I
275—GALLON /
KEROSENE UST / I .
MW-3
I
I�
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w §
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APPROXIMATE SCALE IN FEET

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Gradient:
(0.0016 ft/ft
r
LEGEND;
(91.o6)
1
\ 7 1
\ 1
500-GAaON T f FUEL 01t6004
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/
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/
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APPROXIMATE SCALE IN FEET

Notice of Intent to Construct or Operate injection Wells
Don Lee Auto Sales. Willow Springs, North Carolina
APPENDIX A
MSDS FORM
ATC
1.411111E-fi[EilciElell
dm, ern, uIEiEEClEEI• Y11•41L1*FS111C

rovectus
ENVIRONMENTAL PRODUCTS -
MATERIAL SAFETY DATA SHEET: PROVECT-ORS
Page: 1 of 5
1. PRODUCT IDENTIFICATION:
PRODUCT USE:
MANUFACTURER:
PROVECTUS ENVIRONMENTAL
2871 W. Forest Rd., Suite 2
Freeport, IL
61032
PROVECT-ORS
Soil and water treatment.
EMERGENCY PHONE:
USA: ($.15) 650-223O
TRANSPORTATION OF DANGEROUS GOOD CLASSIFICATION:
Oxidizing Solid, n.o_s. (Calcium Peroxide), Class 5.1, PG II. UN1479
WHMIS CLASSIFICATION:
Oxidizer
2, COMPOSITION/INFORMATION ON INGREDIENTS
Ingredients Chemical Formula CAS No. Percentage
Calcium Peroxide CaO2 1305-79-9 75%-85%
Inorganic Nutrients 15%-25%
3. PHYSICAL DATA
Appearance White & brown granules
Physical state Solid
Odor threshold None
Bulk Density 500-650g/L
Solubility in Water Insoluble
PH -11
Decomposition Temperature Self -accelerating decomposition with oxygen release starting from 275
degrees Celsius
4. HAZARDS IDENTIFICATION
Emergency overview
Oxidizing agent, contact with other material may cause fire. Under fire conditions this material may
decompose and release oxygen that intensifies fire. This product contains c1% non -respirable crystalline
silica. The NTP and OSHA have not classified non -respirable crystalline silica as carcinogenic. Long term
exposure to hazardous levels of respirable silica dusts can cause lung disease (silicosis). ORS does not
contain respirable crystalline silica.
Potential Health Effects:
• General,_. Irritating to mucous membrane and eyes.

PENVRONMENTAL
PRODUCTS'
rovectus
MATERIAL SAFETY DATA SHEET:
PRDVECT-ORS Page: 2 of 5
• Inhalation Irritating to respiratory tract. Long term inhalation of elevated levels
may cause lung disease (silicosis)_
• Eye contact May cause irritation to the eyes; Risks of serious or permanent eye
lesions.
• Skin contact May cause skin irritation.
• Ingestion Irritation of the mouth and throat with nausea and vomiting.
S. FIRST All) MEASURES
• Inhalation Remove affected person to fresh air. Seek medical attention if effects
persist.
• Eye contact Flush eyes with running water for at least 15 minutes with eyelids
held open. Seek specialist advice.
• Skin contact Wash affected skin with soap and mild detergent and large amounts of
water.
• Ingestion If the person is conscious and not convulsing, give 2-4 cupfuls of
water to dilute the chemical and seek medical attention immediately.
Do not induce vomiting.
6. FIRE FIGHTING MEASURE
Flash Point
• Not applicable
Flanunahility
• Not applicable
Ignition Temperature
• Not applicable
Danger of Explosion
• Non -explosive
Extinguishing Media
• Water
Fire Hazards
• Oxidizer. Storage vessels involved in a fire may vent gas or rupture due to internal pressure.
Damp material may decompose exothermically and ignite combustibles. Oxygen release due to
exothermic decomposition may support combustion. May ignite other combustible materials.
Avoid contact with incompatible materials such as heavy metals, reducing agents, acids, bases,

