WI0800547_Injection Event Record_20210410

ATC
ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
April 13, 2021
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
Ms. Shristi Shrestha APR ! 0 2011
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section, UIC Program NC ®WWI
1636 Mail Service Center teitui_Centrai uffice
Raleigh, North Carolina 27699-1636
Reference: Injection Event Record — Permit # WI0800547
Woodcock Oil Company
700 East Church Street
Atkinson, Pender County, North Carolina
NCDEQ Incident No. 16996
Dear Ms. Shrestha:
ATC Associates of North Carolina, P.C. (ATC) is submitting an Injection Event Record for the
Woodcock Oil Company site on behalf of the North Carolina Department of Environmental
Quality State Lead Program. The record documents the installation of three Provect ORS sleeves
each in two monitoring wells (AMW-8 and AMW-9) 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.
Ashley M. Winkelman, P.G.
Senior Project Manager
cc: Hassan Osman, Hydrogeologist for NCDEQ
Attachments

Injection Event Record
Woodcock Oil Company, Stale\ . North Carolina
INJECTION EVENT RECORD
ATC
ENEIIINMENIAL• OEOTECNIIICAL
IOILOI116 SCIENCES • IAIEIIALL iESi1N6

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number WI0800547
1.
2.
3.
Permit Information
NCDEO
Permittee
Woodcock Oil Company
Facility Name
700 East Church St, Atkinson, Pender Count
Facility Address (include County)
Injection Contractor Information
ATC Associates of NC. P.C.
Injection Contractor / Company Name
Street Address. 2725 E. Millbrook Road, Ste 121
Raleigh NC 27604
City State Zip Code
(919? 871-0999
Area code — Phone number
Well Information
Number of wells used for injection 2
Well IDs AMW-8 and AMW-9
Were any new wells installed during this injection
event?
❑ Yes // No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
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
Number of Injection Wells
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
Provect ORS sleeve
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 75-85%
If the injectant is diluted please indicate the source
dilution fluid. Not Applicable _
Total Volume Injected (gal) 2.076 in3- sleeve vol.
Volume Injected per well (gal) 2.076 in3-sleeve vol.
5. Injection History
Injection date(s) April 8.2021
Injection number (e.g. 3 of 5) 1 of 1
Is this the last injection at this site?
n Yes I1 No
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.
`I/3/21
SIGNATURE OF INJECTION CONTRACTOR DATE
ATC Associates of North Carolina.. P.C.
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: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 3-1-2016