WI0600211_DEEMED FILES_20181108

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ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
lA.JL O 6 o 0211 2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
----------------------------------···
November 5, 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: Injection Event Record -Permit# WI0600211
Former Brooklyn Service Station
4601 Marracco Drive
Hope Mills, Cumberland County, North Carolina
NCDEQ Incident No. 9438
Dear Ms. Shrestha:
\t.CE\\JEDINCDEQ/D~ti
NOV O 8 2018
ATC Associates of North Carolina, P.C. (ATC) is submitting an Injection Event Record for the
former Brooklyn Service Station site on behalf of the North Carolina Department of Environmental
Quality State Lead Program. The record documents the installation of two Provect ORS sleeves
in monitoring well MW-2.
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
Former Brooklyn Service Station. Ho pe Mills. North Carolina
INJECTION EVENT RECORD
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North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number WI0600211
Permit Information
NCDEO
Permittee
-
Former Brookh n Service Station
Facility Name
4601 Marracco Drive. Hope Mills. Cumberland
County
Facility Address (include County)
Injection Contractor Information
ATC Associates of NC. P.C.
Injection Contractor / Company Name
Street Address 2725 E. MiIlbrook Road. Ste 121
Raleieh
City
NC
State
(919j 871-4999- _—
Area code — Phone number
27604
Zip Code
3. Well Information
Number of wells used for injection _ 1
WelI 1Ds MW-2
Were any new wells installed during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-1 form for each
well installed
Were any wells abandoned during this injection
event?
❑ Yes ®No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include a copy of the GW-30 for each well
abandoned
4. Injectaut Information
Provect ORS sleeve
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 75-85%
If the injectant is diluted please indicate the source
dilution fluid. Not Applicable
Total Volume Injected (gal) 692 in3 total sleeve vol.
Volume Injected per well (gal) 692 in3-sleeve vol.
5. Injection ITtstory
Injection date(s) October 31. 2018
Injection number (e.g. 3 of 5) l of 1
Is this the last injection at this site?
❑ Yes ® No
I DO HEREBY CERTIFY THAT ALL TIIE
INFORMATION ON TITS FORM 1S CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
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SIGNATURE OF INJECTION CONTRACTOR I iATE
ATC Associates of North Carolina. P.C.
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this torm 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
WI0600211
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Former Brooklyn Service Station
Location Address
4601 Maracco Dr
Hope Mills NC
Owner
Owner Name
Ncdeq State -Lead Program
Dates/Events
Orig Issue
10/12/2018
App Received
10/5/2018
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
28348
Draft Initiated
Scheduled
Issuance Public Notice
Central Files : APS SWP
10/12/2018
Permit Tracking Slip
Status
Active
Project Type
New Project
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Government -State
Owner Affiliation
Hassan Osman
1646 Mail Service Ctr
Raleigh
Region
Fayetteville
County
Cumberland
NC
Issue
10/12/2018
Effective
10/12/2018
27699
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
ATC
ENVIRONMENTAL • GEOTECHHICAL
BUILDING SCIENCES • MATERIALS TESTING
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
October 1, 2018
Ms. Sbristi Shrestha
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section,
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
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UIC Priggipt u aiity ?i,,
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Reference: Notice of Intent to Construct or Operate Injection Wells
Former Brooklyn Service Station
460I Marracco Drive
Hope Mills, Cumberland County, North Carolina
NCDEQ Incident No. 9438
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 one monitoring well 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.
VY-
Ashley M. Winkelman, P.G.
Senior Project Manager
cc: Hassan Osman, Hydrogeologist for NCDEQ
Attachments

