WI0800466_DEEMED FILES_20160715

North Carolina Department of Environmental Quality-Division of Water Resources
INJECTION EVENT RECORD aER)
Permit Number WI O?I0DttC.G.
1. Permit Information
6-eoicc1fu1 'X-1scvrc-es. Iril
Pennitt'ee
Facility Name
71'l' Jer,es B. fllh,'.Jc. Ht;hwr S: tuhihti'U< liJC
Facility Address (include County) C,c:,fvPtb.i, Cct'ilh
2. Injection Contractor Information
G:~o ldJ1w [ Rescurus M C.-
Injection Contractor/ Company Name
Street Address J507, &ct:~ i{,;I .
/II <:..
City State Zip Code
~ 8''tFi-'l oJo
Area code -Phone number
3. Well Information
Number of wells used for injection __ 5"'-----
Were any new wells installed during this injection
event?
0 Yes ~No
If yes, please provide the following information:
Number of Monitoring Wells _____ _
Number of Injection Wells -------
Type of Well Installed (Check applicable type):
0 Bored O Drilled □ Direct-Push
D Hand-Augured D Other(specify) __ _
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
D Yes ~ No
If yes, please provide the following information:
Nwnber of Monitoring Wells------'---
Number of Injection Wells ______ _
Please include a copy of the GW-30for each well
abandoned.
4. Injectant Information
PB P M: o,·, B"~k,
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration ¾ OZ _..c.,_.;;....=:....._ ______ _
If the injectant is diluted please indicate the source
dilution fluid. , __________ _
Total Volume Injected (gal) 12 o-z.i f,1¢of-:
Volume Injected per well (gal) ______ _
5. Injection History
Injection date(s). ___________ _
Injection number (e.g. 3 of 5) _____ _
Is this the last iajection at this site?
D Yes D No UnAflCWn Q,.J.
;hi~ Tim<-
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.
~--07116/J (
SI GNATi)RE fLNTRACTOR DA TE
it
PRINT
Submit the original of this form to the Division of Water Resources within 30 days of injection. 5 Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-64 64J UL 1~ 2016 Rev. 3-1-2016
Water Quality
~nal Operations Section
NUN REsinrivm t. WELL CONSTRU(110N AECcRJJ
North ('calms Dep uirnetit of Fn►itnrurieniars: Natural Resources• Division fit W er Lrrnstl},
V1 ELL CONTRACI OR CERTIFICkTJON M µ39,
1 WELL CONTRACTOR;
Krell Contlaera tartiac rj Nettle
W 1 nonbaeserrCoyiLl+iaz u fp y
/ 3 3 71'-.�.L-- -
CRy for Town
Area cave Phone number
6 WELL ItlFORMA71O It
WELL CONSTRUCTION PERMITS
OPICRASSOCIATED PERMITT#7eem•-.c blej_ .
*ATE WELL IDA*dppl F ir1-4 -
3 WELL USE ICher+k One Bost MOrate/ g r' MUnk rel+PuD.;LI
haunt abCorruherCter E_ Agrtatlheal L1 Hocccery J In:octla l
rrrrdaborr'_, Other J OLsn um
GATE DRILLED 574 9 - 0
a- WELL LOCATION:
:1_1_91Ep___L • cak ?AWL r .
See Y Nerri Mu M1Uer4 plu u 1tY 4ib Asia. .nt No, p yr; gip,
oNTY_ A1U4,
▪ r! yyS..r► ! . ANL+ SEri ING .Chen, aplxaorlelr boxi
1Sipisr, ralh+y F,o1 CiiOtiP 1i Ci11er
LATi• Ir7E ' ' DMS OR 3x 1ilt%it7C1r?L1c fix?
ONG Truck ; - _ ' AIuS DR 7K.xx.xxxxxlat DD
LaRiudeFonsrtude spume' t PS r}foOd2repruc map
fiocueror of Neil must be shor'I' .rn a I. SCS lope mob ar+o'adacnec 'r
rhra form +fncf'.i mg VS)
5. FACILITY INerre of fflebusiness whrra the woo is located
Siete
algal/
p ;:b&
Pocky Nahrd
• RL, F 7.reknue.
rFgeet Address,�
rapt or -rovin
f a,c(DO (tf app'tcafile)
I!l1,1_ 5.
JC• C
Stat.. lip Code
C'pnia•S NPm®
Malting Address
rtly De Town
3tOte ID Corte
Alen code Phofse number
6 WELL DETIJLs:
e TOTAL DEPTH: I
b 2OES WELL REPLACE EXISTING WELL? YL Lr
c. WATER LEVEL Bolo* lop oft ds'np•
Ithe ' •' if Above fop of Casing/
NO••
et. TOP OF CASING IS U . E F T AMR/ Lend .lrrace•
'Tr; of :os013 ler1NR€Ged atlor bt:orl tend s.rface mu/require
a vanarrcr rr acurdar.wo with I5A NCAC :C 0118
e YIELD Wpm! METHHOQ OF TEST_
t. DISINFECTION' Type Amount
p. WATER ,ZDues iriepthr
lop &Z. sworn /2.. Fop - Elomom
Top rxltom lap 9auorr
Bottom Top Dam
Tap
7CASING Depth Clarrl'Fter
fop _ &(Sham __. _ Ft __ _
Top_ SotWJm
5 QROLlT.
iup_ 0
iup0.5i
Tap
Thick nes
Werolrt
5C II•J0
Dept' Mal etiat
00110e10•5 F± Wo
Pornrn / Ft 17 Xf2t z
9oro+n r:
1. SCREEN: Depth
TOD ` Bottom is--
OD NOM
TrK` _ ikstiati. �.
MateHMl
Method
aitihetee 6lnt Sian Maeda
4 . - l cI pr. 11 I .
r*. r:r
1C 9ANDJ6FTA1►EL PACK;
.Ntpih r `
7 of 8+rttc'. ' . Ft
Top _ Bottom F1
Cap._.. . _._6altom
t f DRILL ONO IOU
!a-5
12 REMARKS.
Formation DDesd'IFIio11
11a�lr?ir>F.swC_a-lrrNW' r.Q5C ut_-s1rnwCLaaau'cENli•
'5.4.1<'si st; wt*I ..CH4tn,liTe Vii.V.J DS +lhltleei' i +:]W 01-"1--3
kF. i PUOA43 k T2P rl'.E;tr 1.1I YJFIL' Pi• 4
S1G T1s �f1rCCFET1PED C OF DATE
FT i
P RI TELL NAME OF PERSON CONS r'Rv TING THL WELL
f
Submit within 30 days of completion to: i3fvfston of Watt' Quality . Information Proce6Bing.
161 / Matt Service Center, Raleigh, NC 17E99461. Ptrone : r919' 807-43t1D
Irani Cr01-Th
Rev NOG

Jan 04 10 01:34p
WELL
R rMicel
Michael Ransier
9109494555
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
WILL CONTRACTOR CERTIFICATION # 358°
Weil Co der (hldividllaI) Na
Ran tnvIrvnm entai ]rilling, Inc.
�t
1 Pirleyoin � Company Name
Address
ispering Pines
City ofTown •'
(910 ) 690-6688
Arelacode Phone number
2. WEL-L INFORMATtort
WELL CONSTRUCT1ON PERMrrCMW-11
NC 28327
State Zip Coda
OTHER ASSOCIATED PE RMI TAO appicehte)
SITE WELL ID #ta appgreuei
3. WELL USE (Check One Box) Monitoring ileMunic.ipal1Public ❑
Industria I/Commercial 0 A0C0Ur410 Recovery ❑ Injection »
Irrigation° Other (l st )
DATE URILLEA 2 1, /09
4. WELL LOCATION):
7196 Hwy 701 S.
(Stria! Name. Nutters, Camnrurlty, SubdvEsforl, Lot No.. Parcel. Bp Code)
crry: Whiteville CQ,NTyColumbus
TOPOGRAPHIC 1 LAND SETTING: (clack apprapriute hoz)
t�Slope °Valley What ❑Ridge ❑Otter
LATITUDE 34 'y.' .14 '57 ' i)MS OD
LONGITUDE 78 15 pus OD
Latitude/longitude Source: J PS :Topographic map
Qocatfon of wee must be shDM? on a CMGS fop* map andatrached to
E is tom Float usIng GP3)
S. FACILITY (Name of the butane owhere the weli is locted.)
701 Gas + Grocery
Facility Name Fad ID# (Irappllcebls)
Street Address
Whitevi Ile
NC
City or Town
William Regenthal
steno ap code
Contact Name
2301-F Crowd Point Executive Dr
Mailing Address
Charlotte NC 28227
City ar Town State MpCode
i 704 y -4010
Area coda Phone number
G. WELL DETAILS:
a. TOTAL DEPTH: 1 2
b. DOES WELL REPLACE EXISTINGWEU_? YES ❑ MO Soi
c. WATER LEVEL Below Tap of Caslr+g: 3 FT.
(Use "+' if Above Top of Casing)
p.4
d. TOP OF CASING'S -25 .FT. Above Lank( Surface'
'Top of casing terminated atior below land surface' may require
a variance in accordance with 15A NCAC 2C 0115.
e. YIELD (gpm): METHOD OF TEST
T. DISINFECTION: Type Arnaud
g. WATER ZONES (depar):
Top Bottom Top _ - Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 2 Ft. 2" Sch 40 PVC
Top Bottom Ft
Top Bottom Ft
8. GROUT: Depth
Tap .25 Bottom .55
Material
Et. portland
Top Bottom Ft.
Top Bottom Ft
Method
trommie
5. SCREEN: Depth Diameter Slot Sire Mateda!
Top 2 Bottorn 12 _ Ft 2 Err. .010 in PVC
Top Bottom Ft in. in.
Tap Bottom _ Ft in, in.
• 111. SAND/GRAVEL PACK:
Depth Sias Material
Top 1 Bottom 12 Ft. Med. Quartz
Tap Bottom Et.
Top Bottom Ft
11, DRILJ-ING LOG
Top Bottom
❑ 1.5
.5 /7
7 19
9 112
r
r
12. IRO/LARKS:
Formatlerr iiP-scriptjon
asphalt
brown silty sand
yellow brown silty sand
red brown silly day
1 r'ro ►IeflF Yt eTIFY THAT THIS WELL WAS oewsrRlwrEp IN ACk]CpDN' Wfny
15A NCAC 7.C.1419.1. CONSTRUCTION STANDARDS. AND THAT A COPY OF THRS
REcoRRbEX) } ii K ROVIDTp THE W .LOWNut12/1 i Nry� ry 109q�y�
J ' yS�I�o"'t^-7"v
SIGNATURE OF CERTIFIED WELL CONTRAC1 DATE
Michael Ransier
PRINTER NAME OF PERSON CONSTRUCTING THE WELL
'Cr.l.Inn i4+.rHhrnrnnro$inn tn. fl %IiC1hrS ref Water Clrrarilrr lnfr.rr++stlr.n o.r+.-ecc:nr+
Form GW-lb

