WI0100202_Regional Office Physical File Scan Up To 9/23/2022 (2)

k RECEIVED T 2 d. 2511 2 I
ARCADIS N•C. Dept. of ENR
Y10%
'' SEP 18 ARCADIS G8M of North Carolina,
Infrastructure Water- ; Environment. Buildin s „A'R
9 _. Inca —
r. Winston-Salem
Regional Office 801 Corporate Center Drive
Suite 300
Raleigh
North Carolina 27607
Ms. Sherri Knight Tel [phone]
North Carolina Department of Environment and Natural Resources Fax [phone]
Division of Water Quality — Aquifer Protection Section www.arcadis-us.com
585 Waughtown Street
Winston-Salem, NC 27107
Environment
Subject:
Notification of Intent to Construct or Operate Injection Wells
Former ExxonMobil Retail Facility #45552
1920 Chimney Rock Road
Hendersonville, Henderson County, NC 28792 Date:
Incident No. 9644 September 5, 2012
Contact:
Dear Ms. Knight:
Jon Farley
On behalf of ExxonMobil Environmental Services (EMES), ARCADIS G&M of North
Phone:
304.325.3614 x 17
Carolina (ARCADIS) is submitting this Notification of Intent to Construct or Operate
Injection Wells (Attachment A) to the North Carolina Department of Natural Resources
Email:
(NCDENR) Division of Water Quality — Aquifer Protection Section at Former ExxonMobil
[e-mail]
Facility #45552 located at 1920 Chimney Rock Road in Hendersonville, Henderson
County, North Carolina. ARCADIS is proposing to conduct a small scale sodium
Our ref:
persulfate injection of less than 10,000 square feet at the site to reduce dissolved -phase
B0085851.0039
chemicals of concern (COCs) to concentrations below the applicable North Carolina
Gross Contaminant Levels (GCLs) for Groundwater.
ARCADIS-G&M of North Carolina,
Please contact Scott Bostian at [phone] or me at [phone] extension 17 Inc.
with any questions or concerns related to the proposed sodium persulfate injection or this NC Engineering License # C-1869
incident number. NC Surveying License # C-1869
Sincerely,
AR DIS G& I
of North Carolina, Inc.
41
IV-
Certified
Imagine the result
c:\users\jperdue\appdataVocal\microsoft\windowsltemporary intemet files\content.outlook\vk8mn11�1em 45552 - uic permit cover letler.doc

ARCADIS
Attachment A — Notification of Intent to Construct or Operate Injection Wells (EM
45552)
Copies:
Ms. Jewel Cox - EMES
File — EM 45552
Ms. Sherri Knight
September 5, 2012
Page:
C:IUsetslierde%AMDatalL=RMlcrosofllWndowslTwporary Inlemet Fles1Gontwt0 wk1VK8MN11,8EM 45552- UIC PeWt Cwer Lettecdoc 2/2

AttaChment A

NORTH 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 individualpermit when constructed in accordance
with the rules of I5A NCAC 02C.0200. This form shall be submitted at least 2 weeks prior to construction.
AQUIFER TEST WELLS (15A NCAC 02C .0227)
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 (15A NCAC 02C .0229):
1) Passive Injection Systems - 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 - Contaminant plumes located entirely within a land surface area not to
exceed 10,000 square feet. For tracer tests in uncontaminated areas the area of influence of the injection well(s) shall
be entirely within a land surface area not to exceed 10,000 square feet. 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: July 18, 2012 PERMIT NO.(to be filled in by DWQ)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well......................................Complete sections B-F, K, N
(2) Aquifer Test Well.......................................Complete sections B-F, K, N
(3) Passive Injection System...............................Complete sections B-F, H-N
(4) ✓ Small -Scale Injection Operation ......................Complete sections B-N
(5) Pilot Test.................................................Complete sections B-N
(6) Tracer Injection Well...................................Complete sections B-N
B. STATUS OF WELL OWNER: Choose an item.
C. WELL OWNER — State name of entity and name of person delegated authority to sign on behalf of the
business or agency:
Name: Jewel Cox (Exxon Mobil Environmental Services
Mailing Address: 1016 W. Poplar Ave, Suite 106, Number 232
City: Collierville State: TN Zip Code: 38017 County: Shelby
Day Tele No.: 901-850-9009 Cell No.: 901-233-4112
EMAIL Address: jewel.g cox(a,exxonmobil.com Fax No.: 262-313-1830
DWQ/UIC/In Situ Reined. Notification (Revised 4/26/2012) Page 1

D. PROPERTY OWNER (if different than well owner)
Name: Henderson Oil Company
Mailing Address: 745 Ashe St.
City: Hendersonville State: NC Zip Code: 28792 County: Henderson
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
E. PROJECT CONTACT - Person who can answer technical questions about the proposed injection project.
Name: Scott Bostian
Mailing Address: 801 Corporate Center Drive, Suite 300
City: Raleigh State: NC Zip Code: 27607 County: Wake
Day Tele No.: 919-854-1282 Cell No.: 919-417-2643
EMAIL Address:scott.bostian(a,arcadis-us.com Fax No.: 919-854-5448
F. PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: 1920 Chimney Rock Road
County: Henderson
City: Hendersonville State: NC Zip Code: 28792
(2) Geographic Coordinates: Latitude": 350 20' 14" or _°
Longitude": 820 26' 40" or—'
Reference Datum: Unknown Accuracy: Unknown
Method of Collection: Terrain Navigator Pro mapping software
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: Approx. 7,000 square feet (< 10,000 f 2 for small-scale injections)
Land surface area of treatment area/radius of influence: Approx. 1,000 square feet
Percent of contaminant plume area to be treated: 10 % (must be < 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.
DWQ/UIC/In Situ Remed. Notification (Revised 4/26/2012) Page 2

I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES — Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity.
The purpose of the injection is to reduce benzene concentrations in groundwater in the vicinity of monitoring
wells MW-2R and MW-9 to below GCL limits using in -situ chemical oxidation. Sodium persulfate and
ferrous sulfate (persulfate activator) solutions will be injected into wells MW-2R, MW-9 and INJ-2. The izoal
of the injection will be to inject a total solution volume of approximately 2,350 gallons of injectant into each of
the three wells.
J. INJECTANTS — 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
ltttp://portal.ncdenr.or /tiaeb/ivq/aps/�wpro. All other substances must be reviewed by the Division of Public
Health, Department of Health and Human Services. Contact the UICProgram for more info (919-807-6496).
Injectant: sodium persulfate
Volume of injectant: Approximately 7,050 gallons (total for both injectants)
Concentration at point of injection: 50 OL as sodium persulfate (final concentration)
Percent if in a mixture with other injectants: 95% (injectant by dry weight)
Injectant: ferrous sulfate (persulfate activator)
Volume of injectant: Approximately 7,050 gallons (total for both injectants)
Concentration at point of injection: 2.5 g/L, (ferrous iron, final concentration)
Percent if in a mixture with other injectants: 5% (injectant byry weight)
Injectant: N/A
Volume of injectant: N/A
Concentration at point of injection: N/A
Percent if in a mixture with other injectants: N/A
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: 0 Proposed 3 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
DWQ/UIC/In Situ Reined. Notification (Revised 4/26/2012) Page 3

L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Injection activities will likely take approximately one week to complete. Injections will begin once the
Notification of Intent to Construct or Operate Injection Wells is signed and submitted.
M. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
The monitoring plan is included as Attachment 1.
N. CERTIFICATION (to be signed as required below or by that person's authorized agent)
15A NCAC 02C .0211(e) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer;
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer or
ranking publicly elected official;
4. 'for all others: by the well owner;
5. for any other person authorized to act on behalf of the applicant: documentation shall be submitted
with the notification that clearly identifies the person, grants them signature authority, and is signed
and dated by the applicant.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately -responsible for 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 fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon
the injection w,gll and all related appurtenances in accordance with the 1 SA NCAC 02C 0200 Rules. "
Obi I `kd, . MA y
of Applicant
of Property Owner (if different from applicant)
Signature of Authorized Agent, if any
Submit one copy of the completed notification package to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone] Fax: [phone]
10
or Type Full Name
Print or Type Full Name
Print or Type Full Name
DWQ/UIC/In Situ Remed. Notification (Revised 4/26/2012) Page 4

ARCADIS
Tables

Table 1 - Well Construction Data
Revision Date: 9/5/2012 Incident #: 9644 Facility ID#: Former ExxonMobil Facility #45552
Well
Screen
Total
Top of.Casing
Well
Diameter
Interval
Depth
Elevation
Designation
(inches)
(ft-bgs)
(ft-bgs)
(ft-amsl)
MW-1
2
15 - 20
25
97.50
MW-2R
2
20 - 40
40
97.68
MW-3R
2
20 - 40
40
98.96
MW-4
2
10 - 25
25
98.74
MW-5
2
10 - 25
25
97.76
MW-6
2
10 - 25
25
98.53
MW-7
2
10 - 25
25
94.94
MW-8
2
12 - 27
27
98.16
MW-9
4
15 - 40
40
98.18
DW-1
2
32 - 37
37
98.07
INJ-1
2
20 - 30
30
NM
INJ-2
2
20 - 30
30
NM
INJ-3
2
20 - 30
30
NM
Notes:
ft-bgs = Feet below ground surface.
ft-btoc = Feet below top of casing.
ft-msl = Feet above mean sea level.
NM = Not Measured.
Page 1 of 1

ARCADIS
Figures

CITY: (LEXINGTON, KY), SYRACUSE, NY DB: (R. RIDDLE), P. LISTER PM/TM: J.FARLEY TR: J. FRIZZELL LYR: ON= ;OFF=•REF'
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XREFS: IMAGES: PROJECTNAME: —
85851-0039X00
85851-0039X01
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LEGEND
-------
PROPERTY BOUNDARY
REALTY OFFICE
UNDERGROUND STORAGE TANK
is
MONITORING WELL
-+
SOIL VAPOR EXTRACTION WELL
m
>
AIR SPARGE WELL
(Z)
PLANNED INJECTION LOCATION
NOTE:
BASE MAP PREPARED FROM A DRAWING PROVIDED
BY GES; DATED APRIL 16, 2010; SCALE 1"=40'
0 40' 80'
GRAPHIC SCALE
EXXONMOBIL ENVIRONMENTAL SERVICES
EXXONMOBIL SERVICE STATION #4-5552
1920 CHIMNEY ROCK ROAD, HENDERSONVILLE, NC
INJECTION NOTIFICATION
CHEMICAL INJECTION WELL
LOCATION MAP
14 ARCADIS � i

CITY: (LEXINGTON, KY), SYRACUSE. NY DB: (R. RIDDLE), P. LISTER POW: J.FARLEY TR J. FRIZZELL LYR: ON=•;OFF=•REF•
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85851-0039X00
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REALTY OFFICE
i
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LEGEND
=------ PROPERTY BOUNDARY
UNDERGROUND STORAGE TANK
G MONITORING WELL
-0 SOIL VAPOR EXTRACTION WELL
m AIR SPARGE WELL
NOTE:
1. BASE MAP PREPARED FROM A DRAWING
PROVIDED BY GES; DATED APRIL 16. 2010;
SCALE 1'=40'
2. INJ-1, INJ-2, AND INJ-3 NOT INSTALLED AT
THE TIME OF SAMPLING
0 40' 80'
GRAPHIC SCALE
EXXONMOBIL ENVIRONMENTAL SERVICES
EXXONMOBIL SERVICE STATION #4-5552
1920 CHIMNEY ROCK ROAD, HENDERSONVILLE, NC
INJECTION NOTIFICATION
BENZENE ISOCONCENTRATION ;AP
MARCH 2O11
� ARCADIS � z

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LEGEND
REALTY OFFICE
B
B' < (D
0
PROPERTY BOUNDARY
UNDERGROUND STORAGE TANK
MONITORING WELL
SOIL VAPOR EXTRACTION WELL
AIR SPARGE WELL
PLANNED INJECTION LOCATION
NOTE -
BASE MAP PREPARED FROM A DRAWING PROVIDED
BY GES; DATED APRIL 16. 2010; SCALE 1"=40'
0 40' 80'
GRAPHIC SCALE
EXXONMOBIL ENVIRONMENTAL SERVICES
EXXONMOBIL SERVICE STATION #4-5552
1920 CHIMNEY ROCK ROAD, HENDERSONVILLE, NC
INJECTION NOTIFICATION
CROSS SECTION
LOCATION MAP
(�l ARCADIS 1FIGURE
3

CITY: (LEXINGTON. KY), SYRACUSE, NY DB: (R. RIDDLE), P. LISTER PM/TM: J.FARLEY TR: J. FRIZZELL LYR: ON=•;OFF= REF*
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XREFS: IMAGES: PROJECTNAME:
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Al
SOUTHEAST
MW-6
TOC: 98.53'
TD: 25.0'
BE: 73.53'
I
I
100
95
90
85 w
z
.;
0 Z
4 --
O
t.ji.00
75
MW-6
70
3-17-10
B
I <1.00
T
<1.00
65
E
1.00
X
<3.00
M
d.00
60
55
GCLs
B
5.000
T
260.000
E
84,500
X
85,5DO
M
20,000
GCL: GROSS CONTAMINATION LEVELS
CONCENTRATIONS ARE REPORTED IN
MICROGRAMS PER LITER (ugA)
ESTIMATED GROUNDWATER
ELEVATION CONTOUR
NOTES:
1. MW-6 DISCONTINUED FROM GROUNDWATER SAMPLING
SCHEDULE IN 2011 AS DISSOLVED -PHASE CHEMICALS
OF CONCERN WERE HISTORICALLY BELOW THE GCL
STANDARD AND/OR NOT DETECTED.
2. WATER LEVELS MEASURED 3-30-2011.
0 30' 60'
GRAPHIC SCALE
EXXONMOBIL ENVIRONMENTAL SERVICES
EXXONMOBIL SERVICE STATION #4-5552
1920 CHIMNEY ROCK ROAD, HENDERSONVILLE, NC
INJECTION NOTIFICATION
LITHOLOGIC CROSS-SECTION
A -A'

U
K
Ld
w
w
Z
Z
O
F
Q
H
w
B
SOUTHWEST
d
95
70
55
MW-4 DW-1
TOC: 98.74' TOM 98.07'
TD: 25.0' TD: 37.0'
BE: 73.74' BE: 61.07'
I
I �J
WATER
LEGEND:
fiilw-2R
r� TOC:97.68'
TD: 40.0'
i BE: 57.68'
l I
TOC.98 8'
TD: 40.0'
T BE: 58.18'
I
I
� I
ASING SILTY SAND
•: UNKNOWN DEPTH
INTERVAL
NOTES
TOC
TOP OF CASING
TD
TOTAL DEPTH
BE
BOTTOM ELEVATION
B
BENZENE
T
TOLUENE
E
ETHYLBENZENE
X
TOTAL XYLENES
M
METHYL TERTIARY —BUM ETHER
ND
NOT DETECTED

ASPHALT
MW-1
TOC: 97.50'
TD: 25.0'
BE: 72.50'
I
I
I
I
GCLs
B
5.000
T
260.000
E
84.500
X
85,500
M
20.000
GCL: GROSS CONTAMINATION LEVELS
ND: NOT DETECTED
CONCENTRATIONS ARE REPORTED IN
MICROGRAMS PER LITER (ugA)
5,0o0.--- ESTIMATED EXTENT OF
BENZENE GCL EXCEEDANCE
ESTIMATED GROUNDWATER
ELEVATION CONTOUR
BOLD = GCL EXCEEDANCE
= PLANNED INJECTION
LOCATION
MW-7
TOC: 94.94'
TD: 25.0'
BE: 69.94'
F
I
I
I
B'
NORTHEAST
00
95
70
w
w
w
z
z
0
F
W
w
W
L55
NOTES:
1. MW-7 LAST LOCATED IN SEPTEMBER 1993.
HISTORICALLY DISSOLVED —PHASE CHEMICALS OF
CONCERN WERE NOT DETECTED AT MW-7.
2. DW-1 LAST SAMPLED IN 1995. HISTORICALLY
DISSOLVED —PHASE CHEMICALS OF CONCERN WERE
BELOW GCLs OR NOT DETECTED AT DW-1.
3. WATER LEVELS MEASURED 3-30-2011.
4. LITHOLOGY FOR MW-2R AND MW-9 ESTIMATED BASED
ON BORING LOGS FROM MW-2.
5. ACTUAL INJECTION WELL SCREENED INTERVALS WILL
BE ADJUSTED BASED ON WATER LEVELS.
0 30' 60'
GRAPHIC SCALE
EXXONMOBIL ENVIRONMENTAL SERVICES
EXXONMOBIL SERVICE STATION #4-5552
1920 CHIMNEY ROCK ROAD, HENDERSONVILLE, NC
INJECTION NOTIFICATION
LITHOLOGIC CROSS-SECTION
B-B'
MARCADIS s'

ARCADIS
Attachment 1

Attachment 1
Underground Injection Monitoring Plan
Former ExxonMobil Facility #45552
Hendersonville, North Carolina
Groundwater Incident #9644
During the injection, two samples per day will be collected via bailers from the dose -response well
locations within the injection ROI (INJ-1 and INJ-3) and monitored for field parameters (pH, redox
potential [ORP], conductivity, turbidity, temperature, and dissolved oxygen). At the end of injection,
groundwater samples will be collected from INJ-1 and INJ-3 for laboratory analysis of volatile organic
compounds (VOCs), sulfate, and, if iron activation is selected, total and dissolved iron and for field
screening of persulfate using field test kits.
Following the injection event, ARCADIS will gage groundwater monitoring wells associated with the site
(MW-2R, MW-3R, MW-4, MW-5, MW-6, MW-7, MW-8, MW-9, DW-1, INJ-1, INJ-2, and INJ-3) and sample
wells MW-2R, MW-9, INJ-1, INJ-2 and INJ-3 for benzene, ethylbenzene, toluene, and total xylenes
(BTEX) and sulfate to determine the effectiveness of the in -situ chemical injection monthly for two
consecutive months. Semi-annual groundwater sampling will resume after the second month of
groundwater sampling and monitoring.
Monitoring wells to be sampled will be purged of three times the well volume so that the water in the well
after purging is representative of the water in the aquifer. Monitoring wells that do not generate three well
volumes of water will be bailed dry and then given sufficient time to allow for recharging. Groundwater
samples will be collected from each monitoring well using a dedicated disposable polyethylene bailer. The
bailers will be of single check valve construction, and will be inserted into the monitoring well using nylon
rope of sufficient size and diameter so that the bailer will be easily raised and lowered. Groundwater
samples collected from the monitoring wells will be placed in laboratory -supplied containers and shipped
to TestAmerica, Inc. in Nashville, Tennessee for laboratory analysis. Following the completion of the
above proposed remedial actions, ARCADIS recommends that semi-annual monitoring and sampling be
conducted for one year. The monitoring and sampling of the wells will be used to further evaluate the
effectiveness of the treatment.

ARCADIS
Attachment 2

ARCADIS WELL CONSTRUCTION LOG- UNCONSOLIDATED
Flush Mount Completion
LAND SURFACE
Project B0085851.0039
Town/City Hendersonville
Well INJ-2
County Henderson
State NC
8 inch diameter
Permit No. N/A
do e'IleFioTe—
LandSurface Elevation and Datum:
Not Measured feet
Surveyed
Well casing,
❑ Estimated
2 inch diameter,
Installation Date(s) 6/28/2012
Sch. 40 PVC
Drilling Method Hollow Stem Auger
�Backfill
x❑Grout
Drilling Contractor Geologic Exploration
Drilling Fluid
16 ft'
Development Technique(s) and Date(s)
::
Bentonite nslurry
18 fr @pellet.
Electric Submersible Pump (6/29/2012)
20 ft'
'Well Screen.
2 inch diameter
PVC , 20 slot
Gravel Pack
Sand Pack
Formation Collaspse
30 ft'
30 ft'
Measuring Point is
Top of Well Casing
Unless Otherwise Noted.
' Depth Below Land Surface
Well Purpose Injection Well
Remarks
Prepared by VPaouncic
G:\Env\Common\Field Forms\INJ-2xls

Mp - 2A
Np CONSTRUCTION 9M.0-M
Noilb Carolina - Dqmment ofFzvkonm=W and Natural Resources - Division of Water Quality - Groundwater Section
WEllemimeroR (DMPADUAL) NAM licoamAHEY Cr:RTWWATMN# 24m
WELL CON TRACMRCOMPANY NAME GggLow
PHONE 0 (7o4) mjm
STATE WELL CONSTRUCTION PMLWffr# ASSOMED WQ PROMW
(1fappucabb)
1. WELL USE (Check Applicable Box): Resmantu 13 Muniow"alig El b&swd 13 AwbAwdE3
McniforMN RMvew13 Hunt Pump Water huewon❑ Odleto FfOdM4 us; Use
2. WELL LOCATION: TopoffapMdLaod setag
Weanallown: MMQ)gR9oNvnzE_CoMdy EENDMON 13 Rifte [3 slop Cl VWL-Y R Fiat
192D=YROCKM le box)
(8twdNwmN=bw Cw=ndt .olM;WM-Lot tj0,.r*Cade) orwou locacm
3. OWNEM
Add= 2217-D AMMUM
TOWNSHIP PARKWAY PM 315
(StwdorRaftNo.)
NC 29105
aWariawn Sam rewco&
4. DATE DRILLED
S. TOTAL DEPTH: 400 PmT
6. DOES WELL REPLACE EUSTING WELL? YES 0 NO
7 STATIC WATER LEVEL Beiaw Top of C z7.o FT
& TOP OF CASING IS o.o Fr Above Land SurfbcO
'T4
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9. YIELD (gpM): X/A METHOD OF IM MA
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11. DwRomMON: Type
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Wall Thickness
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Show dhection and distance in milm from at Jam
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16. REMARKS: MW-2R BEMOMMIALFROM MOTOMOPM
I DO HEARBY COMFY THAT THM WELL WAS - CONMRUC`= IN ACCORDANCE WMi ISA'NCAC = WELL
CONSTRUCMN STANDARDS, AND THAT A COPY OF TREQORD HAS BEEN pOvMM To THEWELL OWN
ER
to dke Division of water Quditn GEOM&OW Section, 1636 Mail Service Ceuta- PjdchA NC
=7ll0hC=No. [phone], within 30 dap.
GW-1 REV. 072001

/ 4 W WELL CONSTRUCTION RECORD
North Carolina - Department of F.mieotnnentel and Natural Rmurces - Division of Water Quality - Qmidwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DANNY SU1&Rs CERTIFICATION # 25W
WELL CONTRACTOR COMPANY NAME G WLO01C EXPLORATION INC. PHONE # (704) a72-7656
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERUM
(rfapplrcable) Of )
WELL USE (Check Applicable Box): Renda" ❑ MnmcgditWic ❑ Industrial 0 Agriaaldrral ❑
Mmmnng D Recovery® Heat Pump water I ❑ others] If Oalsr, list tin
2. WELL LOCATION:
,NewestToven: HmFj SONVILLE County HENDERSON
1920FMILSEASON BLVD
(Shad Name.Nambea%C--Udy. SitbdiWm%La4No, Tip Code)
3.OWNER- E1acoNMOBa
Address 22174WMAMMWS MNSHIPPARKWAY/PMB.315
(sh'adorRonteNo.)
MATTEEWS NC 28165
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Area Code-PhoneNimber
4. DATE DRILLED o912AM
5. TOTAL DEPTH: 4o.o FEBr
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 23.0 FT.
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9. YIELD (am): WA METHOD OF TEST NIA
10. WATER ZONES (dew): N/A
11. DLSINFECCION: Type WA Amount
12. CASING: Wall Thew
Depth Diameter or Warght/Ft. Material
From 0.0 To 13.0 Ft 41NCR KU40 PVC
Fn= To Ft
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13. Grout: Depth Material Metbod
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14. SCRffiV: Depth M unatar Slot Size Material
pm m 15.0 To 40.0 Ft 4.0 in. M0 in pvC
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IS. SANDIGRAVEL PACK:
Depth Site Material
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❑ Ridge ❑ Slope ❑ VaQey 0 Flat
(dwk appropriate box)
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( )
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( bax)
DEPTH DRILLING LOG
From To Fotoation Desertion
0.0
25.0
25.0
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BROWN SILT
BROWWTAN SANDY CLAY
wanoSIKETCH
Show direction and distant is miles from at least
two State Roads or County Roads, inculed the mad
numbers and obmmam road names.
16. REMARKS: MW.9 BRIT M E S&OL FROM 11.0 TO t3.0 FEET
zOwn
Mw.1
1 DO BEARBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to the Division of Water Quality, Gmundwata Saflog, 1636 Mau Service Ce,- Raleigh, NC
27699-1636 PhmttNo. [phone], within 30 days. GW-1 REV. 07=1

ARCADIS
Attachment 3

Material Safety Data Sheet
Ferrous sulfate heptahydrate MSDS
Section 1: Chemical Product and Company Identification
Product Name: Ferrous sulfate heptahydrate
Catalog Codes: SLF2029, SLF1228
CAS#: 7782-63-0
RTECS: OD5525000
TSCA: TSCA 8(b) inventory: No products were found.
CI#: Not available.
Synonym:
Chemical Name: Ferric Sulfate Heptahydrate
Chemical Formula: FeSO4.71-12O
Contact Information:
Sciencelab.com, Inc.
14025 Smith Rd.
Houston, Texas 77396
US Sales: 1-800-901-7247
International Sales: 1-281-441-4400
Order Online: ScienceLab.com
CHEMTREC (24HR Emergency Telephone), call:
1-800-424-9300
International CHEMTREC, call: 1-703-527-3887
For non -emergency assistance, call: 1-281-441-4400
Section 2: Composition and Information on Ingredients
Composition:
Name CAS # % by Weight
Ferrous sulfate heptahydrate 7782-63-0 100
Toxicological Data on Ingredients: Ferrous sulfate heptahydrate: ORAL (LD50): Acute: 1520 mg/kg [Mouse].
Section 3: Hazards Identification
Potential Acute Health Effects: Hazardous in case of skin contact (irritant), of eye contact (irritant), of ingestion, of inhalation.
Potential Chronic Health Effects:
CARCINOGENIC EFFECTS: Not available. MUTAGENIC EFFECTS: Mutagenic for bacteria and/or yeast. TERATOGENIC
EFFECTS: Not available. DEVELOPMENTAL TOXICITY: Not available. The substance is toxic to liver. The substance may be
toxic to kidneys, cardiovascular system, central nervous system (CNS). Repeated or prolonged exposure to the substance can
produce target organs damage.
Section 4: First Aid Measures
Eye Contact:
Check for and remove any contact lenses. In case of contact, immediately flush eyes with plenty of water for at least 15
minutes. Cold water may be used. Get medical attention.
P. 1

Skin Contact:
In case of contact, immediately flush skin with plenty of water. Cover the irritated skin with an emollient. Remove contaminated
clothing and shoes. Cold water may be used.Wash clothing before reuse. Thoroughly clean shoes before reuse. Get medical
attention.
Serious Skin Contact:
Wash with a disinfectant soap and cover the contaminated skin with an anti -bacterial cream. Seek immediate medical
attention.
Inhalation:
If inhaled, remove to fresh air. If not breathing, give artificial respiration. If breathing is difficult, give oxygen. Get medical
attention.
Serious Inhalation: Not available.
Ingestion:
Do NOT induce vomiting unless directed to do so by medical personnel. Never give anything by mouth to an unconscious
person. If large quantities of this material are swallowed, call a physician immediately. Loosen tight clothing such as a collar,
tie, belt or waistband.
Serious Ingestion: Not available.
Section 5: Fire and Explosion Data
Flammability of the Product: Non-flammable.
Auto -Ignition Temperature: Not applicable.
Flash Points: Not applicable.
Flammable Limits: Not applicable.
Products of Combustion: Not available.
Fire Hazards in Presence of Various Substances: Not applicable.
Explosion Hazards in Presence of Various Substances:
Risks of explosion of the product in presence of mechanical impact: Not available. Risks of explosion of the product in
presence of static discharge: Not available. Explosive in presence of heat.
Fire Fighting Media and Instructions: Not applicable.
Special Remarks on Fire Hazards: Not available.
Special Remarks on Explosion Hazards: Not available.
'.'Section 6 Accidental: Release Measures
Small Spill:
Use appropriate tools to put the spilled solid in a convenient waste disposal container. Finish cleaning by spreading water on
the contaminated surface and dispose of according to local and regional authority requirements.
Large Spill:
Use a shovel to put the material into a convenient waste disposal container. Finish cleaning by spreading water on the
contaminated surface and allow to evacuate through the sanitary system. Be careful that the product is not present at a
concentration level above TLV. Check TLV on the MSDS and with local authorities.
Section 7 Handling and Storage
Precautions:

Keep locked up.. Do not ingest. Do not breathe dust. Wear suitable protective clothing. In case of insufficient ventilation,
wear suitable respiratory equipment. If ingested, seek medical advice immediately and show the container or the label. Avoid
contact with skin and eyes. Keep away from incompatibles such as oxidizing agents, alkalis.
Storage:
Hygroscopic. Air Sensitive. Keep container tightly closed. Keep container in a cool, well -ventilated area. Do not store above
24°C (75.20F).
Section 8: Exposure Controls/Personal Protection
Engineering Controls:
Use process enclosures, local exhaust ventilation, or other engineering controls to keep airborne levels below recommended
exposure limits. If user operations generate dust, fume or mist, use ventilation to keep exposure to airborne contaminants
below the exposure limit.
Personal Protection:
Splash goggles. Lab coat. Dust respirator. Be sure to use an approved/certified respirator or equivalent. Gloves.
Personal Protection in Case of a Large Spill:
Splash goggles. Full suit. Dust respirator. Boots. Gloves. A self contained breathing apparatus should be used to avoid
inhalation of the product. Suggested protective clothing might not be sufficient; consult a specialist BEFORE handling this
product.
Exposure Limits:
TWA: 1 CEIL: 2 Consult local authorities for acceptable exposure limits.
Section 9: Physical and Chemical Properties
Physical state and appearance: Solid.
Odor: Not available.
Taste: Not available.
Molecular Weight: 278.01 g/mole
Color: Blue to blue-green. (Light.)
pH (1% soln/water): Not available.
Boiling Point: Not available.
Melting Point: Not available.
Critical Temperature: Not available.
Specific Gravity: 1.898 (Water = 1)
Vapor Pressure: Not applicable.
Vapor Density: Not available.
Volatility: Not available.
Odor Threshold: Not available.
Water/Oil Dist. Coeff.: Not available.
lonicity (in Water): Not available.
Dispersion Properties: See solubility in water.
Solubility: Soluble in cold water.
Section '10: Stability and Reactivity Data -
p. 3

Stability: The product is stable.
Instability Temperature: Not available.
Conditions of Instability: Incompatibles
Incompatibility with various substances:
Reactive with oxidizing agents, alkalis. Slightly reactive to reactive with moisture.
Corrosivity: Not available.
Special Remarks on Reactivity:
Hygroscopic. Oxidizes when in contact with mositure to form ferric sulfate. Air Sensitive Incompatible with alkalies, soluble
carbonates, Au and Ag salts, Pb acetate, lime water, KI, K, and Na tartrate, Na Borate, tannin, vegetable astringent infusions
and decoctions.
Special Remarks on Corrosivity: Not available.
Polymerization: Will not occur.
Section 11: Toxicological Information
Routes of Entry: Inhalation. Ingestion.
Toxicity to Animals: Acute oral toxicity (LD50): 1520 mg/kg [Mouse].
Chronic Effects on Humans:
MUTAGENIC EFFECTS: Mutagenic for bacteria and/or yeast. Causes damage to the following organs: liver. May cause
damage to the following organs: kidneys, cardiovascular system, central nervous system (CNS).
Other Toxic Effects on Humans: Hazardous in case of skin contact (irritant), of ingestion, of inhalation.
Special Remarks on Toxicity to Animals:
Lowest Published Lethal Dose LDL [Rat] - Route: Oral; Dose: 1389 mg/kg
Special Remarks on Chronic Effects on Humans:
May affect genetic material (mutagenic). It is excreted in maternal milk in animal.
Special Remarks on other Toxic Effects on Humans:
Acute Potential Health Effects: Skin: May cause skin irritation. Eyes: May cause eye irritation. Inhalation: May cause
respiratory tract irritation. Ingestion: Harmful if swallowed. May cause gastrointestinal tract distrubances and irritation with
nausea, vomiting, colic, constipation, diarrhea, black stool. May also affect behavior/Central Nervous System (somnolence
-general depressed activity), respiration, cardiovascular system, liver, kidneys (pink urine discoloration). Chronic Potential
Health Effects: Repeated exposure via ingestion may increase iron levels in the liver, and spleen. Damage may occur to
spleen and liver.
Section 12: Ecological Information
Ecotoxicity: Not available.
BOD5 and COD: Not available.
Products of Biodegradation:
Possibly hazardous short term degradation products are not likely. However, long term degradation products may arise.
Toxicity of the Products of Biodegradation: The products of degradation are less toxic than the product itself.
Special Remarks on the Products of Biodegradation: Not available.
Section 13: Disposal Considerations
p. 4

Waste Disposal:
Waste must be disposed of in accordance with federal, state and local environmental control regulations.
Section 14:.Transport Information
DOT Classification: Not a DOT controlled material (United States).
Identification: Not applicable.
Special Provisions for Transport: Not applicable.
Section 1S- Other -Regulatory Information
Federal and State Regulations:
Connecticut carcinogen reporting list.: Ferrous sulfate heptahydrate Illinois toxic substances disclosure to employee act:
Ferrous sulfate heptahydrate New York release reporting list: Ferrous sulfate heptahydrate Pennsylvania RTK: Ferrous sulfate
heptahydrate Massachusetts RTK: Ferrous sulfate heptahydrate Massachusetts spill list: Ferrous sulfate heptahydrate New
Jersey spill list: Ferrous sulfate heptahydrate Louisiana spill reporting: Ferrous sulfate heptahydrate CERCLA: Hazardous
substances.: Ferrous sulfate heptahydrate: 1000 lbs. (453.6 kg)
Other Regulations: OSHA: Hazardous by definition of Hazard Communication Standard (29 CFR 1910.1200).
Other Classifications:
WHMIS (Canada): Not controlled under WHMIS (Canada).
DSCL (EEC):
R36/38- Irritating to eyes and skin. S2- Keep out of the reach of children. S46- If swallowed, seek medical advice immediately
and show this container or label.
HMIS (U.S.A.):
Health Hazard: 2
Fire Hazard: 0
Reactivity: 0
Personal Protection: E
National Fire Protection Association (U.S.A.):
Health: 2
Flammability: 0
Reactivity: 3
Specific hazard:
Protective Equipment:
Gloves. Lab coat. Dust respirator. Be sure to use an approved/certified respirator or equivalent. Splash goggles.
Section M.Other Information
References: Not available.
Other Special Considerations: Not available.
Created: 10/09/2005 05:33 PM
Last Updated: 11/01/2010 12:00 PM
P. 5

The information above is believed to be accurate and represents the best information currently available to us. However, we
make no warranty of merchantability or any other warranty, express or implied, with respect to such information, and we assume
no liability resulting from its use. Users should make their own investigations to determine the suitability of the information for
their particular purposes. In no event shall ScienceLab. com be liable for any claims, losses, or damages of any third party or for
lost profits or any special, indirect, incidental, consequential or exemplary damages, howsoever arising, even if ScienceLab.com
has been advised of the possibility of such damages.

MATERIAL SAFETY DATA SHEET
Sodium Persulfate .
MSDS Ref. No.: 7775-27-1
#MC' Date Approved: 06/01/2009
Revision No.: 13
This document has been prepared to meet the requirements of the U.S. OSHA Hazard Communication
Standard, 29 CFR 1910.1200 and Canada's Workplace Hazardous Materials Information System (WHMIS)
requirements.
1. PRODUCT AND COMPANY IDENTIFICATION
PRODUCT NAME: Sodium Persulfate
SYNONYMS: Sodium Peroxydisulfate; Disodium Peroxydisulfate
GENERAL USE: Polymerization initiator. Etchant and cleaner in manufacture of
printed circuit boards. Booster in hair bleaching formulations in
cosmetics. Secondary oil recovery systems as a polymerization
initiator and a gel breaker.
MANUFACTURER
FMC CORPORATION
FMC Peroxygens
1735 Market Street
Philadelphia, PA 19103
[phone] (General Information)
[e-mail] (Email - General Information)
EMERGENCY TELEPHONE NUMBERS
[phone] (Medical - U.S. - Call Collect)
For leak, fire, spill, or accident emergencies, call:
[phone] (CHEMTREC - U.S.A. & Canada)
2. HAZARDS IDENTIFICATION
EMERGENCY OVERVIEW:
• White, odorless, crystals
• Oxidizer.
• Decomposes in storage under conditions of moisture (water/water vapor) and/or excessive heat causing
release of oxides of sulfur and oxygen that supports combustion. Decomposition could form a high
temperature melt. See Section 10 ("Stability and Reactivity").
POTENTIAL HEALTH EFFECTS: Airborne persulfate dust may be irritating to eyes,
nose, lungs, throat and skin upon contact. Exposure to high levels of persulfate dust may cause difficulty in
breathing in sensitive persons.
Page 1 of 10

Sodium Persulfate (7775-2771)
Date: 06/01 /2009
3. COMPOSITION / INFORMATION ON INGREDIENTS
Chemical Name
CAS#
Wt.%
EC No.
EC Class
Sodium Persulfate
7775-27-1
>99
231-892-1
Xn-O; R8-R22-R36/37/38-
R42/43
4. FIRST AID MEASURES
EYES: Flush with plenty of water. Get medical attention if irritation occurs and persists.
SKIN: Wash with plenty of soap and water. Get medical attention if irritation occurs and persists.
INGESTION: Rinse mouth with water. Dilute by giving 1 or 2 glasses of water. Do not induce
vomiting. Never give anything by mouth to an unconscious person. See a medical doctor immediately.
INHALATION: Remove to fresh air. If breathing difficulty or discomfort occurs and persists,
contact a medical doctor.
NOTES TO MEDICAL DOCTOR: This product has low oral toxicity and is not irritating to
the eyes and skin. Flooding of exposed areas with water is suggested. For gastric lavage or emesis
induction, consider the possible aggravation of esophageal injury, and the expected absence of system
effects. Treatment is controlled removal of exposure followed by symptomatic and supportive care.
5. FIRE FIGHTING MEASURES
EXTINGUISHING MEDIA: Deluge with water.
FIRE / EXPLOSION HAZARDS: Product is non-combustible. On decomposition releases
oxygen which may intensify fire. Presence of water accelerates decomposition:
FIRE FIGHTING PROCEDURES: Do not use carbon dioxide or other gas filled fire
extinguishers; they will have no effect on decomposing persulfates. Wear full protective clothing and self-
contained breathing apparatus.
FLAMMABLE LIMITS: Non-combustible
SENSITIVITY TO IMPACT: No data available
Page 2 of 10

Sodium Persulfate (7775-27-1)
Date: 06/01/2009
SENSITIVITY TO STATIC DISCHARGE: Not available
6. ACCIDENTAL RELEASE MEASURES
RELEASE NOTES: Spilled material should be collected and put in approved DOT container and
isolated for disposal. Isolated material should be monitored for signs of decomposition (fuming/smoking).
If spilled material is wet, dissolve with large quantity of water and dispose as a hazardous waste. All
disposals should be carried out according to regulatory agencies procedures.
7. HANDLING AND STORAGE
HANDLING: Use adequate ventilation when transferring product from bags or drums. Wear
respiratory protection if ventilation is inadequate or not available. Use eye and skin protection. Use clean
plastic or stainless steel scoops only.
STORAGE: Store (unopened) in a cool, clean, dry place away from point sources of heat, e.g.
radiant heaters or steam pipes. Use first in, first out storage system. Avoid contamination of opened
product. In case of fire or decomposition (fuming/smoking) deluge with plenty of water to control
decomposition. For storage, refer to NFPA Bulletin 430 on storage of liquid and solid oxidizing materials.
COMMENTS: VENTILATION: Provide mechanical general and/or local exhaust ventilation to
prevent release of dust into work environment. Spills should be collected into suitable containers to prevent
dispersion into the air.
8. EXPOSURE CONTROLS / PERSONAL PROTECTION
EXPOSURE LIMITS
Chemical Name
ACGIH
OSHA
Supplier
Sodium Persulfate
0.1 mg/m3 (TWA)
ENGINEERING CONTROLS: Provide mechanical local general room ventilation to
prevent release of dust into the work environment. Remove contaminated clothing immediately and wash
before reuse.
PERSONAL PROTECTIVE EQUIPMENT -
EYES AND FACE: Use cup type chemical goggles. Full face shield may be used.
RESPIRATORY: Use approved. dust respirator when airborne dust is expected.
Page 3 of 10

Date: 06/01 /2009
Sodium Persulfate (7775-27-1)
PROTECTIVE CLOTHING: Normal work clothes. Rubber or neoprene footwear.
GLOVES: Rubber or neoprene gloves. Thoroughly wash the outside of gloves with soap and
water prior to removal. Inspect regularly for leaks.
9. PHYSICAL AND CHEMICAL PROPERTIES
ODOR: None
APPEARANCE:
AUTOIGNITION TEMPERATURE:
BOILING POINT:
COEFFICIENT OF OIL / WATER:
DENSITY / WEIGHT PER VOLUME:
EVAPORATION RATE:
FLASH POINT:
MELTING POINT:
ODOR THRESHOLD:
OXIDIZING PROPERTIES:
PERCENT VOLATILE:
pH:
SOLUBILITY IN WATER:
SPECIFIC GRAVITY:
VAPOR DENSITY:
VAPOR PRESSURE:
White crystals
Not applicable. No evidence of combustion up to S00°C.
Decomposition will occur upon heating.
Not applicable
Not applicable
Not available
Not applicable (Butyl Acetate = 1)
Non-combustible
Decomposes
Not applicable
Oxidizer
Not applicable
typically 5.0 - 7.0 @ 25 °C (I% solution)
73 % @ 25 °C (by wt.)
2.6 (H2O=1)
Not applicable (Air = 1)
Not applicable
10. STABILITY AND REACTIVITY
CONDITIONS TO AVOID:
STABILITY:
POLYMERIZATION:
INCOMPATIBLE MATERIALS:
Page 4 of 10
Heat, moisture and contamination.
Stable (becomes unstable in presence of heat,
moisture and/or contamination).
Will not occur
Acids, alkalis, halides (fluorides, chlorides,
bromides and iodides), combustible materials, most
metals and heavy metals, oxidizable materials,
other oxidizers, reducing agents, cleaners, and
organic or carbon containing compounds. Contact

Sodium Persulfate (7775-27-1) Date: 06/01/2009
with incompatible materials can result in a material
decomposition or other uncontrolled reactions.
HAZARDOUS DECOMPOSITION PRODUCTS: Oxygen that supports combustion and oxides of
sulfur.
COMMENTS: PRECAUTIONARY STATEMENT: Use of persulfates in chemical reactions
requires appropriate precautions and design considerations for pressure and thermal relief.
Decomposing persulfates will evolve large volumes of gas and/or vapor, can accelerate exponentially with
heat generation, and create significant and hazardous pressures if contained and not properly controlled or
mitigated.
Use with alcohols in the presence of water has been demonstrated to generate conditions that require
rigorous adherence to process safety methods and standards to prevent escalation to an uncontrolled
reaction.
11. TOXICOLOGICAL INFORMATION
EYE EFFECTS: Non -irritating (rabbit) [FMC Ref. ICG/T-79.029]
SHIN EFFECTS: Non -irritating (rabbit) [FMC Ref. ICG/T-79.029]
DERMAL LD50: > 10 g/kg [FMC Ref. ICG/T-79.029]
ORAL LD50: 895 mg/kg (rat) [FMC Ref. ICG/T-79.029]
INHALATION LC50: 5.1 mg/1(rat) [FMC Ref. I95-2017]
SENSITIZATION: May be sensitizing to allergic persons. [FMC Ref. ICG/T-79.029]
TARGET ORGANS: Eyes, skin, respiratory passages
ACUTE EFFECTS FROM OVEREXPOSURE: Dust may be harmful and irritating.
May be harmful if swallowed.
CHRONIC EFFECTS FROM OVEREXPOSURE: Sensitive persons may develop
dermatitis and asthma [Respiration 38:144, 1979]. Groups of male and female rats were fed 0, 300 or 3000
ppm sodium persulfate in the diet for 13 weeks, followed by 5000 ppm for 5 weeks. Microscopic
examination of tissues revealed some injury to the gastrointestinal tract at the high dose (3000 ppm) only.
This effect is not unexpected for an oxidizer at high concentrations. [Ref. FMC 190-1151, Toxicologist
1:149, 1981].
Page 5 of 10

Sodium Persulfate (7775-27-1)
Date: 06/01 /2009
CARCINOGENICITY:
NTP:
Not listed
IARC:
Not listed
OSHA:
Not listed
OTHER:
ACGIH: Not listed
12. ECOLOGICAL INFORMATION
ECOTOXICOLOGICAL INFORMATION:
Bluegill sunfish, 96-hour LC50 = 771 mg/L [FMC Study I92-1250]
Rainbow trout, 96-hour LC50 = 163 mg/L [FMC Study I92-1251]
Daphnia, 48-hour LC50 = 133 mg/L [FMC Study I92-1252]
Grass shrimp, 96-hour LC50 = 519 mg/L [FMC Study I92-1253]
CHEMICAL FATE INFORMATION: Biodegradability does not apply to inorganic
substances.
13. DISPOSAL CONSIDERATIONS
DISPOSAL METHOD: Dispose as a hazardous waste in accordance with local, state and federal
regulatory agencies.
14. TRANSPORT INFORMATION
U.S. DEPARTMENT OF TRANSPORTATION (DOT)
PROPER SHIPPING NAME:
PRIMARY HAZARD CLASS / DIVISION:
UN/NA NUMBER:
PACKING GROUP:
LABEL(S):
PLACARD(S):
MARKING(S):
ADDITIONAL INFORMATION:
Page 6 of 10
Sodium Persulfate
5.1 (Oxidizer)
UN 1505
III
5.1 (Oxidizer)
5.1 (Oxidizer)
Sodium Persulfate, UN 1505
Hazardous Substance/RQ: Not applicable

Sodium Persulfate (7775-27-1)
Date: 06/01 /2009
49 STCC Number: 4918733
This material is shipped in 225 lb. fiber
drums, 55 lb. poly bags and 1000 - 2200 lb.
IBC's (supersacks).
INTERNATIONAL MARITIME DANGEROUS GOODS 0MDG)
PROPER SHIPPING NAME: Sodium Persulfate
INTERNATIONAL CIVIL AVIATION ORGANIZATION (ICAO) /
INTERNATIONAL AIR TRANSPORT ASSOCIATION (IATA)
PROPER SHIPPING NAME: Sodium Persulfate
OTHER INFORMATION:
Protect from physical damage. Do not store near acids, moisture or heat.
15. REGULATORY INFORMATION
UNITED STATES
SARA TITLE III (SUPERFUND AMENDMENTS AND REAUTHORIZATION ACT)
SECTION 302 EXTREMELY HAZARDOUS SUBSTANCES (40 CFR 355, APPENDIX A):
Not applicable
SECTION 311 HAZARD CATEGORIES (40 CFR 370):
Fire Hazard, Immediate (Acute) Health Hazard
SECTION 312 THRESHOLD PLANNING QUANTITY (40 CFR 370):
The Threshold Planning Quantity (TPQ) for this product, if treated as a mixture, is 10,000 lbs;
however, this product contains the following ingredients with a TPQ of less than 10,000 lbs.:
None
SECTION 313 REPORTABLE INGREDIENTS (40 CFR 372):
There are no ingredients in this product, which are subject to Section 313 reporting
requirements.
CERCLA (COMPREHENSIVE ENVIRONMENTAL RESPONSE COMPENSATION AND
LIABILITY ACT)
CERCLA DESIGNATION & REPORTABLE QUANTITIES (RQ) (40 CFR 302.4):
Unlisted, RQ = 100 lbs., Ignitability
Page 7 of 10

Sodium Persulfate (7775-27-1) Date: 06/01/2009
TSCA (TOXIC SUBSTANCE CONTROL ACT)
TSCA INVENTORY STATUS (40 CFR 710):
All components are listed or exempt.
RESOURCE CONSERVATION AND RECOVERY ACT (RCRA)
RCRA IDENTIFICATION OF HAZARDOUS WASTE (40 CFR 261):
Waste Number: 13001
CANADA
WHMIS (WORKPLACE HAZARDOUS MATERIALS INFORMATION SYSTEM):
This product has been classified in accordance with the hazard criteria of the Controlled Products
Regulations and the MSDS contains all the information required by the Controlled Products
Regulations.
Hazard Classification / Division: C
D2A
13213
Domestic Substance List: All components are listed or exempt.
INTERNATIONAL LISTINGS
Australia (AICS): Listed
China: Listed
Japan (ENCS): (1)-1131
Korea: KE-12369
Philippines (PICCS): Listed
New Zealand: Listed
HAZARD AND RISK PHRASE DESCRIPTIONS:
EC Symbols: Xn (Harmful)
O (Oxidizer)
EC Risk Phrases: R8 (Contact with combustible material may cause fire)
R22 (Harmful if swallowed.)
R36/37/38 (Irritating to eyes, respiratory system and skin.)
R42/43 (May cause sensitization by inhalation or by skin contact.)
16. OTHER INFORMATION
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Sodium Persulfate (7775-27-1)
Date: 06/01 /2009
HMIS
Health
1
Flammability
0
Physical Hazard
1
Personal Protection (PPE)
J
Protection = J (Safety goggles, gloves, apron & combination dust & vapor respirator)
HMIS = Hazardous Materials Identification System
Degree of Hazard Code:
4 = Severe
3 = Serious
2 = Moderate
1 = Slight
0 = Minimal
NFPA
Health
1
Flammability
0
Reactivity
1
Special
OX
SPECIAL = OX (Oxidizer)
NFPA (National Fire Protection Association)
Degree of Hazard Code:
4 = Extreme
3 = High
2 = Moderate
1 = Slight
0 = Insignificant
REVISION SUMMARY:
This MSDS replaces Revision #12, dated April 30, 2006.
Changes in information are as follows:
Section 1 (Product and Company Identification)
Section 3 (Composition / Information on Ingredients)
Section 15 (Regulatory Information)
Section 16 (Other Information)
FMC - Trademark of FMC Corporation
© 2009 FMC Corporation. All Rights Reserved.
FMC Corporation believes that the information and recommendations contained herein (including data and
statements) are accurate as of the date hereof. NO WARRANTY OF FITNESS FOR ANY PARTICULAR
PURPOSE, WARRANTY OF MERCHANTABILITY, OR ANY OTHER WARRANTY, EXPRESSED
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Sodium Persulfate (7775-27-1)
Date: 06/01 /2009
OR IMPLIED, IS MADE CONCERNING THE INFORMATION PROVIDED HEREIN. The information
provided herein relates only to the specific product designated and may not be applicable where such
product is used in combination with any other materials or in any process. It is a violation of Federal law to
use this product in a manner inconsistent with its labeling. Further, since the conditions and methods of use
are beyond the control of FMC Corporation, FMC Corporation expressly disclaims any and all liability as
to any results obtained or arising from any use of the product or reliance on such information.
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