WI0800498_DEEMED FILES_20171215

J)~
'.\orth Carolina Department of Em iron mental Qualit:v -Dh-ision of\\ atcr Resources
IN,JECTlON EVENT RECORD {lEll)
--------------------,
Permit Information
·1. •
L.1.~:~ "-.r... X'
P.._>nnitke
~ ...
racilit) ~am.:
\ ~"--S,.:__1 "--.: ~ 'l , '-'--'AC c\ . .._\ \..~.f ...._\_ \.C-...(:_ \. .... ··--• .... ·• -······ . ---·· . --· ---··. -" \
l· Jcilit) Addrc:-:,, (include County)\'> .... ...:;;:-' ,,
,..-· .. .._,__,
2. Injection Contractor Information '-· -
~\e 'i;>,.,c <, ,, "-'-'0t:
lnjs:d1on ( \mtractm / Ctllnpan~ 1\am..;
~ \~'\,..:.,,..~~---t,.......'-
c Hy ) State
..., \'-\cC"i
.lip C\1dc
, ~ \S) .. ~~ .\.:::-.?? ~_:t3 __
Area coJe Phone mnnh1,;r
RECENEO/NCDEQ/O
3 Well Information DEC 15 2017
\\ er.: ;1n~ \\el!;, ahandtml!-d during. thi::. injc.:til'n
eH.·nt'.'
0 )e.; ·t-t 'w
>iumbcr of \hmitoring Well~ -
:\umber l'f Inj..:ction Wells -
Pleave iliclmk ,, copy of the GW-3().for each well
(li,and(J11ed.
·t. InJecbmt Information
·~ -\ ,,. , .. ';(_ _t: _ · "-•":"!!:.'l:U~ ........ C,. -::· A . _ . . .... .
Injedant(s} rype 1.can use separate additional sheet;..
if necessary
( ·oncentmtiPn
If.the injcc:rant is diluted pleas(.'. indicate the sour..:.c
diluti,m fluid. -
l"--: _\ ~
\-.: \"
1\umhcr of wdl-; US<:,! for inj,·ction . \ Water Quality
Regional Operations Sec iorl :-.
I
\' o!mm: lnjt:1.:t,xl per well (gal)
Injection Histo11-
Wdl IDs
\\\:re an~ llC\\. 1-\dls install.:d during 1hi, injccti,,n
C\ cnt?
OY1:s ~'.\(,
!J ye:,,, rl<.:asc pwv ide the folh1\\ ing information:
Type of\\ di Instalkd (Ch..:ck dpplicahk typ1..:):
!J l·km;d D Drilled C Dir..:..:t-Pthh
[J I land Au~u1"1.:d O Other.~ "r1eci(,) _
Please indmfe a copy oj tlte G~f-1 (ormfor eacft
wdl i11stt1lled.
lnjcctinn date! :,J.
Submit the original M thi-; forn1 to the Divismn of Water Rcsourc..:s ~\ ithin 30 day~ o!' iniection.
.-\ttn: l:l.C Progr,,m 1616 \Llii Service Cenkr. R.tk<gh, ~C 27699-16:1-6, Phon-i No. 9 l9-&0''i-6•i6.l
Fonn U( -lf'R
Rev. 3-1-2016
Permit Number WI0800498
Program Category
Deemed Ground Water
Permit Type
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Pantry #3197
Location Address
1330 N Norwood St
Wallace
Owner
Owner Name
Circle K Stores Inc
Dates/Events
NC
Orig Issue
11/17/2017
App Received
11/14/2017
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
28466
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
11/17/2017
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
Brent Puzak
Director Environmental
1100 Situs Ct Ste 100
Raleigh
Region
Wilmington
County
Duplin
NC
Issue
11/17/2017
_Effective
11/17/2017
27606
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
Shrestha, Shristi R
From:
Sent:
To:
Cc:
Subject:
Shrestha, Shristi R
Friday, November 17, 2017 1:58 PM
'[e-mail]'; '[e-mail]'
King, Morella s
WI0800498 NOi Pantry #3197
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) Well 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 (ori ginals 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 well construction/abandonment information is the same for the wells, only one form
n.eeds to be completed-just indicate total number of injection points in the Comments/Remarks section of
form. These forms can be found on our website at
http://deg.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/gr ound-water-
protection/ ground-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 [e-mail] 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., WIOXXXXXX) that has been assigned to the injection activity at this site. This notification has been given the
deemed permit number WI0800498. This number is also referenced in the subject line of this email. You may if you
wish, scan and send back as attachments in r eply to this email, as it will already have the assigned deemed permit
number in the subject line.