Notice of intent to Construct or Operate injection Wells
Brooklyn Service Station_ Hope Mills_ North Carolina
NOTICE OF INTENT FORM
ATC
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North Carolina Department of Environmental Quality -Division of Water Resou·rces
NOTIFICATION OF INTENT (NOi) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C .0200. This form shall be submitted at least 2 WEEKS prior to injection.
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02c .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive 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 Injection 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 Injection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: October 1, 20 18 PERMIT NO. VV J O 0 0 02, I j (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
B.
C.
(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 ,tic,utalU'-N\'\,
___ Tracer Injection Well ................................... Complete section~~ ~w \?)
sr ~ tj 1\'i G C ' . r,.a\
STATUS OF WELL OWNER: Choose an item. ~~ ~e9~o t\
au~\ sec\.\O
\f'la\e\" a.\\o\"\s
WELL OWNER(S) -State name of Business/Agency, and Name and Title of person de ~~d authority to
sign on behalf of the business or agency:.
Name( s ): __ __,H=as=s=an=--=Oc...:s=m=an==--~H=v=dr=-=o""i!.=e=ol=o=g=is=t ,'-'N'--'-=-'orth=-=C=ar=-o=l=in=a=-=D=-=ep""'artm==e=n=t-=o=f=E=n'--'-v=ir=o=nm=e=nt=al=-".....,ua=li"--t '--
Mailing Address: ----=lc.=6~4=6=M=ai~l =S=erv~ic=e~C=en=t=er~--------------------
City: Raleigh State: NC Zip Code: 27699-1646 County:_W~ak=e ___ _
Day Tele No.: 919-707-8167 Cell No.: --~N~o_t_A_v_a_i_la_b_le ___ _
EMAIL Address: __ ~h=a=s=san=·=os=m=a=n=®=n=cd=e=nr==.g=o....:..v __ _ Fax No.: -----=-N=o=t-=-A=-vc.=a=il=a=bl=e'----
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page 1
D. PROPERTY OWNER(S) (if different than well owner)
Name and Title: --~D~arr~el=-1-=-F~o=rt-=-e ______________________ _
Company Name ---~N~o~t _A=p_p=li~ca~b~l~e ________________________ _
Mailing Address: --~6~0~6_3_G_a_ll_b_e~m~1_F_arm __ s _R_o_a_d ___________________ _
City: Ho pe Mills State: NC Zip Code:.-=2=83=---4-'---'8'------______ County: Cumberland
DayTeleNo.: 910-425-1326 Cell No.: ----=N-'-o=tc.:.A-=-v'--'a=il=a=bl=e ___ _
EMAIL Address: Not Available Fax No.: --~N-'---'o=t -=-A=vc.:.a1.=·1=a=bl=e ___ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Ashley M. Winkelman. Senior Pro ject Manager
Company Name ---=A=T~C"-A=--=ss=o=c=ia=t=es"-o=f=....cN~ort=-c=h --=C=ar=-o=l=in=a=-. -=-P_,_.C=.'------------------
Mailing Address: ---=2~72=5"-E~. M=il=lb=r-=-oo=k~R=o=ad=·--=S=u=it=e --=1=2-=-1 ________________ _
City: Raleigh State: NC Zip Code:~27~6~0~4 ____ County:~W~ak=e ___ _
Day Tele No.: 919-871-0999 Cell No.: __ ~9 ~19_-~83~0~-3~5~7~6 ___ _
EMAIL Address: __ ___;as=h""le .... y---'---.w'--'-=ink=e=lm=an=®=at=cccg=s.=c=om:=.__ Fax No.: __ ...:.7=37_,__--=2 -"----07'-----=82=6=-1 ___ _
F. PHYSICAL LOCATION OF WELl, SITE
(1) Facility Name & Address: Former Brooklyn Service Station
4601 Marracco Drive
City: --~H=o__.p_e~M~il-ls~ ____ County: Cumberland Zip Code: ---=2=8-=--34---'-8=--------
(2) Geographic Coordinates: Latitude**: :H,_0 ---=--5 _,__7' ____12__" or 0
Longitude**: ----'-7-=-8° 55' ___JQ" or 0
Reference Datum: __ ~W~G--=S--=8~4 ___ Accuracy: __ ~1~0~-m=et'--'e~r __ _
Method of Collection: DOO -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 ofinj. 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; 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. -Cross-sections were not identified in
previous reports submitted for the site.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
Deemed Permitted GW Remediation NOi Rev. 8-28-2017 Page 2
See Figures 1 and 2 for a site location and injection zone map. A groundwater flow direction map is included
as Figure 3. Figure 4 includes the contaminants of concern in groundwater.
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 two Provect ORS sleeves in monitoring well MW-2 in order to aide in natural attenuation and
reduce compounds concentrations to below the North Carolina Groundwater Quali tv Standards (2L Standards).
Based on the most recent sam pling event performed in A pril 2018 , naphthalene exceeded the 2L Standard in
MW-2 at 53.3 µg/L . The sleeves come in 3-foot sections. ATC will install two 3-foot sections at the base of
the well. across the well screen. The socks will release oxidizing solids into the groundwater for a pp roximately
6 months , at which point the chemicals in the sock will have de pleted.
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 http ://deg .nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/ground-water-protection/gr ound-water-a pproved-in jectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more irifo (919-
807-6496).
Injectant: --~P~r~o~v_e_ct_O~R=S~s~l~ee~v~e=s _______________________ _
Volume of injectant: 692 in3 -volume of socks
Concentration at point of injection: ___ 7.:..:5=----=8=5.._%~------------------
Percent if in a mixture with other injectants: --~N~o~t~A'-'='p=pl=ic=a=b""'l~e ____________ _
See Appendix A for MSDS information.
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: _____ 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
See Appendix B for well construction details. Note that a GW-1 form was not provided for the well; however,
it was documented that South Atlantic Environmental Drilling and Construction Company, Inc. had installed
the well.
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page 3
L. SCHEDULES -Briefly describe the schedule for well construction and injection activities.
A pp roximatel y two weeks after submitting the NOL ATC will install two Provect ORS sleeves in monitorin g
well MW-2.
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.
A TC will collect one samp le a pp roximatel y 6 months after the installation of the Provect ORS sleeves in MW-
2 (October 2018 . with sam pling to occur A pril 2019 ). During the sam plin g event. ATC will collect a sam ple
from monitorin!! well MW-2 for anal ysis of volatile organic com pounds by EPA Method 6200B. The sam ple
will be shi pp ed to SGS Accustest in Scott, Louisiana. ATC will also measure dissolved oxyg en. conductivi ty,
tem perature , pH . and oxygen reduction potential in MW-2 durin g the A pril 2019 sam pling 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 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 appurtenances in accordance with the 15A NCAC 02C 0200 Rules."
/"'' I ~
Signature of Applicant
Ashle y Winkelman on behalf of Hassan Osman. NCDEO
(see Authorization to sign on next page)
Print or Type Full Name and Title
PROPERTY OWNER (i f the pro pe rty is not owned b y the permit a pp licant):
"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
(.1 5A 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.
See A pp endix C Darrell Forte
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 TWO hard copies of the completed application package with an electronic version in CD or
USB Flash Drive to:
Deemed Permitted GW Remediation NOI Rev. 8-28-2017
DWR -UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Page4
Ashley Winkelman
From:
Sent:
Osman, Hassan < hassan [e-mail]>
Tuesday, July 24, 2018 3:16 PM
To: Ashley Winkelman
Subject: FW: WI0600204 NOI Sampson Tire -Provectus ORS
FYI
Thanks
From: Rogers, Michael
Sent: Tuesday, July 24, 2018 3:14 PM
To: Osman, Hassan <[e-mail]>
Cc: Shrestha, Shristi R <[e-mail]>
Subject: RE: WI0600204 NOi Sampson Tire -Provectus ORS
Ok, thanks. Please print out this email and attach to all NOls moving forward when she signs so you will not get
inquiries.
From: Osman, Hassan
Sent: Tuesday, July 24, 2018 3:04 PM
To: Rogers, Michael <michael.ro gers @ncdenr.gov>
Subject: RE: WI0600204 NOi Sampson Tire -Provectus ORS
Hi Michael:
Jam a1,1thorjzjngA5hiey Winkelma n from ATCA ssocTaE;-. N()J° as"' . a ent -Turbw&t. lfy_QJJ hall£' any
·f!f~ m ~ inc.ire r nformation, please" iet m kno~.
Thanks
From: Rogers, Michael
Sent: Tuesday, July 24, 2018 2:50 PM
To: Osman, Hassan <hassan.osman @ncdenr.g ov>
Subject: RE: WI0600204 NOi Sampson Tire -Provectus ORS
Would you send me a letter or email from you authorizing Ashely to sign as an Agent for DWM. You can use a copy of
this email to attach to all NOls moving forward.
Thanks
From: Osman, Hassan
Sent: Tuesday, July 24, 2018 2:34 PM
To: Rogers, Michael <michael.ro gers @ncdenr.gov>
Subject: RE: WI0600204 NOi Sampson Tire -Provectus ORS
Yes.
1
Notice of Intent to Construct or Operate Injection Wells
Brookl yn Service Station . Ho pe Mill . North Carolina
FIGURES
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ATC
NEVI RENMENIAL • GEOIECEMI CAL
OOIIEIMO SCIENCES • MATERIALS TESTING
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
[phone]
PROJECT NO: SLP0943801
DATE: 3/17/15
1 inch = 3,860 feet 1 REVIEWED BY: KRS
FIGURE 1
SITE TOPOGRAPHIC MAP
Former Brooklyn Service Station
incident #9438
4601 Marracco Drive
Hope Mills, North Carolina

