WI0300488_Injection Event Record_20230328

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10300488
1. Permit Information
NCDEQ DWM, UST Section, Siate Lead
Permittee
TF#10782 Jones Grocpa
Facility Name
1156 East Memorial HioLway, NC, Iredell Co
Facility Address (include County)
2. Injection Contractor Information
ATC Associates of NC, PC
Injection Contractor / Company Name
Street Address 7606 Whitehall Executive Center
Dr., Suite 800,Zharlotte, NC 28273
city State Zip
[phone]
Area code — Phone number
3. Well Information
Number of wells used for injection —5
Well IDs MW-11) and AS-1 (air sparge); OW-2, �3
and 4 (ai�injection)
Were any new wells installed during this injection
event?
F1 Yes No
If yes, please provide the following information:
Number of Monitoring Wells 0
Number of Injection Wells
Type of Well Installed (Check applicable type):
F� Bored El Drilled El Direct -Push
F� Hand -Augured E] Other (specify)
Please include a copy of the GW-1 fo for each
well installed
Were any wells abandoned during this injection
event?
El Yes Z No
If yes, please provide the following information:
Number of Monitoring Wells NA
Number of Injection Wells _NA
Please include a copy of the GW-30for each well
abandoned
4. Injectant Information
Air
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 100%
If the injectant is diluted please indicate the source
dilution fluid. _NA
Total Volume Injected (cubic feet) —21,550 sparge;
804,000 vadose
Volume Injected per well (cubic feet) 10,775 sparge;
268,000 vadose.
5. Injection Iffistory
Injection date(s Jan 30-Feb 3, 2023
Injection number (e.g. 3 of 5) 1 (possibly more later)
Is this the last injection at this site?
El Yes 0 No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON TIES FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
-=/;Z 9/z 3
SIGNATYRE OF INJECTION CONTRACTOR DATE
'A-� / 4� L,-a r le 5- , '4 -?-c "P155-'0 C 0- dr 10-es- c' -r
PRINT MAME OF PERS014 PERFORMING TBE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection. Form LTIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464 Rev. 3-1-2016