WI0700488_DEEMED FILES_20190401

Permit Number
Program Category
Deemed Ground Water
Permit Type
WI0700488
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Frog Pond
Location Address
730 Queen St
New Bern
Owner
Owner Name
NC 28563
Ncdeq Dwm Ust Section-Federal & State Lead Program
Dates/Events
Orig Issue
3/28/2019
App Received
3/25/2019
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
4/1/2019
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
Scott Ryals
1646 Mail Serivce Ctr
Raleigh
Region
Washington
County
Craven
NC
Issue
3/28/2019
Effective
3/28/2019
27699164
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
I. WithersRavenel
115 MacKenari Drive
Cary, North Carolina 27511
i4469.334fi If•014.i_,i F.n08
NCDEQ - Water Quality Regional Operations &
TO: Groundwater Protection Branch
1636 Mail Service Center
Raleigh, NC 27699-1636
WE ARE SENDING YOU
❑ Shop Drawings
D Copy of Letter
® Attached
❑ Prints
❑ Change order
Letter of Transmittal
03/18/19 • 02170214.92
Shristi Shrestha
Frog Pond
730. Queen. Street
New Bern, Craven County, NC
Incident # 16272
❑ Under separate cover via
❑ Plans
❑ Diskette
❑ Samples
the following
items:
❑ Specifications
COPIES
1
- _ DATE
03/18/19
NO.
1
"DEEMED AS PERMITTED" APPLICATION FOR SURFACTANT INJECTION
i
THESE ARE TRANSMITTED as chocked below
® For approval
❑ For your use
❑ As requested
❑ For review and comment
❑ FOR BIDS DUE
rt�IvS�I;
❑ Approved as submitted
❑ Approved as noted
❑ Returned for corrections
❑ Resubmit
❑Submit
['Return
copies for approval
copies for distribution
corrected prints
❑ PRINTS RETURNED AFTER LOAN TO US
COPY TO: NCDEQ - State Lead Branch, File
Matthew James, PG
REGENEDINOnvoire p
MAR252fl19
Weller Quallty