Notice oflntent to Construct or Operate Injection Wells
Brooklyn Service Station. Ho pe Mills . North Carolina
APPENDIX A
MSDSFORM
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IUllDIH UIEICES • IATDWJ TmllC
p rovectus
ENVIRONMENTAL PRODUCTS'
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 1 of 5
1. PRODUCT IDENTIFICATION: PROVECT-ORS
PRODUCT USE: Soil and water treatment.
MANUFACTURER: EMERGENCY PHONE:
PROVECTUS ENVIRONMENTAL
2871 W. Forest Rd., Suite 2
Freeport, IL
61032
USA: (1$15) 650-2230
TRANSPORTATION OF DANGEROUS GOOD CLASSIFICATION:
Oxidizing Solid, n.o.s. (Calcium Peroxide), Class 5.1, PG II, UN1479
WHMIS CLASSIFICATION:
Oxidizer
2. COMPOSFHONIINFORMATION ON INGREDIENTS
Ingredients
Calcium Peroxide
Inorganic Nutrients
3. PHYSICAL DATA
Chemical Formula
CaO2
CAS No_ Percentage
1305-79-9 75%-85%
15%-25%
Appearance White & brown granules
Physical state Solid
Odor threshold, None
Bulk Density 500--650g%L
Solubility in Water Insoluble
pH -11
Decomposition Ternperarure 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 <1% 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 crvstalline silica_
Potential Health Effects:
• General Irritating to mucous membrane and eyes.