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 @ ncdenr.g ov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
Email correspondence to and from this address is subject to the
Norlh Carolina Public Records Law and may be disclosed to third parties.
Shrestha. Shristi R
From:
Sent:
To:
Subject:
Attachments:
Please find the attached NOi.
Shristi
Shrlstl R. Shrestha
Hydrogeologist
Shrestha, Shristi R
Friday, November 17, 2017 2:02 PM
King, Morella s
WI0800498 NOi PAntry#3197
NOI.pdf
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
Email correspondence to and from this address is subject to the
t\Jorih Carolina Public Records L a w and may be disclosed to third parties.
ATC
609A Piner Road
Suite 115
Wilmington, North Carolina 28409
Tel: [phone]
Fax: [phone]
ENVIRONMENTAL • GEOTECNNICAI, www.atcgroupservices.cam
N.C. En ineerin9 License No, C-1598
November 7, 2017
Ms. Shristi Shrestha
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section, UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Reference: Notice of Intent to Construct or Operate Injection Wells
Former Pantry #3197
1330 North Norwood Street
Wallace, Duplin County, North Carolina
Risk Classification: I160D
Dear Ms. Shrestha:
RECEI'IEDINCDEN IR
NOV 14 2017
Waier uualrty Regional
Operations Section
ATC Associates of North Carolina, P.C. (ATC) has prepared the enclosed Notice of Intent to
Construct or Operate Injection Wells on behalf of Circle K Stores, Inc. The permit application
covers the performance of passive remediation in one monitoring well associated with the above
referenced site
If you have questions or require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
r \,n
W uw (I'-.
Maureen A. Jackson,':[.
Senior Project Manager
cc: Mt. Brent Puzak, Circle K Stores, Inc.
Attachments

N i I:"It F Of MIEN f FORM
1.47

NOR1H CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C .0200. This form shall be submitted at least 2 weeks prior to injection.
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02c .0225> or TRACER WELLS l15A NCAC 02C .0229):
1) Passive Injection S stems -In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small-Scale Injection Operations -Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall 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: November 2 , 201.I._ PERMIT NO. bf.IO; {> (> '-f't ~ (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
B.
c.
(1)
(2)
___ Air Injection Well ...................................... Complete sections B-F, K, N
___ .Aquifer Test Well ....................................... Complete sections B-F, K, N
(3) X Passive Injection System ............................... Complete sections B-F, H-N
___ Small-Scale Injection Operation ...................... Complete sections B-N (4)
(5)
(6)
Pilot Tes~····.·············································Complete sect~ons B~CE\VED/NCDEQ/DWR
___ Tracer lnJectlon Well ................................... Complete sect10ns B*
NOV 14 2017
STATUS OF WELL OWNER: Business/Organization water Quality Reg_ional
Operations Section
WELL OWNER -State name of entity and name of person delegated authority to sign on behalf of the
business or agency:
Name: Circle K Stores. Inc.
Mailing Address: 1100 Situs Court. Suite 100
City: Raleigh State: NC Zip Code:. __ ~2~7~6~06~County:_W~ak=e~------
Day Tele No.: ~9~19_-7~7~4~-6~7~00~------Cell No.: --~N~o~t~A~v~ai~·l~a~b_le ___ _
EMAIL Address: ___ B_P~uz~a_k .... @_,..c_i_rc_l_ek_._co_m _____ Fax No.: ----=-N"-"o:..:.t .:...A~v=a:.:.::ila:cab=l=e ______ _