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3270
1, WELL CONTRACTOR:
Justin Radford
Well Contractor (Individual) Name
Geological Resources. Inc
Well Contractor Company Name
2301 F Crown Point Executive Dr
Street Address
Charlotte NC 28227
City or Town State Z!p Code
(704 845-4010
Area coda Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WM0800949
OTHER ASSOCIATED PERMiT#(if appfrcabte)
SITE WELL ID # if appiicabiey MW-23
3. WELL USE (Check One Box) Monitoring' MuniclpalfPublic C]
IndustriallCommercial LI Agricultural ❑ Recovery 0 injection ❑
Irrigation° Other E (list use)
DATE DRILLED 02/1 5/201 1
4_ WELL LOCATION:
7253 James B. White Highway. South
(Street Name, Numbers, Community, Subdivision.. Lot No.. ParaeI. Zip Code)
CITY: Whiteville cauNTYCalumbu5
TOPOGRAPHIC / LAND SETTING' (c1+eok appropriate boxy
CiSlflpe E Valley UrFlat ❑ Ridge CI Other
LATITUDE 36 ° - DMs Dii 34.248639 DD
LONGITUDE 75 " DMS OR 78.755222 DD
Latitude/longitude source DCPS 1ZTopographIc map
(location of well must be shown on a USGS Expo map ancief[echad to
this form if nor using GPS)
6. FACILITY (Name of the business where the well is located )
7P1 Gas & Grocery 0-011645
Facility Name Facility IDA (If applicable)
719.6 dames B. White Hiihway. South
Street Address
Whiteville NC 2Fi472
City or Town
Hershel Prince
Contact Name
PO Box_750
State ap Code
Mailing Address
Y11hii�vilie NC 2847,2
City or Town
( 0104 642-4208
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 10
State Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES rJ NO G/
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Tap of Casing)
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0110.
e. YIELD (gpm).
V. DISINFECTION: Type
g. WATER ZONES (depth):
METHOD OF TEST
Amount
Top_ Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness)
7_ CASING: Depth Diameter Weight Material
Top 0 Bottom 2 , Ft. 2" SCh 40 PVC
Top Bottom Ft. -
Top Bottom Ft.
8. GROUT' Depth
Top 0 Bottom 0.5
Top 0.5 Bottom 1 Ft. Bentonite
Top Bottom FL
Material
FL Cement
9. SCREEN: Depth
Top 2 Bottom 10
Top Bottom
Top Bottom
Method
Daisf
DOitr
Diameter Slot Sirs
Ft 2 In 0.01 in.
Ft in. in.
Ft. in. in.
Material
PVC
10. SAND/GRAVEL PACK:
Depth Store
Top 1 Bottom, 10 _FL #2
Top Bottom Ft.
Top Bottom Ft.
Material
Sand
11. DRILLING L_OG
Top Bottom Formation Description
0 --- 1 2 Brown silty sand
2 / 5 Orange CIavev sand
5 1_ 8 Gray fine sand
8 1 1 0 Gray claw
1
1
12. REMARKS:
i DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THT3
RECORD HAS UEEN PROVIDED TO THE y1ELL Ow
SIGNATU
RTIF1ED NTRACTOR
3
Justin Radford
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing.
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GIN-1 b
Rev. 2J00

.00
ww
•
1. WELL CONTRACTOR:
.Justin Radford
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3270
We Contractor ttndivldual) Name
Geolaa€cal Resources. Inc
Weil Contractor Company Name
2301 F Crown Point Executive Dr
Street Address
Charlotte
City or Town
{ 704) 845-4010
Area code Phone number
2_ WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WM0800957
NC 28227
State 21 p Code
OTHER ASSOCIATED PERMIT(irapoltcable)
SITE WELL ID ill!{jf [applicxb=.e) MW-24
3. WELL USE {Chuck One Box) Monitoring Ij" Munldpal/Publlc El
industrial/Commercial O Agricultural0 Recovery ° infection 0
IrrigationO Other 0 (list use)
DATE DRILLED 09/27/2011
4. WELL LOCATION:
7196 Jaynes B. White Hichway. South
(Skeet Name, Numbers, Camrnurnty, SubdMsion, Lot No., Parcel Zip Code)
CITY; Whiteviile COUNTY COIembus
TOPOGRAPHIC / LAND S f I1NG: (check appropriate bms)
{Slope °Valley I (Flat °Ridge °Other
LATITUDE 36 DMS OR 34.248639 DD
LONGITUDE 75 " D S OR 79.755222 au
Latitude/longitude source: D3PS 0fopagraphic map
(lacatfon of weif must be shown on a USGS topo map andetfached to
this farm if nor using CPS)
S. FACILITY Name of the business where the welt is located.)
7l1 iris & lawn( 1-011645
Faerllty Name Facility ID* Of applicable)
714E .limes 13 White Hiahwav South
Street Address
WhifevilIe NO 28472
City or Town State Zip Cade
Hurshel Prince
Contact Name
PO Rnx 750
Mailing Address
Whiteui€le NC 2F1477
City or Town State Zap Code
910,$ 642-4208
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: -12 - -- .
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cif
t:. WATER LEVEL. Below Top of Casing: FT.
!Lisa ' - if Above Top of Casing)
C. TOP OF CASING 1S FT - Above Land Surface"
'Top of caning terminated atfor ba(ow land surface may require
a variance In accordance with 15A NCAC 2G .0118.
e. YIELD (gpm): METHOD OF TEST
f. DFSINFECTlON: Type Amount
g, WATER ZONES (depth):
Top Bottom Top Bottom
Tap Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 2 Ft. 2'' sch 4Q PVC
Top Bottom Ft.
Top Bottom_ Ft.
8, GROUT: Depth Material Method
Top 0 Bottom 0.5 Ft, Cement pgur
Top 0,5 Bottom 1 Ft. Bentonite ❑Our
Top_ Bottom Ft.
9, SCREEN; Depth Diameter Slot Size Material
Top 2 Bottom 12 Ft. 2 in. 0,01 tn. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10, 2ANDIGRAVEL PACK.
Depth Size Material
Top 1 Bottom 12 _ Ft. #2 5and
Tap Bottom Ft.
Top Bottom Ft..
11. DRILLING LOG
Top Bottom
Q 11
1 14
4 IH
a
9 1 1?
1
1
1
12. REMARKS:
Formation Desorption
Brown fine topsoil
Tan sekndv clay
Light tan fine sand
_Gray tan clay
Gray fine sand
00 HERESY CERTIFY THAT TH;S WELL WAS CONSTRUCTED IN ACCORDANCE wrTii
t5A NCAC 2C. WELL CONSTRUETJON sTANDARns. AND THAT ACORY OF THIS
RECORD HAS SEEN FRONpE❑ TO TF . WELL OWNra
SIG U OF CS r !FIE a LL +CAITRAL fl DATE
Justin Radford
PRINTED NAIVE OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing,
1617 Mail Service Center, Ftatalgh NO 27699-161, Phone . [phone]
Farm GW-1b
Rev. 2/09

i:041
1. WELL CONTRACTOR:
Justin Radford
NON RESIDENT4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
Well Contractor (individual) Name
Geological Resources. Irtq
Wed Contractor Company Name
2301 F Crown Point Executive Dr
Street Address
Charlotte NC 26 27
City or Town State Zip Code
704) 845-4010
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WM0804957
OTHER ASSOCIATED PERMITl(trappReabla)
SITE WELL ID t4tir applicable) MW-25
3. WELL USE (Check One Box) Monitoring t9/ Municipal/Public 0
Industrial/Commercial 0 Ngrdevitural ❑ Recovery ❑ injection 0
Irrlgetlon0 Other 0 (het use)
DATE DRILLED 09/27/2011
4. WELL LOCATION:
7196 James B. White Hiuhway. South
Sleet Name, Numbers, community, Subdivision, Lot No., Parcel, by Code)
ciTr Whiteville COUNTY Columbus
TOPOGRAPHIC' LAND SETTING: i;4he_ti appropriate Ao4
Q$tope ❑Valley &tat C Ridge ❑Other
LATITUDE 35 ' ^ DMS OR 34.248639 ad
LONGITUDE 75 " " DMS OR 15 7 222 OD
Latltt►deRongltude source: QPS iifropographic nip
()coition of well moat be shown on a USGS ropo map arldattected to
this form if not using GPS)
S. FACILITY (Name of the business where the weft Is located.)
701 Gas & Grocer►/ 0-011 f 45
Facility Name Facility ID* (If applicable)
7196 Jpnj s-R White±biltt ,ll, SDUfh
Street Address
llllbite�►ille NC 28472
City or Town State Zlp Code
Hutrhel Prim
Contact Name
PO Bnx 750
Malting Address
WhitRVilifl NC 78472
City or Town state Zip Code
t 910.0 642-4208
Area code Phone number
G. WELL DETAILS'
a, TOTAL DEPTH: 12
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO q+f
c. WATER LEVEL Below Top of Casing: FT.
(Use °+^ if Above Top of Casing)
3270
d. TOP OF CASING IS FT. Above Land Surface'
'Top of rasing terminated aVar below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD Wpm): METHOD OF TEST
f. DISINFECTION: Type Amount
• WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASINO: Depth Diameter Weight Matartal
Top 0 Bottom 2 Ft. 2" soh 40 PVC
Top Rattom Ft.
Top Bottom FL
8. GROUT: Depth Material
Top 0 Bottom 0.5 FL Dement
_Pour
Top 0.5 Bottom 1 Ft. Bentonite our
Top Bottom FL
Method
8. SCREEN: Depth Diameter Slot Size
Top 2 . Bottom_ 12 Ft. 2 in. 0,01 in.
Top Bottom Ft. in. In.
Top Bottom Ft.
10. SANDIGRAVEL PACK:
Depth size
Top 1 Bottom 2 Ft. #2
Ft.
Top Bottom
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
4 16
6 112
1
1
1
1
12. REMARKS..
Material
PVC
Material
Sand
Formation Description
Brown fine topsoil
Tan sandy clay
Light tan fine sand
Foray tan Clayey sand
I IX) HEREBY CERTIFY 1NAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C WELL CONSTRUCTION STANDARDS. AND THAT A DOPY DE THIS
RECORD HAS BEEN FRONDED TO'NE WELLOWNER
SIGNACERT IED
NTRACTOR
DATE
Justin Radford
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mall Service Center, Raleigh. NC 27699-161, Phone [phone]
Form GW-lb
Rev. 21DB

Permit Number
Program Category
Deemed Ground Water
Permit Type
WI0800466
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
701 Gas & Grocery
Location Address
7196 James B White Hwy S
Whiteville
Owner
Owner Name
Hurshel
Dates/Events
NC
Orig Issue
7/14/2016
App Received
7/11/2016
Regulated Activities
Well Construction
Outfall
Waterbody Name
28472
Prince
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
7/14/2016
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Holden McClenney
113 W Firetower Rd Ste G
Winterville NC 28590
Major/Minor
Minor
Region
Wilmington
County
Columbus
Facility Contact Affiliation
Owner Type
Individual
Owner Affiliation
Hurshel Prince
PO Box750
Whiteville
Issue
7/14/2016
Effective
7/14/2016
NC 28472
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
Shrestha, Shristi R
From:
Sent:
To:
Cc:
Subject:
Shrestha, Shristi R
Thursday, July 14, 2016 11:23 AM
' hwm @g eo l og ical reso u rces i n cco m'
Gregson, Jim; King, Morella s; Rogers, Michael
WI0800466 NOI Gas & Grocery
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells (NOI) for the above referenced
site.
Please remember to submit the following regarding this injection activity:
1) Weft Construction Records (GW-1) and Abandonment Records (GW-30) when completed. Please provide
copies of the GW-ls and GW-30s if not already submitted (oriiinals go the address printed on the
form). NOTE: Direct push or Geoprobe wells are considered wells and require construction (GW-1) and
abandonment forms (GW-30). If we11 construction/abandonment information is the same for the wells, only one
form needs to be completed just indicate total number of injection points in the CommentsfRemarks section of
form_ These forms can be found on our website at
ht tp:lldeg.nc.govlaboutldi visionslwater-resources/water-resources-permits/wastewater-branch/gr Quad-water-
protection/ound-water reporting -forms
2) Injection Event Records (IER). All injections, including air and passive systems require an IER. The IER can
be modified for air sparge wells (e.g., air flow `continuous' for date or rate of injection, etc.).
You can scan and send these forms directly to me at Shristi.shresthaa a ncdenr. i ov or via regular mail to address
below. When submitting the above forms, you will need to enter the nine -digit alpha -numeric number on the form
(i.e., WI4X)0000C) that has been assigned to the injection activity at this site. This notification has been given the
deemed permit number W10800466. This number is also referenced in the subject line of this email_ You may if you
wish, scan and send back as attachments in reply to this email, as it will already have the assigned deemed permit
number in the subject line.
Thank you for your cooperation.
Shristi
Shristi R. Shrestha
Hydrogeoiogist
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shrestha©ncdenr_gov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
9..
Email con-ospondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties,

Shrestha, Shristi R
From: Shrestha, Shristi R
Sent: Thursday, July 14, 2016 11:25 AM
To: Gregson, Jim; King, Morella s
Cc: Rogers, Michael
Subject: WI0800466 NOI Gas & Grocery
Attachments: WI0800466 NOI well info,pdf; WI0800466 NOT site map.pdf; WI0800466 GAs &
Grocery NOI.pdf; W10800466 Gas & Grocery NOT info.pdf
Please find the attached NOI and supporting information.
Shristi
Shristi R. Shrestha
Hydrogeologist
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shrestha a ncdenr..-av
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to The
North Carolina Public Reoorris Law and may be disclosed to third parties