rovectus
ENVIRONMENTAL PRODUCTS'
MATERIAL SAFETY DATA SHEET:
PROVECT-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 A]D 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
Flammability
• Not applicable
Ignition Temperature
• Not applicable
Danger of Explosion
• Non -explosive
Extinguishing Media
• Water
Fire Hazards
• Oxidizer. Storage vessels involved in a fire may vent gas or rupture due to internal pressure.
Damp material may decompose exothermically and ignite combustibles. Oxygen release due to
exothermic decomposition may support combustion. May ignite other combustible materials.
Avoid contact with incompatible materials such as heavy metals, reducing agents, acids, bases,

' rovectus
ENVIRONMENTAL PRODUCTS"
MATERIAL SAFETY DATA Sm ET:
PROVECT-ORS Page: 3 of 5
combustible (wood, papers, cloths etc.) Thermal decomposition releases oxygen and heat.
Pressure bursts may occur due to gas evolution. Pressurization if confined when heated or
decomposing. Containers may burst violently.
Fire Fighting Measures
■ Evacuate all non -essential personnel
■ Wear protective clothing and self-contained breathing apparatus.
• Remain upwind of fire to avoid hazardous vapors and decomposition products.
• Use water spray to cool fire- exposed containers.
7. ACCIDENTAL RELEASE MEASURES
Spill Clean-up Procedure
• Oxidizer. Eliminate all sources of ignition. Evacuate unprotected personnel from equipment
recommendations found in Section 9. Never exceed any occupational exposure limit.
• Shovel or sweep material into plastic bags or vented containers for disposal. Do not retum spilled
or contaminated material to inventory. Avoid maldng dust.
• Flush remaining area with water to remove trace residue and dispose of properly. Avoid direct
discharge to sewers and surface waters. Notify authorities if entry occurs.
• Do not touch or walk through spilled material. Keep away from combustibles (wood, paper, oils,
etc.). Do not return product to container because of risk of contamination.
S. HANDLING AND STORAGE
Storage
• Oxidizer. Store in a cool, well -ventilated area away from all source of ignition and out of direct
sunlight. Store in a dry location away from heat.
• beep away from incompatible materials. Keep containers tightly dosed. Do not store in
unlabeled or nuslabeled 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 or organic materials.
• Label containers and keep them tightly closed when not in use.
■ Wash thoroughly after handling.