North Carolina Department of Environmental Quality-Division of Water Resources
NOTIFICATION OF INTENT (NOi) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are ''permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C .0200 (NOTE: This form must be received at least 14 DAYS p rior to in jection)
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 (1 5A NCAC 02c .0225 ) or TRACER WELLS (15A NCAC 02C .0229 ):
1) Passive In jection S v 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 Operations -Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests -Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: 20 -----~ PERMIT NO. t,,,'tl'l--el-0 0 4-g ~ (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(I)
(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
___ Passive Injection System ............................... Complete sections B through F, H-N
XXXX Small-Scale Injection Operation ...................... Complete sections B through N
___ Pilot Test ................................................. Complete sections B through N
___ Tracer Injection Well ................................... Complete sections B through N
B. STATUS OF WELL OWNER: State Government
C. WELL OWNER(S) -State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): NCDEO -DWM. UST Section. Federal & State Lead Program: Attn: Scott R vals
Mailing Address: 1646 Mail Service Center
City: Ralei2h State: N~C __ Zip Code: 27699-1646 County:~W~A~KE~---
Day Tele No.: ---~9~19~-~70~7~-~81~6~8_ Cell No.: Unknown
EMAIL Address: ___ s~c~o=tt~.ry_.__a=l=s@~n~c~d=enr~.g~o~v ______ _ Fax No.: ___ 9_1_9-_5_7 _1-4_71_8_
Deemed Permitted GW Remediation NOi Rev. 3-21-2018 Page I
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: ______ C=it ___ v--=o~f ~N~e~w~B~ern~---------------------
Company Name ---------------------------------
Mailing Address: -----~P--=-O--=B=o=x~l 1=2=9
City: New Bern State: _NC_ Zip Code: 28563 County: Craven
Day Tele No.: 252-639-7501 Cell No.: ____ _
EMAIL Address: _____________ _ Fax No.: ___________ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: ___ G==-. =M=a=tth=ew-'-'--"J--=a=m=-=e=s,L.aPa....a•=G=·•L.aP'-'r'""o.._,je'""c_,_t =M=a=n=a=ge=r'-----------------
Company Name ___ ...,_W'-'i=th=e=rs=R--=a=v--=e=ne=l"--""In=c°'"". ______________________ _
Mailing Address: __ ______,l'---=l--=-5--=M=ac=K=e=n=a=n'---=D=r=iv_,__e=--------------------
City: _____,C=a=.,_ _________ State:~ Zip Code:=2 "'""75a...ala..al ____ County: WAKE
Day Tele No.: ---~9-"--19"-----=23=8"----=03=3=5 ___ _ Cell No.: __________ _
EMAIL Address: m james(al,withersravenel.com Fax No.: 919-467-6008
F. PHYSICAL LOCATION OF WELL SITE
(I) Facility Name & Address: Frog Pond : 730 Q ueen Street
City: ----=N~e~w~B'-'e=rn~ _____ County: Craven Zip Code: __ 2_8~5~63~
(2) Geographic Coordinates: Latitude**: 0 "or ---0
Longitude**: 0 __ "or 0
Reference Datum: _______ --'Accuracy: ________ _
Method of Collection: __________________ _
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COO RD INA TES.
G. TREATMENT AREA
Land surface area of contaminant plume: 5.000 square feet
Land surface area of inj. well network: -1 .000 square feet (.::: 10,000 ft 2 for small-scale injections)
Percent of contaminant plume area to be treated: -20% (must be.::: 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS -Attach the following to the notification.
(I) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
Deemed Permitted GW Remediation NOi Rev. 3-21-2018 Page2
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration
of injection over time.
Pu rp ose: Elimination of free-phase petroleum product on l!.foundwater surface at location
Sco pe: In iection of EnviroClean surfactant into one existing monitorin g well followed b the performance of a
surfactant enhanced recove ry event (A gg ressive Fluid/Vapor Recove rv).
Goals: Reduction of source area contamination through removal of free-phase and dissolved-phase petroleum
contamination with the aid of surfactants.
J. APPROVED INJECT ANTS -Provide a MSDS for each injectant (attach additional sheets ifnecessary).
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 ://de q.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/ground-water-protection/gr ound-water-a pp roved-in jectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UJC Program for more irifo (919-
807-6496).
Injectant: __ ....:E=n=v.:..:iaa..ro:a..C=-la.::e=an"'--"S'-=u=r=fa=c=tan=t ______________________ _
Volume ofinjectant: _....:2=5'----'0'----=G=a=ll=o=n=-s_._,(5"----0g=al=lo=n=s'-'E=n=v.:..:i=ro"-C=-la.::e=a=n--=d=il=u""te::..:d=---w-'--'---"'it=h....:w""a=t:.:.e._r ...,to"-=2°""'1/o"-s=o:::..:l=ut~i""on=),_ __
Concentration at point of injection: ------'2=-0'----'1/o'-'M=ix=t=u=re"-'-'w""'it=h._.p...,o:.::t=ab=l=e....:w""a=t:.:.era,.._ _________ _
Percent ifin a mixture with other injectants: ---=2""'o/c..a.o-=E=n"-'v=ir'-"o--=C'-"l.:.aea=n"",""'9""'8'""o/c-=-o.l.Cp=o=ta=b=le~w-=a=te=r _____ _
lnjectant:
Volume of injectant: _____________________________ _
Concentration at point of injection: _______________________ _
Percent ifin a mixture with other injectants:
lnjectant:
Volume of injectant: _____________________________ _
Concentration at point of injection: _______________________ _
Percent if in a mixture with other injectants: ____________________ _
K WELL CONSTRUCTION DATA
(1) Number of injection wells: ----=O'---__ Proposed. __ ___,:: ___ Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as-built):
Deemed Permitted GW Remediation NOi Rev. 3-21-2018 Page 3
L. SCHEDULES -Briefly describe the schedule for well construction and injection activities.
I) Following gau giny of free product thickness in well MW-lR, complete injection of EnviroClean Surfactant
into each well.
2) Approximate! I-week followin g iniection activities. perform surfactant enhanced AFVR event on MW-
lR.
M. MONITORING PLAN -Describe below or in separate attachment a monitoring plan to be used to determine
if violations of growidwater quality standards specified in Subchapter 02L result from the injection activity.
1) Gau e and le MW-IR four months followin , com letion ofin.ectioo/AFVR.event
2) If Free Phase Product is detected following the injection / AFVR even t additional surfactant enhanced
recove events will be conduc
3) Monitor site annually until incident closed.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: "I hereby certify, under penalty of law, that I am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information. I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for suhmittingfalse ieformation. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in_:,a ~ordance with the 15A NCAC 02C 0200 Rules. "
Signature of Applicant /
Scott R y.us . PE, NCDEO-DWM , Incident Manager
Print or Type FaU Name and Tide
Property Owner (if the prope r1 is not owned b y the Well Owner/Applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A NCAC 02C .02001."
"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 ATTACHED NCDEO STATE -LEAD ACCESS AGREEMENT FOR PROPER1Y
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Tide
• An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form .
Please send 1 (one) hard color copy of his NOi along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR-UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOi Rev. 3-21-2018 Page4
SECTION 1
ENVIRO CLEAN
SAFETY DATA SHEET
MATERIAL IDENTIFICATION
PRODUCT NAME / DESCRIPTION: EnviroClean
DISTRIBUTED / MANUFACTURED BY:
ENVIRO CLEAN PRODUCTS & SERVICES
PO BOX 721090
OKLAHOMA CITY, OK 73172
DATE: 05/18/2015
PHONE: [phone]
EMERGENCY PHONE: [phone]
FUNCTION: Industrial Cleaner and Remediation Agent
SECTION 2
HAZARD IDENTIFICATION
CLASSIFICATION:
Acute Toxicity- Oral
Category 4
Skin Corrosion/Irritation
Category 3
Eye Damage/Irritation
Category 2B
Target Organ Specific Toxicity: Single
Category 3
Target Organ Specific Toxicity: Chronic
Category 2
SIGNAL WORD:
WARNING!
HAZARD STATEMENTS:
Harmful if swallowed
Causes mild skin irritation
Causes eye irritation
May cause respiratory irritation
May cause damage to organs through prolonged or repeated exposure
PRECAUTIONARY STATEMENTS:
Obtain special instructions before use
Do not handle until all safety precautions have been read and understood
Use personal protective equipment as required
Avoid breathing dust/fume/gas/mist/vapors/spray
Use only outdoors or in a well ventilated area
Wash all exposed skin thoroughly after handling
Avoid release to the environment