VIC/In Situ Remed. Notification (Revised 3/2/2015) Page I
D. PROPERTY OWNER (if different than well owner)
Name: Taylor Famil y Pro perties
Mailing Address: 1645 Westbrook Plaza Drive
City: Winston-Salem State: _NC_ Zip Code:.=2_,_71"""0=3 ____ County: Fors y1 h
Day Tele No.: 336-407-9222 Cell No.: Not Available
EMAIL Address: suzanne.ramm@taylorcom panies.us Fax No.: 336-774-3860
E. PROJECT CONTACT -Person who can answer technical questions about the proposed injection project.
Name: ---~M~au=r~e~en~Ja=c=k=so=n~-~A=T~C~A_s~s~oc=i=at~e=s~o=f ~N~o=rt=h~C~ar=o~li=n=a .~P~·~C~. ___________ _
Mailing Address: -------"'6=09=A~P~in=e=r-"'R=o=a=d.,_;, S=u=i=te,_1...,1'""5'-----------------------
City: Wilmin gton State: _NC_ Zip Code:.=2-=-84.,_,0=9 ____ County: New Hanover
Day Tele No.: 919-561-3893 Cell No.: 919-561-3893
EMAIL Address: maureen.jackson (@ atcassociates.com Fax No.: 737-207-8261
F. PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: 1330 North Norwood Street County:-=D"-'u~p=li=n'---------------
City: Wallace State: NC Zip Code: -=2=8_,_46=6=--------------
(2) Geographic Coordinates: Latitude**: ______ or _~3_,_4 _0 7509655
Longitude**: or 77 ° 9983874 -------~~
Reference Datum: __ ~N~/=A~ ____ Accuracy: ___ 10_-_m_e_te_r __ _
Method of Collection:'----G==-oo""gl=e -=E=art=h"'°P""'r=o ___________ _
* *FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: AF ACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: _______ square feet
Land surface area of inj. well network: square feet~ 10,000 ft 2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be :S 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS -Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and
vertical extent of the contaminant plume in soil and groundwater, changes in lithology, existing and
proposed monitoring wells, and existing and proposed injection wells .
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus
existing and proposed wells.
See Figures 1 through 4 for site location and injection zone maps.
VIC/In Situ Remed. Notification (Revised 3/2/2015) Page2
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and
duration of injection over time.
A TC will install Adventus O-SOXs in monitorin g well MW-14 in order to aide in natural attenuation and
reduce com pounds concentrations to below the North Carolina Groundwater Ouali tv Standards {2L Standards ).
Based on the most recent sam plin g event performed in Se ptember 2017 . the followin g com pound exceeded the
a pp licable 2L Standard: benzene at 14 .000 micro grams/liter (µg/L). The socks come in 3-foot sections. ATC
will install two 3-foot sections at the base of the well . across the well screen. The socks will release oxidizing
solids into the groundwater for a pp roximatel y 6 months . at which point the chemicals in the socks will have
de pleted.
J. INJECT ANTS -Provide a MSDS and the following for each injectant. Attach additional sheets if necessary.
NOTE: Approved injectants (tracers and remediation additives) can be found online at
http://portal.ncdenr.org/web/wq/aps/gwpro. All other substances must be reviewed by the Division of Public
Health, Department of Health and Human Services. Contact the UIC Program/or more info {919-807-6496).
Injectant: ---=-A=d=vc..-=e=ntu=s----=Oc.._-=s-=o-=-x=------------------------
Volume of injectant: -~9""'0"""5'-in==-3 _-_v~o=l=um=e~o=f~s=o=ck=s~-----------------
Concentration at point of injection: --~9~0~o/c~o __________________ _
Percent if in a mixture with other injectants: --~N~o~t~A~P~P~l_ic_a~b_le ____________ _
See Appendix A for MSDS.
K WELL CONSTRUCTION DATA
(1) Number of injection wells: ---=-O __ ~Proposed __ ~l ___ .Existing
(2) Provide well construction details for each injection well in a diagram or table format. A single
diagram or line in a table can be used for multiple wells with the same construction details. Well
construction details shall include the following:
(a) well type as permanent, direct-push, or subsurface distribution system (infiltration gallery)
(b) depth below land surface of grout, screen, and casing intervals
( c) well contractor name and certification number
See Appendix B for well construction details and the well construction record.
L. SCHEDULES -Briefly describe the schedule for well construction and injection activities.
Two weeks after submitting this NOL ATC will install the Adventus O-SOXs in monitoring well MW-14
UIC/In Situ Remed. Notification (Revised 3/2/2015) Page3
M. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
ifviolations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
Semi-annual sampling events of select monitoring wells are performed in September and March. ATC's next
sampling event will occur March 2018. During the sampling event. ATC will collect a sample from
monitorine well MW-14 for analysis of volatile organic compounds by EPA Method 6200B. The sample will
be shipped to Con -Test Laboratory in East Longmeadow_ Massachusetts. ATC will also measure dissolved
oxygen. conductivity. temperature. pH. and oxvaen reduction potential in well MW-14 durini the March 2018
samplini event.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT; "I hereby certify, under penally 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 far 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 fates 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 iSA NCAC 02C 0200 Rules_ "
�r�.s}mow-t-Cl - DC-..
ignature of Applicant I f �int or Type Full Name
�J G r f LL .