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ENVIRONMENTAL PRODUCTS'
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MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 4 of 5
9. EXPOSURE CONTROLS/PERSONAL 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

trovectus
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. 2000mglkg, rat
• LD50 Inhalation: Min. 4580 mg/kg, rat
12. ECOLOGICAL INFORMATION
Ecotoxicologicai Information
• Hazards for the environment is limited due to the product properties of no bioaccurnulation, 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-O
• Hazard Class: 5.1
• Labels: 5.1 (Oxidizer)
• Packing Group: I1
15. REGULATORY INFORMATION
• SARA Section Yes
• SARA (313) Chemicals No
• EPA TSCA Inventory Appears
• Canadian WHMIS Classification C, D2B
• Canadian DSL Appears
• EINECS Inventory Appears

Notice of Intent to Construct or Operate Injection Wells
Brookl! f] Service Station, Hope Mills, North Carolina
APPENDIX B
MONITORING WELL CONSTRUCTION DETAILS
4NIritllflW •C11RCilICtl
PM19iM ssnlees • Y1Pua1 nsnP

.,
I
C?1-1anda:x -W ELL L OG:
Permit# NIA Dril Date 02/12/01 Site
Cff ent NCFTF Use Monitor Well Handex Loe. #
Ad dress Marracco Drive, Ho oe MIiis, NC Total Oeoth (ft)
Drillin g Method Hollow Stem Borin g De pth (ft) 13.0 Borin g Diam. fi n}
Casing/Scm . Mat Sch.40PVC Csg/Scm Diam (in) 2 Csg Length(ft)
Grout Type Portland Grout Interval (ft) .5 to 2 Scm Length (ft)
Csg Seal Type Bentonlte Seal Interval {ft) 2 to 3 Scm Slot Size {in)
Sand Pack Type Sand Sand Interval (ft) 3 to 13 Static Water Level
Rmrks Soll cutt/na s p laced Into TOC Elevation Sam Dle Method
~ g .!! g io E
QI Cl..c l 8: .c C. Ea .Geolog ic Description a E <( QI IIJ Q)
IV en Cl iii > C ti)' 0
0 Asphalt -
-Fill material, tan c:lavey SILT, moist
4-6 400 Tan line to coa111e SAND, saturated -
-
10 -
-
-
-Boring terminated and monitor \Wll lnstal1ed to 13.0 feet
Screen set from 3 to 13 feel GrouniMatar encountered -
20 -at 3.92 on 2/14/01.
-
-
-
-
30 -
-
-
-
-
40 -
-
-
-
-
50 -
-
-
-
-
Notes:
Geologist J.Kapolka Driller: Saedacco, Inc.
MW-2
Brooklyn #9438
122465
13.0
8
3
10
·-0.010
3.92
Hand aug er/Spllt..aooon
Typical
Diagram ,6l!Willir-
i JI :l
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l r---;IO:== ~~~
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Ii,{· HA NDEX® er ... •·
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Notice of Intent to Construct or Operate Injection Wells
Brooklyn Service Station , Hope Mills. North Carolina
APPENDIXC
ACCESS AGREEMENT FROM SITE PROPERTY OWNER
/4..TC
!HIIIIUIENTll • mncimm
IIIIUIMC.SCIENtH•HTEILILSlUJIII I
Mr. Kevin C. Zegeer .
North Carolina Department of Environment and Natural Resources
Division of Waste Manage
UST Section
163 7 Mail Service Center
Raleigh, North Carolina 27699-1637
Reference: Site Access Agreement
Former Brooklyn Service Center
4601 Marra~co Drive
Hope Mills, Cumberland County, North Carolina
Cumberland County Tax·Parcel #0424-40.;0099
NCDENR incident No.: 9438
Dear Mr. Zegeer:
I am/We are the Owner(s)/Agent(s) of a parcel of property, located at or the incident in question,
and hereby permit the Department of Environment and Natural Resources (Department) or its
contractor(s) to enter upon said property for the purpose of conducting an investigation of the
groundwater under the authority of G. S. 143-215.3(a)2.
I am/We are granting permission with the understanding that:
• The investigation will be conducted by the UST Section of the Department's Division of
Waste Management or its contractor(s). The investigation may include soil and
groundwater sampling, borehole drilling, monitoring well installation, petroleum
underground storage tank (UST) removal, etc.
• The cost of site investigation and maintenance shall be borne by the Department or its
contractor. The Department or its contractor .shall protect and prevent damage to the
surrounding lands.
• 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 may enter
upon t.lie !a..11d at reasonable times and have full right of access during the period of the
assessment investigation.
• 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
Department and Agencies, and as otherwise provided by law.
• 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.
• The activities to be cai.Tied 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.
Access Agreement
Former Brooklyn Service Center
4601 Marracco Drive
Hope Mills, Cumberland County, North Carolina
NCDENR Incident No.: 9438
IItiIe agree not to interfere with, remove, or any way damage the Department's well(s) or its
contractor's well(s), or equipment during the on -going investigation.
Sincerely,
m)._4 /-4--dea ,. 1/
et rie-
Date Type/Print Name of Owner or Agent
Signature
6,03 S/h
Address
Date Type/Print Name of Owner or Agent
ar;ttn s Lei hic2e °e`1. . Ale bgicif
City/State/Zip Code
Address City/State/Zip Code
Vo0,24
Telephone No. (Home)
Telephone No. (Work)
2