ENVIRO GLEAN
Store in a well ventilated place
TOXICITY INFO:
See Section 11,
SECTION 3 HEALTH HAZARDS
CHEMICAL NAME o/oWIW CAS NUMBER
(Proprietary Formula)
Proprietary Blend of Ethoxylated Octylphenolic Surfactants
Non-ionic water based liquid blend, concentrate
This product does not contain any hazardous ingredients as defined by CERCLA and Calitbrnia's Prop. 65_
SECTION 4
FIRST AID
Potential acute health effects:
Eyes:
Skin:
Inhalation:
Ingestion:
May cause irritation with redness and pain.
May cause irritation with redness and pain.
Inhalation may cause irritation.
Ingestion may cause severe irritation, corrosion/ulceration, nausea, and vomiting.
Medical Conditions Aggravated by Exposure:
None known.
Eye Contact:
Skin Contact:
Inhalation:
Ingestion:
SECTION 5
In case of contact, immediately gush eyes with cool running water, Lift and
separate eyelids while flushing with plenty of water for at least 15 minutes. Get
medical attention.
Wash with soap and water. Get medical attention if irritation occurs. Wash
clothing before reuse. Destroy contaminated shoes.
Remove victim to fresh air and keep at rest in a position confortable for breathing.
If not breathing, give artificial respiration. If breathing is difficult, give oxygen.
Seek medical attention if symptoms develop.
Do NOT induce vomiting unless directed to do so by medical personnel. Never
give anything by mouth to an unconscious person. if large quantities of this
material are swallowed, call a physician immediately. Give plenty of water.
FIRE FIGHTING MEASURES
Fire Hazard Classification (OSHAINEPA):
Extinguishing Media:
Special Fire Fighting Procedures:
Hazardous combustion products:
0
As required for fire being fought.
Use self-contained breathing apparatus.
No known.

ENVIROICLEAN
SECTION 6 ACCIDENTAL RELEASE MEASURES
Personal Precautions, PPE, and Emergency Procedures:
Wear protective clothing as described in Section 8 of this safety data sheet.
Containment Procedures: Stop the flow of material, if this is without risk. Wear appropriate protective
equipment and clothing during clean-up. Do not allow the spilled product to enter
public drainage system or open water courses.
Clean -Up Procedures:
Sweep up or gather material and place in appropriate container for disposal.
Wash spill area thoroughly. Wear appropriate protective equipment during
cleanup_ Dispose of collected material according to regulations.
SECTION 7 HANDLING AND STORAGE
Handling:
Storage:
Avoid contact with eyes, skin and clothing. Do not take internally. For industrial
use only. Wash after handling. Don't breathe dust, vapor, or gas. Keep this and
all chemicals out of reach ofchildren.
Keep away from heat, sparks, and open flames. Prevent spills_ Keep container
tightly closed and in a cool, well -ventilated place away from incompatible
materials. Empty product containers may contain product residue, do not reuse.
SECTION 8 PERSONAL PROTECTION / EXPOSURE CONTROLS
Ventilation System: Always keep exposure below permissible exposure limits. In general, dilution
ventilation is a satisfactory health hazard control for this substance_ However, if
conditions of use create discomfort to the worker, a local exhaust system should
be considered.
Airborne Exposure Limits: None Established.
Personal Protection: As prescribed in the OSHA Standard for Personal Protective Equipment (29 CFR
l920.132), employers must perform a IIazard Assessment of all workplaces to
determine the need for, and selection of, proper protective equipment for each
task performed.
Eyes: Wear face shield, safety glasses, or chemical goggles.
Hands & Skin: For prolonged or repeated handling, use impervious gloves. Gloves should be
tested to determine suitability for prolonged contact. Use of impervious apron
and boots are recommended.
Respiratory: If ventilation is not sufficient appropriate NIOSHIMSI-IA respiratory protection
must be provided.
Work Practices: Eye wash fountain and emergency showers are recommended.
SECTION 9 TYPICAL PHYSICAL AND CHEMICAL PROPERTIES
Physical Form: Liquid
Color: Red

