WI0800219_Other Correspondence_20110525

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number WI 08 0 0 219
Permit Information
Mr. John R. Townson, Director
Environmental Management Division
Permittee
Marine Corps Base Camp Lejeune
Facility Name
EQB/EMD/I&E, Building 12 Post Lane
Camp Leleune, NC 28542
Facility Address
2. Injection Contractor Information
Susan Forker /CH2M HILL
Injection Contractor / Company Name
Street Address3201 Beechleaf Ct,. Ste 300
Raleigh
City
NC
State
27604
Zip Code
[phone]
Area code — Phone number
3. Well Information
Number of wells used for injection 1
Well names SWMU3 50 -- TRW - 3
Were any new wells installed during this injection
event?
❑X Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells 2 _
Number of Injection Wells 1
Type o1' Well Installed (Check applicable type):
❑ Bored X❑ Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include two copies ofform GW-I b for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include Iwo copies of the GW 30 for each
well abandoned.
4. Injectant Information
Oxidant (RegenOx by Regenesis)
Injectant Type
Concentration 5
If the injectant is diluted please indicate the source
dilution fluid. MCB CamLej Fire Hydrant
Total Volume Injected 841 gallons
Volume Injected per well 767 (74 by DPT)
5. Injection History
Injection date(s) 4 / 2 6 / 11 - 4 / 3 0 / 11
Injection number (e.g. 3 of 5) 1 of 3
Is this the last injection at this site?
0 Yes 0 No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON 'PHIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IIN THE PERMIT.
!
SIGNATURE OF INJECTION CONTRACTOR D TE
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection.
Attn: MC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221
Form UIC-IER
Rev. 07/09
RECEIVED / DENR / DWQ
Aquifer Prot ctior Suction
MAY 2 5 mil

T
r74.5: JL. • 43723cciets3 May. a1 2011 OS:13r=M p4'4
NON RESIDENTIAL WELL CONSTRUCTION RECO/I 1,
Vr rat. r arelina pl rtinent *T r:twironment and Natural Rca uurofs- DMelon of Weber Quality
WELL CONTRACTOR CERT1F1CATION # 3 s s t
WEL 6NTRACTC?. , , f
57 h� a LA! lc (C . 4� 'I—
.40 r't.ntTactor pndmdual) Name
dr'4 wo'ci
�bCompany
l^!61 rt 714,204. 7ATr}lflr 'a.nr✓.
i� . r1 - Or tet.. f'f 3 2911-
6^ity 'Tnwn State Zlp Case
•Soft code Phalle 'umber
. WELL INFORMATION:
,t)MSTRUCTlON T'1 RMITlF _._
'-ai- r SSOCLAT2D RCRAMT10{44paxa.e•a)
a r' OP CAVING IS ( Lent Surface'
'Top of 098inp btrm(neted se/or helms land Burtece may rMqu1m
a variance In Seeotp8rtee vim 15A NCAC 2C .01 18•
o. YIELD ( 1): 1 MEIR4D OF-E5T 'ecli-rol,
E O181NPErTIQi[N:-�ype_ - - am604t Lam"
0- WilatiR ZONES (6.4.uo):
Top if, &Worn 3cs Tbp Bcdlnm
Top Bottom„
Top &Mom
•
Top @ttilom
rho Ratinm
Thtaknasrt►
7..CASING: Depth D1mnfst0r
Top 0 Saffron 2. Ft. 2. 6
Top Bottom__ — FL
Top 8ottorn Ft.
• WELL 1J$E (CSIOCi flat' hex Montror0n90 Munn califilbtICt7 3ROUT: Depth
1:rGUEttitlf asitTnmtiat r' Agricultural L' Recovery 10 Injection
1a1;,at.o.9C) pther CNct use)
Jf�TE actLLED
Lh:.LL LOL:ATON:
Morn. +4,....:r° °:vrnMilitty.:i,•t 1;va'on. ui 1fo.. POM O. rip G+do)
couNr _ Stet,"
S:ii'JGTiAfi'tNs: ! LAN rr, G::cs,ent appropriate box!