North Carolina Department of Environmental Quality-Division of Water Resources
NOTIFICATION OF INTENT (NOi) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C .0200. This fo rm shall be submitted at least 2 WEEKS prior to in iection.
AQUIFER TEST WELLS (1 5A NCAC 02C .0220 )
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (1 5A NCAC 02C .0225 > or TRACER WELLS (1 5A NCAC 02C .0229):
1) Passive Injection S ystems -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 O p erations -Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
.for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests -Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air 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: 07/08/16 ,20_16_ PERMIT NO. WI O g 00 Lf 6 b (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
B.
C.
(1)
(2)
(3)
(4)
(5)
(6)
___ Air Injection Well ...................................... Complete sections B through F, K, N
___ Aquifer Test Well ....................................... Complete sections B through F, K, N
x. ___ Passive Injection System ............................... Complete sections B through F, H-N
___ Small-Scale Injection Operation ...................... Complete sections B through N
Pilot Tes~ ..... · ............................... E,\~EQ/N~-Rt~ons B through N
___ Tracer lnJect10n Well ............... Re,C . ; ......... -~~mplete sections B through N
JUL 11 20'6
STATUS OF WELL OWNER: Business/Organization : f{egio.na\
Water Q~allt)' section ooerat1ons
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): --~H=urs=h=e=l =P=in=c~e _______________________ _
Mailing Address: -----"'P-"o'""'st=-O=ffi~c=e'-'B=ox~7=-50-"------------------------
City: ____ Wh_i_te_vi_·l_le _____ State: _NC_ Zip Code:28472 County: Columbus
Day Tele No.: -------"'u=nkn=o"'"'wn'-'-=---------Cell No.: _______ _
EMAIL Address: _____________ _ Fax No.: ___________ _
Deemed Permitted GW Remediation NOi Rev. 3-1-2016 Page 1
D. PROPERTY OWNER(S) (if different than well owner)
Name and Title:
Company Name ---------------------------------
Mailing Address:---------------------------------
City: _____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: ____________ _ Cell No.: __________ _
EMAIL Address: ____________ _ Fax No.: ___________ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: ------'H=ol=d=e=n-=-M=-=-cC=-l=e=nn==-e y...,,-=P-=-r-=-o =je-=-ct~M=an=ag-"e=r _____________ _
Company Name ----=G~e-=-o=lo=g=ic=a=l-=-R=e-=-so=-ur~c=es~In=c_,_. ____________________ _
Mailing Address: ------'1~1-=-3_W~. =-F=ir-=-et~o~w~e-=-r -=-R=o~a=d~Su=i~te~G~------------------
City: -------'W_,_1=·n=te=rv-'-'i=ll=e __ State: _NC_ Zip Code: __ ---=2=8=5"'-90"--___ County: ____ P_itt __
Day Tele No.: ___ ....... (-'--'70""""'4'-'-)8"-4=5_-4"-'0"""1-=-0 _____ _ Cell No.: [phone]
EMAIL Address: __ ----'h=-wm~c,,.@,...·,g=eo~lo=-g=i-=-ca=l=-re=s=o=ur=c~e=si=n-=-c.=c-=-om= Fax No.: [phone]
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: ------'-70=-1=-=G=a=-s =an=d=--Gr=o=c=e,__,ry'-----'-7-=-1=-96-"--"-'J am=e=s'-'B"".'-Wh-'-'-==it=-e =H=i =gh=-w""'a"'"v .... S=o=u=th=--
City: ___ Wh~1=·te=-vi-=-·1=1e~ _____ County: Columbus Zip Code: 28472. __ _
(2) Geographic Coordinates: Latitude**: ___ 0 ____ " or_~34~0 .24895 ____ _
Longitude**: ___
0
--__ " or 78 ° 754806 -------
Reference Datum: _____ Accuracy: ________ _
Method of Collection: ___ ----'T=-o""'p=o~m=a.__p __________ _
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: _______ square feet
Land surface area of inj. well network: square feet(::: 10,000 ft 2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be::: 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS -Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and
vertical extent of the contaminant plume in soil and groundwater, changes in lithology, existing and
proposed monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus
existing and proposed wells.
Deemed Permitted GW Remediation NOI Rev. 3-1-2016 Page2
I. DESCRIPTION OF PROPOSED INJECTION ACTMTIES -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.
WellBooms will be placed in monitorin g wells as soon as possible. Durin g semi-annual ground water
monitorin g (6 months ) the booms will be removed from the well and it will be determined if new booms will
be reinstalled. as well as the effectiveness of the previous Well booms. Wells will be sampled to determine the
effectiveness of the W ellbooms.
J. APPROVED INJECT ANTS -Provide a MSDS for each injectant. Attach additional sheets if necessary.
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved irif ectants can be found online at http ://de g.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/ ground-water-protection/ ground-water-app roved-in j ectants.
All other sub~tanc es mus t be reviewed by the DHHS prior to use. Conta ct th e UIC Program for more info
(919-807-6496).
Injectant: PRP or Oil buster
Volume of injectant: 12 oz per foot
Concentration at point of injection: 36oz
Percent if in a mixture with other injectants : --~N~A~-----------------
Injectant:
Volume ofinjectant:
Concentration at point of injection: _______________________ _
Percent if in a mixture with other injectants :
Injectant: ----------------------------------
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 __ ~5 ___ Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-1 s, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as-built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
( c) Well contractor name and certification number
Deemed Permitted OW Remediation NOi Rev. 3-1-2016 Page3
L. SCHEDULES -Briefly describe the schedule for well construction and injection activities.
Wellbooms will be installed in MW-3 , MW-11, MW-23 , MW-24 and MW-25 which are existing monitorin g
wells.
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 pro posed Universal Wellbooms will tra p petroleum h ydrocarbons from l!roundwater in an effort
to remediate contamination levels to below the NC 2L standard. Monitorin g wells will be gauged for depth to
water and sam pled prior to installin g wellbooms. Every six months after the install wells will be sam pled aeain
and booms will be removed. It will be determined b y the effectiveness of the wellbooms whether the booms
will be reinstalled post sam plin g.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, under penalty of law, that I am familiar with the information submitted in
this document and all attachments thereto and that, based on my inquiry of those individuals immediately
responsible for obtaining said information, I believe that the information is true, accurate and complete. I am
aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well
and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules."
Signature of Applicant Print or Type Full Name and Title
PROPERTY OWNER (if the pro perty is not owned b y the permit a pp licant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent
to allow the applicant to construct each injection well as outlined in this application and agree that it shall be
the responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction
Standards (15A NCAC 02C .0200)."
"Owner" means any person who holds the fee or other property rights in the well being constructed. A
well is real property and its construction on land shall be deemed to vest ownership in the land owner, in
the absence of contrary agreement in writing.
SEE ATTACHED SERVICES AGREEMENT
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Submit the completed notification package to:
DWR-UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted OW Remediation NOI Rev. 3-1-2016 Page4
PROFESSIONAL SERVICES AGREEMENT
In Reference to Pro posal # 16-028
I. SERVICES. Geological Resources, Inc. ("GRI") proposes to perform the services for the
undersigned client ("CLIENT") at the fees and costs set forth in the scope of services and cost proposal
attached hereto and incorporated herein by reference (the "Services"). GRI represents and warrants that the
Services will be performed in a manner consistent with customary industry standards. No other representation,
warranty, or guaranty, expressed or implied, is intended.
II. FEES. GRI reserves the right to revise its fee schedule subject to thirty (30) days written notice. In
the event GRI revises its fee schedule, CLIENT shall have fifteen (15) days from receipt of notice of the
revision to detennine whether to te11ninate this Agreement. Any revision to the Services shall be pursuant to a
written ·change order agreed to in advance by CLIENT and made a part of this Agreement.
ID. CONFIDENTIALITY. The Services are solely for the benefit of CLIENT. This Agreement shall
not be construed as creating any contractual relationship of any kind between GRI and any third party. The
information and materials provided by GRI to CLIENT in connection with the Services shall be utilized by
CLIENT only for the purposes contemplated by this Agreement, and shall not be provided by CLIENT to third
parties without the prior written consent of GRI, except that GRI agrees that information and materials
provided by GRI to CLIENT may, if required, be provided to and used by governmental regulatory agencies,
CLIENT's attorneys, and pursuant to any valid court order. GRI agrees that all reports and other documents
prepared for CLIENT pursuant to this Agreement are the property of CLIENT. GRI also agrees that it will not
disclose to any third party any documents, reports, laboratory data or other infonnation generated, created or
produced for CLIENT pursuant to this Agreement unless required by law, pursuant to a valid court order, or
upon written instruction of CLIENT.
IV. CLIENT DISCLOSURES. CLIENT shall notify GRI of any known or suspected hazardous
substances or conditions on the property upon which the Services are to be perfonned which in anyway relate
to or affect the Services and GRI shall have the right to rely on the accuracy of such CLIENT-furnished
information. Thereafter, GRI shall take all reasonably necessary and appropriate measures to protect its
employees, agents and subcontractors against such possible hazards and to prevent adverse impacts to the
environment. The cost of such measures shall constitute a revision to the Services and shall be mariaged in
accordance with Section II of this Agreement.
V. RIGHT OF ENTRY. GRI is to have free access to the applicable properties at the times and on the
dates Services are scheduled. Delays to GRI are subject to waiting time charges to the extent such delays are
caused by CLIENT or its employees, contractors or agents. GRI shall take reasonable and customary
precautions to prevent damage to CLIENT's property. CLIENT understands that the discovery of certain
hazardous substances and conditions and/or the taking of preventive measures relative to these substances and
conditions may result in a reduction of the value of the property upon which the substance or condition is
found to exist or on which the preventative measures are taken. Accordingly, CLIENT waives any claim
against GRI and its subcontractors and agrees to defend, indemnify and hold GRI and its subcontractors
harmless from any claim based upon the diminished value of real property allegedly arising from the discovery
of a hazardous substance or condition or the taking of a preventive measure, unless such claim is based upon
GRI's gross negligence.
VI. INDEMNIFICATION GRI will defend, indemnify and hold harmless CLIENT and its
representatives, agents, employees and successors and assigns from and against any and all claims, suits,
actions, losses, penalties, fines and damages of any nature whatsoever, including reasonable attorney's fees,
expert witness fees, consultant fees and court costs (collectively "Legal Claims and Costs") arising or resulting
from {1) GRl's breach of this Agreement; and/or (2) GRl's negligence or intentional misconduct. In addition
to the specific provisions set forth above, CLIENT will defend, indemnify and hold harmless GRI and its
representatives, agents, employees and successors and assigns from and against any and all Legal Claims and
I of2
Costs arising or resulting from (1) CLIENTS breach of this Agreement; and/or (2) CLIENT's negligence or
intentional misconduct, and (3) the existence of any hazardous substance or condition at any site(s) where
Services are performed, unless the negligent conduct of GRI exacerbates and causes the spread of such
hazardous substance(s) or the development of such hazardous condition.
Vii. PAYMENT TERMS CLIENT agrees to be responsible for all charges as set forth in the GRI
Proposal # 15-486. The work outlined in Proposal #16-028 will be payable by the CLIENT in the following
manner.
After all tasks related to the named proposal are complete, GRI will submit a co -pay reimbursement package to
the NCLUSTTF for those tasks pursuant to GRI Proposal # 16-028 and approved in the NCLUSTTF's
associated task authorization. CIRI will wait for payment from client until the North Carolina State Trust Fund
Program has reimbursed client these costs. Therefore, upon receipt of the Trust Fund reimbursement check.
client will endorse the check and send it to GRI within 1 tone; business day of receivinv the reimbursement,
Additionally, as GRI completes the reimbursement package, client is required to sign the appropriate
documents as requested.
VII1. COMPLETE AGREEMENT. This Agreement, along with its attachments, including the GRI
Proposal # 16-028 incorporates all of the provisions and contemporaneous discussions, representations,
understandings, and agreements between the parties with respect to the subject matter of this Agreement, The
terms and conditions expressed in this Agreement shall not be altered except in writing, signed by both parties.
IX. APPLICABLE LAW. This Agreement is governed by, and will be construed in accordance with
the laws of the state where such property is located.
Executed as of the latest date set forth below.
OM:
GEOLOGICAL RESOURCES, INC.
CLIENT:
MR. HURSHEL PRINCE
701 GAS & GROCERY
J‘1914;e04111"---.
By: _ By:
Date: 01 /1416
Date:
2 of 2