ENVIRC LEAN
Odor:
Odor Threshold:
pH:
Boiling Point:
Melting Point:
Flash Point:
Evaporation Rate
Flammability:
UEL:
LEL:
Vapor Pressure:
Vapor Density:
Specific Gravity (Water = 1):
Solubility Water:
Partition Coefficient:
Auto -ignition Temperature:
Decomposition Temperature:
Viscosity (CPS):
SECTION 10
Wintergreen
NE
8.5+l-0.5
NE
N/A
>200 deg I'
(Butylacetate = 1) NE
Non -Flammable
NE
NE
NE
NE
1.03+/-.05
Complete
NE
NE
NE
NE
STABILITY AND REACTIVITY
Stability:
Incompatibility:
Decomposition Products:
Conditions to Avoid:
SECTION 11
This product is stable under normal temperatures and pressures.
Strong Oxidizers and strong acids.
No Known hazardous products.
Sparks/flames/high heat.
TOXICOLOGICAL PROPERTIES
Raw Material
N/A
Test Result
Route
Species
See Section 4 for symptoms.
CARCINOGENICITY:
No known carcinogens, mutagens, or reproductively toxic ingredients
SECTION 12
ECOLOGICAL INFORMATION
Raw Material
Test
Result
Time ; Species
N/A
PERSISTENCE & DEGRADABILITY!
NE

ENVIR<>t£~§~
BIOACCUMULA TION:
NE
MOBILITY
NE
SECTION 13 DISPOSAL CONSIDERATIONS
Whatever cannot be saved for recovery or recycling should be managed in an appropriate and approved
waste disposal facility. Processing, use, or contamination of this product may change the waste
management options. State and local disposal regulations may differ from federal disposal regulations.
Dispose container and unused contents in accordance with federal, state, and local requirements.
SECTION 14 TRANSPORT INFORMATION
Not Regulated by DOT or IATA.
SECTION 15 REGULATORY INFORMATION
US FEDERAL REGULATIONS
SARA (SUPERFUND AMENDMENTS AND REAUTHORIZATION ACT):
SARA 302 EXTREMELY HAZARDOUS SUBSTANCES LIST: NA
SARA 312 HAZARD CATEGORY: NA
SARA 313 TOXIC CHEMICALS LIST: NA
CERCLA (COMPREHENSIVE ENVIRONMENTAL RESPONSE. COMPENSATION AND
LIABILITY ACT): NA
RCRA (RESOURCE CONSERVATION AND RECOVERY ACT) LISTED HAZARDOUS WASTES:
NA
CWA (CLEAN WATER ACT) LISTED SUBSTANCES: NA
FDA (FOOD AND DRUG ADMINISTRATION): NA
TOXIC SUBSTANCES CONTROL ACT (TSCA): NA
IATA: NA
ENVIRCIttLAN1
NFPA HAZARD INFORMATION SIGN
101
191
4 - DEADLY
3 - EXTREME DANGER
2 - HAZARDOUS
1 - SLIGHTLY HAZARDOUS
0 - NORMAL MATERIAL
FLASH POINTS:
4 -BELOW 73 F
3-BELOW 100 F
2 - BELOW 200 F
1 - ABOVE 200 F
0 - WILL NOT BURN
[0] REACTIVITY HAZARD (YELLOW DIAMOND)
4 - MAY DETONATE
3 --- SHOCK AND HEAT MAY DETONATE
2 - VIOLENT CHEMICAL CHANGE
1- UNSTABLE IF HEATED
0 - STABLE
[] SPECIFIC HAZARD (WHITE DIAMOND)
OXY OXIDIZER
ACID ACID
ALK ALKALI
COR CORROSIVE
W IISE NO WATER
SECTION 16 OTHER INFORMATION
THIS INFORMATION IS OFFERED IN GOOD FAITH AS TYPICAL VALUES AND NOT AS A
PRODUCT SPECIFICATION. NO WARRANTY, EXPRESSED OR IMPLIED, IS HEREBY MADE. THE
RECOMMENDED INDUSTRIAL IIYGIENE AND SAFE HANDLING PROCEDURES ARE BELIEVED
TO BE GENERALLY APPLICABLE. HOWEVER, EACH USER SHOULD REVIEW THESE
RECOMMENDATIONS IN THE SPECIFIC CONTEXT OF THE INTENDED USE AND DETERMINE
WHETHER THEY ARE APPROPRIATE.

