WI0300409_Injection Event Record_20240424

North Carolina Department of Environmental Quality—Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10300409
Were any wells abandoned during this injection
1. Permit Information event?
❑ Yes ® No
Marathon Petroleum Company, LP
Permittee If yes,please provide the following information:
Marathon Charlotte East Terminal Number of Monitoring Wells
Facility Name
Number of Injection Wells
7401 Old Mount Holly Rd,Charlotte,Mecklenburg
Facility Address(include County) Please include a copy of the GW-30 for each well
abandoned.
2. Injection Contractor Information
4. Injectant Information
Eastern Solutions
Injection Contractor/Company Name RegenOx Part A
Injectant(s) Type(can use separate additional sheets
Street Address: 10909 Rozzelles Ferry Rd if necessary
Charlotte NC 28214 Concentration: 3%
City State Zip Code
If the injectant is diluted please indicate the source
[phone] dilution fluid. Charlotte Water(Mecklenburg_
Area code—Phone number CopM)-Hydrant
3. Well Information Total Volume Injected(gal) 825
Number of wells used for injection: 3 Volume Injected per well(gal) MW-01 —825
Well IDs: MW-21,MW-47,MW-48 5. Injection History
Were any new wells installed during this injection Injection date(s) 4115—4/24/2024
event?
❑ Yes ® No Injection number(e.g. 3 of 5) 213 of 3
If yes,please provide the following information: Is this the last injection at this site?
❑ 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 L OUT 1N THE PERMIT.
❑ Hand-Augured ❑ Other(specify) -: 6/03/2024
Please include a copy of the GW-1 form for each SIGNATURE OF DOECNON CON RACTOR DATE
well installed. Derek Rothaupt
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.3-1-2016