... _
MATERIAL SAFETY DATA SHE ET
Oil Buster® I PRP®
Effective Date:
Revised:
September 2004
January 2001
Product Names; Beeswax/ Soy Wax/ Com Cob
Section 1: Manufacturer's Infonnaffon
UNIVERSAL REMEDIATION, INC.
1405 PARKWAY vmw DRIVB
PITTSBURGH, PA 15205
TOLL FREE: [phone]
PHONE: [phone]
FAX: [phone]
Seetian 2: Composition I Information on Ingredients
FOR EXPOSURE LIMITS SEB SBCTION 8
FOR OTHER TOXICOLOGICAL JNFORMATION SBE SECTION 12
COMPONENT
NAME
Filtered Beeswax
Filtered Soy wax
Corncob Fractions
Section 3: Hazards Identification
Emergency Overview
%HXPOSURE
LIMITS
YES HQ
X
X
x .
SEC 12INFO
~
X
X
X
This is a non-combustible, non-reactive, granular, solid material. It is supplied in the fonn of a
powder. Use methods suitable to fight surrowtding fire. Exposure to dusts may be irritating to
eyes, nose and throat At very high exposure levels, the dust may have an effect on the llmgs.
Firefighters should wear self--oontained breathing apparatus and full protective clothing. Use
extinguishing methods suitable for surrounding fire.
Potendal EO'eets of Acute Exposure
Eye~
Skin Contaet:
Powder may cause mechanical eye irritation.
May cause skin initation. Long-term contact may cause depletion of natural skin
n•lo
Skin Absorption:
Ingestion:
Inhalation:
Possib]e Effects of
Chronic Exposure:
No components are known to be available for absorption through the skin.
May cause gastric disturbance if large amounts are swallowed.
Breathing large amounts may cause initation to the lungs. Treat as a nuisance
particulate.
None known for product.
Section 4: First Aid Measures
Eyes:
Skin:
Inhalation:
Ingestion:
Flush eyes immediately with plenty of water for at least 15 minute.,. Consult a
physician if irritation persists.
Wash skin thoroughly with mild soap and water.
Move person to non-contaminated air. Call a physician if irritation persists.
No need fur fu"St aid is anticipated if material is swallowed.·
Section 5: Fire .Fighting Meuares
General:
Flash Point:
Flammability
Lim.its:
Auto Ignition
Temperature:
Hazardous
Combustion
Products:
Fire Fighting
Instructions:
The wax will bum at high temperature. As with other organic material, any dust
that is generated may be explosive if mixed with air in critica1 proportions and in
the presence of a souooe ignition.
Greater than 2300 C / 4000 F.
Not available.
Not applicable.
As Product is heated,. it proceeds to a liquid form, and at higher tempera~ and
it forms combustion products that include oxides of carbons sulfur and nitrogen.
Wear full protective clothing; including helmet, self-contained positive pressul\'I
or pressure demand breathing apparatus, protective clothing and facemask.
Section 6: Accidental Spill/ Release Measures
General:
Large/Small Spill:
Waste .Disposal~
The Products are not considered hazardous material. The :function of this product
is to aid in the spills / releases of oiJ..based products 1hat may be regulated under
Federal, State and Local authority.
Collect spill using a vacuum cleaner with HEPA filte:r. Plaee in a closed
container. Do not dry sweep.
Products as produced do not contain any material regulated as hBZfll'dous. When
product is used to aid in clean up of oil~based product, the treated oil product
must be tested tQ derormine its status as a regulated waste and disposed of in
accordance with all applicable regulations.
Secdon 7; Handling and Storage
General Handling
Precautions:
Storage Requirements:
Incompatibil~:
Avoid-inhalation of dusts. Avoid contact with skin and eyes. -Wash thoroughly
after handling. Keep container closed and dry.
Store in a dry, eool area. Avoid tempemtures in exeess of 3S° C 195° F.
Detergents/ Surfiwiants
Section 8: Exposure control/ Personal Protection
V entilatlon:
Exposure Limits:
Chemical Name:
Particulates (not
otherwise regulated):
NFPA Rating:
Whenever dusts are generated, use appropriate local exhaust ventilation to keep
exposures below the regulated limits.
OSHA: TWA..STBL ACGm: TWA·STEL ~ TWA..STEL
OSHA: total dust: IS mglm!
Respirablo Fraction: 5 mg/m3
Health -o. FJammahility-1, Reactivity-0
Personal Protective Equipment
Eye Protection: Wear safety glasses with side shields.
Skin Protection: Wear cotton, rubber or other appropriate work glov~ if necessary for type of
operation.
Protective Clothing: Coveralls, apron.
Rospiratory Protection~ Not norma11y needed. If permissible, levels arc exceeded use NIOSH approved
-dust Tespirator.
Section 9: Phyaieal and Chemkal Properties
Physioal State:
Odor and Appearance:
Specific Oravity:
Boiling Point:
Vapor Pressure:
Percent Volatile:
Vapor Dens~
Softening Point
pH:
Solubility 9in H~):
Freezing Point~
Evaporation Rate:
Viscosity:
MeJting Point:
Solid (particulate)
Yellow/ White/ Amber (Honey Odor)
0.97 gm/ cml' (density)
Not applicable.
Not applicable.
Not applicable.
Not applicable.
Not applicable.
Not applicable.
Insoluble.
Not applicable.
Not applicable.
Not applicable.
130°F/55°C
Section 10: Stability and Reactivity
Stability: Stable at temperatures below 2300 C / 4000 F.
Conditions to Avoid: Sparks, flames and exposure to heat.
Hazardous
Polymerization:
Incompatibility:
wm not occur.
Detergents and Surfactants.
Section 11: Transport Information
This product is not regulated as a hazardous material by the United States (DOT) or Canadian {TGD)
transportation regulations.
Section 12: Toxicological Information
Eye Effects:
Skin Effects:
AcuteOraJ:
Chronio Effects:
Particles may cause mechanical irritation. Symptoms can include irritation and
redness.
Particles may cause irritation.
No adverse health effects are known for this product. Ingestion may cause
transient irritation of throat, stomach and gastrointestinal tract
Long-term skin contact with this product may .lead tn depletion of natural skin
oils.
Section 13: Regulatory Information
TSCA Sta1us:
CERCLA/SARA:
RCRA:
All components are Jisted on the TSCA inventory.
This product does not contain any ingredient that is subject to the reporting
requirements of Section 313 of SARA and its associated regu1ations.
This product does not contain any component identified as hazardous under 40
CFR 261.24. Waste must be handled in aacordanoe with all applicable
regulations. Purchaser is advised to review regulations referenced for
applicability as determined by purcbasefs use of product.
Section 14: Diselalmer of EXPRESSED and Implied Warnmties
Seller warrants that the goods will, assuming proper application, enhance and stimulate the
biodegradation of certain hydrocarbons. Seller expressly limits its obligation and liability under this
limited warranty to either, at Seller~s option, .replacement of the defective goods or granting Buyer credit
in the amount paid for the dofective goods. If requested by Seller, goods for which a warranty claim is
made will be returned to Seller, transportation prepaid.
SELLER EXPRESSLY LIMITS ITS WAR.RANlY TO nm TERMS SET FORTH ABOVE AND
HEREBY EXCLUDES ALL OTHER WARRANTIES EXPRESSED OR IMPLIBD, IN PARTICULAR
EXCLUDING ANY AND ALL WARRANTIES OF MBRCHANTABIL11Y AND WARRANTIES OF
FITNESS FOR ANY PARTICULAR PURPOSE. SHLLBR LIKEWISE LIMITS THB REMEDIES
AV AH,ABLE TO THOSE SET FOR111 IN THIS LIMITBD WARRANTY. IN NO EVENT SHALL
SELLER BE RESPONSIBLE FOR ANY LOSS OF INCOME, LOSS OF PROFITS OR ANY OTHER
FORM OF CONSEQUENTIAL OR INDlRECT DAMAGES WHATSOBVBR
PRP® OIL BUSTER'
Hydrocarbon SO Response Prnduc[
PRP° SPECIFICATIONS
BULK
BIO,SCtID
Bro-BOOM®
MTh. drums
8er. par SOK
12oz pert
Do NOT use this product with env other Shp
cleaners or detergents as they prevent the oil(fuell
from being absorbed.
BULK
Apply dry by nand or d 'aflame by agitation in water using
a hydroseederfire cannon or other Venturi apparatus.
An application ratio of t:2 by weightof PRPu to a1 is recom-
mended for control and containment of Mho spill.
DIRECTIONS FOR USE:
e
DIO-SDI(
After removing the Sokfrorn the plastic baci,.tie it securely
with the cord provided to e f iziore in the bilge of the beat Be
certain to piece the Sok where it win not get .caughk up in
moveable ale Fasts. Then drop Unto *Frd water is the hilgotank
wham ftwill float. ebsurteng and biodegrading tht IaakEng
nil/fuel
0
have plastic sleeves position DioBoerns, and tie secure ly
with the cords our each artd. Do rlitilt€alch tightft Leave
towslac k. She old the area intoned the length of a single
Rle8aom, link as follows: La the I mo and to and,
overleaping so that tita and Lay
Loomis adjacent tG the
loop of the otter boom (Ir From oniI . l7€rw cord around
oppaire berms and tie to loop Attach both overlapping ands.
Blanc mist mustlit tine her snugly. two indarduly boon
witli cord.
nut Mete 000.00
huadous undo!'
lfM TEO WARM) i
ems* 1r1i .
onvori
0171
Ingredients are 100%natural, nont►aza.rcloit5.
nontoxic and biada adat>la
• Naturally cawing mcroo#gamsms
Nutrients and rrdctvrrdionts which
era required nor metabolic activity of
microorganisms
3 rho wornworrefig opuLrVntfin Satan 3r3 of NM einei its ziaipma ex any carror vrt &War
isst inF!KW aAdeakan. a t e and snored,* tat biodegnzdatotn ofNit.150 OduattliS Sa fir
wanly is OW a! S6118e$ 4001l. t i rrr Ir+o 004We Cr' guar+ ig i4ryEr creM in dis
paws Mr whirs a wavrgnry dim is 413Lt bTs •et1Arred 10 Siva imilsgeaVon prize. SELLER
TFQ7i1PABOVE AND HMV EXCLUDES At,! OTHER WARR,W3JFS ExPPESS 01# Wei Ea iutt
HWEES OF MERGHANTAB& TV MD WARRANTIES Of MESS FOR PARTICUCAR PURPOSE.
Art L+C TO THOSE ,SET FORM Hit Try Ztt ein WARRANTY. AY NO t vavr SNAL1 SELLER BE
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RECEIVED AUG 3 n 7011
STATE Ole NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PE1 DUB
GOVERNOR
August 23, 2011
Columbus County
EUGENE A. CONTI, JR.
S$CRECARY
Subject: Encroachment Contract on US 701, with (2) groundwater monitoring
wells. See Attached Plans and Special Provisions.
Geological Resources, Inc.
2301 Crown Point Executive Drive Suite F
Charlotte, NC 28227
Gentlemen:
Attached is an approved Right of Way Form 16: IA and plans for your proposed ground
water monitoring wells.
This encroachment is approved subject to the following:.
1. You will notify Ken Clark. County Mainteuuuce Engineer, minimum of
three (3) days before construction is to begin-- Telephone No. (910) 642-
7597.
2. Traffic will be maintained and proper signs, signal lights, flagmen, and
other warning devices will be provided fox the protection of the traffic, in
conformance with the latest MANUAL ON UNIFORM TRAFFIC
CONTROL DEVICES FOR STREETS AND IfIGIPWAYS.
3. Disturbed areas shall be seeded and mulched according to the attached
Seeding and Mulching Specifications. Disturbed areas within NCDOT
right-of-way shall not be left untreated for more than 15 calendar days
unless otherwise permitted by the District Engineer or his representative,
4. A copy of this agreement and letter of approval is required to be available
at the construction site at all tunes.
5, Prior to beginning construction, receipt of performance and indemnity bond
is required to be completed in the amount of $2,500.00. Transfer of funds
will take place in the District Office.
1 194 PRISON CAMP RD. - WI-JITE171LLE, NC 28472 - PH: [phone] - PAX: [phone]