EnviroClean
Degassing/Hydrocarbon Removal/Remediation Chemistry
PHYSICAL PROPERTIES
EnviroClean Product Name
Physical Form
Color
Clear Liquid
Colorless unless dyed
Specific Gravity (Water = 1)
Solubility in Water
Freezing/Melting Point
Flash Point (°F)
pH
Reportable Quantity (RQ)
1.028 +/-.01
100%
NE
>200° F
8.5 +/-.25
None
Complete information on health hazards, protective
equipment, handling precautions, environmental
hazards and disposal is listed in the current
EnviroClean Safety Data Sheet (SDS) for this product.
SUMMARY
EnviroClean is a non-flammable, non-toxic,
water-based, proprietary blend of non-ionic
ethoxylated octylphenolic surfactants that has
been specifically engineered as a
cleanup/mitigation agent for a wide range of
hydrocarbon products. EnviroClean has been
shown to be effective for quickly and effectively
suppressing or completely eliminating voes,
LEL's, benzene and low levels of H2S and
mercaptans in open or confined spaces.
EnviroClean has been used for cleanup of
hydrocarbon spills and soil remediation. In these
applications, EnviroClean effectively conditions
(physically) the hydrocarbon such that the
microbes that naturally occur can more readily
consume it. It turns hydrocarbons into a nutrient
source for the microbes. When sufficiently mixed
with hydrocarbon and water, the EnviroClean
forms a homogeneous solution of hydrocarbon,
EnviroClean and water, which is very stable.
EnviroClean is a concentrated product that
readily biodegrades.
EnviroClean is commercially available in 5-gallon
units, 55-gallon drums, 275 and 330-gallon totes
and bulk from Oklahoma City, Oklahoma and
Houston, Texas.
Page 1 of 2
FLUID DESIGN
EnviroClean is a proprietary blend of surfactants
that needs to be diluted to be effective and it is
very safe to workers and the environment.
EnviroClean does not contain caustic, therefore
does not have the common harmful side effects
associated with caustic based products. The
product is designed for use as a degassing agent
and a cleaner/degreaser for remediation. The
product does not contain any enzymes or
biomass itself. It works by conditioning the
hydrocarbon so that the naturally occurring
microbes (bacteria) are able to readily consume
it. Through the application of the appropriate
dilution and mixing, the EnviroClean will capture
the hydrocarbon and tie it up in a solution that is
very stable. The formation of this solution results
in extremely small particles that will not
recoalesce. It is important to note that if
EnviroClean reaches its saturation point the
oversaturated hydrocarbon will breakout of
solution very quickly. This will allow for easy
removal or reclamation of any hydrocarbon that is
not preconditioned for remediation.
In addition to tying up the hydrocarbon in
solution, the product is very effective when
contacted with hydrocarbon vapors at
suppressing volatile organic vapors, gases, and
odors. Once combustible and flammable
hydrocarbon vapors are tied up in the resultant
solution, the solution will be very difficult to ignite.
It also accelerates the biodegradation process of
the hydrocarbon, thereby enhancing recycling or
reclamation of water.
EnviroClean has been demonstrated to be
effective on gas, oil, lube oil, hydraulic oil, most
petroleum-based products, animal and vegetable
oils, fats, and tallow oils. EnviroClean cleans the
heavy tar build-up, asphaltenes or oily residue
from inside of tanks and vessels. Furthermore,
once a surface has been cleaned with
EnviroClean, the cleaned surface will resist the
deposition of oily materials.
EnviroClean can be used to cleanup oil spills
whether in/on soil or hard surfaces. The first step
in this process is to remove as much of the free
oil as possible. This step is followed by
contacting the contaminated surface
appropriately with the proper dilution of
EnviroClean and water. The treatment solution
will contact the hydrocarbon molecules and
change their behavior such that they are now
essentially water soluble. The large increase in
interfacial surface area creates conditions that
are favorable to degradation and consumption by
bacteria and microbes. The product converts
hydrocarbons into a very good nutrient source for
bacteria and microbes.
EnviroClean is typically fed at concentrations
between 1 % and 6%, depending on the nature of
the hydrocarbon contamination problem. It can
be diluted with most types of water -hard, soft or
brackish water. The product has an unlimited
shelf life when unopened. EnviroClean is
effective at ambient temperatures. However, the
effectiveness will increase as the tern rature
of the a pp lication is increased. EnviroClean
does not require the use of steam, but has been
shown to be very effective when injected into the
steam (vapor) phase.
FIELD MIXING PROCEDURES
Mixing Concentrates
EnviroClean is usually delivered as a concentrate
and must be diluted with water to work properly.
Cleaning solutions can be formulated by
premixing or eduction. It is not necessary to
provide high shear agitation when preparing a
batch of cleaning solution since EnviroClean is
100% soluble in water. It is recommended that
when preparing the cleaning solution you first
add the water into the mix container and then
follow by the addition of EnviroClean. This will
minimize foaming as the EnviroClean and water
form a homogeneous solution.
For premixing, the following procedure may be
used:
1. Add the correct amount of water to the
container.
2. Depending on the desired strength, add
the correct amount of EnviroClean to the
container.
3. If the final solution is not a consistent
pink color, mild agitation may be
required until a consistent pink color is
achieved.
Quality Control Testing
There is no easy field testing procedure to
monitor the concentration of active ingredients in
the EnviroClean formulation. Visually the color
changes from rose color to lighter pink as the
product is further diluted. Effectiveness can also
be predicted by quantifying the amount of
hydrocarbon that is to be picked up. By
observing the effluent from the use of
EnviroClean, an adjustment in the cleaning
solution concentration can be made. If it is
observed that free oil is floating on the effluent
Page 2 of 2
solution, then the concentration should be
increased.
MATERIAL REQUIREMENTS
For specific protocols and application rates,
please refer to the available Product Usage
Guide, product label, or consult with the
manufacturer or authorized distributor for
additional guidance.
LEGEND
TYPE II MONITORING WELL LOCATION
NOTES:
142013 AERIAL OBTAINED FROM NC CHEW.
■■ WithersRavenel
Engineers j Planners j Surveyors
1l5 Mxliamm 7rias I Cary. NC 4755111: 919.) h9.73101 Ikenst ihea492 I nww.aR[heruarenelean
Anal ytfcal Method
Sample
PD
Dale
LotlapeG
1M-1 91 11127.12017
T-11 11/2712517
a1w-a 11127i2017
MW 4 1 11127;2017
8
1
j
a
1
7143-2 10451-6 1354/343 I 96966 1o0-[phone]- 103435.1
LIMIEMZMMZMMIEM
MIIMMZM
0:IM00 4.7410
OQ 20.8 MEM�' : 1
�M�._.�._0-- — M::
� _ MOO M=M 20600 0000
00l6.3 95-67.0 106876 94,47.4 117920.7
NA
ENIMIsAM
13.43
t6Y
400
066W
Molex
l.J An results proAdee in u, J1. [mkagrams per AIM) or pens par b. Mon
2.) Compounds mishaed 6r by labomkny 6M not noted waro n l ticicc1 d o6ac Iabsysfvry Euoalen limns. Sue 1M laboratory reper.:ncl dud -m 1ha Appendix For a Enka! or constiWerly.
3J [JC 2L 0land6f6 - 41M1.11 Celdiaa GF:vodv d6r Quarry 61.104arl as per NC Atil-alislrive COde 15R KAC 02L
4.) GCLe for Gpprdpular a td:'PEFR UST5ecli on Limas Corium -Loudon heals {or Gmwldwele:
5.) Mall T-1 was misladed as 7444 and MW1R was 1:119994 as MW-1 on Om COC
�= Rid Elwood& La beratwy Uato %on JrMl
Result mosue Eeoo.de 21-Stanrard
M r.n Eeceatla OCL VIMss
FORMER FROG POND STORE
INCIDENT# 16272
730 QUEEN STREET
NEW BERN, CRAVEN COUNTY, NC
T-1
MW-1R
saw
-11
4I
SITE MAP
C SCALE
DR -ye: H'•
CF
SCAT F
1"'30'
1
APPROVED BY!
MJ
DATE
12/11/2017
PRO/EC-ND.:
02170214.92
r�7arot-62f0i1t0iw7.40550 - Pig rr1elE.rli$1 ry w w....sAc A671en1..na.4- par# r1, 2ar1 - vrsr, 04141O1m(11