Co Kok -
PROPERTY OWNER (if the propert". is not owned by the permit applicant):
"As owner of the property on which the injection well(s) are to he 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 NC.4C 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.
- "1/ i I 1 - %t- i ( ' _tC+ 5 k o •t�.ry :... =� @�C� �
Signature* of Property Owner (if [%rent from applicant) :L Print or Type Full Name
* 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]
UICJIn Situ Reined. Notification (Revised 3/2/2015) Page 4

From: Puzak, Brent
To; Maureeq ]ackwn
Subject; RE: Well Permits
Date: Friday, March 04, 2016 B:05:19 AM
Attachments: jrnayeQ03.Qnn
Maureen,
'I hanks fur processirt;. lase us,. this e• mail as supp.:r k 01 my authorization yuu to sif;r. pei t t
un behalf of Pantry , c`y le. IF you need ,3dthtiar. i sr • !> r, s; ; ,
toilow-up lull t•
Thanks,
BRENT PUZAK
Environmental Director
Circle K, Enc.
Cary ❑ivisianai Office
919-566-1549
bosnakPcirciek,oitl
From: Maureen Jackson[maiito:maureen,jackson@atcassociates,com]
Sent: Thursday, March 03, 2016 4:19 PM
To: Puzak, Brent
Subject: Well Permits
Importance: High
I submitted 2 well permits for the off -site wells at Pantry #161 in Elon. I signed the permit as ATC
Project Manager on behalf of Pantry. I need to get an email from you to send to DEQ— Public Water
Supply stating that I could sign on behalf of Pantry for the well permit. I have submitted many of
these signing like that and never needed a letter - guess it has changed.
Can you provide a brief email just saying you all me to sign on behalf of Pantry for the well permit for
Elan.
Thx — if that is a problem, let me know and 1 will upload well permits to Titan so you can sign and
then I can submit them.
Maureen 3ackson !SENIOR PROJECT MANAGER I ATC Group Services LLC
[phone] l [phone] mobile
2512 Independence Boulevard, Suite 200-34 I Wilmington, NC 28412
fax I masrrean.lacksanftatcassociates.co f www.atcgrouoservicessom

FIGl RES
1M!
I
4
i7
l / 4.
1• r
i
X +• !' • W.na y� I.
•^';fir f X •, •, ._
i
1
• i
+hM1
- ..r
ire
/n .4s ^'',
•
• }0
•
y
r •
•
R• i
t
a.
e
Source, USGS Charity, North Carolina, Topographic Map. 1,2400 Scale.1981. Also, USGS Wallace East.
Wallace West and Rose Hill Topographic maps.
TC2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
F '" ; d:r2Irs:11Wo;;s [phone]
PROJECT NO: PANT319713
CREATED
BY: DM R
SCALE: SEE DATE: 06/22/15
ABOVE
Figure 1
SITE TOPOGRAPHIC MAP
PANTRY #3197
1330 NORTH NORWOOD STREET
WALLACE, DUPLIN COUNTY, NORTH CAROLINA

ti
131Y3S 31V141X041ddv
7.0
0
N
`dr
ti
df
NOTES:
FIGURE 2
PANTRY #3 7 9 7
1632 NORTH NORWOOD STREET
WALLACE, NORTH CAROLINA
Z045000271
ar .xy row
r+t
��• } 1/14/14
AS SPOISW
ypY grMJ
AIME

r !NW,
LEGEND:
S — TYPE N MONfOR1NC 1VEL! LOCtTT0t4
• = TYPE xr MONiiCRMNC WELL WCM!0H
[S7 — RECOVERY WELL
WI. -Op} - DEP7W 70 GROUNDWATER thr EEEY
vary — NOT MEASURED
= GROUNDWATER CONTOUR LYVE (OAShMD WMERE APPROXIW1E)
�— GROUNDWATER ROW ONEC770N
(NM)
(NM)
(N14)
(96.21) 111
-1
L.♦• � r
eti
•em - i97 R6,1,
t �I \ c•.1 1 — i� LNM) 1=r 1 '
V.
\. _-5
1 1 (NM) ,a \
1 ij 1,
rr
(NM).
r.•v-4
(Ni) N TOM) �-
(98.49)
:OF.Mr-R
U51
5 23 50
APPROXIMATE SCJLE IN FEET
PANT319717
X !
41-t
a
COMTCUR MAP
a
ur
fl
7
LA

(Ns)
70j
/la -S)
0) 25
0.334
(Ns) =,
-:7
\ -L
4INNS}i
1211(NS]
LEGEhn
1 - TY?C !I 1✓OM0'E0Rol i WFa LacATKIN
TYPE nl MONTTORINO WFLI LOCATION
- RECOVERY WELL
(NS) - NOT SWPLED
(15) = BEN2ENE 75OCONCENTRATION (up/L)
- BFN7ENE ➢54CQNCCNTRArioN CONTOUR LINE Ek CEFOrNG NCGCL STANCAROS
Lr
,./ -06:1:7
(D.95)
A!
'
APPROXIMATE SCALE IN FEET
5
Ai
1

\PPls.~DIX A
\.l~DS FOR:\l
ADVENTUS
-1S lklil I'•t'Tl �I1T-1v'C:
0-SOX'" Page: I a 5
1. I'RO)DU( 1 LDI I li• IC.%F1(1N:
PROD! t 1 Liti1.;
11 A:i.I.'1( rum R;
1,1kers:u.,.\rxa IL. in
211.71 \\ . 1•rlrr'.s Rd tiuife
treipf1.l1:
hJlj��
SUIT Lind ll:-ti r tre:ltn.LTt.
I'M1•.H(1F (`\'
['SA: 1-ti1H1--I'4- 111 rt'I 1i s\31 l;lC
C'onada: tlh(; • .tif, r(.'A
It1NSPUR1't1IO 01 17\1ti(•121101.S M;OD (TA SSIF•!t'.1'l1()!ti:
O irli n 5.11i,l. 11 i+ ,. It'nlrislrtt 1'; rt 1e1. Cl:r,- z. PG t 1 l-L1
tiri 11S CLASS!! I(:.11'1(.)�:
Oxidizer
UOMP0 ITTON/I'S1()lt\I \'i ION ON I\GE}i)II ti-IS
ingredients
Perc• BLit•
1 I yu1'11\ rl1C
3. PM SIC .U..DA1't
lr1
1.'hemit•a! 1 armula
White & ll . rule
Phv.:4•i1 stare Sort]
(ldur :111:'khillLi Nom
13uf1, l)enr;tl
siirubilitr in Water irt,• Juflie
theumpirwititlri'fenlileratt�r� tint 1•L.eier:iring deeomr,
( 1,1u.
-1. 11A%ARTS ll]I• N. ! 11'I(' 1'1 ION
Ensi rgenev overview
(ixidix;ng Lgent. luhr rt'tsterial iian
tie- nii-T+nwc• and t.FX) ;C'- tl+::t in L'Ct4.tics
L;ilic.s. The N I'I' .tnel t 1S1.11 hnvL• n, I Cl •,iticsl nun-
c \i+n�ure al har.lr J ,i;. Irl l I 1. l rg irl+l,lz iiir,
�nntaip rtsp;+•.lhlE.-
1'crr. ita r
- fl
inn LL Ith sl'n rclease:.al%in!t from
!ire. LIridhr mate n t lii:ll
-I h.. rludu,.•• comains .1' non-r•espirable .rrStstl}1nL'
resltirahlr• ry i. rrr.uI1 ..
l;rl! ILIA{ Lllhl a+ • 14i0. I.11('-) doe, n,+;
1'ntuttial tiadlth b &ct•:
■ LirnL .tl Init:rtink fil iMit7n:1y k1 I11Flr,111• Glad eft

ADS ENTUS
a
NIA! t.f IALSAIL' k'1i11 1M MILL I:
0-SOAre 1 Page: 2 11-' 5
• illil:Lt.i..s':r .:1:.-1ng • irio; I trng tern) 1Yt eler,ttect Ievcl
rlY Call • !I ri tii;[ ':a� ( iI i Sid
• Eve iisflla. 1.i. eaLse Itnitati[ n :+1 the cvc Ri.ks 1il serious or rir111,:l1CIt t•!1:
le\ions,
• Skin Lonna:' ti1.15 l.bYt+C
h•ritafon the nu .lih :rid hrn,it v. i tll mask :1tnc1 v,rnli'tng
5. 11RN'1' A111 Alt- 1SIltk:S
• 1n1t,L1 itcrnt.vr:l';eeled ptrtiun In t e h .sir. Sock nt tfi:al :amnion it U.
per rst.
• 1:LL einitat_. Flush c}es rt• th runtliiti- it,rcr' for at 1e INC I i1:t11 nc,i a iih vt•c•lith
held op •13. Szek specialist
• Skin 11. sh , i:clod .kin with t[,a11 ;inii n ':4 Uric and I.ir_e ::in
nl
stet.
• 1n 'catitirl .....................[1'tht' per,lm I. cnti%elSnle sn{l not a fl ul.inc. eit•c 2-4 'pIufi+ Lil
watc I. to dill. C the Chetii•t, 11 ali e IIILLIiiai .1itC11I1[in eiiHILC{Is,.rrll
iFldnii . Lrltllrlil_.
G. 1`•IRIE<. H IGit TIN 11I..AS1. RL
Flavtt. Pont
• \n. aprlienhi•
Fhimrnability
• Not applic.lkie
ignition •Temperulni
Darrgtr at f plosirni
▪ Lm-L spI iuie
Extinguishing Media
•
f irc Yiaxstrds
• ()tiJj,.cr. lhit'Lte !two' 5LLi in Inds r. Li •r rupUirC I+1 i/vernal pretisL[r..'_
11d11 p i1315'tiec"L1inp '+r cxothernitiallL and tarnte U 11Ihll,:ihlc',, ifllcen release Li I_ t,t
i%iithCl'Ini1, dt'L-[)IYl7l'+ItiOn n3Li1 •aprort CI I.ribu.tirin, 1'1.i5' ignite other elguimstible 11'atcn 11!..
AeL :ii with ir1Lun .1;,lv1L• mat vials such .Iti h sncL IS. reduetnr :agents..cidy, base..,

0 ADVENTI
MkikWAIL `;lf']:31 PAT1Silf.Lr:
0-SON"' Page: 3 „f 5
.I1a11Uuali iIt Sswod, ,sprrc cl Ilh. etc., "henna' Je.'uitlpa1i;il,it uxrc]I :Ind h.at
Pre,tire i"4iirit. I:I,t► occur (hie • =«} evolution. Pre.-[Eriz:llion Of ,:t]tltine:t when honied • •
Jeo:osi npotiin,_- (inuainer4 sur.t ►i lcnily
Fire lighting Airutiurc i
• k:►,Ieuate permmneii
• 1.-ear protecri►e clothing:irad •clt ct•[]Ssi11id 3 tt:lihin otlapara:u
• tunl,lin I!p..t:ld tlf fire n103Lt11J h:iutdi,u. tapl.1. and '•tic+nillll ilit+}, prt]Juetx
• l tit water .pro) i.l chill fire . xtw.e.l 40.71%111(4:1s
7. A('(:II)i.NT.U. KNEE .1S1: NILAME RE;S
Spill ('lean -up I'L.urdutc
+ •gotir.e• ut i1 niil,sn. l:Yile:[ate ;+nproterted perionne! tront tiquiputent
re..onionenJal-]tln., round in Sct:71t]n U. \e►er t'tece.1 Loin t,.:cupLltirtt]..I expnnurc liri'it.
• Shovel or SReep rn Lte!i.tl irito$ pl.l.trr has:. or ►-etllel{ IN, Ill+t !Our!) .5pillei.l
LI:.on.ttl':-i.i to 1n►'e111Ialy, 1c,'x11 making this'
• 1=1u�h Ielr.aoning area Leith .rakLr to mint \e to -cue rr.idae :Intl c{itptl,l• of Lr',peri}. lsl!IA i1Er.
d1.cI. trge [11 tit v 'Iti and ,ar1•.srr ►c;+tt:a (+Eti► :l'ath.sririus it unit) • •
• t)u nut lut.ci' s• . ►r.,ik ihrukrh .pifletl ru treri.11. Kee' .w,ty [corn e,111}bt.•libl• . Iwog t1. pap.
,'tt.;. Dta no[ reitan ptkIdU:l , l]IIS:IuI. ht cat -e rll risk ofe nll.t 1il1:1Eil]n
S. IIANDLIN(r AND S'I OR t(i11.,
Storage
• Shire in a 1c 1. +►c II-.enliIatc.1I are:l Zi frt n, .ui:rt•s_ owl ;It;.1 un' nI direr.
.unl[pltE, �rtnre iu a Lir) 1g-cation:,w.n troun
• Kee;.i 1% 1) iowineornpata■1e Et1.lrrri:11s. I' ct` eutl:,:iner, ti2hlly eI . c[I I)t' not s'oi
unlabeled or ont•laiarlrJ mtairaer.,
• }'r;'l:ir from rkoiti:ure 1)I' no-it't1,re near :tin,iv. •i1ble I11,.terools. Keep .a+ntaint'r++1•::1 ..•. 1 •a-
t:11.titir: pressure rt'11s.'t anl1 ;Idt +hate ►cnlllitiln .
• tilt.re %cp[lrately Iron • . ti d Nth:, . rnithsi;tI,. Arrliil •entam'n::[ • th,la
,l.:I.ontpo-411( •
r Iandlin
■ 1wid:srnlael s;illl e e.. ckil}, ..1tJ el, inuig_ 1- >t' with ;idet{u tit' ►•..nr]ital:I kt-
■ 11t, nor. NIX ,lli rst. 1t OIL! 1sr,::.lhin,' vapor., inikti. (Jr clta.t, 1)' not eal. t,r ul;,]i:e ■►t,I1
• Pn rrru ,., Inl.,ct With •t]onhil,rihie or organic nt.tteriais.
• Label , nt.tincrs ail• them a:.htlti rIt e.i when t lu a•
• V4'u.h th :rotogIIIN Litt• 1 h rnclltlt��

ADvEtvrus
M1'TF1tIAl,SiF I1 DiC1:5f11:i.
0-SOX "4 Page: et c r 5
ci•
11'f1SI 12U. CON 1'ROI.SIPLItsON.1L PH()1E( l l()
Lnginerring Contru144
• t Iencr;:l ru irn +.cntilatior r aluir'J• e%hat) t sli, enclosure,: al
L nt;ineer' control may he needed it) naint,l:n airborne 1c)els I+ell•u recommended exposure lirni[ti.
,Al. rid i.r.ating Just s•r.ni.t. )lointain .:itger,ste sclttilarionllti in dosed or t:.mliifell
.paces. heel, le‘rh h low rtpu.urc limits, T i tiet nn'nc expotii:•e iini;t . inuiiitorlitg hi1u'd
per formed reguIt ..
llttspiratury Protection
• 1-or maw, w.onditiun, nrr m..pirimy p• ureclion may y be reeled' now in di sr! or Unknown
'lime sphere -Ili uhi ll cxpn s exit' J 1ii1 I Mild.:, Kr.ir:l N1Q 1-1 .'nlliit:CU revirainr.
1- ►-e/F`a et Protection
• \l ear Izog_ It's :Ind a lull Late shield lire dilfi
Skin f're It i tiuu
• Prevent i.intact tx1Lh in; prtldu.t. Wear gicnesand princerixeclothl.lg depending on
,I+r. Prinectae ; ttw .,; C'hemteti:-rcaistani lReconlnlcntleci 1'\ l", neoprene I ruh .r!
Othi.'r i'rrllit ti►c Equipment
•
• 'Nalco; NlriH,cr
• :Wiper,. ions .•luthil
• Ituhhcr hoot
General 11) giene C'o ntiidl: ra tiu ns
• 11•.1411 «ith Miap and water helm meal rink.' ;,it the end t•r ti:h n !irk si it . (r,lutf
tt=..aul.ictnlin-r pear^i.r: r l ' tr••.a :if rwu n'etl in. •I• si•r•rl •1•
}rr.l�lii,.,. t •('tit.:fi) htlr•I r snrcrcin�.
10. ST.1131I,1T1 :1Ni) lt;i i( T1Vr1 �
Stability
• `iafily 'tier Isnrnial condislurh
ronrliliun to :1+c,id
• hirer
• Allis.
• llascs
• nSalt, o lit ) n ^l
• ltt't111L'lrig agerliy
• t)rganiL IjratL'rrtl:
• +-l:illnl:llil. „�I'til.11} l'�
E1:iyardous Dcournpel,.itiurr Products
• yup1wtn, combust

AD' '•FLATUS
a r }' i
�1 k1 F I-1.1..SALk'F 11 17 k i t ti1I1 1F I :
0-SOX" Page: 5 pl 5
11. LU.XIC OLO(,[C'•S.L I'tL 0101. -11ON
• I.1)'t1 tlrtl: Mln,'_I}[Hl nrL ;at
• L.1.7i013rnnal. Alin, :111111nt -c. r.i
• I.1751 Min - -1,Sl l rt41
12. F(:OI OGR .11, ISII fRti.t'FI'r\
it;coto'uroIiigical information
• 11..4,ii- k for the envir4Intrent linti:cd slat tn'iie prvtl.ILt r+41,L•s~io: 11 1u1 birr,:cr;utildutiort. w
yslluhtiat' and wt.:p .:tinn +sitiat;e _n imnmetr
( heroical I'ale information
• \ 4i Ltll'rl;;ia1 I+ri IcrL:C L1C3Ldt: ''t 4)1 en11rt+tnii2111
I;3. DISI'1 i+SAi. I +l1\SiDLIt.1'I IONS
Waste 1 renlnu'nt
• I}iy1111;e 4+1 in ..n a jstsn,LA1
I41L 1 rLTLIIi:i: lriti.