6. Notify NCDOT Division Traffic Engineer at (910)-486-1452 one week
prior to any excavation within 500 feet of a signalized intersection.
7. Shoulders, ditch slopes, and ditches disturbed as a result of this
encroachment shail be restored to the satisfaction of the County
Maintenance Engineer.
8. All equipment and materials shall be removed from the right-of-way when
not in use.
9. Any drainage structure that is disturbed or damaged shall be restored to its
original condition as directed by the District Engineer.
10. The encroaching party shall comply with all applicable state and
federal environmental regulations, and shall obtain all necessary state
and federal environmental permits, including but not limited to those
related to sediment control, stormwatcr, wetlands, streams,
endangered species, and historical sites.
11. Written notice of the completion of work and a set of as-built drawings will
be furnished to Mr. H. L. Cox, Jr., District Engineer, 1194 Prison Camp
Rd., Whiteville, NC 28472, when the work has been completed.
If forther information or assistance is needed with reference to this project, please feel
free to call our District Engineer, H. L. Cox, Jr. at(910) 642-3760.
GB/I-ILC/rls
Attachments
cc: Mr. Robert Memory. -w/ Attachments
Mr. H . L. Cox, Jr. -w/Attachments
Mr. Ken Clark -w/Attachments
Greg Burns, P .E .
DIVISION ENGINEER
August 17, 2011
Mr. H. L. "Drew" Cox, PE
N.C. Department of Transportation
1194 Prison Camp Road
Whiteville, Notth Caroli11a 28472
Re: Encroachment Agreement
701 Gas & Grocery
7196 James B. White Highway South
Whiteville, North Carolina
Dear Mr. Cox:
Geological Resources, Inc. (GIU) is currently conducting ground water assessment activities associated
with a subsurface release of petroleum products at the 701 Gas & Grocery facility located at 7196 James
B. White Highway South in Whiteville, Columbus County, North Carolina. A Site Vicinity Map is
attached. 111e work is being completed under the direction of the North Carolina Department of
Environment and Natural Resources (NCDENR). In order to complete contaminant plume delineation
activities, ORI has determined that two Type IT monitoring wells will need to be installed on the west side
of James B. White Highway (US Highway 701) to the south of the subject site. GRI has determined that
the wells will have to be installed in the North Carnlina Department ofTranspo1tation (NCDOT) right-of-
way (ROW). Therefore, an approved NCDOT Encroachment Agreement must be obtained before the
work can be conducted. A completed Right Of Way Encroachment Agreement For Non-Utility
Encroachments On Primary And Secondary Highways (FORM R/W 16.lA) has been attached for your
review.
The proposed well locations are located on the west sides of James B. White Highway (US Highway
701 ). A Site Map showing the proposed well locations is attached. The wells will be installed to total
depths of approximately 12 feet and will be properly abandoned upon completion of assessment activities.
The activities are scheduled to occur as soon as access to the area is granted by the NCDOT. The
activities are expected to be completed in one day. Prior to start up of the activities, the NCDOT will he
notified of the date for which the work is scheduled.
• . . n--,!~/,l·l~"'-1=--S-•~r.:,1i,~ ...
2301 Crown Point Executive Drive Suite F Charlotte,
.. --.
Encroachment Agreement
701 Gas & Grocery
7196 James B. White Highway South
Whiteville, North Carolina
Your prompt attention to this platter will be greatly appreciated. If you have any questions or require
additional information please do not hesitate to contact me at [phone] or
w I rM geolo j calresoutc esi nc. cc m.
Sincerely,
Geological Resort s, no.
Ulm Regen nal, 'IT
Project Manager
enclosures
cc: file

ROUTE dames B. White
Highway South (US
HWY 701)
STATE OF NORTH CAROLINA
PROJECT 701 Gas & Grocery COUNTY OF Columbus
DEPARTMENT OF TRANSPORTATION RIGHT OF WAY ENCROACHMENT AGREEMENT
FOR NON -UTILITY ENCROACHMENTS OM
-AND- PRIMARY AND SECONDARY HIGHWAYS
GEOLOGICAL RESOURCES, INC.
2. 3a t( L t Porr.+T tQ'1 a Ogre ' SalrE f4
Crtx4fII rf77 MI— 2t0 Z4_7 - - --
r ---
TI•IIS AGREEMENT, made and entered into this the 17th day of Aug , 20 11 , by and between the Department
of Transportation, party of the first part; and GEOLOGICAL RESOURCES, INCORPORATED
party of the second part,
WITNESSETH
THAT WHEREAS, the party of the second part desires to encroach on the right of way of the public road designated as
Route(s) James B. White Highway (US Highway 701) , located Whitevllle, Columbus County
with the construction anchor erection of, Two Type II monitorintl wells for the purpose of assessing petroleum impacted
ground water associated with the 701 Gas & Grocery retail petroleum facility_
WHEREAS, it is to the material advantage of the party of the second part to effect this encroachment, and
the party of the first part in the exercise of authority conferred upon it by statute, is willing to permit the
encroachment within the limits of the right of way as indicated, subject to the conditions of this agreement;
NOW, THEREFORE, IT IS AGREED that the party of the first part hereby grants to the party of the second
part the right and privilege to make this encroachment as shown on attached plan sheet(s), specifications and
special provisions which are made a part hereof upon the following conditions, to wit:
That the said party of the secorsd part binds and obligates himself to Install and maintain the enoroeching facility In such safe
and proper condition that it will not interfere with or endanger travel upon said highway, nor obstruct nor Interfere with the proper
maintenance thereof, to reimburse the party of the first part for the cost Incurred for any repairs or maintenance to its roadways
and structures necessary due to the installation and existence of the facilities of the party of the second part, and if at any time
the party of the first part shall require the removal of or changes in the location of the said facilities, that the said party of the
second part binds himself, his successors and assigns, to promptly remove or alter lice said facilities, In order to conform to the
said requirement, without any cost to the party of the first part.
That the party of the second part agrees to provide during construction and any subsequent maintenance proper signs, signal
lights, flagmen and other warning devices for the protection of traffic In conformance with the latest Manual on Uniform Traffic
Control Devices for Streets and Highway and Amendments or Supplements thereto. information as to the above rules and
regulations may be obtained from the Division engineer of the party of the first part.
That the party of the second part hereby agrees to Indemnify and save harmless the party of the first part from all damages
and claims for damage that may arise by reason of the installation and maintenance of this encroachment.
It is clearly understood by the party of the second part that the perry of the first part will assume no responsibility for any
damage that may be caused to such facilities, within the highway rights of way limits, in carrying out its construction and
maintenance operations.
That the party of the second part agrees to restore all areas disturbed during Installation and maintenance to the satisfaction
of the Division Engineer of the party of the first part. The party of the second part agrees to exercise every reasonable
precaution during construction and maintenance to prevent eroding of sail; silting or pollution of rivers, streams, takes, reservoirs,
other water impoundments, ground surfaces or other property; or pollution of the air. There shall be compliance with applicable
rules and regulations of the North Carolina Division of Environmental Management, North Carolina Sedimentation Control
Commission, and with ordinances and regulations of various counties, municipalities and other official agencies relating to
pollution prevention and control. When any installation or maintenance operation disturbs the ground surface and existing
ground cover, the party of the second part agrees to remove and replace the sod or otherwise reestablish the grass cover to
meet the satisfaction of the Division Engineer of the party of the first part.
FARM R/W 16.1A (January, 1981)

That the party of the second part agrees to assume the actual cost of any Inspection of the work considered to be necessary
by the Division Engineer of the party of the first part.
That the party of the second part agrees to have available at the encroaching site, at all times during construction, a copy of
this agreement showing evidence of approval by the party of the first part. The party of the first part reserves the right to stop all
work unless evidence of approval can be shown.
Provided the work contained In this agreement Is being performed on a completed highway open to' traffic; the party of the
second part agrees to give written notice to the Division Engineer of the party of the first part when -all work contained herein has
been completed. Unless specifically requested by the party of the first part, written nonce of completion of work on highway
projects under construction will not be required.
That in the case of noncompliance with the terms of this agreement by the party of the second part, the party of the first part
reserves the tight to stop all work until the facility has been brought Into compliance or removed from the right of way at no cost,
to the party of the first part.
That it Is agreed by both parties that this agreement shall become void if actual construction of the work contemplated herein
Is not begun within one (1) year from the date of authorization by the party of the first part unless written waiver Is secured by the
party of the second part from the party of the first part.
RIW (161A) Party of the Second Part certifies that this agreement is true and accurate copy of the form
RIW (161A) incorporating all revisions to date.
IN WITNESS WHEREOF, each of the parties to this agreement has caused the same to be executed the day and
year first above written.
ATTEST OR WITNE
/may I I 1o,' -vazil -
/4!Lf'Ai,.
nsule..c
DEPARTMENT O RANSPO • TION
BY:
Asst. Manager of Right of Way
Geological Resources, Irto.
Secretary e y
Second Party
INSTRUCTIONS
When the applicant is a corporation or a municipality, this agreement must have the corporate seal and
be attested by the corporation secretary or by the empowered city official, unless a waiver of corporate
seal and attestation by the secretary or by the empowered City official is on file in the Raleigh office of
the Manager of Right of Way, in the space provided in this agreement for execution, the name of the
corporation or municipality shall be typed above the name, and title of all persons signing the agreement
should be typed directly below their signature.
When the applicant is not a corporation, then his signature roust be witnessed by one person. The
address should be included in this agreement and the names of all persons signing the agreement
should be typed directly below their signature,
Thls agreement must be accompanied, in the form of an attachment, by plans or drawings showing the
following applicable informations
1. All roadways and ramps.
2. Right of way lines and where applicable, the control of access lines.
3. Location of the proposed encroachment.
4. Length and type of encroachment.

5. Location by highway survey station number. If station number cannot be obtained, location
should be shown by distance from some identifiable point, such as a bridge, road,
intersection, etc. (To assist in preparation of the encroachment plan, the Department's
roadway plans may be seen at the various Highway Division Offices, or at the Raleigh
office.)
6. Drainage structures or bridges if affected by encroachment.
7. Typical section indicating the pavement design and width, and the slopes, widths and
details for either a curb and gutter or a shoulder and ditch section, whichever Is applicable.
8. Horizontal alignment indicating -general curve data, where applicable.
9. Vertical alignment Indicated by percent grade, P.I. station and vertical curve length, where
applicable.
10. Amount of material to be removed and/or placed on NCDOT right of way, if applicable.
11. Cross-sections of all grading operations, indicating slope ratio and reference by station
where applicable.
12. All pertinent drainage structures proposed. Include all hydraulic data, pipe sizes, structure
details and other related information.
13. Erosion and sediment control.
14. Any special provisions or specifications as to the performance of the work or the method of
construction that may be required by the Department must be shown on a separate sheet
attached to encroachment agreement provided that such information cannot be shown on
plans or drawings.
15. The Department's Division Engineer should be given notice by the applicant prior to actual
starting of installation included in this agreement.
16. Method of handfing traffic during construction where applicable.
17. Scale of plans, north arrow, etc.
Type 117MontOr1fg We
Typle t be:instruction Details
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A

July 11, 2011
Edgar and Naomi Hinson
7253 James B. White liighway South
Whiteville; North Carolina 284 72
Re: Right To EnterAgreement
701 Gas & Grocery
7196 James B. White Highway, South
Whiteville, North Carolina
Columbus County
Tc)Whom it May Concern,
Geological Resources, Inc. (GRI) is conducting ground water assessment activities on behalf ofHurshel Prince
at the 701 Gas & Grocery site in Whiteville, North Carolina. You are listed as the owner ofa property that is
adjacent to the 701 Gas & Grocery site. The property owned by you is identified as Columbus County Parcel
No. 2432. ASite Map showing your property in relation to the 701 Gas & Grocery site is enclosed.
Based on a review of the data c .ollected at the 701 Gas & Grocery site to date, it will be necessary to collect
ground water samples from your property to determine the extent of affected ground water. Therefore, GRI
r~uests permission to install four additi<>nal Type II ground water monitoring wells 011 your property. lf
approved byyou, GRiwill install the monitoring wells to total depths of approximately 12 feet. The wells will
consist of 2" PVC sqreen and riser and ·completed with a flush tnounted 2'x2' concrete pad and 8" manhole
cover. The wells will not impede traffic or other daily activities conducted on your property. Ground water
samples will be collected from the monitoring wells on a periodic basis and submitted for analyses for
petroleum contatninants. The monitoring wells Will rem1:1in on-site until North Carolina Department .of
Environment and Natural Resources (NCDENR) Underground Storage Tank (UST) Section requests
abandon$erit A,t thattime, the wells will be prt>pedyabandoned and the ground cover will be tetumed to its
original condition. A figure of a typical monitoring well is enclosed. The proposed locations of the wells are
shown on the encfosed Site Map;
Prior to installing the monitoring wells, GRI must obtain .a Well Construction Permit from NCDENR.
NCDENR will not approve the Well Construction Permit without your authorization. GRI has enclosed the
Well Construction Permit Application for your review. To authorize the installation of the proposed
monitoring wells, please sign the highlighted space at the end of page 2 of the permit and return the entire
package to G-RI in the self addressed envelope provided. GRI has tentatively scheduled the well installation to
be completed during the months of July/August 2011. Therefore, your prompt attention in this matter is
requested.
2301 Crown Point Executive Drive Suite f Charlotte, NC 28227
Phone: [phone] fax: [phone]
(Gelb is gd Reseittatc.-es,, 3into
July 11, 2011
Mr. Hurshel Prince
701 Gas & Grocery
Post Office Box 750
Whiteville, North Carolina 28472
Re: Right -to -Enter Agreement
701 Gas & Grocery
7196 James 13. White Highway, South
Wbiteville, Columbus County
Incident No: 32552
Dear Mr. Prince:
Please find the enclosed Right -to -Enter Agreement for the installation of four Type II monitoring wells,
located on the Naomi Hinson property (Columbus County Parcel No. 2432). If you could please contact
Ms. Hinson, similar to how you have assisted previously, and have her sign the access agreement. Please
let her know that we will install these wells by hand, in order to minimize any inconvenience this well
installation may cause.
Your help this matter is greatly appreciated. If you have any questions or require additional inforrnation
please do not hesitate to contact me at [phone]
Sincerely,
,/‘b
William Regenthal, GIT
Project Manager
enclosures
cc: file
2301 Crown Point Executive Drive Suite F Charlotte, NC 28227
Phone: [phone] Fax: [phone]