Q Water Meter
Hre Hydrant
Q Power Pale
—WL— Water line
—ss — Sanitary Sewer Line 0
Overhead Electric •
Storm Drain Line
ceck
—NG
e Residence d
e 1
k f
Type Ii Monitoring Well
Type 111 Monitoring Well
Storm Drain
Natural Gas Line
Sanitary Sewer Manhole
Soil Boring
Notes:
1. (190.00) Top of Casing
Elevation in Feel
Al
r•r�fiecl I�er�urice MariacicmarG PC
P.a 6c4 882, Hanipsfecid, NC 28443
91 ❑) 270-2919 FAX [phone]
: SITE MAP WITH MONITORING
WELL AND BORING LOCATIONS
JOB: SCALE: DATE: DRAWN BY:
0225 1 " = 40' 4/13/03 JLZ
FIGURE:
�2

a)
LEGEND
MW-2
(96.10)
i4 Type it Monifodng Well
Type III Monitoring Well
[96.29) Groundwater ration in Feet
FP Free Product Present
Concrete Wall
Abandoned
Bldg
MW-.5
(95.28 '
� r
9s \ 1- - �
8a t
• t s TAW-4
N (95.25')
� rFPI �eQi\
(96.29)
Notes:
T . Contour Interval = O.2CE
2. Well with FP not considered in contouring
3. Type 1I { well not considered in contouring
76c,rAi& resource Mark3lernerrt FC
Q Sox 882, Harnpsiead, NC 28443
91Q) 270-2919 FAX [phone]
TILE: GROUNDWATER CONTOURS
AS OF 4/22/03
JOB: SCALE: DATE: DRAWN BY'
0225 ] " = 40' 4/13/03 I JLZ
FIGURE:
3

Conners watl
ra ft- e"."
Concrete 19
T MW-3
FA
UST AIea !Nmn
Abandoned
Bldg
Estimated Extent Of
' Free Product Plume
�, •1J 'L
�n
Abarxioned
Building
LEGEND
60 Type II Monitoring Well
f Type III Monitoring Well
f Soil Boring
i6c.
pp['red Iourre Manraleme PC
P.Q. Bar 882. Hampstead, NC 28443
[phone] FAX [phone]
TME: SITE MAP WITH FREE PRODUCT
PLUME AS OF 4/22/03 _
JOB: SCALE: DATE: DRAWN BY:
0225 1 " = 40i 4/ 13/03 J�Z
FIGURE:
4