II 11i1V • i11L'I.11
tl ttahtu I+litl'i.C'Ior NI Al
Package-friatenent
• 1 he enirkty .:nil .1 "in .:of min 1' :11. Li h i yviet1 it cd 41t 1n L:1 Illy 1111111 51''tit 1'1C.II
1'r�i'I:Irtnll+
14. I R L\y1'oitr IM (JR'll 11 10'ti
• I'r+,pet ."1I ping i.srr.: !i( (]
• I lur trtl Clay: 5. t
• I -Olds-. {.1 ,t )tlLlira•rl
• I' ii k:rti (11.4 kap: 11
15. R>a3;11L,1TtlbtV INIORN1.t'I'1[)"
• S. J& \ SLR n )-.s
• SARA (3131 C'herni. i \4i
• 111)A 'I'SC'.% invent; irY _ ..- -- ____-• _ Ip;tr,irti
• C:urrdi,tn V111f4i1S Ca:l�,iliL ati� n ..-- C. l)'B
• Canadian DS1.
• L:1\1X S Invetitrlr. 1I7t,4:1r.
i6. I KI PAR t i'1O\ i\1i OHMMAF1O'
l-ri p'ir LI I3y:
KOr• t Bolan, is- ' lt:1',+
. .i niu Ren-Ectii.litt ti 1 1in1.1 +.L,
l.,4-' I'cKstrr )1; . r
%' y.:ug.1, Omar' •
I,.iy1 ?A5
1)ute Pr.-p,iti�
Nrint I}al.
1'h,
ill10'
9/ 12'07
u15-273-53; 1
iJ114."17 i-44?ti7

\PPF'\l)I:\ B
:\H),\ITORL';<.., \\LLL l OlV-iTRt CIIO'i\ DETAJLS
TABLE 1
MONITORING WELL CONSTRUCTION DETAILS
and GROUNDWATER ELEVATION DATA
THE PANTRY #3197
1330 NORTH NORWOOD STREET
WALLACE, DUFLIN COUNTY, NORTH CAROLINA
NCDEQ INCIDENT NOS. 9271 AND 24289
Well ID
Date
Installed
Well Casing
Diameter
(Inches)
Screened
Interval
(feet)
Depth of Well
(feet)
Top of Casing
(feet)
Date Measured: 9114/17
Depth of
Water (feet)
Depth to Free
Product (feet)
-
Elevation
(feet)
MW-3
10/15/1992
2
4-14
14
r
99.74
Well NoL Measured
MW-4
10/15/1992
2
4-14
14
100.35
Weil Not Measured
MW-5
2/10/1993
2
3.5-13.5
13,5
99.20
Cannot locate
MW-6
2/10/1993
2
4-14
14
100.17
Well Not Measured
MW-11
2/18/1994
2
4-14
1 •1
99.69
2.48
-
97.21
MW-16
2/18/1994
2
4-14
14
99.64
2.i8
--
97.46
MW-17
Unknown
2
Unknown
20
99.67
2.06
-
97.61
MW-19
Unknown
2
Unknown
Unknown
99.35
Well Not Measured
MW-21
10129I2014
2
2-12
12
98.56
2.35 _
--
96.21 a
MW-22
10/29/2014
2
2-12
12
99.40
Well Not Measured
MW-24
10/29/2014
2
2-12
12
100.73
2.24
--
98.49
DW-1
2/11-12/93
2
29-34
34
99.75
Well Not Measured
RW-2
Unknown
4
Unknown
23.16
NS
2.06 , --
NA
RW-3
Unknown
4
Unknown
23
NS
Well Could Not Be Accessed
RW-4
Unknown
4
Unknown
24
NS
-
NA
Notes:
1. " = Corrected Groundwater Elevation = (Groundwater Elevation + (Product Thickness 10.78))
2. Elevations are referenced to an arbitrary on -site benchmark of 100.00 feet.
3. Total well depths measured from Lop of casing.
4. NS denotes top of casing elevation was not available.
5. NA denotes not applicable.