RIGHT TO ENTER AGREEMENT
FOR
CONDUCTING SUBSURFACE INVESTIGATIONS
STATE OF NORTH CAROLINA
COUNTY OF COLUMBUS
We, the undersigned, being all of the fee simple owners of certain tracts or parcel designated as 2432 of the
County of COLUMBUS, recognizing the benefits to said property by reason of conducting subsurface
investigations hereby grant to Hurshel Prince and the agents the right to enter said property in accordance with
the requirements of the State of North Carolina. Hurshel Prince's agents may include Geological Resources
Services, Inc.
The undersigned hereby covenant and warrant that they are the sole owners of said property; that they
solely have the right to grant this right to enter for conducting subsurface investigations against the lawful
claims of all persons whomsoever.
It is agreed that. Hurshel Prince and his agents shall have the right of future entry for the purpose of maintaining
any permanent monitoring points for the duration of the monitoring period, as required by the North Carolina
Department of Environment and Natural Resources (NCDENR).
It is further agreed that Hurshel Prince shall be responsible for restoring any damage done to the ground of said
property by its employees or its agents during the subsurface investigation and monitoring period, and that
Hurshel Prince shall abandon sampling points on said property in accordance with the NCDENR requirements
at the conclusion of the monitoring period.
It is agreed that Hurshel Prince shall hold harmless the owner of the aforementioned property for any personal
injury that might be sustained during the course of conducting or proximately resulting from the conduct of
subsurface investigations.
Right to Enter denied.
/ Right to Enter granted.
11' Ct O'vYl t le Irt 5) Y?
Name
Signature
Phone :
Date

Monitoring Well Installation
701 Gas & Grocery
Page 2 of2
If you do not wish to allow GRI to install monitoring wells on your property, please check that you do
not wish to allow access. GRI needs physical documentation of a granted or refused Right-To-Enter
Agreement before work can proceed for the site. If you choose not to allow access to your property, or
require additional information concerning this matter please call me at 704-815..0653.
Sincerely, Goo!;;;~ ~ Regentba~ GIT
Project Manager
enclosures
cc: file
17fev O'51 1 IA.5krBed ale It per. t"i•s
a/Ie It' RJ,d i 4)5. Q,tiach otor 0,?v,1ii9
Lv4'Lc It S4,6r-05 40 40 dej f,/Ccrfl►ll dip / r nk
5erect it
NON
RESIDENTIAL WELL CONSTRUCTION RECORD
North Caroline Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3270
1. WELL CONTRACTOR:
Justin Radford
Well Contractor (Individual) Name
Geological Resources, Inc
Well Contractor Company Name
2301 F Crown Poinj. Executive Dr
Street Address
Charlotte NC 28227
City or Town State lip Code
(704 _) 845-4010
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WM0800957
OTHER ASSOCIATED PERMIT#{it applicable)
SITE WELL ID #{if applicable) MW-24
3. WELL USE (Check One Box) Monitodng I1Municipal/Public0
IndustrlalUCommerciai ❑ Agricultural LI Recovery 0 Infection 0
Irrigabono Other r] (list use)
DATE DRILLED 09/27/2011
4. WELL LOCATION:
7196 James B. White Hiahwav, South
(Street Neme. Numbers. Community. Subdivision. Lot No., Peirce/. Zip Code)
CITY: Whiteville couNTv Columbus
TOPOGRAPHIC 1 LAND SETTING: (check appropriate box)
❑Slope ❑Valley elet LIRidge 0Other
LATITUDE 36 " DMS OR 34.248639 Da
LONGITUDE 75 ' " DMS OR 78.755222 ❑D
Latitude/lorrgitude source' COPS ctropographic map
(location of weft must be shown an a USGS tapo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
701 Cos & Grocery
Facility Name
0-011645
Facility ID* (If applicable)
71 % .lamas R White }-linhwav
Street Address
Whiteville
City or Town
HLIrshe! prince
Contact Name
PO Box 750
Smith
NC
State
28472
hip Code
Malting Address
Whiteville NC 28472
City or Town State Zip Cods
(_A10n 642-4208
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: _ 1 5
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Eit
c_ WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d, TOP OF CASING IS FT. Above Land Surface`
'Top of casing terminated al/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
1. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top _ Bottom
7. CASING: Depth
Top 0 Bottom 2
Diameter
Ft.
Top Bottom Ft.
Top Bottom Ft.
Thickness/
Weight Material
sch 40 PVC
8. GROUT: Depth Material Method
Top 0 Bottom_0.5 FL Cement Dour
Top 0.5 Bottom 1 FLj3ent0nite pOt.r
Top Bottom FL
9, SCREEN: Depth Diameter Slot Size
Top 2 Bottom 12 Ft. 2 in. 0.01 in.
Top Bottom Ft. in. in.
Top Bottom _ Ft, in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 1 Bottom 12 Ft. #2
Top Bottom Fi_
Material
PVC
Material
Sand
Tap Bottom Ft.
t I. DRILLING LOG
Top Bottom
0 /1
1 14
1 5
6 19
9 / 12
1
IL REMARKS:
Formation Description
Brown fine topsoil
Tan sandv ciao
Light tan fine sane
Gray tan clay
Gray find sand
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITi1
15A NCAC 2O. WELL CONSTRLIC ;OH STANDARDS. AND THAT A COPY OF THIS
RECORDDHHASSEEN PROVIDED TO THE WELL OWNE5
SIG/an/RE OF CERTIFIE ELL TOI— DATE
Justin Radford
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water duality - information Processing.
1617 Mali Service Center, Raleigh, NC 27699-181, Phone : [phone]
Form GW.lb
Rev. 2/09

•
I. WELL CONTRACTOR:
Justin Radford
NON ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment Bnd Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 14 3270
Weil Contractor (Individual) Name
Geological Resources, Inc
Well Contractor Company Name
2301 F Crown Point Executive Dr
Street Address
Charlotte NC 28227
City or Town State Zip Code
(704 } 845-4010 -
Area coda Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WM0800957
OTHER ASSOCIATED PERMFT#(a applicable)
SITE WELL ID #(if applicable) MW-25
3. WELL USE (Check One Box) Monitoring rir Municipal/Public ❑
Industrial/Commercial Cl Agricultural 0 Recovery p Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 09/27/2011
4. WELL LOCATION:
7196 James B. White Hiahway. South
(Street Name. Numbers, Community, Subdivision, Lot No., Pares]. Zip Code)
cm Whiteville cowry Columbus
TOPOGRAPHIC 1 LAND SETTING: (check appropnate box)
tjSiope ❑Valley iileFtat ❑Ridge IJOther
LATITUDE 38 " DMS OR 34.248639 DE)
LONGITUDE 75 °' " DMS OR 78.755222 DD
Latitude/longitude source: ❑FS Oropographic map
(location of well must be shown on a USGS 1opo map andatiached 10
this fomm if not using GPS)
S. FACILITY (Name of the business where Itre well is located.]
701 Gas & Grorery 0-Q11645
Facility Name Facility !DI (if applicable)
7196 Jaynes B White Hiohway South
Street Address
Whitevilie NC 28472
City or Town State Zip Code
Hurshel Prince
Contact Name
PO Box 750
Mailing Address
hiI viiIP. NC 2847?
City or Town State Zip Code
f 91 ❑ a9 642-420
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 12
b. noes WELL REPLACE EXISTING WELL? YES [+ NO W
c. WATER LEVEL Below Top of Casing: FT.
(Use "+' if Above Top of Casing)
d. TOP Of CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118
e, YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth)_
Top Bottom Top
Top_ Bottom Top
Top Bottom Top
7. CASING: Depth Diameter
Tap 0 Bottom„ 2 Ft, 2"
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 BottornA5 FI. Cement
Top 0-5 Bottom 1 Ft. Bentonite
Top Bottom Ft.
Bottom
Bottom
Bottom
Thickness!
Weight Material
sch 4g PVC
Method
pour
pour
9, SCREEN: Depth Diameter Slot Size IHateriei
Top 2 Bottom 12 Ft, 2 in. CV in. PVC
Top Bottom Ft. in. in.
'fop Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Tap 1_ Bottom 12 Ft, #2 Sand
Top Bottom . Ft.
Top Bottom Ft.
11, DRILLING LOG
Top Bottom Formation Description
0 / I Brown fine top&pi!
1 / 4 - Tan sandy clay
4 / 6 Light tan fine sand
_f 12
1
1
12. REMARKS:
Gray tan clayey sand
CO HEREBY CERTIFY -THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 7G WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROV10E0 7O; 1•IE WELL OWNER
S1GNA
Justin Radford
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1817 Mail Service Center, Raleigh, NC 27699-461. Phone : [phone]
NTRACTOR DATE
Form GW-1 b
Rev. 2109

