WI0700424_DEEMED FILES_20160414

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Resources
Permit Number_w_10_10_04_24 ____ _
1. Permit Information
Riverbanks Properties, LLC -Charles Dees
Permittee
Gussman Cleaners
Facility Name
223 Craven St, New Bern, NC 28560
Facility Address
2. Injection Contractor Information
Terraquest Environmental Consultants, P .C.
Injection Contractor/ Company Name
Street Address 100 E. Ruffin St
Mebane NC 27302
City State Zip Code
[phone]
Area code -Phone number
3. Well Information
Number of wells used for injection _3 ___ _
Well names MW1, MW2, MW3
Were any new wells installed during this injection
event?
D Yes Ii] No
lf yes, please provide the following information:
Number of Monitoring Wells _____ _
Number oflnjection We11s ______ _
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-I form for each
well installed.
Were any wells abandoned during this injection
event?
D Yes Ii] No
If yes, please provide the following information:
Number of Monitoring Wells _____ _
Number oflnjection Wells _______ _
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
Oxygen BioChem
Injectant Type
Concentration =solubility=? weight %
If the injectant is diluted please indicate the source
dilution fluid. municipal water ·------------
Total Volume Injec~ed 0,6 gallons
Volume Injected per w~ll 0.2 gallon/well
5. Injection History
Injection date(s)_4_J_1_4_J_1 _6 ______ _
Injection number (e.g. 3 of 5),_1_o_f_B ___ _
Is this the last injection at this site?
D Yes Ii] 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.
t-r>./4 Oigimny signed by Ryan D. Kerins
ON: en•Ryao 0 . Kerins, o. au. emal =crdkarir1s@lem11quastpc;,com,
C'!'l,JS
Oate;2018.04.191!5;52;02-04'00'
SIGNATURE OF INJECTION CONTRACTOR DATE
Ryan D. Kerins
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, NC27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 8/5/2013
Q 1
Permit Number WI0700424
program Category
Deemed Ground Water
Permit Type
Injection Deemed In-situ Groundwater Remediation Well -Primary Reviewer
michael.rogers
Coastal SWRule
Permitted Flow
Facility
Facility Name
Gussman Cleaners
Location Address
223 Craven St
New Bern
Owner
Owner Name
Riverbanks Properties LLC
Dates/Events
NC
Orig Issue
1/5/2016
App Received
1/4/2016
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
28560
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS __ SWP
1/6/2016
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Washington
County
Craven
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
Charles Dees
PO Box 1506
New Bern
Issue
1/5/2016
Effective
1/5/2016
NC 28563
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasln
Ro gers, Michael
From: Rogers, Michael
Sent:
To:
Wednesday, January 06, 2016 10:12 AM
May, David; Tankard, Robert
Subject:
Attachments:
FW: WI0700424 Riverbanks Properties
20160106093501379.pdf
Please find attached a NOi> this is part 1 of 2. Thanks.
-----Original Message-----
From: Michael Rogers [mailto:[e-mail]]
Sent: Wednesday, January 06, 2016 9:35 AM
To: Rogers, Michael <[e-mail]>
Subject:
This E-mail was sent from "RNPAC7DD0" (Aficio 2075).
Scan Date: 01.06.2016 09:35:01 (-0500)
Queries to: [e-mail]
1
Ro gers, Michael
From:
Sent:
To:
Subject:
Attachments:
NOi part 2 of 2.
Rogers, Michael ·
Wednesday, January 06, 2016 10:14 AM
May, David; Tankard, Robert
FW: NOi -WI0700424 Riverbanks Properties -New Bern -Gussman Cleaners Part 2 of 2.
In Situ Remediation Notification-OBC Socks -Figure 1 Site Location.pdf; In Situ Remediation
Notification-OBC Socks -Figure 2 Site Vicinity.pdf; In Situ Remediation Notification-CBC
Socks -Figure 3 GWA.pdf; In Situ Remediation Notification-OBC Socks -Figure 4 X-
section .pdf; In Situ Remediation Notification-OBC Socks -Well Construction Records -Soil
Boring Logs .pdf; In S itu Remediation Notification-CBC Socks -OBC MSDS.pdf
From: Ryan Kerins [mailto:[e-mail]]
Sent: Tuesday, January 05, 2016 10:28 AM
To: Rogers, Michael <[e-mail]>
Subject: NOi -Riverbanks Properties -New Bern -Gussman Cleaners
Attached are the missing files for our NOi. Thanks Michael!
Ryan Kerins
Terraquest Environmental Consultants, P.C.
100 E Ruffin St, Mebane, NC 27302
919 .563 .9091
1
/Let,' '14 M
s Y6/6-
DATE: November 17
A.
B.
C.
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT 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 l5A NCAC 02C .0200. This form shall be submitted at least 2 weeks prior to injection.
AQUIFER TEST WELLS (t5A NCAC 02C .02201
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics,
IN SITU REMEDIAT 1ON (15A NCAC 02C .02251 or TRACER WELLS 1 l5A NCAC 02C .02291:
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small -Scale Injection Operations - Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall he required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility ofa
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
Print Clearty or Type Information. Illegible Submittals Will Be Returned As Incomplete.
PERMIT NO. i ;'._ I • r - f ' i+' ; iv '
, 20 15
WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well
(2) Aquifer Test Well
(3) X Passive Injection System
(4) Small -Scale Injection Operation.
(5) Pilot Test
(6) Tracer Injection Well
STATUS OF WELL OWNER: Business/Organization
JAW 4 4 7016
.Complete sections B -F,atiRegional
�1!lfBxiQils $8Coo11
.Complete sections B-F, IC, N
Complete sections B-F, H-N
Complete sections B-N
Complete sections B-N
.Complete sections B-N
WELL OWNER - State name of entity and name of person delegated authority to sign on behalf of the business
or agency:
Name:
Riverbanks Properties. LLC - Charles Dees
Mailing Address: PO Box 1506
City: New Bern State: NC Zip Code: 28563 County: Craven
Day Tele No.: 252-229-3830
EMAIL Address_rbkconstruction'ii)suddenlink.net
CeI1 No.:
Fax No.:
UIC/In Sias Remed. Notification (Revised 11/19/2U13)
Page 1

D. PROPERTY OWNER (if different than well owner)
Name: ---~P~o=lo~E=n=te'-'-rp"'"'n=·s=e=s"""'. L=L~C ______ _
Mailing Address: ___ 11_5_W~al~d~e_n _R~d _____________ _
City: New Bern State: N~C __ Zip Code: _2_85_6_2 ___ County: Craven
DayTeleNo.: __________ Cell No.: __________ _
EMAIL Address:_________ Fax No.: __________ _
E. PROJECT CONTACT-Person who can answer technical questions about the proposed injection project.
Name: _______ R __ y~an~K~e~r_in~s _________________________ _
Mailing Address: -----------"'---10=0'-'E=R=u=ffi=m=S-=---t ___________________ _
City: ------=M=eb=an=e'--------State: NC Zip Code: 27302 County: Alamance
Day Tele No.: ____ 9~1~9~-5_6~3_-9_0-9-1 _____ _ Cell No.: 919-906-0960
EMAIL Address: ___ r_dk_er_i_ns~@_.._.te_rr_a ___ q._u_es_t..,_pc_._co_m __ _ Fax No.: --~9---"'-1~9---=5-=63=-----"'--9=09"---=5'---------
F. PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: ----=22=3=-=C=ra~v~e=n~S=t'---------
City: New Bern State: NC Zip Code: ~2~85~6~0 ____ County: Craven
(2) Geographic Coordinates: Latitude**: 35 __ 0 _6 __ ' 20.8_" or _____ 0
Longitude**: 77 __ 0 _2 __ ' 20.1_" or _____ 0
Reference Datum: World Geodetic Sv stem of 1984 (WGS84) datum
Accuracy: error is less than 2cm Method of Collection: Goo gl e Maps
**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 ofinj. well network: square feet (:5 10,000 tt:2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be _:s 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS -Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
UIC/In Situ Remed. Notification (Revised 11/19/2013) Page2
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity.
The purpose of the injection is to provide oxygen to enhance natural degr adation of petroleum-typ e com pounds
from a varsol release at a dry cleaners. Oxygen BioChem socks will be placed in monitoring wells MW l, MW2,
and MW3. The goal is to lower the existing concentrations of 1-Methylna phthalene below the 2L Standards.
J. INJECT ANTS -Provide a MSDS and the following for each injectant. Attach additional sheets if necessary.
NOTE: Approved irif ectants (tracers and remediation additives) can be found online at
http://portal.ncdenr.org/weblwqlapslgwpro. All other substances must be reviewed by the Division of Public
Health, Department of Health and Human Services. Contact the UJC Program for more info (919-807-64 96).
Injectant: Oxygen BioChem
Volume ofinjectant: _The volume is 0.2 gallons of solid per point. ________ _
Concentration at point of injection: The solubilitv is a pproximately 7 wei gh t percent, so that is the
concentration.
Percent if in a mixture with other injectants: 100%~(=n=o~o=th=e=r~) __________ _
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" __ ----=3 ___ Existing
(2) 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:
(a) well type as permanent, direct-push, or subsurface distribution system (infiltration gallery)
(b) depth below land surface of grout, screen, and casing intervals
( c) well contractor name and certification number
UIC/In Situ Rerned. Notification (Revised 11/19/2013) Page 3
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Monitorinwells already exist. Well socks will be hung in December 2015.
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.
The addition of oxygen to the subsurface is not expected to create anv further 2L violations but to reduce them.
Terraquest will sample the groundwater at the site for the target VOCs approximately 3-6 months following sock
placement.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certif +, under penalty of law, that 1 am familiar with the information submitted in this
docwnent and all attachments thereto and that, based on my inquiry of those individuals immediately responsible
for obtaining said information,) 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 a •; o construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related irten'ances in accordance with the 15A NCAC 02C 0200 Rules."
Signa ifr .uLApplicant
Riverbanks Properties. L1C - Charles Dees
Print or Type Full Name
PROPERTY OWNER if the property is not owned by the permit appjicantj:
"As owner of the property on which the injection wells) 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 .0200i. "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its cons Eton on land shall be deemed to vest ownership in the land owner, in the
absence of contrary apeem nt n writing,
Polo Enterprises. LLC - Y f s%
Signature* of Prop ty OCrir (if different from applicant) Print or Type Full Name
* An acce4 agreement etween the applicant and property owner may be submitted in lieu ofa signature on this form.
Submit one copy of the completed notification package to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699- 1 636
Telephone_ [phone]
UIC/In Situ Reined. Notification (Revised 1111912013) Page 4