rovectus
ENVIRONMENTAL PRODUCTS"
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 3 of 5
combustible twood, papers, cloths etc.) Thermal decomposition releases oxygen and heat.
Pressure bursts may occur due to gas evolution. Pressurization if confined when heated or
decomposing. Containers may burst violently.
Fire Fighting Measures
• Evacuate all non -essential personnel
• Wear protective clothing and self-contained breathing apparatus.
• Remain upwind of Ere to avoid hazardous vapors and decomposition products_
■ Use water spray to cool fire- exposed containers.
7. ACCIDENTAL RELEASE MEASURES
Spill Clean-up Procedure
• Oxidizer. Eliminate all sources of ignition. Evacuate unprotected personnel from equipment
recommendations found in Section 9. Never exceed any occupational exposure limit.
• Shovel or sweep material into plastic bags or vented containers for disposal. Do not return spilled
or contaminated material to inventory. Avoid making dust.
• Flush remaining area with water to remove trace residue and dispose of properly. Avoid direct
discharge to sewers and surface waters. Notify authorities if entry occurs.
• Do not touch or walk through spilled material. Keep away from combustibles (wood, paper, oils.
etc.). Do not return product to container because of risk of contamination.
8. HANDLING AND STORAGE
Storage
• Oxidizer. Store in a cool, well -ventilated area away from all source of ignition and out of direct
sunlight. Store in a dry location away from heat.
• Keep away from incompatible materials. Keep containers tightly closed. Do not store in
unlabeled or wislabeled containers.
• Protect from moisture. Do not store near combustible materials. Keep containers well sealed.
Ensure pressure relief and adequate ventilation.
■ Store separately from organics and reducing materials. Avoid contamination that may lead to
decomposition.
Handling
• Avoid contact with eyes, skin, and clothing. Use with adequate ventilation.
• Do not swallow. Avoid breathing vapors, mists, or dust_ Do not eat, drink, or smoke in work
area.
• Prevent contact with combustible oI organic materials.
• Label containers and keep their tightly closed when not in use.
• Wash thoroughly after handling.

FIENVIRONMENTAL PRODUCTS
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MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 4 of 5
9. EXPOSURE CONTROLSIPERSONAL PROTECTION
Engineering Controls
■ General room ventilation is required. Local exhaust ventilation, process enclosures or other
engineers controls may be needed to maintain airborne levels below recommended exposure limits.
Avoid creating dust or mist. Maintain adequate ventilation. Do not use in closed or confined
spaces. Keep levels below exposure limits. To determine exposure limits, monitoring should be
performed regularly.
Respiratory Protection
• For many condition, no respiratory protection may be needed; however, in dusty or unknown
atmospheres or when exposures exceed limit values, wear a NIOSH approved respirator.
Eye/Face Protection
• Wear chemical safety goggles and a full face shield while handling this product.
Skin Protection
■ Prevent contact with this product. Wear gloves and protective clothing depending on condition of
use. Protective gloves: Chemical -resistant (Recommended materials: PVC, neoprene or rubber)
Other Protective Equipment
• Eye -wash station
• Safety shower
• Impervious clothing
• Rubber boots
General Hygiene Considerations
• Wash with soap and water before meal times and at the end of each work shift_ Good
manufacturing practices require gross amounts of any chemical removed from skin as soon as
practical, especially before eating or smoking.
10. STABILITY AND REACTIVITY
Stability
• Stable under normal conditions
Condition to Avoid
• Water
• Acids
+ Bases
• Salts of heavy metals
• Reducing agents
• Organic materials
• Flammable substances
Hazardous Decomposition Products
• Oxygen which supports combustion