Date: 12/11/15
Date Date Water
Well ID Installed Level Measured
(mm/dd/yy) (mm/dd/yy)
04/02/09
05/28/09
06/26/09
12/09/09
10/27/10
MW-1 04/01/09 02/15/11
09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
12/02/15
04/02/09
05/28/09
06/26/09
12/09/09
10/27/10
MW-2 04/01/09 02/15/11
09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
05/28/09
06/26/09
12/09/09
10/27/10
02/15/11
MW-3 05/28/09 09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
12/02/15
05/28/09
06/26/09
12/09/09
10/27/10
02/15/11
MW-4 05/28/09 09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
12/02/15
12/09/09
10/27/10
02/15/11
MW-5 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
12/09/09
10/27/10
02/15/11
MW-6 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
12/09/09
10/27/10
02/15/11
MW-7 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
12/09/09
10/27/10
02/15/11
MW-8 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
TABLE 1
WELL CONSTRUCTION AND GAUGING INFORMATION
701 GAS & GROCERY (INCIDENT NO. 32552)
Screened Top of Depth to
Well Casing Bottom of Water from
Depth Interval Well Casing Top of ~toy ft. Elevation (ft. BGS) BGS) (ft. BGS) (ft.) Casing
(ft.)
NM 3 .27
NM
4.58
2.87
4.06
2 2 -12 12 2.76
100.00 3.66
3.95
2.16
3.61
4.74
2.64
NM 6.82
NM
5 .83
2.26
4.94
4 4 -14 14 101.87 3.39
3.47
5 .08
2.59
4.15
5.81
4 .02
5 .1 3
2 .22
4.43
3.11
2 2 -12 12 100.30 3.88
4.50
2.15
3.98
5.19
3.11
3.15
3 .94
1.29
3.51
2.25
2 2 -12 12 99.15 3.07
3.26
1.66
3.06
4.05
2.14
0 .55
3.24
1.71
1 1 -11 11 100.20 1.68
3.48
1.14
2.56
2.35
5.16
3.58
2 2 -12 12 102.34 3.50
5.34
2.84
4.40
3.60
6.49
4 .94
2 2 -12 12 103.57 4.84
6.70
4.11
5.76
1.82
4.38
2.83
2 2 -12 12 100.80 3.08
4.30
2.08
3.44
5.07
Page 1 of 3
Facility ID#: 0-011645
Ground Free Product
Thickness Water Comments Elevation (ft.) (ft.)
---NM
NM NM
---95.42
---97.13
---95.94
---97.24
---96.34
---96.05
---97.84
---96.39
---95.26
---97.36
---NM
NM NM
---96.04
---99.61
---96.93
---98.48
---98.40
---96.79
---99.28
---97.72
---96.06
---96.28
---95.17
---98.08
---95.87
---97.19
---96.42
---95.80
---98.15
---96.32
---95.11
---97.19
---96~00
---95.21
---97.86
---95.64
---96.90
---96.08
---95 .89
---97.49
---96.09
---95.10
---97.01
---99.65
---96.96
---98.49
---98.52
---96.72
---99.06
---97.64
---99.99
---97.18
---98.76
---98.84
---97.00
---99.50
---97.94
---99.97
---97.08
---98.63
---98.73
---96.87
---99.46
---97.81
---98.98
---96.42
---97.97
---97.72
---96.50
---98.72
---97.36
---95.73
Date: 12/11/15
Date Date Water
Well ID Installed Level Measured
(mm/dd/yy) (mm/dd/yy)
10/27/10
02/15/11
09/27/11
MW-18 10/26 /10 06/19/12
04/2 1/14
12/04/14
06/02/15
10/27/10
02/15 /11
09/27/11
MW-19 10/26/10 06/19/12
04/21/14
12/04/14
06/02/15
12/02/15
10/27/10
02/15/11
09/27/11
MW-20 10/26/10 06/19/12.
04/21/14
12/04/14
06/02/15
12/02/15
02/15 /11
09/27/11
06/19/12
MW-21 02/15/11 04/21/14
12/04/14
06/02/15
12/02/15
02/15 /11
09/27/11
06/19/12
MW-22 02/15/11 04/21/14
12/04/14
06/02/15
12/02/15
02/15/11
09/27/11
06/19/12
MW-23 02/15/11 04/21/14
12/04/14
06/02/15
12/02/15
09/27/11
06/19/12
MW-24 09/27/11 04/21/14
12/04/14
06/02/15
12/02/15
09/27/11
06/19/12
MW-25 09/27/11 04/21/14
12/04/14
06 /02 /15
12/02/15
12/09 /09
10/27/10
02/15/11
TW-1 12/07/09 09/27/11
06/19/12
04/21 /14
12/04/14
OW-1 05/03/12 06/19/12
OW-2 05/03/12 06/19/12
OW-3 05 /03/12 06/19/12
OW-4 05/03/12 06/19/12
RW-1 05/02/12 06/19/12
AS-1 05/02/12 06/19/12
Notes:
TABLE 1
WELL CONSTRUCTION AND GAUGING INFORMATION
701 GAS & GROCERY (INCIDENT NO. 32552)
Screened Top of Depth to
Well Casing Interval Bottom of Casing Water from
Depth ~toy ft. Well Elevation Top of
(ft. BGS) BGS) (ft. BGS) (ft.) Casing
(ft .)
5.44
2.07
2 .94
2 2 -10 10 96 .77 4.40
1.26
3.24
5.07
5.63
2 .21
2.93
2 2 -10 10 96.40 NM
1.25
3 .51
5.24
2.73
4.93
2 .00
2.59
2 2 -10 10 95 .97 NM
0 .89
2 .79
4 .66
2.04
1.96
3.40
NM
2 2 -10 10 94.67 1.09
NM
4.90
2 .18
1.77
1.44
NM
2 2 -10 10 94 .87 1.12
NM
4 .94
2.28
1.55
4.42
NM
2 2 -10 10 94.82 0 .98
NM
5.42
2.01
6.49
NM
2 2 -12 12 98 .64 3.54
NM
5.11
3 .70
4.74
NM
2 2 -12 12 98.16 3 .51
5 .34
6.23
3.94
14.45
17 .00
14.74
45 45 -50 50 100.50 15.10
16.41
14.22
15.02
2 2 -12 12 100.31 4 .53
2 2 -12 12 99 .79 3 .54
2 2 -12 12 99.69 4 .00
2 2 -12 12 100 .28 4.22
3 3 -20 20 100 .15 NM
15 15 -20 20 100 .50 4.66
Free Product
Thickness
(ft.)
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
• Ground water elevations relative to a temporary benchmark with an assumed datum of 100.00 feet; data reported in feet.
• ft BGS : feet below ground surface
• NM: Not measured.
• MW-15 was completed with a 3-foot stand-up cover.
Page 3 of 3
Facility ID#: 0-011645
Ground
Water
Elevation Comments
(ft.)
91.33
94.70
93.83
92 .37
95.51
93.53
91.70
90.77
94.19
93.47
NM
95.15
92.89
91.16
93.67
91.04
93.97
93.38
NM
95.08
93.18
91.31
93.93
92.71
91.27
NM
93.58
NM
89.77
92.49
93.10
93.43
NM
93.75
NM
89 .93
92.59
93.27
90.40
NM
93.84
NM
89.40
92.81
92.15
NM
95.10
NM
93.53
94.94
93.42
NM
94.65
92.82
91.93
94.22
86.05
83.50
85.76
85.40
84.09
86.28
85.48
95.78
96.25
95 .69
96.06
NA
95.84
G
9
•
LEGEND
TYPE 11 MONITORING WELL
TYPE Ill MONITORING HELL
PILOT TEST OBSERVA770N HELL
AIR SPARGING WELL
RECOVERY WELL
WATER SUPPLY HELL
DISPENSER
FORMER PRODUCT PIPING
LIGHT POLE
FENCE
PROPERTY LINE
OVERHEAD UTILITY LINE
UNDERGROUND U77LITY LINE
DITCH
FIBER OPTIC LINE
NATURAL GAS LINE
RIGHT OF WAY
— — 97 — — WA 7FR TABLE SURFACE CONTOUR
(9RJ) GROUND WATER ELEVA770N (FT)
(N►r) NOT MEASURED
•
SHELTER
•
•
BARNES
PROPERTY
•
•
•
AUTO REPAIR
BUILDING
MN-7
()
1 #91
/OW04 5::. 07.
r• MY- 011L2a .IIF0
p1tl
(9z.I•s) ow-. (Au)
MW-400.1
.197ai) 1
c-a4 MI1�13
1.g�i aOw)
CP
•
1.v1f rr
(9&58)
1T ri-J.
1-12 0./
r
/
/
1 /
1 /
l /
/
/ /
//
M Oa
/ (9193)
.. C1 � .0/
-
/
�/ � f /tr��!
1 / f I (sm+,9)
ilk c5
MIv25
(94t22) / / / /
- MO24
(9494)
.
g
AM-18
QOM)
MIK-I9
(9.z$7)
. -.
.
.00
BARN
i
9
r
MJY-23
(0281)
S?HEL 7ER
Geological Resources, Inc.
0 .30 60
120
(IN FEET)
1inch =sort
WA TER TABLE SURFACE MAP (12/0245)
701 Gas do Grocery
ifMifewYle, Columbus County, NC
7796 James a Mite Hwy S.
Incident / 32552
Date: 12/17/15
Drown by
ECH
Figure J

LEGEND
❑ TYPE 11 MONITORING WELL
TYPE 111 MONITORING WELL
PILOT TEST OBSERVA 770N HgLL
AIR SPARGING WELL
RECOVERY WELL
t1 WA IER SUPPLY WELL
DISPENSER
- - - FORMER PRODUCT PIPING
LIGHT POLE
--- FENCE
PROPERTY LINE
OVERHEAD U77LITY LINE
UNDERGROUND UTILITY LINE
DITCH
FIBER OP77C LINE
NA TU AL GAS LINE
RIGHT OF WAY
BENZENE
TOLUENE
ETHYLBENZEN£
773 ES
NAPHTHALENE
<0.17
<0,17
0.17 J
<0.43
29.7
0.26 J
COI/CENT/FAWNS IN frgA
<0.17 LESS TYAN 771E METHOD DE7EC77 W LIMIT
SPECIFIED IN THE LABORATORY REPORT
1" ES77MATED VALUE
(NS) NOT SAMPLED
CONCENTRA LIONS IN BOLD FACE TYPE EXCEEDED
THE 2L STANDARDS
<0.17-
<3.17
<0.15
<0.43
<0.16
<0.12
1
BARNES
PROPERTY
1
1
1
1
l
' AIN�74
<0.17
0.17 J
MW-6
/NS)
t
t AIW-2
(Ns)0
MW-5
STORE
GP
AUTO REPAIR
BUILDING
MW-73
(M5)
r
INS W-3
0 4 is RW t(NS)AIW-10
SJOW=2v CO
os-J �Sl NV
Mir -4
O
<0.17
r0.17
0.71
<0.43
2.1
1.9
1
Jr
36.33
nfi
1000
ra.17
<0.17
[0.15
<0.43
11.4
<0.12
AIW- 11
15.2
0.71
7
3
,dW-16
O
(Ns)
A/ 20
AM-
0.34 J
1.1
8.9
36.4
0.69
7.0
Milt- 74
0.95 J
<0.33
<0.30
<0.86
64.4
0.50 .1
MW-13
Geological Resources, Inc
0
3O
60
120
( IN FEET)
1inch60 ft
0
❑
AIW-17
(NS)
<0.17
<0.17
<0.43
11.8
0.30. J
MW-22
<0.17
<0.17
<0.15
<0.43
0.37 J
<0.12
(Ns)
8_
14.
4
SILO
BARN
•. r1-73 l.I.1
1i
MUM
MOM
KIM
anal MEM
ICIER
GAS
REEKS
Irani
CUR
GROUND WA TER QUALITY MAP (12/02/15)
701 Gas & Grocery
H,ite71e, Columbus County. NC
7196 James B. PA its Hwy S.
Incident , ' 32552
Dofe.• 12/ 7/15 I Drown by. ECH
Figure: 4