WELL CONSTRUCTION RECORD
This fonn can~ used for single or multiple w,11,
J. Well Contractor Information:
Jonathan Grllbbs
WeU Contractor Narne
3001
NC Well Conlra~or C.:rtifioation Numb<r
Terraquest Envirohrnental Consultants, P .C.
Company Name
2. Well Constructio11Perm.it#:
Li,Jt qlf.applit ilbfr. u"f!1/ permits (U:,.Cm!nlJ'. Sias.!, l-'(1rl,wc.!, l1Jj1.•c1_io11, _elt:.}
3. Well Use (ehel'k well use):
Water Suppl)' Well:
□Agricultuml tlMui1icipal/J>ublic
□Geo.th~rma l (Heating/<;ooling Supply) □Resident ial Water Supply (single)
Dlndustrial/~ommerc jal □Residentia l Water Supply (shared)
□Irrigation
l\'011-WalffS11pply Wtll:
0Moriitoring □Rceovel)'
Tnjcrtion Well:
□Aquifer Recharge □Groundwater ·Remediation
□Aquifer Storage and Rcco,·el)' □Sa!iuiiy Barrier
□Aquifer Test □Stormw:ite r Drainage
OE.~perimenial Technology □Subsi<;le nce Co nt ro l
OGe.oth.ermal (Closed Loo p) □Tracer
□Geotherma l lHeating/Coo!ing Return) □Other (e~p lain under #21 Remarks)
4. D.1te Well(s) Compklcd: 7/6/15 Wellfl)liMW1
Sa . Well Location :
Gussman Cleaners
f:oC:ility/Owner Nam-c Facility lDii (if •Pt>licable}
223 Craven St. New Bern, NC
Ph rsical Address, City, and Zip
Craven 8-001-C ~097
Co!Ulfy Par~cl ldentiftcationJl/o. (PIN)
Sb , Lotitude :rod LongifutTe in degrees/min111.cs/seco111ls or dedm:tl degrees:
(if\\'cll !idil. on;, faLnon g is sufficient)
35.1057 N -77.0389 \V
6. Is (arc}tlrc well($): @Permanent or □Temporn,-y
7. rs this a repni.r lo :1n c.d sting 1nll: □Yes .or ~No
ff1Jt i:r ;r a rt pair,fill out t 1imrn ,rel/ t·onsln1<_Jiiui i11foh1mlio11 and explai11 l_he.. 1,n/nf.:.of tlk
• r .-:pair·1i1it.ft!.r !i l J umark.-r s~•.._•fio11 or on llh! ~1i.:k of this form.
8 . Number of ,wlfs constrnrtcd: _1.,....---.----,-----
Fo, multiple. itifecl/Oll_"()f 11ai1--w~ir .rnpply wdls.. Oi\'J ... )' with tire suml! C(tJISffllCfii.111, p.ni .COil .
3ut.mil Qi1i!fnm1. · ·
! For Internal Use ONJS.:
14. WATER ZONE".S
FROM TO DESCRIPTION ·
ft . rt.
ft. (t:
l S. OlffER CASING (formulli-t .ued wollil ORLINER.lir a nr,licJihl,.)
FROM I TO DIA.\IETER ·rtt1CK/1/ESS .\UTERrAl.
ft; ft. io~
J6. JNt\'tR.CASING OR TUBJNG .(2fothermal ·t10,ed-lon nl
J'ROM TO DUMF.TER TIU{'KNESS MATERIAL
. ft .. .ft . ln:
ft. ft. in.
l?,SCREl::l'.',
FROM TO DIAMETER 51.0TSIZE Tlllt:Kl\'£SS 1\IATERIA L
5 : ft. 15 rt, 2in -ill. .010 Sch.40 PVC
ff. ft. in.
18,GROut
fl\OM I 'IO MATERIAL EMPLACEMEl'ff METHOD & AMOUNT
0 ~5 r,. 2 Jt, Portland Pour
2 (t. 3 (t. Bentonite Pour
ft. ft..
19. SAND/CR,\ VF.L PACK . if o olirablr)
FllOM TO ,\J.\Tf.RIAL EMPLACDIE1'T METIIOD
3 rr. 15 ft. No.2 Sand Pour
r,. ft.
iD. J)RILLJNC LOG iatt~ch addiiloaal •hr.is l(nttus~n ·)
t'll.OM TO DESCRIPTION (ulor, banlnf'.!f1 soll!rock tn 1r, u ain si:T.t, ~le.)
0 ft. 1 (t. Concrete .
1 rt. 9 (t. Sand (SC), grey, loose, fine grained
9 n. 15 n. Sandy Fat Clay (CH) grey,sliff,clay,fine sand
rr. ft .
ft. ft.
ft; (t.
fr. ft.
21 .REMARKS
~~::;~
C-, V o~!Lsz 7/18/15
' . S1gnoture ofC'•rl1fitd \\ •ll Ct'ntra.::tor -
ny s1~1ing tltis farm, I INuby r,:-rJify tbar tlii! lrt!ll(s) 11·.cH 6 ••tr.!} caiutn,c:u,1 in nu 11;<1m,ce
n-ii/t ./5A XC:A C OZC .Q/(JO or /5ANCAC 02C .OWO HWi C<mstr11aion Smi,lar,ls aiid tha1 a
C(IP),' af th.is r L'~llrd -has been pr<n·idi!il ltJ rJ,,, u•e// ou·11 l"1·,
. 23:Site:diagrnm or addllional well details;
You may use lhc back of this pag~ to provid e additiona l well site details or well
construction d etails. You may al so attach additional pages if necessary.
SlIBi\JITTAL L-..:STUCTIONS ......... -... ·-······-~-·
9. Total uell depth below land surface: _1_5_'__,,....---,--,------(ft.) 24,,, For All Wells: Submit this fom, \\i1hin 30 days of completion of well
For r,11i/1ipl• ,.-,//, list olf d<pths if diff~r,,11 (ex,infp/e-J @]00 · nJ(,f 1@;/0Q') construction to the follo"i ng:
7.06' 10 .. Statk water lhel bel ow tap of ca.sing: ____________ (ft.}
/f1i'f''~' Je,'.d is abo~·"; co.ri1Jg , ttrc :•-;-"
ll. JJorcholcdiameter: 8 .2S" (in.)
12. Well constrnctio.n method: Hollow-Stem Auger
(ic, aug<r .. <OW}\ <•bk, dir«t pu;h, <re.)
FOR WATER SUPPL\'WELLSOXLY:
13a. Yield (g11111) _____ _ ~fothod oftest : _____ _
Di\•ision of Water Resource~, Information Processing Unit,
1617 Mail Scn·ice Centci-, Raleigh, NC27699cl617
2-lb. For In jec t ion Wells ONLY:. rn addition to sending the fom i to tr,e ad dress in
24a abo\'e, also submit a copy of this fonn within 30 days of completion of well
con struction ·to the following: · ·
Ilh·isio11 of Water Resources, U nderground fojccti on Control Prog·rnm,
1636 Mai! Sen·ic~ C~nter, Ralrigh, NC 27699-i636
2-k For Waler S11 p11Jr & . .Inj ection Wells:.
A lso submi t one copy of this form within 30 days of completion of
13b, l)isinferlion type.: Amount: we ll cons1mct ii.1n to 1h~ county health depa rtment of the county where
L ~...::.:.:.:.::.:.::.:.:.::.::.::_~:.:.::.=======:......:..:.:.:.::...::..:..::..:=========.J constrncted .
formGW-1 :t\•orth Carolina °"=partmtnt o fl::n.vironmen1 and Natura.I Re-som ,e s -Di\·i:s ion of \Va.tc r Rrsour(eS Rn is,d Augu st 2013
TERRA
uest
EI RO vf. lTatl 10.6.-ammu
COWSULTMAS. P.C.
GRAPHIC LETTER
SYMBOL SYMBOL TYPICAL DESCRIPTION
'�'ffo
�0Y o
� P
f 1 011
0
00
0
0
0
0
90
00
0
P`
0r
rc
GW
Well —graded gravels, gravel —
sand mixtures.
GP Poorly —graded gravels. gravel —
sand mixtures.
GM Silty gravels. grovel —silt --sand
mixtures.
GC
SW
sP
SM
SC
Clayey gravels, grovel —sand —clay
mixtures.
Well —graded sands, gravelly sands.
Paariy—groded sands. gravelly —sands
Silty sands. sand —silk mixtures.
Clayey sands, sand —cloy mixtures.
WELL COMPLETION SYMBOLS
•
PORTtAND CEMENT
BENTONITE
WELL SAND
LEGEND FOR SOIL BORING
LOGS AND WELL COMPLETION
DIAGRAMS
GRAPHIC LETTER
SYMBOL SYMBOL TYPICAL DESCRIPTION
Ciassilk etian symbol one name oar bawd upon tar r,yool-mempol p.uerdures drsc,i ed . ASTl! Test Flellwd Q 2r E8.
ML inorganic sills and vfily fine
sands, silly or ocyvry i,r,e fonds
CL
Inorganic cloys of low to
medium plasticity, gravelly cloys,
sandy cloys, silly or lean clays,
OL Organic silts and cloys.
MH Micaceous or silty soils.
CH Inorganic cloys of high plasticity.
OH Organic cloys, organic silts with
medium to high plasticity.
Soprolite wilh the soil
characteristics of a sand,
grovel, slit, or clay
Bedrock
BLOWS/FT, DENSITY
0-4 VERY LOOSE
5-10 LOOSE
1 1 —30 MED. DENSE
31-50 DENSE
BLOWS/FT. CONSISTENCY
0-2 VERY SOFT
3-4 SOFT
5-8 MEDIUM STIFF
9-15 STIFF
16-30 VERY STIFF
31+ HARD
COMPONENT 7 I_
MOSTLY 50-1007
SOME 30-45%
LITTLE 15-257.
FEW 5-10%
TRACE <SI