- ;0pe OValley 3Rot View tJOfl
BRAS $X-XXX IDI X OD
_'_ P:G T:J OE _"' DIVISOR 7:3,,Igtnn7Iptx DD
-rHride•ionglotpat:[urt i3',F'S fJropograontemap
!ae-ppee pf wag must he strewn on a USG* topo mny aricrad tchAel ac
.ryry !prat' h'not ueng t..PSI
Av:.ILITY tName olthe eitslnesn we+aa the well i5 10oetwd.)
d;\. t i :Yj ;S A� JZ C•1t,rn
=aclity Nral)te Facility Ithe if applicable)
Sine 1 .5'4,!„2,1
:rfofTwm
•eGi tJAT.4
^A9rdrt{{ l ddr0r~
;;I•. 'Ir'tthte t
N 3 11—
slate Zip Code
i-E'LL 1%w-TAlLs: f t(
n 't,TAL 0EPTi4
30
Stow 29p Code
Doe 5 vveL1_ REPLACE EXISTING WELL? rES 43 jO
-VAT'E1t Level_ Deslow Too ofCadn4T-_..._._.,..
(Uee '+°' +f _Above Top of OWN)
ToR _ Want / 3 ._.. Ft,
;Top
i3onoI1 _FL
�ese anal Mtthorl
Top Radom Ft..`_
SCREEN: Depth D1.ine er Slea3tae
Top 7 4 Bgiion C Ft �- o. rd le In
Top Donate _Pt._ in. in
Top Sodom = Ft. In, In.
Material
10.9>aN ]!$RJLtt�E., PQCt1C:
C»pt�h Blza P vt.T
Top P3 � Fi.
Top { Bottom 11 t'?�''' �
Tap• i...__ioftom f FI. )aE7ivch p
11. DRILUNG LOU
Top Etote rit
f 'C¢f
/ .gr1
12. RRMARK&
Formation Dee opeon
ne an rd:'
4-• 7'rs nr' i71'Irt S
WO- - ro
t — �
r W WNW Cii1T*FY THAT MS WELL WAS CONSTRUCTED IN ACCDTPLcuara Tam
15A e4CAC an. wELL CONSPKICTION STA1ibMt06, AM1tMMIAT A COF'r 4F Trim
R6XffJ PROVIDED TO e
Ae...., ICR 4.
URE OF CERTIFIED
W 1- CON f R ■.
T—` i &) ✓ q c 4af 1—
Kalif= NAME OF iRSOl4 CONSTRUCTING 714E LL
rltr iI1.within 30 days of ootnpklt1On to: Division of Viktor Cx1la1((y - tr;afo melon Ere teesSNitig.
7 man ...service Center, Raleigh. NC 27699-161. Phone : [phone]
.omit within 3d days of completion to: Division Of Wator Quality - TnfcsnhatiOn Homing.
Mail Service Cantor. Raleigh. RC 276119-161. loitane: (919) 807-$3o0
RECEIVED /DENR / DWQ
Aquifer Prrltpction Section
g reCll'COT6 LC RLO TTOVo'T'SO
MAY 2 i 294
Forth aw-1b
Pelf a.mg
rurl'']vW-Iu
Rov, 7109

•Fpx. N..472g56 May. 11 2011 CS: 13AM P4/4
NiliVir?.ESIDENTYAL WICT.T. CONSTRUCTION RECOKEI
wolina LaptraTtans or rinviroorneor and Natural Rumoutoet,- I.tiviaion of Water .Quality
WELL CONTRACTOR CERTIFICATION # zsri
tz_4 LAT
;Aro t-;41,-arautor Ondiuldua0 Name
-
Wolf ^ Qr Ced.ripAny P4m
Rai% 3.
iry.ret,
Town State 21p Cosa
03
t,s3:ce
Phone number
WELL INFORMATION:
soNST RUCTION PERMIT*
ACiEtOCIATEG Paralutattiir apoikoapia)
rrgr iArera.
