WI0800536_Injection Event Record_20230912

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10800536
1. Permit Information
MCB Camp Lejeune
Permittee
Gottschalk Marina 31/S-17
Facility Name
728 Cross Street, Camp Lejeune, Onslow County
Facility Address (include County)
2. Injection Contractor Information
Rhea Engineers & Consultants. Inc.
Injection Contractor / Company Name
Street Address 333 Rouser Road, Suite 301
Moon Township PA 15243
City State Zip Code
724 443-4111
Area code — Phone number
3. Well Information
Number of wells used for injection 2
Well IDs UST31 -MW02 and SWMU118-GW04
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 form for 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
PetroBac and Custom Blend Nutrients
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 5% and 3%, respectively
If the Injectant is diluted please indicate the source
dilution fluid. Lot 203 water supplv
Total Volume Injected (gal)20 gal and 12 gal, respectively
Volume Injected per well (gal)10 gal and 6 gal, respectively
5. Injection History
Injection date(s) 8/16/2023
Injection number (e.g. 3 of 5) 1 of 1
Is this the last injection at this site?
0 Yes ❑ 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.
Ik _9z' 8/21 /2023
SIGNATURE OF INJECTION CONTRACTOR DATE
Jim Ferguson, PG
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. 3-1-2016