. Blow
Counts
co
BORING LOG/MONITORING WELL INSTALLATION DETAIL
Contractor. TPrrarluPatfStarted r c
r11119tethort-finIlow._ iern iuigP naty Fint.twPd_ _8112L1 i -
• n elggadhy. anrty7 21i}Pr]n
OVM Depth
Completion (ppm) Feet
i_ithatogy
Scale as shown; Hatch pattern denotes so'l sampfe depth;
Solid denotes lab sample depth: Litholagy hatch pattern legend is attached:
Well Construction
2" diameter Sch. 40 PVC; .010" slotted screen
Sand: no. 2 sand; Grout: poured puriland; Bentonite: poured pellets
Finished with 8--diarrieter metal boll down manhole.
NA - Not Applicable; BGL - Below Ground Level
Description
Boring Number:
MW3
Concrete
Sand (SC)
Mostly loose, fine grained, gray sand
Sandy Fat Clay (C1- )
Stiff gray, mostly clay, with fine sand.
Well Completed at 15ft BGL.
Site:
Gussman Cleaners
223 Craven Street
New Bern, NC
Client:
Riverbanks Properties, LLC
PO Box 1506
New Bern, NC
Project No.: 05015 1 Page 1

07
a
go
go
07
Blow
Counts
Completion
BORING LOG/MONITORING WELL INSTALLATION DETAIL
Irarinr• Tnrrario1PCi
nri Ffnlinw Stem A$igr
t]r}Iker• Nirk PFr7r
Depth
Feel
5
10
15
slate Stang __ d j5
r darn Finished. tit2tZ5
_itttoiogyJ
s • �r
fr
R -a -
ip
Scale as shown; Hatch pattern denotes soil sample depth;
Solid denotes lab sample depth; Lithology hatch pattern legend is attached;
Well Construction
2" diameter Sch. 40 PVC; .010" slotted screen
Sand: no, 2 sand; Grout- poured outland; Bentonite: poured pellets
Finished with 8•'-diameter metal bolt down manhole.
NA - Not Applicable; BGL - Below Ground Level
I ngg�rl hy• Anrt W nr,
Description
Boring Number
MW2
Concrete
Sand (SC)
Mostly hose, fine grained. gray sand
Sandy Fat Clay (CH)
Stiff, gray, mostly clay, With fine sand.
Well Completed at 15ft BGL.
Site:
Gussman Cleaners
223 Craven Street
New Bern, NC
Client:
River anks Properties, LLC
PO Box 1506
New Bern, NC
Project No.: D5015
Page 1

WELL CONSTRUCTION RECORD
Tiiis form can be used for single or mulliple well<
1. Well Controctor Information;
NICK PERRY
Well Contr2dor Naiue
3329A
~c ,v~u (;~tractor Cffli!kalion_Number
Terraquest Envlronm~ntal Consultants, P.O.
Con,p.myName
2. Well Construction Perilli!#:
. LJ.Jr ttll npplie.nbli',wel! pe_nnifs (i.e. County, Sime. f'~rimll.'t', ltVi!ction, ~le.)
3. WellUsc(cheekwelluse):
W11ter Supply Well:
□Agrkult11ral O!lfunicipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
Dfndustri:il/Commcrcinl □Residential Wnter Supply{slmre.d)
□frri 2atio11
Nou:watcr S11pply Well:
0Moriitoring □Rccovery
Injection Well:
□Aquifer Rechurge □Groundwater Remediation
□Aquifer Slomge and Rccove,y □Salinity Barrier
□Aquifer Test □Stom1w:itcr Drainage
□Experimental Technology □Subsidence Control
□Gcothennal (Closed loop) □Tracer
□Geothem1ol (He.itin11/Cooling Return) OOiher(exL;Jain under #21 Remarks)
4. Date Wcli(s) Completed; 8/12/15 WclllD# MW2,MW3
Sa. Well Lociilio1J:
Gussman Cleaners
fa,ilily/Ownec N'ame facility ID# (if applicable}
223 Craven St. New Bern, NC
Phy,ical Addr«s. Ciry. and Zip
Craven 8-001-C -097
Cot~nty Parcel ldenlifkarion No. (PJN)
5b. Lafitudr nnd ·Longitude In degncs/minutcs/seconrls or decimal degrrcs:
(1fwdl field, one loVloog is sullidcnt)
35.1057 N -77.0389 w
6. Is (are) theweU(s): @Permanent or □Temporary
7 . Is this n repair lo an exisling .wrll: □Ye.~ or ~No
Jf ,Mi· ls ii rcpoir, fill 011t bw11·11 well <<1m.rr11ction infonm.uimJ nndt!xplufli 1}~,! 1tt:J11,u i.if tl1t..•
upolr und~r #} I r .. ·11,arJs.set•tiu11iJr on tl,,1. lmcl: oftlu:tform.
8. Number of wells roosiructetl: _2 __________ _
For 11111/n"pl-t! i1U4!cthm or J1dlM1'0lt'f .s11pply wills· O:\'l rwilh th~ same l!011.str11cthm. ytJu L',WI
iuhmif one form.
I for Internal Use ONLY:
14. WATER ZOl'l'ES
·fRO)l TO DESCRIPTIOX'
fr. .fr.
ft; fr;
1$. .OLTTER CASING Ho{multi•casrd .w,ll,1 OR LINER tifannlicabltl
·nmr I TO I DIA.\1£TI:R l TI!ICKNESS · I MATl:RIAL
ft. fr; in,
16 •. (NNER CASING OR TVBl!'iG· f•.torherm·a1 dosrd-looo\
.FROM TO DU.\IETER THICKl\T.SS. MATERIAL
r,. rt • in.
ft. f,. in.
17.SCitEEN
f'll.0)1 TO .DIAMETER SLOTSIZC l THICKNESS MATERIAL
5 ft. 15 ft. 2in in. .010 l Sch.40 PVC
ft. n. in. I
18.GROUT
PRO~! TO ·M.\Tf.RIAL EMPLAC£M£NT METHOD & AMOUNT
0 .. 5 rr. 1 rr, Portland Pour
1 n. 2 ft. Bentonite Pour
ft. fr.
·a. SAND/GRAVEi, PACK (ifs rrolicabl,1
FRO)I TO ~IATl;ll!AL EMfl-H'.E.\IEl'iT MLTHOD
2 ft. 15 ft. No.2 Sand Povr
ft. fr.
20. DRILLING LOG (a1iath sddilion:il sheet, if rirc,su~•I
FRO)! TO ni:.s c,ur no.:-i: itolor, b;'l.nfn.ess,,oillrock tq ,r, r n1.in siu. ~~EJ_
0 ft. 1 rt . Concrete
1 ft. 9 {I. Sand (SC), grey,. loose, fine grained
9 n. 15 fl. Sandy Fat Clay (CH) grey,stiff,clay,fine sand
n. rr.
ft. rr.
fr. fl.
ft. fl.
21.REMARKS
17
I I 1'C•77~ 8/14/15
SigrunwcofCrrtificd \~raclor DJI<
B;r .signing 1hl.s form. 1 1,i:n:by carif,· t/i(l/ lhi! lr1..•ll(s) u-as (u·er<) ,~011.Snw:11.·,I in uccord01rci?
wi1!, 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Co11rrmclio11 Sumdard< mid tl"'r n
capy of this ritorJ has betn pmrided /1> tire well dwncr: ·
23. Site diagram or addiHonal well dl'lails:
Yo11 may use lh.e back otthis page 10 prm·id~ additiooal well si.te details or well
constrnction decai!s. You may also attach additional pages if necessary.
SlJB:\llTTAL INSHiC.TIOXS
9. Total well depth below hind s.urfart: _1_5_' ___________ (fl.) 24a. For All Wells: Submit this form 1Yilhi11 30 days of completion <if well
F<>r m11/tipl,• ,,·,·/Is /ivn/1 d<p1hs ![d{ffem11 (o:amp/,. J@200' oJJd l@lOO') c<insirncii<in to the.following:
.IO. Static wnter le\·cl below top of cflsing: _7_._9_0_' ,_7_._2_0_' _____ (Ct.)
If tfOtcr /~wl is nbol·~ cosh1g, ust •◄ -: ''
11. Borehole dl:uuctcr: 8.25" {in.)
12. Well conslructiou method: Hollow-Stem Auger
(i.~. augu, rOwy, cnblt. dir..:ct prnh, ck.)
FOR WATER SUPPLY WELLS 01'.;".LY:
13a. Yidtl {gpm) ________ Method of frsr:
Dh·ision of\"\'aler Resourccs,foformntion Processing Unit,
1617 Mail Ser"ice Center, R;ilcigh, NC 27699-1617
Hb. for lnjcctioo Wells ONLY: In addiiion to sending the form io the .iddr,:ss in
24a abo,·e, also submit a copy of this fom, within 30 da)'S of complecion of well
constrnction to th.e following:
Dhision of Water Resources, Underground l11jcction Control Program,
1636 ]\fail Service Cenle,·, R.~lcigb, NC 27699-1636
24c. For Waler Su 1111h· & Injrc1ion Wells:
Also submit one copy of this form 11ithin 30 days of completion o(
J3b . .Disinfection typ~: Amount: wdl 1:unstruc1ion to the counly h~Jhh depar1111e111 of the county where L:.::.=-::::.::.:::.:::.:.:_.:::._:::..:.=.=======-:_:_:::_:.:::.:.:.:..:=========J constn1cted_
FormGW•l North Carolina Dtpartmcnt of Em-ironmcnt and N'an11a.l Resowc-cs -O:i"ision of Water .Resources Rc,·l.sed August 20 n
cv
E
en
Blow
Counts
Completion
G
OG/MONITORING WELL INSTALLATION DETAIL
.-
eqntrartlor• Tectaaupct
_Drill ridethed...HnLhos AlprriAirpr
OVM
(PPM)
L
iir
Ppreiv.
Depth
Feet
5
15 —
:_ithology
tlate_Starte
_Date. Finished..
_Logged_by
Concrete
r
1
Description
Boring Number:
MWI
Sand (SC)
Mostly loose, fine grained, gray sand
Sandy Fat Clay (CH)
Stiff, gray, mostly clay, with line sand.
Well Completed at 15it BGL.
Scale as shown; Halch pattern denotes soil sample depth;
Solid denotes lab sample depth; Lilhology hatch pattern legend is attached;
Well Construction
2" diameter Soh. 40 PVC; .010" stoned screen
Sand. no. 2 sand; Grout poured portiand; Bentonite: poured pellets
Finished with Cr-diameter metal bolt down manhole.
NA - Not Applicable; BGL - Below Ground Level
Site:
Gussman Cleaners
223 Craven Street
New Bern, NC
Client:
Riverbanks Properties, Lt_C
PO Box 1506
New Bern, NC
Project No.: 05015 Page 1

TERRA~uest ---., ~ § :.,s ~ ---w,.-=_,.,~ µ -~
ENVIRONMENTAL CONSULTANTS, P.C.
November 17, 2015
RECEIVED
N.C. Dept. o! ENA
JAN O 8 2015
Winiton•Salem
P.~.:.i~:i:.: Otrico
Michael Rogers
RECEIVEDINCOEQ/r)WR
Underground Injection Control
NCDEQ-DWR ·
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Re: Submittal of Figures for NOi
JAN 12 2016
Water Quality
Regional Operations Seclbl
Gussman Cleaners ..: 223 c;raven ·street, New Bern, Craven County, NC
Terraquest Project Number: 05015
NCDWM-UST Incident No.: 93254
Dear Mr. Rogers:
Enclosed are Figures and other supporting information omitted from the previous submitted
Notice of Intent. I am submitting hard copies per our phone call today. Thanks for your help.·
Sincerely,
TERRAQUEST ENVIRONMENTAL CONSULTANTS, P.C.
(v~
Ryan D. Kerins
Project Manager
Enclosures
100 E. Ruffin Street • Mebane, North Carolina 27302
Telephone (919f 563-9091 • Facsimile [phone]
www.terraquestpc.com
RECEtDINCDECIIDWR
JAN 1$2016
vV&ter Quality
Regional Operations Section
tH.
MAP SOURCE: USGS 7.5 MINUTE TOPOGRAPHIC - NEW BERN, NC
GRAPHIC SCALE
ImmiT
❑'
2,000'
4,000'
TERRAiuest
ENVIRONMENTAL CONSULTANTS, P.C.
SITE LOCATION MAP
GUSSMAN CLEANERS
223 CRAVEN STREET
NEW BERN, CRAVEN COUNTY, NC
RIVERBANKS PROPERTIES, LLC
NEW BERN, NC
PROJECT NO, 05015 DRAWN BY: JTL [DATE: 11/l7/i5
SCALE; 1" - 2.000� CHECKED BY: JRG FIGURE NO.

Q WATER SUPPLY WELL LOCATION
ZONING BOUNDARY
C-1, C-2, C-3, C-4, C-5, C-5A - COMMERCIAL
R-10 - RESIDENFIAL
NUMBER CORRESPOND TO SURROUNDING PROPERTY
OWNER INFORMATION USTED IN TABLE 2.
GRAPHIC SCALE
200' 400'
1" = 400'
TERRAQuest
� r �
allillissor
ENVIRONMENTAL CONSULTANTS, P.C.
SITE VICINITY MAP
GUSSMAN CLEANERS
223 CRAVEN ST.
NEW BERN, CRAVEN COUNTY, NC
RIVERBANKS PROPERTIES, LLC
PROJECT NO. 05015
BRAWN BY: NKP
SCALE: 1 = 400' CHECKED EY'
JRG
NEW BERN. NC
DATE; 11/17/15
FIGURE NO. 2

A
100 00'
g0,00•
B0.00'
B
100.00•
TW--3 MW2
/
/
TA'— 1
MW1
MW1
i's; C'.0 •• i' a...- �� r v;•t.1:' .i•� eSg"
•
•: • " � ;'ti e�' . q r 5 `F� Loose, gr y, mostly fine—grained sandw; W ;
• '•:,t wHh few day.
•.ti
/
TW-2
3 -Y••yi S�Y..JFii�.l- Y
/ / FAT CLAi' (CH) with'
/ / few— in" sand. /
,[w-- . grcy, %
r/ /f/fi./I ,/ f/!./ r
Rue
a � ' , ` i v:: ,.r wC.,; •• •
,f 1R
SAND (SC)
Loose, grey, mostly fine—grained Bond
with few cloy.
SAND FAT CLAY (CH)
SUN, gray, mostly cloy with
few --grained Bond.
/
GRAPHIC SCALE
HORIZONTAL: 1" = 30'
VERTICAL: 1" = 15'
VERTICAL
EXAGERATION X 2
15' 30'
A`
GEOLOGIC CROSS SECTIONS
GUSSMAN CLEANERS
223 CRAVEN ST
NEW BERN, CRAVEN COUNTY, NC
RIVERBANKS PROPERTIES, LLC
NEW BERN. NC
Mqust
_
■
ENVIRONMENTAL CONSULTANTS, P.C.
PROJECT NO. 05015
CHECKED BY: JRG
DATE:
SCALE: AS NOTED
11/17/15
DRAWN BY:
RDK
FIGURE NO. 4

rERRAauest
CIMRON[NlTR. CONSUL TA OS, A C
LEGEND FOR SOIL BORING
LOGS AND WELL COMPLETION
DIAGRAMS
GRAPHIC LETTER
SYMBOL SYMBOL TYPICAL DESCRIPTION
0 0
a
n n
OVV40
GW Well —graded grovels, gravef—
sand mixtures.
GP Poorly —graded grovels, gravel—
sond mixtures.
GM Silty gravels, gravel--silt--sand
mixtures.
GC Clayey gravels, grovel —sand —clay
mixtures.
SW Well—groded sands, gravelly sands.
SP Poorly —graded sands, gravelly —sands.
SM Silty sands, sand —silt mixtures,
SC Clayey sands, sand —clay mixtures.
WELL COMPLETION SYMBOLS
■
PORTtAND CEMENT
BENTONITE
WEL1. SAND
GRAPHIC LETTER
SYMBOL SYMBOL
Cu1Hirmellun simeol cne name ore posed upon the visual -man,* lupceetool delcoreed h ASTL Test LtetIW 0 208.
TYPICAL DESCRIPTION
ML Inorganic silts and very fine
sands, silty or clayey fine sands
CL
Inorganic cloys of low to
medium plasticity, gravelly clays,
Sandy clays, silty or lean cloys.
OL Organic sills and cloys.
MH Micaceous or silty soils.
CH fnorganic clays of high plasticity.
OH Organic Cloys, organic silts with
medium to high plasticity.
Soprolite with the soil
characteristics of ❑ sand.
grovel, silt, or clay.
Bedrock
BLOWS/FT. DENSITY
BLOWS/FT. CONSISTENCY
COMPONENT %
0-4 VERY LOOSE
5-10 LOOSE
11--30 MED, DENSE
31-50 DENSE
"0-2 VERY SOFT
3-4 SOFT
5-6 MEDIUM STIFF
9-15 STIFF
16-30 VERY STIFF
31+ HARD
MOSTLY 50-10Ox
SOME 30-45%
LITTLE 15-25%
FEW 5--1 O%
TRACE [5%

WELL CONSTRUCTION RECORD
This farm inn he used for single rr nut* rs e11s
1. We1i Contractor Information:
Jonathan Grubbs
Well Contractile Name
3001
NC Well Conn radios Cenific.o inn tiurubcr
Terraquest Environmental Consultants, P.C.
Company Nome
2. Constriction Permit II:
(,fir nil applicable ++rrl permire (i.e. Cnuxn: Scare. 1'nrI:iIc , hyrelfu'. eyed
3. Well Use (check well Ilse):
Water Supply Well:
❑Agticui:urai
❑Geothermal [Heating'Caoting Supply)
❑ industrial/Commercial
❑ 1rtigatiotl
\oit-WalerSupply ►Veit:
Monitoring
❑ Ainrn icinaI/Public
❑Residenfiat Water Supply (single)
❑ Residential Vat Supply (shared)
❑Recovery•
Injection 11'c1I:
°Aquifer Recharge
°Aquifer Storage and Recovey
❑Aquifer Test
❑Experimental 1 win -trilogy
❑ Geothermal (Closed Loop)
ClGrntindwatet RCmediation
DSatinity Raspier
❑ Storm water Drainage
❑ Subsidence Control
❑ Tracer
❑ Geothermal (lfeatlog/Cool ing Return) ❑0lher(explain under 821 Remarks)
4. Dale Well(s) Completed: Mil 5 NW' rim MW1
5a, Well Location:
Gussrnan Cleaners
Facility/Owner Name FactIiry ID (if applicable)
223 Craven St. New Bern, NC
Physical Address, City. and hip
Craven
8-001-C -097
Fa
lydernrt Use ONLY:
r� 1T'A7ER7.ON1.S
FROM
10
l FSCRIlrtoN
It.
fr.
n.
rL
1 .. OLT£I( CASING (ler muf tW ased elil Oft 1.1 NE R o f a t 'lentil el
FROM T TO DSA\IElTR TIHC7C" L5.S MATE RL1L
LB' [ I
it INNER CAS I ItiG Olt Tr:n1\IAlirothrrn s1 closed•roop]
FROM
TO
ALINSI:TER
THICKNESS
!HATE RIAI.
n.
R.
n.
In.
n.
1n.
17. SCREEN
FROM
5 11.
ft.
t8. GROVE
FRO'.I
0.5
2
It.
rr.
ft.
TO
15
LLLNETER
2in
Is.
51.0T S tik.
.010
ItriciCXrss
Sch. 40
MATERIAL
PVC
n.
tn.
TO
2
fr.
MAT ER1A L
Portland
EMPrACEMF'.T METHOD k A.sI01J%T
Pour
3
n.
Bentonite
Pour
I4. SArsAICttAVEL PACT, ril epplirable)
FROM
TO
MATERIAL
E►1etACEMENT altTitop
3
n.
15
n.
No.2 Sand
Pour
fr,
fr.
Io. t7ft ILLIVC LOC [.Hach ad El Iinstsl Fbeetr $1 nmeeminn')
r R OM
0
8
A.
Ir.
tr.
fr.
n.
n.
TO
1
9
rt.
DESCRIPTION trek r, lwan. i. ++u•ra,4 el p, L .:n ilr+. 01-1
Concrete
Sand (SC), grey, loose, fine grained
15 n-
Sandy Fat Clay (CH) grey,stiff,clay,(iine sand
ft.
n,
rt.
County Parcel Hewitt ration No. WIN)
Sh. Latitude and Longitude In degrees/nttnules/seronris or deeltnat degrees:
fife. ell Sties, one Istilong is so ffroiroc,
35.1057
N-77.0389
6. is (are) the well(x): d Permanent or ❑Telrtporary
11'
7. is this a repair to nil existing well: ❑Yes or Z,No
yew it a reptile, fHl aril liruwrr well rwufrnrriaa h farmnrlu+san.l crpiala fire ninee of the
repair rwrr.•r r 21 remarks reci1n11 ar On the hark of 44r1,r form.
8. ,Number of spells Constructed: 1
cut ltifrllfple A fe rrfnlf or ensifaraftr rupply wells O.YLF't+ lib 111e Aware ccnsrriI ''llvie, you Carl
sl+hrrilr am / .nit
9. Total well depth belots indent -fate: 15' (f1.)
FarranIrlpl; nrlls Vial all AqpilLc irdrffrreuf ((,ample-35100'nm11G100'1
to. Static Witter level below lap of casing: 7.06' (ft.)
(js+area- had 14above cotIrg rtsc"
I, Borehole dtomeler: 8.25n (iu.)
12.11'tllcoast ruction method: Hollow -Stem Auger
(it auger, rotary, cable, direct push. etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gptn) Method of test:
13b. Disinfection type: Amount:
Form G W. t
North Carolina Department of Easiroaro al
It. RF.a1ARI
22. Cer(illratlon:
7/18/15
Signature of Certified Well Connector Dare
sty signing diesProm I hus'D.' rerlif}' ilia rite a r4(s) uar (sure) rallslrueled let ac conla.rr
Wilt 13.4 AT.Or 01C .0100 or 73.1 h'C.IC OK .0200 Weil Cofwfriecllo i Stn,Alarrli nod 'bar o
en( el:his r.xtr+f bar Areapr rrkrrcti i Ilk well owner.
23. Site diagram or additional well details:
You may use the ieack of' this page to provide additional well site details or well
constnrction details. You may also a each additional pages it necessary.
SUBMITTAL INSTl1CTIO\S
24a. For Mi Welk: Submit This fonts within 30 days of completion of Ise!l
construction to the Fallowing.
Division of Water Resources, information Processing Unit,
1617 Mail Service Center. Raleigh. NC 27699-1617
24b. For lniecliou Weill ONLY: fn addition 10 sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
canstniciron to the following:
Dislslon of Water Resources, Underground Injection Control Program,
1636 Mall Serrke Center, Raleigh. NC 27699..1636
24c, Far Water Stipp/N. & Injction Welts:
Also subunit one copy of this form within 30 days of completion of
well constriction to to county health department of the county where
constructed.
and Natural Resaicors - Oisision of Water Ittsnsstes
ReiisedAugust2ot7

WELL CONSTRUCTION RECORD
This limn can be used for sinpe or mul1iplcwc:lls
1. Well Contractor Information:
NICK PERRY
Wc,11 Contractor Name
3329A
NC Well Contntctor Ccrlilka1ion Number
Terraquest Environmental Consultants, P.C.
Company Name
2. Well Construction Ptrnilt #:
Lbt nil nppli~ab/-, u·e// p,rmlts (i.t. Cou11i,•. StQI~. l'arim,<V, Ill}et:1/011, etc.)
3, Well U$C (check well use):
Wnter Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
OindustrinVCommercinl □Residential Water Supply(shared)
tlirriaation
Non-WatcrSuppb· Well:
@Monitoring □Recove,y
Injection Well:
□Aquifer Recharge OGroundwater Remediation
□Aquifer Storage and Reco\'CI}' □Salinity Barrier
□Aquifer Test DStornmater Drainage
□Experimental Technology □Subsidence Control
□Geothermal {Closed Loop) □Tracer
DOeothermal (Hcatinll.iC:oolin2 Return) □Olher ( eimlain under #21 Remarks)
4. Date Wcll(s) Completed: 8/ 12/15 WcllIDI# MW2,MW3
Sa. Well Location:
Gussman Cleaners
Facilil)'/OwnerName Facility JD/I (if applicable)
223 Craven St. New Bern, NC
Physical Address. City, and Zip
Craven 8-001-C -097
Coµnly Parcel ldenllficarion No. (PIN)
!ib, Latitude a.nd Longitude In degrees/minutes/seconds or dedmal degrees:
(if well field. Oil!' lat/loo:; is sufficient)
35.1057 N -77.0389 w
6. Is (are) thewell(s): 121Penmment or □Temporary
7. Is thlsa repair to an eslstin11;weil: □Yes or eJNo
Jf 111/s Is a repair, fill out know11 11-ell c(!lutrucli011 l1,formatloi1 am/ expla/11 tlu 1111111r<1 of 111~
TiJ)(Jlr u,llfer #2 I r,111Qtb secl/011 or on 1//e back of 1/1/J fon11.
8. Number of wells constructed: _2_· _________ _
. For 11111/tlp/<1 ulf<1tilo11 or 11011-water suppl)' ll't/ls ONLJ',r/1/1 1/1<1 same constr11c1/on, yon ·cw,
submit 011efom1.
lforlwmal Use ONLY:
1-1.WATERZOJl.'ES
FROM TO DESCRIPTIOX
ft. fl.
ft. ft.
IS, OUTER CASING I for multkastd \Tc:llsl OR LlNER llfannli .. bltl
FRO'.\I I TO DIA~IETER T THICK.,'ESS T UnERIAL
ft. ft. In.
16. l~NER CASING OR nTBJNG <•tolhomial dosed-looal
FRO~I TO DIA.\IETER nnCK.,"ESS MA'FERIAL
ft. rr. In.
r,. fr. In.
17.SCREEN
FROll TO DIA~IETER SLOTSIZE THJCKl\"[SS alATERIAL
5 r,. 15 fl. 2in ·In. .010 Sch.40 PVC
rt. ft. In.
JILGROlTT
FRO~I TO MATERIAL EMPLACEME,'l;T METHOD & A:lfOIJll,"T
o.~ ft. 1 rt. Portland Pour
1 r,. 2 ft. Bentonlte Pour
rt. ft.
19, SAND/GRAVEL PACK Ir ..-oUc•blt)
FRO)I TO l\L\TIRIAL EMl'UC£)1 £11,"T lll ETH OD
2 fl. 15 fl. No.2Sand Pour
ft. ft.
20. DRILLING LOG •attach atddlllonal 1heets lfnt<eSSl"'l
FllO)I TO nts(ll)"110.~ <«tor. lw-4•u,, .. ,v,..k -•• •C'aln th<,.,..,
0 ft, 1 n. Concrete
1 ft. 9 fl. Sand (SC), grey, loose, fine grained
9 ft. 15 ft. Sandy Fat Clay (CH) grey,stlff,clay,fine sand
ft. ft.
fl. ft.
ft. ft.
ft. rt.
21 . RUIARKS
/l
I
"°"tlt~-,< 8/14/15
SignotureofCntilied ~raclor Dale
By •lg11/11g lhls form. 1 h,nb)' cerllf}' that 1/w well(•) was (11·en) co1rs1rue1ed 111 a«orda11ce
w/1/1 ISA NCAC 02C .0/00 or JSA NCAC 01C .0200 JJW/ Comtn1tllon Slnndards a11d 1/,01 n
copy 0/11,is ncord lms be.-11 pro,•f,kd ro the well oll"ntr.
23. Site diagram or additional well details:
You may use the back of this .page lo provide additional well site details or well
constructjon details .. You may al~o attach additional pages ifnecessacy .
SUB:\llTTAL INSTUCfIONS
9. Total well depth below land surfac~: _1_5_' __________ (ft.) 24a. For All Wells: Submit this form \\ithin 30 days of completion of well
For nmltlp/• wt/ls Ii~/ all d,p1//s if di.ffer,n/ (exil/llple-J@200' m,J 2@100') construction to the following:
10. Static water lent below top of casing: 7 .90' • 7.20'
lfwata lewl Is abo,-., c(Hlng. we "+ •
11. Borehole diameter: 8.25• (In.)
12. Well construction method: Hollow-Stem Auger
(ie. a11gtr, rowy, cable, direct push. ete.)
FORWATERSUPPLYWELLSONLY:
(rt.)
13a. Yield (gpm) ______ 1\lethod oftest: ______ _
Dh-lslon of Water Resources, Information Processing Unit,
16171\Jall Senice Center, Raleigh, NC 27699-1617
24b. For Jnjectlop Wells ONLY: In 11ddition to sending the form to the address in
24a abo\•e, also submit a copy of this. form within 30 days of completion of well
construction to the following:
DMsloil of Water ReJources, Undergroun.d Injection Control Program,
1636 l\Jall Servke Center, Raleigh, NC 27699-1636
24c. For Water Supply & luJeclion Wells:
Also submit one copy of this fQflll \\ithil! 30 days of completion of
13b. Disinfection type: Amount: well constmction to the county health department of the county where t.::=.:===.::..:::'..!'.::'...======:......'.:::::=:::..:=======..l constructed.
l'ormOW•l 1'/orth Carolina Department of Environment and Natural Rcsour<:cs -Dhnioo of Water Rftoun:es Rc1iscd AugUJt 2013
r ;
Blow
Counts
Completion
BORING LOG/MONITORING WELL INSTALLATION DETAIL
Driller.
OVM
(PPm)
Nirk PQry
Depth
Feet
5
15
Dail/ Stardom 7I6[S5
DatafinLshed• 7r6d1i
L nO0 d by• tnnalhan Cnihhc
Description
Concrete
Sand (SC)
Mostly loose, fine grained, gray sand
Sandy Fat Clay (CH)
Stiff, gray, mostly clay, with fine sand.
Well Completed at 15ft 8GL.
Boring Number:
MWI
Scale as shown; Hatch pattern denotes sal sample depth;
Solid denotes lab sample depth; Ethology hatch pattern legend is attached;
Well Construction
2" diameter Sch. 40 PVC; .010" slotted screen
Sand: no. 2 sand; Grout: poured partland; Bentonite: poured pellets
Finished with 8"-diameter metal bolt down manhole.
NA - Not Applicable; BGL - 0elow Ground Level
Site:
Hussman Cleaners
223 Craven Street
New Bern, NC
Client:
tit erbanks Properties, LLC
Pa Box 1506
New Bern, NC
Project No.: 05015
Pale 1

BORING LOG/MONITORING WELL INSTALLATION DETAIL
,ConIr cnr Tarraci es.t
n4j+gtai1ers• r111211c
Boring Number:
nr1,*l Math
Finiehrrl• 1tit2,115
flrilur Nirk Per-y
_1]i+ta
Ln jg rl by Andy Wrenn
MVV2
lYY11 YYYY�r
Blow
Counts
Counts
Completion
OVM
{Pp }
Depth
Feet
Lbtholog
Description•
A:�:
#:4:
* • • '
f:,..;
-
��1:1 •
•••
.:i:•
;�
- :40;
oli
..yam
i-R
4-•• i►.
i •�;
Concrete
-.
�■
9 e
° i :.
'a' .r a= •
1• "Y #•
P .r'
} r
i • ¢•.
► 9.1'
V -
i '.9•
-
i•.r•
I Y d'
9 •
e .t r1;.
Sand (5C)
Mostly loose, fine grained, gray sand
r' =
— id �0/
r Y
/ / /
/
/ /
�//!%///
• : /
Sandy Fat Clay (CH)
Stiff, gray, mostly clay, with fine sand,
Well Completed at 15ft BGL,
y='.
:ti
.
IFS-{•
5:.`r
- ,•••
ti L ,�•_
yi::
r �5
Scale as shown; Hatch pattem denotes soil sample depth;
Solid denotes lab sample depth; Lithology hatch pattern legend Is attached;
Weil Constructim
Site:
'07.ssnnan Cleaners
223 Craven Street
New Bern, NC
Client:
2" diameter Set. 40 PVC; ,O10" slotted screen
Sand: no. 2 sand; Grout: poured portland; Bentonite: poured pellets
Finished with 8"-diameter metal haft down manhole.
NA - Not Applicable; BGL - Below Ground Level
Riverbanks Properties, LLC
PO Box 1506
New Bern, NC
Project No.: 05015
Page 1

a
Blow Completion
Counts
if
�=
•
BORING LOG/MONITORING WELL INSTALLATION DETAIL
Ccuattactor Tarry
r'1db ethod:1 bl
llMllisr_ "-- -lick PLy
OVM Depth
(ppm) Feet
LIthology
•
4
— r4.
/4:
5
15
r.
4
d•
4
4
a
ri
r►'
*'
:V_ 4
r
►y
t •
►
Y 4
► •
•
artpil• 1111211c
islmrt 13/12/15
Logged by Anrly Wrpnn
Concrete
Boring Numbor:
MW3
Description
Sand (SC)
Mostly loose, tine grained, gray sand
Sandy Fat Clay (CH)
Stiff, gray, mostly clay, with fine sand.
Well Completed at 15ft BGL.
Scale as shown; Hatch pattern denotes so I sample depth;
Solid denotes lab sample depth; Llthology hatch pattern legend is attached;
Well Construction
2" diameter Sch. 40 PVC; .010" slotted screen
Sand: no. 2 sand; Grout, poured portland; Bentonite: poured pellets
Finished with 8"•diameter metal bolt down manhole.
NA - Not Applicable; BGL • Below Ground Level
Site:
Z sman Cleaners
223 Craven Street
New Bern, NC
Client:
1 verbanks Properties, LLC
PO Box 1506
New Bern, NC
Project No.: 05015
Pane 1

