WI0800564_Injection Event Record_20230425

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Resources
Permit Number W10800564
1. Permit information
Citv of Jacksonville North Carolina
Permittee
Jacksonville Fleet Maintenance Facility
Facility Name
350 South Marine Blvd, Jacksonville, NC
Facility Address
2. Injection Contractor Information
Cape Lookout Env Sci, PLLC
Injection Contractor / Company Name
Street Address 8005 Clear Brook Dr.
Raleigh, NC 27615
City State Zip Code
[phone]
Area code — Phone number
3. Well Information
Number of wells used for injection 38
Well names IR-1-IR-37 and MW-10
Were any new wells installed during this injection
event?
❑ Yes © No
If yes, please provide the following information:
Number of Monitoring Wells: 0
Number of Injection Wells: 0
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-I 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: None
Number of Injection Wells: 0 Please include a
copy of the GW-30 for each well abandoned.
4. Injectant Information
Injectant Type: Aqueous Solution Sodium Dioctyl
Sulfosuccinate (Surfactant) and Jacksonville
Municipal Water
Concentration: Surfactant 0.5% to 1 % and Water
99.5% to 99%
If the injectant is diluted please indicate the source
Total Volume Injected:—25,800 gal. solution
Volume Injected per well: 27.5 g to 1031 g (avg.
—697 g /well)
5. Injectant Information
Injection date(s) Infection 1: AFVR/Surfactant
Infection 3/21-29/23 Extraction 4/19-27/23.
Injection number (e.g. 3 of 5) 1 of ?
Is this the last injection at this site? Will be based on
results of monitoring.
❑ 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 OUT IN THE PERMIT.
Aavl�(r Weas
4/25/23
SIGNATURE OF INJECTION CONTRACTOR DATE
David B_ Wells
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464 Rev. 8/5/2013