• wri,t_ ti$1 Ctno Box) M0n80A1110 NurucitimMtatue
iniumtliducommeittim AGnasiblialU Racov*yD Ilteann
1:110ato i c.Igt
DA re taFtiu.ert
WOLL LOCATION:
'4:7,4;1 hieMs, t.tunthrfa, COMMUrntaf. 80bnidialan. Farealk .711, e=dr.)
• TS cot.,Nry_C,111Siot.d
opot4Ap4 lc /LAN SartiNG: the appropriate am,
ovaiity CROI r3. Ridge Li Other
.A.7rruon. 3s_ _ • bk4s 3X-KaMonccoi on
14GiTUDK 75 " MIS OR 7Xxvoormacx DO
iDatu-c; 17r4PS Oroclanaloble map
Mian uf wan must be shown an 4!I USG$ tap° mop oranintociren
•r7.!$ form firm; 1401/0 GP)
ANGISJTY (Hama of h fa usinewp OM WW1 *100II100)
Pi% ri6f>nr fk-cde
torb T pedlity IE (if applleabla)
ry or TOMAI She Zia Coda
t,,tallino Andrea!:
::ityor l'-owl)
•,-,!:a mat eherul number
i'4ELL Mr4111LS:
istYT.AL. DEPTH:
t
Mato ZIP Cade
3.10e5 WEL,. FrAPLACE EXISTING WELL? YES
WATeT2 LEVEL Bristow Tau of Clatilng:
(use .abcora Tap Cr colons?)
41, TOP Of' CMINto 15 -FT-relbolre Land Surface
Tap oreamag torognatod .d/or barmy land sa.tnfato may wawa
a valiance, In aoOnlnortors varh 1SA NGAG ac .1:r11.8.
a.. VICO.D ispra): t MEMOD OF TElitT f3t.-A oa-P
f. DIESOFtC110Th TWO ig Antatalt f
a. MOM awes (�.on):
Tok_le Down_ 3ca rap Bottom
Top Fiallark_ Tap Bottum— •
Top Bottom Top_ BottoM
7..cASING: Dopth memoir's
Too_ 0 litanami
TopBottom_ Pt
Top Bottom „PI _
, GROUT: Deplli
TOILC___ &MOM 13_ rt
Top &Morn , Ft
Top Bytom H.
Maeda!
;
Thialuracartd
w4"s lert/htit—
.5tit/
a. SCREEN: Beath Dlomotor
Top Z. osnornab Ft, a. In.
Top &Aiwa R. in
Top Bottom Ft. in.
Method
slot size Malarial
r d I in.
in
In.
10.3ANDICIRAYF-L, PACK:
Death Stye Materiel
Tap Bottom -5 Fr,".4, Sii7ar ft 14.2—
TopBoltom I Pt.
= roej,Rrdtoro 1 i1,..
: 11, ORILuNG LOG
-MP Gonara
at
A:6
1
iz mamma:
rattaadom Dealenpnaa
aj 41,1
lij'It.Y44.
IVA PrL4_ 119 1,1a
TAN. ..t,/
00 itSaliar CaftTiFY Mitt MS WcilVa.5 OONSTALC•whINACCORDANca wrria
ira r4,110 C. vsureue.rwiclioNistioinARDA.Atiratita A COF.,
PECDjiA0eV1N MOWED TO 1Hg MIL
PR
Tti RE CFRTIF CON I
A..A) AACA--
AME 01-FS' cON$THIJeTiNo 1-Fr V1LL
limit within :30 stays of completion to: DiVialon Wier CROAKY' - inforntatiOn PiMaeadinti“
Sore (anter, Ralaigh, KC 27699-161, phane igrig) g0743op
.onvit within 34) days ot completion to: Divinion a Water Quality - Informatfon
rixlit srnvice Contor. Raleigh, fiC 271389-161. Phone : [phone]o
RECEIVED / DENR / DWQ
Arrfr-Prigi
MAY 25 2011
A
Form GW-lb
Rev. MB
riiN.311,1-1U
Rey, 2109
91SCLI,CON XVZI Lc;Lo ITOZ/Zirqo