SAFETY DATA SHEET
I. Identification
Product identifier Oxygen Biochem (OBC]rM
Other means of identification Not available.
Recommended use Oxygen Biochem (OBC)TM is used to promote chemical oxidation and aerobic bioremediation of
petroleum compounds in groundwater.
Recommended restrictions Use in accordance with supplier's recommendations.
lvlanufacturerlImporter/SupplierlDistributor information
ManufacturerlSupplier Redox Tech. LLC
Address 200 Quade Drive Cary
NC 2751
Telephone [phone]
E-mail [e-mail]
Contact person Dr. John Hasetowi
Emergency Telephone For Hazardous Materials [or Dangerous Goods] Incidents ONLY
(spill, leak, fire, exposure or accident), calf CHEMTREC at
CHEMTREC®, USA: 001 [phone]
CHEMTREC®, Mexico (Toll -Free - must be dialed from within country):
01-800-681-9531
CHEMTREC®, Other countries: 001 [phone]
2. Hazard(s) identification
Physical hazards
Health hazards
Oxidizing solids
Category 3
Acute toxicity, oral Category 4
Skin corrosion/irritation Category 2
Serious eye damage/eye irritation Category 2
Sensitization, respiratory Category 1
Sensitization, skin Category 1
Specific target organ toxicity, single exposure Category 3 respiratory tract irritation
OSHA defined hazards Not classified.
Label elements
Signal word
Hazard statement
Precautionary statement
Prevention
Response
Danger
May intensify fire; oxidizer. Harmful if swallowed. Causes skin irritation. Causes serious eye
irritation. May cause allergy or asthma symptoms or breathing difficulties if inhaled_ May cause an
allergic skin reaction. May cause respiratory irritation.
Keep away from heat. Keep/Store away from clothing and other combustible materials. Take any
precaution to avoid mixing with combustibles. Wear protective gloves/eye protection/face
protection. Wash thoroughly after handling. Do not eat, drink or smoke when using this product.
Avoid breathing dust/fume. In case of inadequate ventilation wear respiratory protection.
Contaminated work clothing must not be allowed out of the workplace. Use only outdoors or in a
well -ventilated area.
In case of fire: Use foam, carbon dioxide, dry powder or water fog for extinction. If swallowed: Call
a poison center/doctor if you feel unwell. Rinse mouth. If on skin: Wash with plenty of water. If
skin irritation or rash occurs: Get medical advice/attention. Take off contaminated clothing and
wash before reuse. If in eyes; Rinse cautiously with water for several minutes. Remove contact
lenses. if present and easy to do. Continue rinsing. If eye irritation persists: Get medical
advice/attention. if inhaled: if breathing is difficult, remove person to fresh air and keep
comfortable for breathing. If experiencing respiratory symptoms: Call a poison center/doctor.
Oxygen Biochem (OBC)n'
920293 Version #: 01 Revision date: - Issue date: 09-May-2014
Sf)S US
117

Storage
Disposal
Hazard(s) not otherwise
classified (HNOC)
Store in a well-ventilated place. Keep container tightly closed . Store locked up.
Dispose of contents/container in accordance with local/regional/national/international regulations .
None known .
3. Composition/information on ingredients
Mixtures
Chemical name
Sodium persulfate
Calcium peroxide
Composition comments
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
CAS number %
7775-27-1 70 -90
1305-79-9 10 -20
All concentrations are in percent by weight unless ingredient is a gas . Gas concentrations are in
percent by volume.
Move to fresh air. Do not use mouth-to-mouth method if victim inhaled the substance. For
breathing difficulties, oxygen may be necessary. Call a physician or poison control center
immediately. ·
Remove and isolate contaminated clothing and shoes. For minor skin contact, avoid spreading
material on unaffected skin . Wash clothing separately before reuse. If skin irritation or an allergic
skin reaction develops, get medical attention.
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 if irritation develops and persists .
Rinse mouth. Do not induce vomiting without advice from poison control center. If vomiting occurs ,
keep head low so that stomach content doesn't get into the lungs. Do not use mouth-to-mouth
method if victim ingested the substance. Induce artificial respiration with the aid of a pocket mask
equipped with a one-way valve or other proper respiratory medical device. Get medical attention if
any discomfort continues.
May cause redness and pain. Symptoms may include coughing, difficulty breathing and shortness
of breath.
Provide general supportive measures and treat symptomatically .
Ensure that medical personnel are aware of the material(s) involved, and take precautions to
protect themselves.
Suitable extinguishing media Water fog. Foam. Dry chemical powder. Carbon dioxide (CO2).
Unsuitable extinguishing None known.
media
Specific hazards arising from Contact with combustible material may cause fire.
the chemical
Special protective equipment Self-contained breathing apparatus and full protective clothing must be worn in case of fire.
and precautions for firefighters
Fire-fighting In the event of fire, cool tanks with water spray.
equipment/instructions
General fire hazards May intensify fire; oxidizer.
6. Accidental release measures
Personal precautions,
protective equipment and
emergency procedures
Methods and materials for
containment and cleaning up
Environmental precautions
Oxygen Biochem (OBC)™
Keep unnecessary personnel away . Keep people away from and upwind of spill/leak. Wear
appropriate protective equipment and clothing during clean-up . Do not touch damaged containers
or spilled material unless wearing appropriate protective clothing . Avoid skin contact and inhalation
of vapors during disposal of spills . Ventilate closed spaces before entering them. Local authorities
should be advised if significant spillages cannot be contained. For personal protection, see Section
8 of the SDS.
Stop the flow of material, if this is without risk. Prevent entry into waterways, sewer, basements or
confined areas. Following product recovery, flush area with water. For waste disposal, see Section
13 of the SDS.
Avoid discharge into drains, water courses or onto the ground.
920293 Version#: 01 Revision date : -Issue date: 09-May-2014
SDS US
2/7
7. Handling and storage
Precautions for safe handling
Conditions for safe storage,
including any Incompatibilities
Avoid inhalation of vapors/dust and contact with skin and eyes. Wash thoroughly after handling.
Keep away from clothing and other combustible materials. Use only with adequate ventilation. Do
not taste or swallow. Wear appropriate personal protective equipment (See Section 8). Observe
good industrial hygiene practices.
Store in original tightly closed container. Store away from incompatible materials (See Section 10).
Keep locked up.
8. Exposure controls/personal prot~ction
Occupational exposure limits
US. ACGIH Threshold Limit Values
Components
Sodium persulfate (CAS
7775-27-1)
Biological limit values
Appropriate engineering
controls
Type Value
TWA 0.1 mg/m3
No biological exposure limits noted for the ingredient(s).
Observe occupational exposure limits and minimize the risk of exposure. Ensure adequate
ventilation, especially in confined areas.
Individual protection measures, such as personal protective equipment
Eye/face protection Wear safety glasses with side shields (or goggles).
Skin protection
Hand protection
Other
Wear protective gloves.
Neoprene or rubber gloves are recommended. Apron and long sleeves are recommended.
Respiratory protection
Thermal hazards
General hygiene
considerations
In the case of respirable dust. use self-contained breathing apparatus. Wear positive pressure
self-contained breathing apparatus (SCBA).
Wear appropriate thermal protective clothing, when necessary.
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
Odor
Odor threshold
pH
Melting point/freezing point
Initial boiling point and boiling
range
Flash point
Evaporation rate
Flammability (solid, gas)
Off-white, granular solid.
Solid.
Solid.
Off-white.
Odorless.
Not available.
11.7±0.4 (1-40% solution, slurry)
Not available.
Not applicable.
Not available.
Not available.
Not available.
Upper/lower flammability or explosive limits
Flammability limit • lower
(%)
Flammability limit -upper
(%)
Explosive limit -lower(%)
Explosive limit -upper(%)
Vapor pressure
Vapor density
Relative density
Oxygen Biochem (OBC)™
Not available.
Not available.
Not available.
Not available.
Not applicable.
Not applicable.
2. 76±0.16 (25°C)
920293 Version#: 01 Revision date: -Issue date: 09-May-2014
SDSUS
317
Solubility(les)
Solubility (water)
Partition coefficient
(n-octanol/water)
Auto-ignition temperature
Decomposition temperature
Viscosity
Other information
Oxidizing properties
10. Stability and reactivity
Reactivity
Chemical stability
Possibility of hazardous
reactions
Conditions to avoid
Incompatible materials
Hazardous decomposition
products
Soluble in water.
Not available.
Not available .
Not available.
Not available.
Oxidizing .
The product is stable and non-reactive under normal conditions of use, storage and transport.
Material is stable under normal conditions.
No dangerous reaction known under conditions of normal use.
Contact with combustibles.
Combustible material. Oxidizing material. Reducing agents.
No hazardous decomposition products are known.
11. Toxicological information
Information on likely routes of exposure
Ingestion Harmful if swallowed.
Inhalation May cause irritation to the respiratory system .
Skin contact
Eye contact
Symptoms related to the
physical, chemical and
toxicological characteristics
Causes skin irritation.
Causes serious eye irritation.
May cause redness and pain. Exposed individuals may experience eye tearing, redness, and
discomfort. Symptoms may include coughing, difficulty breathing and shortness of breath .
Information on toxicological effects
Acute toxicity Harmful if swallowed .
Skin corrosion/irritation
Serious eye damage/eye
irritation
Respiratory or skin sensitization
Respiratory sensitization
Skin sensitization
Germ cell mutagenicity
Carcinogenicity
Reproductive toxicity
Specific target organ toxicity -
single exposure
Specific target organ toxicity -
repeated exposure
Aspiration hazard
Chronic effects
Further information
12. Ecological information
Ecotoxlclty
Persistence and degradability
Bioaccumulative potential
Oxygen Biochem (OBC)™
Causes skin irritation.
Causes serious eye irritation.
May cause allergy or asthma symptoms or breathing difficulties if inhaled.
May cause an allergic skin reaction.
No data available .
This product is not considered to be a carcinogen by IARC, ACGIH, NTP , or OSHA.
No data available.
May cause respiratory irritation.
No data available .
Not applicable.
Prolonged exposure may cause chronic effects.
No data available.
This product's components are 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.
No data is available on the degradability of this product.
No data available for this product.
920293 Version#: 01 Revision date: -Issue date: 09-May-2014
sos us
4/7
Mobility in soil Not available.
Other adverse effects No data available.
13. Disposal considerations
Disposal instructions Consult authorities before disposal. Dispose in accordance with all applicable regulations.
Hazardous waste code The Waste code should be assigned in discussion between the user, the producer and the waste
disposal company.
Waste from residues/ unused Dispose of in accordance with local regulations.
products
Contaminated packaging Empty containers should be taken to an approved waste handling site for recycling or disposal.
14. Transport information
DOT
UN number UN1479
UN proper shipping name Oxidizing solid, n.o.s . (Sodium persulfate)
Transport hazard class(es)
Class 5.1
Subsidiary risk
Packing group II
Environmental hazards
Marine pollutant No
Special precautions for user Read safety instructions, SOS and emergency procedures before handling .
Special provisions 62, 1B5, IP1
Packaging exceptions None
Packaging non bulk 211
Packaging bulk 242
IATA
UN number UN1479
UN proper shipping name Oxidizing solid, n.o.s. (Sodium persulfate, Calcium peroxide)
Transport hazard class(es)
Class 5.1
Subsidiary risk
Label(s) 5.1
Packing group II
Environmental hazards No
ERG Code 5L
Special precautions for user Read safety instructions, SOS and emergency procedures before handling.
IMDG
UN number
UN proper shipping name
Transport hazard class(es)
Class
Subsidiary risk
Label(s)
Packing group
Environmental hazards
Marine pollutant
EmS
UN1479
OXIDIZING SOLID, N.O.S. {Sodium persulfate, Calcium peroxide)
5.1
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 This product is not intended to be transported in bulk.
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.
Oxygen Biochem (OBC)™
920293 Version#: 01 Revision date: -Issue date: 09-May-2014
SDSUS
5/7
US. 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 -Yes
Fire Hazard -Yes
Pressure Hazard -No
Reactivity Hazard -No
SARA 302 Extremely hazardous substance
Not listed .
SARA 311/312 Hazardous Yes
chemical
SARA 313 (TRI 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
(SOWA)
Not regulated .
US state regulations This product does not contain a chemical known to the State of California to cause cancer, birth
defects or other reproductive harm.
US. Massachusetts RTK -Substance List
Not regulated.
US. New Jersey Worker and Community Right-to-Know Act
Calcium peroxide (CAS 1305-79-9)
Sodium persulfate (CAS 7775-27-1)
US. Pennsylvania Worker and Community Right-to-Know Law
Not listed.
US. Rhode Island RTK
Not regulated.
US. California Proposition 65
US -California Proposition 65 -Carcinogens & Reproductive Toxicity (CRT): Listed substance
Not listed.
International Inventories
Country(s) or region
Australia
Canada
Canada
China
Europe
Europe
Japan
Korea
New Zealand
Philippines
United States & Puerto Rico
Inventory name
Australian Inventory of Chemical Substances (AICS)
Domestic Substances List (DSL)
Non-Domestic Substances List (NDSL)
Inventory of Existing Chemical Substances in China (IECSC)
European Inventory of Existing Commercial Chemical
Substances (EINECS)
European List of Notified Chemical Substances (ELINCS)
Inventory of Existing and New Chemical Substances (ENCS)
Existing Chemicals List (ECL)
New Zealand Inventory
Philippine Inventory of Chemicals and Chemical Substances
(PICCS)
Toxic Substances Control Act (TSCA) Inventory
•A "Yes" indicates this product complies with the inventory requirements administered by the governing country(s).
On inventory (yes/no)*
Yes
Yes
No
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
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 ).
Oxygen Biochem (OBC}™
920293 Version #: 01 Revision date: -Issue date: 09-May-2014
SDSUS
6/7
16. Other information, including date of preparation or last revision
Issue date
Revision date
Version #
Further information
NFPA Ratings
List of abbreviations
References
Disclaimer
09-May-2014
01
HMIS® Is a registered trade and service mark of the NPCA.
NFPA: National Fire Protection Association.
Registry of Toxic Effects of Chemical Substances (RTECS)
HSDB® - Hazardous Substances Data Bank
The information contained herein is accurate to the best of our knowledge. However, data, safety
standards and government regulations are subject to change and, therefore, holders and users
should satisfy themselves that they are aware of all current data and regulations relevant to their
particular use of product_ CARUS CORPORATION DISCLAIMS ALL LIABILITY FOR RELIANCE
ON THE COMPLETENESS OR ACCURACY OR THE INFORMATION INCLUDED HEREIN.
CARUS CORPORATION MAKES NO WARRANTY, EITHER EXPRESS OR IMPLIED,
INCLUDING, BUT NOT LIMITED TO, ANY WARRANTIES OF MERCHANTIABILITY OR FITNESS
FOR PARTICULAR USE OR PURPOSE OF THE PRODUCT DESCRIBED HEREIN. All conditions
relating to storage, handling, and use of the product are beyond the control of Carus Corporation,
and shall be the sole responsibility of the holder or user of the product.
(Carus and design) is a registered service mark of Carus Corporation.
Oxygen Biochem (OBC)'"
920293 Version #: 01 Revision date: - Issue date: 09-May-2014
SDS US
7/7

