WI0300459_Injection Event Record_20210929

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10300495
1. Permit Information
Duke Energy
Permittee
Marshall Steam Station
Facility Name
8320 NC 150, Sherrills Ford, Catawba County,
NC 28673 Facility Address (include County)
2. Injection Contractor Information
ERM
Injection Contractor / Company Name
Street Address 300 West Summit Ave.
Charlotte NC 28203
City State Zip Code
( 704 ) 737-6625
Area code — Phone number
3. Well Information
Number of wells used for injection 1
Well IDs MW-1D
Were any new wells installed during this injection
event?
❑ Yes 0 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 formfor each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes ❑ X 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
Air
Injectant(s) Type (can use separate additional sheets
if necessary)
Concentration NA
If the injectant is diluted please indicate the source
dilution fluid. NA
Total Volume Injected (gal)
Volume Injected per well (gal)
5. Injection History
Injection date(s) 09/29/2021
Injection number (e.g. 3 of 5) 1
Is this the last injection at this site?
❑ Yes X 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
LAID OUT IN THE PERMIT.
l�'�-ae, 7 : , 10/29/2001
SIGNATURE OF / ECTION CONTRACTOR DATE
Chris Means
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