rovectus
P
ENVIRONMENTAL PRODUCTS'
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 5 of 5
11. TOXICOLOGICAL INFORMATION
• LD50 Oral: Min.2000 mg/kg, rat
• LD50 Dermal: Min. 2000mg1kg, rat
• LD50 Inhalation: Min. 4580 mg/kg, rat
12. ECOLOGICAL INFORMATION
Ecotoxicological Information
■ Hazards for the environment is limited due to the product properties of no bioaccumulation, weak
solubility and precipitation in aquatic environment.
Chemical Fate Information
■ As indicated by chemical properties oxygen is released into the environment.
13. DISPOSAL CONSIDERATIONS
Waste Treatment
• Dispose of in an approved waste facility operated by an authorized contractor in compliance with
local regulations.
Package Treatment
• The empty and clean containers are to be recycled or disposed of in conformity with local
regulations.
14. TRANSPORT INFORMATION
• Proper Shipping Name: EHC-0
• Hazard Class: 5.1
• Labels: 5.1 (Oxidizer)
• Packing Group: II
15. REGULATORY INFORMATION
• SARA Section Yes
• SARA (313) Chemicals No
• EPA TSCA Inventory Appears
• Canadian WHMIS Classification C. D2B
• Canadian DSL Appears
• EJINECS Inventory Appears