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NOTES:
TITLE FIGURE 2
SITE MAP
FORMER BROOKLYN SERVICE STATION - INCIDENT #9438
4601 MARRACCO DRIVE
HOPE MILLS, NORTH CAROLINA
Raleigh, North Carolina 27604
[phone] FAX [phone]
,ETC
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
CAD FILE
1254122,DW0
TYPE CODE
PREP, BY
LA
REV. BY
SCALE
1" = 40'
DATE
05-15-2018
PROJECT NO.
SLP0943801

05� 15. 2008 4:1P;m - S1homl.yan - 11:' 125 - ATC'_1254122-0-05-t5-1&drr•,
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GROUNDWATER ELEVATION CONTOUR (ft.)
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Hydraulic Gradient: 0.0046 ft/ft
/
/
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/
/
000
/
95.6
N
NOTES:
1, GROUNDWATER ELEVATIONS WERE MEASURED ON
04/04/2018.
TITLE FIGURE 3
GROUNDWATER ELEVATION CONTOUR MAP
FORMER BROOKLYN SERVICE STATION - INCIDENT #9438
4601 MARRACCO DRIVE
HOPE MILLS, NORTH CAROLINA
Raleigh, North Carolina 27604
j819) 811.08911 FAX (919)871-D335
ATC
ENVIRONMENTAL • GEOTECNNICAL
BUILDING SCIENCES • MATERIALS TESTING
CAD FILE
1254122, DWG
TYPE CODE
PREP. BY
LA
REV. BY
SCALE
1" = 401
DATE
05-15-2018
PROJECT NO.
SLP0943801

05..15:2010 4 49c.4.rt - SLhompson - H! 125 - ATC\__1254122.j 1-05-15-16.cirri
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NOTES'
1. GROUNDWATER SAMPLES WERE COLLECTED ON
04/04/2018.
TITLE FIGURE 4
DISSOLVED NAPHTHALENE ISOCONCENTRA11ON CONTOUR MAP
FORMER BROOKLYN SERVICE STATION — INCIDENT #9438
4601 MARRACCO DRIVE
HOPE MILLS, NORTH CAROLINA
Raleigh, North Carolina 27604
[919)871-0999 FAX (919)B71-0335
ATC
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
CAD FILE
1254122.DWG
TYPE CODE
PREP. BY
LA
REV, BY
SCALE
1' = 40'
DATE
05-15-2018
PROJECT NO.
SLP0943801