13. GROUT: Depth
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natmaal Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR ttNorvioDMI) NAME (prat) Donald Curtimings CERTIFICATION A! 2412
WELL CONTRACTOR COMPANY NAME ARM Watarwarks
STATE WELL CONSTRUCTION PERMIT! NIA . _ASSOCIATED WQ PERMIT/1 NIA
(if applicable) (iifapplieehte)
PHONE # (31 D1 270`29 T 9
I. WELL USE (Check Applicable Box): Residential © Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring KI Recovery 0 Heat Pump Water Injecticm 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: New Bern Comity Craven
730 Queen Street, 26560
(Street Name, embers, Community Subdivision, Tor No., Zip Code;)
3, OWNER; Ballard Tire & Olt Company, Inc_
Address 3500 Marlin Luber King Blvd
(StromorRoine No.)
New Bem NC
7R
City or Town Stew
252 r 633-1186
Atria code- Moue amber
4. DATE DRILLED 12/18102
5. TOTAL DEPTH: 13.
Zip Code
6. DOES WELL REPLACE EXIST/NG WELL? YES 0 NO KI
7. STATIC WATER LEVEL Below Top of Casing: 6 _FT.
(Use "+" if Above Top of fixing)
8, TOP OF CASING lS 0 FF. Above Land Surface*
'Top of casing terminated ober below Iaed surface requires a
variance iu accordance with 15A NC -AC 2C _411&
9. YIELD (pm)_ N/A METHOD OF TEST NIA -
10. WATER ZONES (depth): Surilciat Aquifer - -
11. DISINFECTION: Type WA
12. CASING:
Depth Diameter
From 0 To 3 FL 2"
From To
From To Irt
Material
From 0 To 0.5 It Grout
Amount NIA
Wall Thickness
or Weight/Ft_ Maeda!
SCI-140 PVC
From 0-5 To 1.5 It Bentnnile
14. SCREEN: Depth Diameter
Ft.
From 3 To 13
From— To Ft_an_
Method
Trernmie
Poured
Slot Size Material
.014 in, PVC
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From T.5 To 13 FL Course Sand
From To Ft._
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope :Walley Mar
(check approia-iare box)
Latitude/longitude of well location
(degre s/mineteslaewndb)
Latitude/longitude source: QGPS0Topographic map
(r]r box)
DEPTH DRILLING LOG
From To Formation Deo:ription
SEE ATTACHED
MW-1
LOCATION SKETCH
Show direction and distance in mike front at feast
two State Roads or County Roads. Include the road
numbers and common road names
I DO HEREBY CERTIFY THAT THLS W WAS CONSTRUCTED IN ACCORDANCE WITS 15A NCAC 2C, WELL
CONSTRUCTION DARDS, AND AT ACOPY OF TIES RECORD RAS BEEN PROVIDED TO ELL WNER
pig
Submit the original to the 'Division of Water , Groundwater Secdoa, 1636 Mail Service Center -Raleigh, NC
2T699-] 636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

FROG POND SERVICE STATION
730 QUEEN STREET
NEW BERN, NC
MW-1
Dulled by: ARM's WaterWo ks
Lagged by: Joseph L. Zu,cich
Date:12)18032
_ate ,.
Depth
Descnptio r
--Water
Maw Count,
2 - 4
Btnwn to dark, gray fine grained sand.
Hydrocarbon odor. Moist.
Low
Grab
5 - 7
Dark gray- brown, slightly clayey fine
grained sand. Strong hydrocarbon odor.
Wet at 6.5'.
High
HP
10 - 12
Tan to medium brown, slightly clayey fine
to medium grained sand. Strong
hydrocarbon odor_ Wet Product sheen
High
HP
HP = Hydraulic Push

Steel IVIanhole
Gfound Surface
1' Bentonite
1.
MW-1
Lacking Wei Cap
Concrete/Grout CrOWT1
3' Riser
" 9 • - • • •
• • • I • • •
49 • /Wei
i
,-; • • • I•••00IIqJ
- • •
r '• • • •
0*0009.
( •' '--• IA
• •N •• •• ••
• • •
• • - • •• ••
• • • •• •• •
• •
• • 0 • •
• • • • •
• • • 0 • •
'4•11
..0 11
• • In• • • •
9. • •
• • •
• • •
• _... •••
Groundwatei <Ains I, • • •
Tabie eir• o•••
• • •
• • • J • • ,.
•• •• • I • • •
• •
•• •• • • •
• • •
• • •
• • • • • •
1 1 .5' Sand
• •
0,06111. :::--•,....i
I .-
,.. .- . 0.9.0 •• •• •• 4-,
GA.0 • • • --
• • • 1 - .
- are* ill • • • -..
• • • • •
••••• —1••••••
---- • • • • • •
-. . . • • • • •
---- - dre•;• -711.10.11Pi•••••
.410,..f•
i
0 • •
• • • -
: - • • •• •• ••
- '
• • • 0 •• •• •. -- '
' • i • • IV -
0 • • • • •
9 •• , 0 • • 1.: -.
../ • a • - •
• •
10' Screen
13' Total Depth