Date: 12/11/15
Date Date Water
Well ID Installed Level Measured
(mm/dd/yy) (mm/dd/yy)
04/02/09
05/28/09
06/26/09
12/09/09
10/27/10
MW-1 04/01/09 02/15/11
09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
12/02/15
04/02/09
05/28/09
06/26/09
12/09/09
10/27/10
MW-2 04/01/09 02/15/11
09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
05/28/09
06/26/09
12/09/09
10/27/10
02/15/11
MW-3 05/28/09 09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
12/02/15
05/28/09
06/26/09
12/09/09
10/27/10
02/15/11
MW-4 05/28/09 09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
12/02/15
12/09/09
10/27/10
02/15/11
MW-5 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
12/09/09
10/27/10
02/15/11
MW-6 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
12/09/09
10/27/10
02/15/11
MW-7 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
12/09/09
10/27/10
02/15/11
MW-8 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
TABLE 1
WELL CONSTRUCTION AND GAUGING INFORMATION
701 GAS & GROCERY (INCIDENT NO. 32552)
Screened Top of Depth to
Well Casing Bottom of Water from
Depth Interval Well Casing Top of
(ft. BGS) ~toy ft. (ft. BGS) Elevation Casing BGS) (ft.) (ft.)
NM 3.27
NM
4.58
2.87
4.06
2 2 -12 12 2.76
100.00 3.66
3.95
2.16
3.61
4.74
2.64
NM 6.82
NM
5.83
2.26
4.94
4 4 -14 14 101.87 3.39
3.47
5.08
2.59
4.15
5.81
4.02
5.13
2.22
4.43
3.11
2 2 -12 12 100.30 3.88
4.50
2.15
3.98
5.19
3.11
3.15
3 .94
1.29
3.51
2.25
2 2 -12 12 99.15 3.07
3 .2 6
1.66
3.06
4.05
2.14
0.55
3.24
1.71
1 1 -11 11 100 .20 1.68
3.48
1.14
2.56
2.35
5.16
3.58
2 2 -12 12 102.34 3.50
5.34
2.84
4.40
3.60
6.49
4.94
2 2 -12 12 103.57 4.84
6.70
4.11
5.76
1.82
4.38
2.83
2 2 -12 12 100.80 3.08
4.30
2.08
3.44
5.07
Page 1 of 3
Facility ID#: 0-011645
Ground Free Product
Thickness Water Comments
(ft.) Elevation
(ft.)
---NM
NM NM
---95.42
---97.13
---95.94
---97.24
---96.34
---96.05
---97.84
---96 .39
---95.26
---97.36
---NM
NM NM
---96.04
---99.61
---96.93
---98.48
---98.40
---96.79
---99.28
---97.72
---96.06
---96.28
---95.17
---98.08
---95.87
---97.19
---96.42
---95.80
---98.15
---96.32
---95.11
---97.19
---96:00
---95.21
---97.86
---95.64
---96.90
---96.08
---95.89
---97.49
---96.09
---95.10
---97.01
---99.65
---96.96
---98.49
---98.52
---96.72
---99.06
---97.64
---99.99
---97.18
---98.76
---98.84
---97.00
---99.50
---97.94
---99.97
---97.08
---98.63
---98.73
---96.87
---99.46
---97.81
---98.98
---96.42
---97.97
---97.72
---96.50
---98.72
---97.36
---95.73
Date: 12/11/15
Date Date Water
Well ID Installed Level Measured
(mm/dd/yy) (mm/dd/yy)
12/09/09
10/27/10
02/15/11
MW-9 12/07/09 09/27/11
06 /19/12
04/21/14
12/04/14
12/09/09
10/27/10
02/15/11
MW-10 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
12/09/09
10/27/10
02/15/11
09/27/11
MW-11 12/07/09 06/19/12
04/21/14
12/04/14
06/02/15
12/02/15
12/09/09
10/27/10
02/15/11
MW-12 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
12/09/09
10/27/10
02/15/11
MW-13 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
04/08 /10
10/27/10
02/15/11
09/27/11
MW-14 04/07/10 06/19/12
04/21/14
12/04/14
06/02/15
12/02/15
04/08/10
10/27/10
02/15 /11
MW-15 04/07/10 09/27/11
06/19/12
04/21/14
12/04/14
04/08/10
10/27/10
02/15/11
MW-16 04/07/10 09/27/11
06/19/12
04/21/14
12/04/14
06/02/15
10/27/10
02/15/11
09/27/11
MW-17 10/26/10 06/19/12
04/21/14
12/04/14
06/02/15
TABLE!
WELL CONSTRUCTION AND GAUGING INFORMATION
701 GAS & GROCERY (INCIDENT NO. 32552)
Screened Top of Depth to
Well Casing Interval Bottom of Casing Water from
Depth ~ to x ft .
Well Elevation Top of
(ft. BGS) BGS) (ft. BGS) (ft.) Casing
(ft.)
2.70
5.18
3 .61
2 2 -12 12 101.33 3.80
5.02
2.83
4.13
2.04
4.37
3.09
2 2 -12 12 100.00 3.80
4.36
2.51
4.09
5.29
1.80
3 .87
2 .70
3.39
2 2 -12 12 99.37 3.90
2.34
3.64
4.88
2.69
1.95
3.95
2 .59
2 2 -12 12 99.09 3.64
3.54
NM
NM
0.40
2.72
1.33
2 2 -12 12 98.27 2.12
1.98
0.83
2.12
1.98
3.36
1.41
1.85
1 1 -10 10 96.44 2.77
0.91
2.34
3.69
1.67
3.09
5.50
2.53
1 1 - 8 8 98.09 6.59
4.64
3.04
3.49
2.73
4.75
2.09
1 1 - 8 8 97.68 2.10
3 .82
1.58
3.14
4.67
4.44
2.00
2 .88
2 2 -10 10 96 .52 2.80
1.33
3.12
4.23
Page 2 of 3
Facility ID #: 0-011645
Ground Free Product Water Thickness Elevation Comments
(ft.) (ft.)
---98.63
---96.15
---97.72
---97.53
---96.31
---98.50
---97.20
---97 .96
---95.63
---96.91
---96.20
---95.64
---97.49
---95.91
---94.71
---97.57
---95 .50
---96.67
---95.98
---95.47
---97.03
---95.73
---94.49
---96.68
---97.14
---95.14
---96 .50
---95.45
---95.55
---NM Not Foun d
---NM Not Found
---97.87
---95.55
---96.94
---96.15
---96.29
---97.44
---96.15
---94.46
---93.08
---95.03
---94.59
---93.67
---95.53
---94.10
---92.75
---94.77
---95.00
---92 .59
---95.56
---91.50
---93.45
---95.05
---94.60
---94.95
---92.93
---95 .59
---95.58
---93.86
---96.10
---94.54
---93.01
---92.08
---94.52
---93.64
---93.72
---95.19
---93.40
---92.29
Date: 12/11 /15
Date Date Water
Well ID Installed Level Measured
(mm/dd/yy) (mm/dd/yy)
10/27/10
02/15/11
09/27/11
MW-18 10/26/10 06/19/12
04/21/14
12/04/14
06/02/15
10/27/10
02/15/11
09/27/11
MW-19 10/26/10 06/19/12
04/21/14
12/04/14
06/02/15
12/02/15
10/27/10
02/15/11
09/27/11
MW-20 10 /26/10 06/19/12
04/21 /14
12/04/14
06/02/15
12/02/15
02/15/11
09/27/11
06/19/12
MW-21 02/15/11 04/21/14
12/04/14
06/02/15
12/02/15
02/15/11
09/27/J 1
06/19/12
MW-22 02/15/11 04/21/14
12/04/14
06/02/15
12/02/15
02/15/11
09/27/11
06/19/12
MW-23 02/15/11 04/21/14
12/04/14
06/02/15
12/02/15
09/27/11
06/19/12
MW-24 09/27/11 04/21 /14
12/04/14
06/02/15
12/02/15
09/27/11
06/19/12
MW-25 09/27/11 04/21/14
12/04/14
06/02/15
12/02/15
12/09/09
10/27/10
02/15/11
TW-1 12/07/09 09/27/11
06/19/12
04/21/14
12/04/14
OW-1 05/03/12 06/19/12
OW-2 05/03/12 06/19/12
OW-3 05 /03 /12 06/19/12
OW-4 05/03/12 06/19/12
RW-1 05/02/12 06/19/12
AS-1 05/02/12 06/19/12
Notes :
TABLEl
WELL CONSTRUCTION AND GAUGING INFORMATION
701 GAS & GROCERY (INCIDENT NO. 32552)
Screened Top of Depth to
Well Casing Interval Bottom of Casing Water from
Depth ~ to yft. Well Elevation Top of
(ft . BGS) BGS) (ft. BGS) (ft.) Casing
(ft .)
5.44
2.07
2 .94
2 2 -10 10 96 .77 4.40
1.26
3.24
5.07
5.63
2.21
2 .93
2 2-10 10 96.40 NM
1.25
3.51
5.24
2.73
4.93
2.00
2.59
2 2 -10 10 95 .97 NM
0 .89
2.79
4 .66
2 .04
1.96
3.40
NM
2 2 -10 10 94.67 1.09
NM
4.90
2.18
1.77
1.44
NM
2 2-10 10 94.87 1.12
NM
4.94
2.28
1.55
4.42
NM
2 2 -10 10 94 .82 0.98
NM
5.42
2.01
6.49
NM
2 2 -12 12 98.64 3.54
NM
5.11
3.70
4.74
NM
2 2 -12 12 98.16 3.51
5.34
6.23
3.94
14A5
17.00
14.74
45 45 -50 50 100 .50 15.10
16.41
1422
15 .02
2 2 -12 12 100.31 4.53
2 2 -12 12 99.79 3.54
2 2 -12 12 99 .69 4 .00
2 2 -12 12 100.28 4.22
3 3 -20 20 100.15 NM
15 15 -20 20 100 .50 4 .66
Free Product
Thickness
(ft.)
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
---
• Ground water elevations relative to a temporary benchmark with an assumed datum of 100.00 feet; data reported in feet.
• ft BGS : feet below ground surface
• NM: Not measured .
• MW-15 was completed with a 3-foot stand-up cover.
Page 3 of 3
Facility ID#: 0-011645
Ground
Water
Elevation Comments
(ft.)
91.33
94.70
93.83
92 .37
95.51
93.53
91.70
90.77
94.19
93.47
NM
95.15
92.89
91.16
93.67
91.04
93.97
93.38
NM
95.08
93.18
91.31
93.93
92.71
91.27
NM
93.58
NM
89.77
92.49
93.10
93.43
NM
93.75
NM
89.93
92.59
93.27
90.40
NM
93.84
NM
89.40
92 .81
92.15
NM
95.10
NM
93.53
94.94
93.42
NM
94.65
92.82
91.93
94.22
86.05
83.50
85.76
85.40
84 .09
86.28
85.48
95.78
96.25
95.69
96.06
NA
95.84
LEGEND
TYPE 11 MONITORING HELL
TYPE 111 MONITORING KELL
PILOT TEST OBSE7?VA170N HELL
0 AIR SPARGING WELL
41a RECOVERY WELL
WATER SUPPLY WELL
Qo DIS°ENSER
— — — — — FORMER PRODUCT PIPING
LIGHT POLE
----- FENCE
PROPERTY LINE
0frERHEAD Ll77UTY LINE
UNDERGROUND U77LITY UNE
DITCH
FIBER OPTIC LINE
NATURAL OAS UNE
RIGHT OF WAY
— — 97 - - WATER TABLE SURFACE CONTOUR
(9Z36) GROUND WATER ELEVA710N (FT.)
(++u0 NOT MEASURED
*SW-2
19
•
BARNES
PROPERTY
as
IYSM- 1
Effl
MW-6
Avg)v
/
MW-2
OvA
STORE
MW-7
0404
MW-8
j > w41(V7
MW-io
T . OW-2o
i No
AUTO REPAIR
BUILDING
(SRJS) ow`j
MW4 /
0/937) 1
,Wry i3
a (vu+)
/`�
MW 16
/
MW-20
/ /(&I93)
/
/
/
W 21
/ (9249)
1,1W-9
3
(►m)
I
Sys
•
f
7 0. Of
10
410
Mil-14
(9(n)
WI -76 I
HOzise
(9259)
BARN
W-23
(9251)
SHEZ TER
Geological Resources. Inc.
a 3O 80
120
(IN FEET)
1inch =60ft
WA TER TABLE SURFACE MAP (12/02/15)
701 cos & Grocery
ffi te►mile, Columbus Coeunty, NC
7196' domes B. White Hwy S
Incident / 32552
Dote• 12/17/15
Drown by.
ECH
figure:
3

<0.17
<0.17
0.17 J
<0.43
29.7
0.26 J
j.EGEND
TYPE 1I MONITORING WELL
TYPE III MONITORING WELL
PILOT TEST OBSERVATION WELL
AIR SPARGING WELL
RECOVERY WELL
WATER SUPPLY WELL
DISPENSER
- FORMER PRODUCT PIPING
LIGHT POLE
- FENCE
PROPERTY LINE
OVERHEAD UTILITY LINE
UNDERGROUND U77L17Y LINE
DITCH
FIBER OPTIC LINE
NATURAL GAS LINE
RIGHT OF WAY
BENZENE
TOLUENE
ETHYLBENZENE
MT8E ES
NAPHTHALENE
CONCENTRA l70NS IN frg/L
<1717 LESS ??-/AN THE METHOD DE7ECl/ON LIMIT
SPEC/RED IN THE LABORATORY REPORT
"I" ESTIMATED VALUE
(NS) NOT SAMPLED
CONCENTRATIONS IN BOLD FACE TYPE EXCEEDED
THE 2L STANDARDS
f1
SHELTER
WSW-2
11
4;1117
<0,17
<0.15
<0.16
c0.12
BARNES
PROPERTY
MW-1
m,f7
m.17
0.17 J
m.43
20.
-0.26 J
fzim
cua
- �l1
I
ors '..-"-
sJa
NW-
(Ns)2 Q
y
STORE
A/W-7
(NS)
TL 1
Jg
i N
Up
/ I AS-2
d 4
r S)ow-20 D
ow-JoMO OW)
AUTO REPAIR (NS)
BUILDING
I
sf
MW-13
(Ns)
Mi14
c4.17
[0.17
0.71
<0.43
2.1
1,9
c0.17
<0.17
c0-1.15
c0.43_
11.4
C0.12
$1'
I1�=1(NS) MW-10
NW-
(NS)
NW- II
a'
-•1a 2
0.71
5.4
2.2
5,3
MW-2!
Mid-15
(NS)
M►f� 44 i
0.95 J
c0.86
B4.4
0.60 J
My 1a
\s)
MW-19
mzse
1NW- 5`f SILO
j (NS)
N -17
m'S)
CAM
CUE
MtliEM
MUM
coRipi
115W-3
05
Geological Resources. Inc.
0
30
60
120
(INFEET J
1 inch = 60 ft
MW-22
r2
MEM
wirgg
4
125
BARN
MW-23•
MEM
87.9
355
14.7
SHELTER
GROUND WA TER QUALITY
MAP (121/02/15)
701 Gas & Grocery
i,Tiiterille, Columbus County, NC
7196 James B. White Hwy 5
Incident ,1 32552
Date:
12/17/15
Drawn by.
ECH
Figure: