WI0700534_Injection Event Record_20221206

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WELL CONSTRUCTION RECORD (GW-11
IA
Ce tra►lOffice
1. Well Contractor Information:
RAWLINS CLARKE IV
\4 ell (onuactor Nam::
4234-A
Ni' N-cl1 Contractor Certification Number
REDOX TECH LLC
Cotnpany I\.IP.IC
2. Well Construction Permit 4: W 10700534
,,ll.rpphcable twit c.'?rn,rnun permit, h c CIC. County, Shire. I'a manse. en-
3. \\ ell Use (cheek well nsc):
\\ aler Supply \\'ell:
Agricultural
DGe„ themtal illeanng`C'onting Supply-)
❑i Industnah, C ommcrci al
DMunicipal Public
O Residcntial Water Supply- (single)
JRcsidential \Vatcr Supply (shared)
Non -Water Supply Well:
11=1,.! Ionitorine
Injection Well:
0 Aquifer Recharge
LAquircr Storage and Recovery
Aquifer fest
Cxpenmcntal Technology
Geothermal (Closed Loop)
jGeothcn'nal 11leatini,Cooling Return)
QRccos cry
▪ Groundwater Itemediaiion
0Salinity Barrier
EStonnscater Drainage
0 Subsidence Control
0ITraccr
❑ Other (explain under tl21 Remarks)
.1. Date VeII(s) Completed: 11/3/2022 Well ID# IW1-IW6
5a. N ell Location:
Dupont Kentec Facility
facdn) !Ow ocr IN dine
4610 Braxton Rd Griffon, NC
Physical \ddrrss. Cast and Llp
PittlLenior
Cuunly
fJnhty ELM (il'applicnblcl
Parcel Idenulkation No (PIN)
51). Latitude and longitude in degrees/minutes/seconds or decimal degrees:
tdnell field^ one L,uIong is sufficient)
na N na
6. Blare/ the Isell(s)QPcrmanent or IL Temporary
7. Is this a repair to an existing well: QYes or ONo
ll rnir Is J ra/.aa'. l.ii Obt ArnQ,,n “ell consrnwnan r' Ior,nur,On and espial,: the rr,,,urr Of the
rt purr sorrier _: / renmds section nr on the bark a( ribs farm
S. For Geoprohe/DPT or Closed -Loup Geothermal Wells having the sane
constriction, only I GW- I is needed. Indicate TOTAL NUMBER of wells
dolled °
9. Total w ell depth below land surface: 20 (ft.)
n.=ris r„t all./ 7vin ,f ddf•r. rr for-Pt/ph- trio -nor d 2Ia Imo
1U. Static ,late( les el below top of casing: na (ft.)
Ir unr. r ,enl is Ir;Ou• n/,n!E.; use ' •
I. Borehole diameter: 1 .5 on.)
Direct Push
12. Well construction method:
n Jrl:cr r'..n cehlc _'u'.o,!pmAi.:k
FROM
FROM _ 10
For Internal l.;sc Onhr-
14. WATER IONFS
111.011
ft.
rD
ft.
rt.
rt.
DIS(RIP F 115,
15.OI;TER CASING (tor multi -cased was) OR LINER (irap IlcaMc)
!HAM1.l117 1III(K\I'SS %l s111t1M
ft. In.
16. INNER CASING OR T TING feeolbermal closed -loop)
1111stt IFIt
n.
n.
TO
ft.
ft.
in.
in.
T1I1(K\FtiS sfFRI\I
17. SCREEN
FROM
ro
kstrrrit
SI OT SIZE
1111('K1ESS
'I.TFR111.
ft.
ft.
in.
n.
ft.
in.
1H. GROUT
FHtlsl
ft.
rO
fi.
at.'JFHI \1.
F.Mrt s('f.sl G\ 1' METHOD & 4010Ir\1
ft.
ft.
fI.
rt.
19. SAND/GRAVEL PACK Of applicable)
FROM
10
sl t UFRI M.
F1Ir1_s(F %IFN I Mk IHUD
rt.
Ft.
rt.
ft.
211. DRILLING LOG (anach additional ',heels If neccssory)
11(OM
ft.
TO DESCRIPTION (color. hardness wilrock Ivpc. a•raln nth- cte)
fi.
ft.
n.
ft.
ft.
ft.
ft.
I OR \%:\ fER SIPPLY 1\ ELLS ONLY:
I3a. \ icld (gpro)
NIedlnd of lest:
13b. Disinfection 1). pc:
An10H111:
F F. (,L1
rt.
ft.
ft.
fl.
ff.
11.
21. REJIARKS
22. !. 1' ftcation:
analure of Ccrhfied Well CI IGIe:
11/20/2022
Date
8, vgnnh this /jinn. f hcrchi ca•r lrJi^ d,or the uc1l4) was 61-rr0 comfy/Wei/ All mconlunae
utd� 15:1 ,VC' IC /2( Ol an or / 5.1 NC. IC NC NM Well Consu'rrrrun Standard.: and that a
rnp:. Di rf,,r r. mare: has been provided !o O ^:ell an•n
23. Site diagram or additional well details:
You may use the back of this page to pru.idc additional well site details or well
constnlction details. You may also attach additional pages if necessary.
SUBMITTAL. INSTRUCTIONS
24a. For A11 Wells: Submit this loon oilhin 30 days of completion of well
construction to the follu,viti ,
Division of Water Resources. Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
241). For Injection Wells: In addition to sending the Berm to the address In 24a
above, also submit one copy of this linen within 30 class of completion of well
construction to the fallowing:
Division of %Voter Resources. Underground Injection Control Program,
1636 Mail Service Center, Raleigh. NC 27699-1636
24e. For Water Simply & Infection \%ells: In addition to scndm•_ line tbmi to
the addresses) above, also suhlnft omt copy of this forth within 1U days of
completion of well construLtn111 to Ilse county health department of the county
ss here constructed
of En- i:a:n:-sut.il I4:.,i i . - Di, cyan rf :i..:1_r Rc-coca:.
2.-22-2Il:t•

WELL ABANDONMENT RECORD
1.11 ell Contractor Information:
Rawlins E Clarke IV
\led Contractor Name for :tell co, net penonaliy tban,lonu'+g Well" Ins her prnpcny
NCWC 42334-A
vC \leil t-'.rmracto: Ccnai..anon Number
Redox Tech IIc
Company N,,ne
2. Well Construction I'crmil'?:
W10700534
I t1 .,C i,ppixahir ur•1! ' in gars trnu ri runt, r, r La" Cnunn St i
3. Well use (check well use):
I+,.sear rc/,i .b,otvt
Rater Supply Well:
°Agricultural
CGeothcrmal (Heating/Cooling Supply)
D Industria 1, Commercial
°lrrieation
Non -Water Supply 1Vell:
Dllon Loring
❑Municipal Pohlic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recosety
Injection \Yc1I:
°Aquifer Recharge
°Aquifer Storage and Recut cry
D.\quifer Test
❑Espenmental Technology
DGenthtmtal (Closed Loop)
DGcolhermal (ilsaunyCuoling Reiuml
a(iroundwater Remcdiation
°Salinity 13arricr
❑Stomnwatcr Doiinagc
❑Subsidence Control
❑Tracer
❑Other (explain under 7e)
4. Date well(s) abandoned: 1 1 /4/2022
5a. Well location:
Dupont Kentec
❑till%.}%Owner Nacre I,tnhty ID+F (ifapplic.ible)
4610 Braxton Rd. Grifton NC
Physical \dins, Cap, and / p
Pitt /Lenoir
t. minty
rye Ilvesn,tl tl,c ONLY
WELL ABANDO\11E\'T DETAILS
7a. For Geoprobe/DP'f or Closed -Loop Geothermal \\ ells having the same
%tell eonstntction depth, only l GW-30 is needed. Indicate 1C) FAL `EMBER of
%ills abandoned
7h. \\pprotiimute volume of seater remaining in wills): 0
(gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. -type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
• Bentonite Chips or Pellets
a Dry Clay
D Drill Cuttings
❑ (irltel
❑ Other (e;cplain under 7g)
❑ Neat Cement Grout
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
❑ Den(ouue Slurry
7f. For each material selected abate, provide amount of materials used:
Bentonite 1/4 bag
7g. Provide a brief description oldie abandonment procedure:
Bentonite was poured down borehole and hydrated with water.
s.CertfI ation:
r� Wcll C
'CcrUlicd rnt�
Asto
n,lpr Ur Welt Owner
11/20/2022
Duce
By signing this form l hereby certify that the well(s) was to ere) abandoned in
crernrdrtue c' with I i,l \'C.I C 112C t110(1 or 2C 02(10 Well Caioi,vctrnn Standard::
and that n cope of this recto -el has been prat tiled to the well au see
9. Site diagram or additional well details:
You may use the back of thts page to provide additional Ad site details or well
Y abandonment details You may also attach additional pages if necessary
Parcel Idcntiticauon No. (PIN)
56. 1 atitude and longitude in degrees/minutes/seconds or dccitnal degrees:
ttf sell fiat one Ltr'long n su$iclenl)
CONS', RUCTION DETAILS OF WELL'S.) BEING ABANDONED
V,✓, L r,e mr ow era non %sums/(%) rf a�adahl,' For nn,litple .,yrenan or non-w arr,uppl. well'
O\Ll' +ra: :lr; s'r; ,'parr hoa.,bsui.lon u•n1.,an ra: vihnvt m:e f•.nn
IW1-IW6
6a. \Veil ID/ :
61). Total well depth: 20 (ft.)
6c. Borehole diameter: 1 '5 fin.)
6(1. 1laler Iesel Ileitis% ground surface: na 0.1.1
6c. Oiler casing lenv,rli (if kilo wnt: 20
61. Inter casing''tubing length (if known): na (ft.)
(, . Scrim length (if knoll n): na (ft)
SURINITT:\l, INSTRUCTIONS
111a. For All Wells: Submit this font within 30 days of completion of well
abandonment to the following-
Di%isiou of Rater Resources, Inforntatinn Processing Unit,
1617 Mail Service Center, Raleigh, \C 27699-1617
Bib. For Infection % elk: In addition to sending the rums to the ad:Iress in Il)a
above, also submit one copy of this form within 30 days of completion of well
ahandotuncnt to the fallow mg.
Di%lsloti of 1\'ater Resources. Underground injection Control Program,
1636 Mail Service Center, Raleigh. \C 27699-1636
Nils. Inc•4% liter Supply & Infection 11 ells: In .tddincn to iendtne the torn to the
addre.io'i) ahu're_ also submit one cop; of this form uithm 3(1 day of completion
of i%ell abandonment to the cation health department of the county where
,,hod,
rh tar+,bca D.p. ors-ni Off 11,w+n 1,nul f)+L i.on t+t',i.a,t
Itet:,td 2-22-20:0

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10700534
. Permit Information
Pernittee
Dupont Kentec Facility
Facility Name
4610 Braxton Rd. Grifton NC 28530
Facility Address (include County)
2" Injection Contractor Information
Rawlins Clarke IV / Redox tech Ilc
Injection Contractor / Company Name
Street Address
200 Quade Dr
Cary NC 27513
City
( 919) 797-5906
State Zip Code
Arca code — Phone number
. Well Information
Number of wells used for injection
Well IDs 1-6
6
Were any new wells installed during this injection
event?
❑ Yes x❑ No
If yes. please provide the following information:
"Number of Monitoring ~Hells
Number of Injection Wells 6
Type of Well Installed (Cheek applicable type):
❑ Bored ❑ Drilled] Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the G.WW'-I form for each
well installed.
Wcrc any wells abandoned during this injection
event'?
®Yes ❑No
If yes, please provide the following information:
Number of Monitoring Wells
0
Number of Injection Wells 6
Please include a copy of the GWi✓ 30 for each 'veil
abandoned.
4. In'cctant Information
sodium persulfale, Hydrogen Peroxide 34wt%, sodium Hydroxide,
FeEDTA, and Sodium citrate,
Injcctant(s) Type (can use separate additional sheets
if necessary
1000Ibs sodium persulrate 170 Ibs sdium
hydroxide, 51bs FeEDTA/ 500 gal mx: 421 Ibs
Concentration hydrordr peroxide „5 sodium cutrate
If the injectant is diluted please indicate the source
dilution fluid. Hydrant water
Total Volume Injected (gal)
3000 gal
Volume Injected per well (gal) 500
5. Injection History
Injection date(s)
11 /1 /2022 -11/4/2022
Injection number (e.g. 3 of 5)
Is this the last injection at this site?
❑ Yes © No
[ DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
TI-IE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WIT[-IIN THE
ST?1NDARDS LAID OUT IN TI-IE PERMIT.
LotZ
[ tRG OF INJECTION CONTRACTOR 2c�Z
DATE
I (J)\ Ina
PRINT NA\TF OF PERSON PERFORMING THE TN.IFCTIUN
Submit the on ulna] of this form to the Division ol'Water Resources within 30 days of injection.
Attn: UIC Program. 1636 Nlail Service Center. Raleigh, NC 27699-1636. Phone No. er 1e1-1107-646 4
Form UIC-IFR
Rev". 3-1-2016