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (LNDIVIlJUAL) NAME (pet) Donald Cummings CERTIFICATION # 2412
WELL CONTRACTOR COMPANY NAME ARM Waterworks > ONE # [phone]
STATE WELL COMMIX -MN Mann N/A -- - ASSOCIATED WQ?ERMT7YI NIA
(if applicable) Of applicable)
1, WELL USE (Check Applicable Box): Residential ❑ Municipal/Public Industrial 0 Agricultural 0
Monitoring ® Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: New Bern
730 queen Street, 26560
County Graven
(Street Name, Numbers, Community, Subdivision, Lot No., Tap Cam)
3, OWNER; Batlard Tire & 01 Company Inc.
Address 3500 Maur Luther 1{aig Blvd
New Bern
(StreetarRecteNo
NC 285562
City oar Town Some
( 252)- 633-1186
Area code- Phone number
4. DATE DRILLED 121t8102
5. TOTAL DEPTH: 12'
bpCode
6_ DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Bclow Top of Casing: 4 FT.
(Use "+^ it Above Top of Casting)
8. TOP OF CASING IS 0 Fr. Above Land Surface*
•'Tap of aging terminated arlor below land 'artier minims a
rarirtnce m accordance with 15A NCAC ZC .61I8
9. YIELD (gpm): NiA METHOD OF TEST N/A
10. WATER ZONES (depth): &Oficial Aglitter
11_ DISINFECTION: Type N/A
12. CASING
Fromm 0
From To
Fran To Ft
13. GROUT: Depth
From 0 To 05
From 0.5 To 1.0
14. SCREEN:
From 2 To 12
From. To
T
I5. SAND/GRAVEL PACK:
Amount NA
Well M ckacss
Depth or Weight/Ft. Material
To 2 SCH40 PVC
Dian>r
FL 2'
Ft.
Material Method
ph Grout Trerrunis_
Ft. Bentonite Poured
Depth Diameter Skit Size Mate Lai
Ft 2' in. .010 in. PVC
Ft in in.
Depth Size Material
From 1.0 To 12 pt, Coarse Sand
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THLS WELL WAS 00
CONSTRUCTION STANDARDS, THATA CO
SIGNATURE OF P
Topographic/Land setting
❑Ridge ©Slope ❑Valley K1Flat
(check appropriate box)
Latitude/longitudc dwell location
()
Latitude/longitude source:❑GPSLJTopograpbic map
(o6eck box)
DBE DRILLING LOG
From To Formation Description
SEE ATTACHE]
MW-2
L9CATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names-
IWCTED IN ACCORDANCE WITH 15A NCAC2C, WELL
THIS RECORD HAS SEEN PROVIDED TO TEE Wks . O •
IZR
N CONSTRU G IRE WELL
Submit the original to the Divi ion of Water Quality, Groundwater Section, 1636 Mai] Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL. RESOURCES
DIVISION OF WASTE MANAGEMENT
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
Dexter R. Matthews, Director
A74,
NCDENR
Norrnt cutouto, RTh MT or
Rwiwrm..r.rr ..m Isar...
UNDERGROUND STORAGE TANK SECTION
September 30, 2009
Mr. Scott C. Ryals, P.E.
Environmental Engineer
DWM UST Section
1637 Mail Service Center
Raleigh, NC 27699-1637
Dear Mr. Ryals:
RE: Former Frog Pond Service Station
610 Bern Street
New Bern, Craven County, NC
Incident Number 16272
I amfWe are the owner(s) of a parcel of property, located at or near the incident in question, and hereby
permit the Department of Environment and Natural Resources (Department) or its contractor to enter upon said
property for the purpose of conducting an assessment and/or reined iation of the groundwater and/or soils under
the authority of G.S. 143-215.94G.
I am/We are granting permission with the understanding that:
1, 1'he investigation shall be conducted by the UST Section of the Department's Division of Waste
Management or its contractor.
The costs of construction and maintenance of'the site and access shall be borne by the Department or its
contractor. The Department or its contractor shall protect and prevent damage to the surrounding lands.
3. Unless otherwise agreed, the Department or its contractor shall have access to the site by the shortest
feasible route to the nearest public road. The Department or its contractor may enter upon the land at
reasonable times and have fill right -of access during the period ef the investigation,
4. Any claims which may arise against the Department or its contractor shall be governed by Article 31 of
Chapter 143 of the North Carolina General Statutes, Tort Claims Against State Departments and Agencies,
and as otherwise provided by taw.
5. The information derived from the investigation shall be made available to the owner upon request and is a
public record, in accordance with G.S. 132-1.
DIVISION OF WASTE MANAGEMENT/UST SECTION
1637 MAIL SERVICE CENTER. RALEIGH, NORTH CAROLINA 27699-1.637
PHONE: [phone] FAX: [phone]
INTERNET: httji:/lwww.wastenat.enr.state.nc.us
AN EQUAL OPPORTUhI}TY/AFFIRMATIVE ACT4ON EMPLOYER - 50% RECYCLEDf1 O% POST -CONSUMER PAPER

6. The activities to be carried out by the Department or its contractor are for the primary benefit of the
Department and of the State of North Carolina. Any benefits accruing to the owner are incidental.
The Department or its contractor is not and shall not be construed ed to be an agent, employee, or
contractor of the landowner.
VWe agree not to interfere with, remove or any ways damage the Department's well(s) or its
contractor's well(s) and equipment during the investigation.
Sincerely,
)07-
er1
I yp&'Print Name of wner or Agent
� ~ �3cr?CID )
Phone Number
i� `fix Zg
Address
4o ?c=3
City/State/Zip Code

RE~QIOWR
MAR 2 6 2019
Water Quality
Aagional ·Opeaons Section