Compound
TW-1
TW-2
TW-3
TW4
TW-5
Analytical
Method
NC2LGWQ5
Sample Date
1122115
1/22115
5120115
5120115
5120115
sec -Butyl benzene
ND
ND
1.1
ND
ND
8260
70
tart-Butylbenun e
ND
NO
12.2
ND
1.3
8260.
70
Chforobenzene
10.1
ND
131
1.0
ND
8260
50
2-Chforotoluene
ND
ND
1.5
ND
ND
8250
100
1,2-Dichlorobenzene
ND
ND
0.85
ND
ND
8260
20
1,3-DIchlorobenz ne
8.4
ND
ND
ND
ND
8280
200
1,4-Di chlorobe =one
1.4
NO
5.2
ND
ND
8260
6
4-Methyl-2-pentanone (MIRK]
28.7
NO
ND
ND
ND
8260
100
o-Xylene
ND
ND
1.4
ND
ND
8260
500
1-Methyinaphthalene
15.2
ND
ND
ND
ND
8270
1
Remaining VOCs
ND
ND
_ ND
ND
NO
8260
Various
Remaining 5VOCs
ND
ND
ND
ND
ND
8270
Various
PRO?ERTY
BOUNDARY
ESTIMATED EXTENT OF
2L STANDARD
VIOLATION
1'
V
i
I°
n-Butylbenxene
Ca
pl
i
°°'
5i
c
41
sa
'
C!
CC
O
c
u
G
s
U
W
1,3-I]ichlorobenzene
4-Isopropyltolu en e
IsopropyFbenzene
=,
sa
0.
v
c
m
E
1-Methyinaphthalenc
2
�}
N
m
22
es
rs
a
t
N
H
LI
t
Q
OD
LY
u
C19-C36 Aliphatics
C9•C22 Aromatics
I
Well ID
Date
Collected
MW1
7/6/15
8/12/15
<0.298
316
19A
15.7
<0.105
<0.105
<0.0940
<0.0980
5.59
<0,0980
32
<0.103
2951
7.91
6.211
1.571
249
358.5
11151 F
446
102
302
934 D
394
MW2
3.536
103
13.9
10.9
1.95
4.75
<0.0890
10.9
19.5
1.01
<123
<1.20
<1.20
1,350_
<100
MW3
8/12/15
<0.298
<0.0600
16.7
13.2
4.28
<0.0940
<0.0980
<0.0890
17.9
36.3
<0.103
<1.23
2LStandard
500
70
70
70
50
20
200
25
70
70
400
1
700
3
700
10,000
200
LEGEND
MONITORING WELL LOCATION
• ECS TEMPORARY MONITORING WELL LOCATION
(TW -1)
IiNC_UDED TABLE (TOP) SUfv1MARI7FS ANAL YT GA -
RESULTS FROM ECS TEMPORARY MONITORING WELL
SAMPLES.
2L STANDARD VIOLATIONS ARE IN BOLD.
ALL RESULTS :N PARTS PER BILLION (PPE).
INC_UDED TABLE (E301 TOM) SUMMARIZES
ANALYTICAL_ RESULTS FROM MONITORING WELLS
MW1 MW3.
ONLY DETECTED CONCENTRATIONS LISTED.
DETECTED CONCENTRATIONS GREATER THAN THE- 7f
STANDARDS SHADED.
ALL RESU_TS IN PARS PER BILLION (PPB).
GRAPHIC SCALE
0' 20' 40'
1 = 40'
8(3'.
ANALYTICAL
GROU
z
w
m
w
z
(f) z
Ztn4
W Z
wz
Qj
¢ UCC
Y)C3
U
r"J
zEr
w
o_
In
z
CO
LeJ
7
11'
r.
rn
_) _)
m
LJ
• 0
U
w
0
•
ran
0
0
0
0
PROJECT NO