WI0500448_Injection Event Record_20201117

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
1. Pernl��
United Technologies Corporation
Permittee
Kidde Technoloeies, Inc. Facility
Facility Name
Permit Number WI0500448
4200 Airport Drive NW. Wilson. Wilson County, NC 27896
Facility Address (include County)
2. Injection Contractor Information
AECOM Technical Services, Inc. — North Carolina
Injection Contractor / Company Name
Street Address 1600 Perimeter Park Drive Ste. 400
Morrisville
City
NC
State
27560
Zip Code
[phone]
Area code — Phone number
3. Well Information
Number of wells used for injection 3
Well IDs HW-1. HW-3, and HW-5
Were any new wells installed during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells Not al : j licable
Number of Injection Wells Not applicable
Type of Well Installed (Check applicable type):
0 Bored /1 Drilled ❑ Direct -Push
❑ Hand -Augured ® Other (specify) HDD
Please include a copy of the GW-1 form 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 Not applicable
Number of Injection Wells Not applicable
Please include a copy of the GW-30 for each well
abandoned
4. Injectant Information
Anaerobic BioChem® (ABC) and pH buffer
(sodium bicarbonate and monopotassium phosphate)
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 0.41 to 0.66 (ABC] and 0.19 (pH
buffer) — in pounds per gallon of solution
If the injectant is diluted please indicate the source
dilution fluid. City of Wilson Water Service
Total Volume Injected (gal) 10,500
Volume Injected per well (gal) 3,523 (HW-1),
3,936 (HW-3), and 3,041 (HW-5)
5. Injection History
Injection date(s) 11/17/2020 through 11/20/2020
Injection number (e.g. 3 of 5) 1 of TBD
Is this the last injection at this site?
❑ Yes ® No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION W S PERFORMED WITHIN THE
STAN ' A RDS AID OUT IN THE PERMIT.
SUI - RE
0.11 5/id o
ION CONTRACTOR D TE
Caleb Krouse (AECOM Technical Services, Inc. — North Carolina)
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UTC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-I ER
Rev. 3-1-2016