Notice of Intent to Construct or Operate Injection Wells
Don Lee Auto Sales . Willow Sprim.!s, North Carolina
APPENDIXB
MONITORING WELL CONSTRUCTION DETAILS
/~TC
EIIYIRCNMUlll•GEOTEC!IHICAl
BIJILDIHSCIEKCES•M.I.TERlllSTESllN&"
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Lawrence D. Opper
Well Contractor Name
NC3322-A
NC Well Contractor Certification Number
Regional Probing Services
Company Name
2. Well Construction Permit#:
List all applicable well construction pennils (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
Dfudustrial/Commercial □Residential Water Supply (shared)
□Irri J:ation
Non-Water Supply Well:
0Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Storrnwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop) □Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under #21 Remarks)
4. Date Well(s) Completed: 1/29/2016
5. Well Location:
Betty Lucas Property Incident #3359
Facility/Owner Name Facility ID# (if applicable)
Red Hill Church Rd., & Ashe Ave, Dunn
Physical Address, City, and Zip
Harnett
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.340921 78.645067 ____________ N ______________ W
6. ls (are) the well(s): □Permanent or @Temporary
7. ls this a repair to an existing well: □Yes or E'INo
If this is a repair, fill out known well constn,ction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: 1 ------------For multiple i,yection or non-water supply wells ONLY with the same co11struction, you can
submit one form.
9. Total well depth below land surface: 20 (ft.)
For multiple wells list all depths if different (example-3@200' and 2@!00')
10. Static water level below top of casing: _a_p_p_r_O_X_._1_2 ______ (ft.)
If water level is above casing, use "+"
11. Borehole diameter: _4 _______ (in.)
12. Well construction method: direct-push ------------------(i.e. auger, rotary, cable, direct push, etc.)
13. FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ________ Method of test: _______ _
I For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
ft. ft.
ft. ft.
15. OUTER CASING lfor multi-cased wells\ OR LINER lif anulicable
FROM TO DIAMETER I TIDCKNESS I MATERIAL
ft. ft. in.
16. INNER CASING OR TUBING (oeothermal closed-Ioo ul
FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 5 ft. 2 in. sch 40 PVC
ft. ft. in.
17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
5 ft. 15 ft. 2 in. .010 sch40 PVC
ft. ft. in.
18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
0 ft. 3 ft. cement grout pour
3 ft. 4 ft. bentonite pour
ft. ft.
19. SAND/GRAVEL PACK (if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
4 ft. 20 ft. #2 sand pour
ft. ft.,
20. DRILLING LOG {attach additional sheets if necessa n )
FROM TO DESCRIPTION (color, hardness, soil/rocktyo e, i!'.-ain size, etc.)
0 ft. 15
15 ft. 20
ft.
ft.
ft.
ft.
ft.
21.REMARKS
22. Certification:
Lawrence
Opper
ft.
ft.
ft.
ft.
ft.
ft.
ft.
Oigi1all;r1l;,inedbyLiwrenceOpper
ON:cn-t.awrenceOpper,o .. 11eglonal
ProblngServlces,ou,
emiil=lanyltleglonalprobilly.com.c•US
0.ite :2C16.02.l310:28:32--0S'OO'
Signature of Certified Well Contractor
Silty Clay
Silty Sand
2/22/2016
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
24. Submittal Instructions:
24a. For· All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For In jection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supph & Geothermal Wells: fu addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
Amount: _________ completion of well construction to the couoty health department of the county
~1_3_b_._D_i_s1_·n_ti_ec_ti_'o_n_ty_p_e_::::::::::::::::::::::::::::::::::::::::::--_____________ ~ where constructed.
FormGW-1 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised Jan. 2013
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Lawrence D. Opper
Well Contractor Name
NC3322-A
NC Well Contractor Certification Nwnber
Regional Probing Services
Company Name
2. Well Construction Permit#:
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
□Agricultural □MunicipaVPublic
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□ Industrial/Commercial □Residential Water Supply (shared)
□Irric ation
Non-Water Supply Well:
0Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop) □Tracer
□Geothermal (Heating/Cooling Return) □ Other ( explain under #21 Remarks)
4. Date Well(s) Completed: 5/23/2016 MW-2, MW-3
5. Well Location:
Betty Lucas Property Incident #3359
Facility/Owner Name Facility ID# (ifapplicable)
Red Hill Church Rd., & Ashe Ave, Dunn
Physical Address, City, and Zip
Harnett
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.340923 78.64491 ___________ N ______________ W
6. ls (are) the well(s): □Permanent or @Temporary
7. ls this a repair to an existing well: □Yes or f"INo
If this is a repair,fill 0111 known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: _2 __________ _
For multiple injection or non-water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 20 (ft.)
For multiple wells list all depths ifdiflerellt (example-3@200' and 2@/00')
10. Static water level below top of casing: _a_p_p_r_O_X_._1_2 ______ (ft.)
If water level is above casing. use "+"
11. Borehole diameter: _4 _______ (in.)
12. Well construction method: direct-push ------------------(i.e. auger, rotary, cable, direct push, etc.)
13. FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ________ Method oftest: ______ _
13b. Disinfection type: Amount: ________ _
l For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
ft. ft.
ft. ft.
15. OUTER CASING (for multi-cased wells) OR LINER (if a ppllcablel
FROM TO I DIAMETER THICKNESS I MATERIAL
ft. ft. in.
16. INNER CASING OR TUBING (t!.eothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
0 ft. 5 ft. 2 in. sch 40 PVC
ft. ft. in.
17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
5 ft. 15 ft. 2 in. .010 sch40 PVC
ft. ft. in.
18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
0 ft. 3 ft. cement grout pour
3 ft. 4 ft. bentonite pour
ft. ft.
19. SAND/GRAVEL PACK (if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
4 ft. 20 ft. #2 sand pour
ft. ft.
20. DRILLING LOG (attach additional sheets ifnecessa rv)
FROM TO" DESCRIPTION (color, hardness soWrock ryp e, e,r11 in sizl!, etc.)
0 ft. 15
15 ft. 20
ft.
ft.
ft.
ft.
ft.
21.REMARKS
22. Certification:
Lawrence
O pper
ft.
ft.
ft.
ft.
ft.
ft.
ft.
Olgitall~s!griedll')'LaWA!!m:eOpper
ON:cn=Uw~~OJlper,c,c.Rl!91onal
PrablngseMces,o",
~m~nyO~ion.alpmblf19.Wm,c-U5
c»it~2016.0fi.040!il;ll235-04'00'
Signature of Certified Well Contractor
Silty Clay
Silty Sand
6/4/2016
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0/00 or 15A NCAC 02C .0200 Well Constn,ction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
24. Submittal Instructions:
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For In jection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion · of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27~99-1636
24c. For Water Supply & Geothermal 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 construction to the county health department of the county
where constructed.
FormGW-1 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised Jan. 2013
Notice of Intent to Construct or Operate injection Wells
Don Lee Auto Sales. Willow Sprints. North Carolina
APPENDIX C
ACCESS AGREEMENT FROM SITE PROPERTY OWNER
ATC
1.1111M11011 • Y111 1KIS
iiiV 111 nitlttr • vimuLT ttsnit

