WI0700544_Injection Event Record_20240214

North Carolina Department of Environmental Quality—Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W 10700544
Were any wells abandoned during this injection
1. Permit Information event?
®
Anthony A Ference ❑ Yes No
Permittee If yes, please provide the following information:
Tank Farm D Number of Monitoring Wells
Facility Name
MCAS Cherry Point,NC Number of Injection Wells
Facility Address(include County) Please include a copy of the GW-30for each well
abandoned.
2. Injection Contractor Information
Catlin Engineers& Scientists 4. Injectant Information
Injection Contractor/Company Name Ivey-sol 106
Injectant(s)Type(can use separate additional sheets
Street Address 1044 Washington Street if necessary
Raleigh, NC 27605 Concentration 10gal Ivey-sol 106:255gal water
City State Zip Code
If the injectant is diluted please indicate the source
( 910) 452-5861 dilution fluid._ water
Area code - Phone number
Total Volume Injected(gal) 530
3. Well Information
Volume Injected per well (gal) 265
Number of wells used for injection 2
5. Injection History
Well IDs 09GW l4,09GW39
Injection date(s) 1/24i24
Were any new wells installed during this injection
event? Injection number(e.g. 3 of 5) 1
❑ Yes No
Is this the last injection at this site?
If yes,please provide the following information: ❑ Yes ® No
Number of Monitoring Wells
I DO HEREBY CERTIFY THAT ALL THE
Number of Injection Wells INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
Type of Well Installed (Check applicable type): INJECTION WAS PERFORMED WITHIN THE
❑ Bored ❑ Drilled ❑ Direct-Push STANDARDS LAID OUT IN THE PERMIT.
❑ Hand-Augured ❑ Other(specify) 2�/Z
Please include a copy of the GW-1 form for each SIGNATURE OPWJECTION CONTRACTOR DATE
well installed. �A e W #110 2 P 1
PRINT NAME OF PERSON PEELFORMING T
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