2Dl5 JUM ... 5 Pt-1 3: 14
UNDERGROUND STORAGE TANK SECTION
Mr. Hassan Osman
Hydrogeologist
DWM/UST Section
1637 Mail Service Center
Raleigh, NC 27699-1637
Dear Mr. Osman
May 7, 2015
RE: Former Southern Riders Motorcycle
1217 Red bill Church Road
Dunn, Harnett County, North Carolina
Incident Number: 3359
I am/We are the owner(s) of a parcel of property, located at or near the incident in question, and
hereby permit the Department of Environment and Natural Resources (Department) or its contractor to
enter upon said property for the puxpose of conducting an assessment and/or remediation of the
groundwater ~d/or soils under the authority of G.S. 143-215.94G.
I am/We are granting permission to the lands we own or control with the understanding that:
l. The investigation shall be conducted by the UST Section of the Department's Division of Waste
Management or its contractor.
2. The costs of construction and maintenance of the site and access shall be borne by the Department or
its con~c~or: '!Jie. p~~~! 9!" i~ ~n~ct2r ~.PT?!~!-~~ pr.~Y~1.:l:~ clam~ge _ to _the surrollildin_g
.Jand~. _Any damages will be resto!"¢.?.Y .t11-~_:Q9>~e.n~ or its_~-0~1:?ctor._to ~ ~l(?se to the pre•w.:C?rl,c
~9!]._dit!~n ~s pr~(?t~cal?ly pos~ible.
3. Unless otherwise agreed, the Department or its contractor shall have access to the site by the shortest
feasible route to the nearest public road. The Department or its contractor iwili notify the land owners
~8-.J>.Q~~-.P~~iJ<?. e~try_ ~~ may enter upon the land at reasonable times ~d have fiiii .right of access
during the period of the investigation.
4. Any claims which may arise against the Department or its contractor shall be governed by Article 31
of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State Departments and
Agencies, and as otherwise provided by law.
5. The information derived from the investigation shall be made available to the owner upon request and
is a public record, in accordance with G.S. 132-1.
6. The activities to be carried out by the Department or its contractor are for the primary benefit of the
Department and of the State of North Carolina. Any benefits accruing to the owner are incidental.
The Department or its contractor is not and shall not be construed to be an agent, employee, or
contractor of the landowner. No representations or warranties, either expressed or implied, have been
made to me/by the Department, the State of North Carolina, or its/their contractor(s) regarding the
results that may be obtained or the quality of work to be performed.
1/We agree not to interfere with, remove or any ways damage the Department's wells) or its
contractor's well(s) and equipment during the investigation.
Sincerely,
6 Lc,0. — rises
Signature
Vt�oajt" 44ft° ±one., li1S Weu.i SR)eG11
—Donn, e. aculeker
Type/Print Name of Owner or Agent
Uzi o di 'J
Phone Number
L70 e_.QC
Address
tori,A1 33(4-
City/StateZip Code
o ,/oal
Date
RE: Former Southern Riders Motorcycle~nui' cecco} Fes.*-'� ¢ !A r ire. -1es
1217 Red Hill Church Road
Dunn, Harnett County, NC
Incident Number: 3359