WI0700489_Other_20190415

An Equal Opportunity Employer

April 15, 2019

Ms. Shristi R. Shrestha
Hydrogeologist
North Carolina Department of Environmental Quality
Underground Injection Control Program
1636 Mail Service Center
Raleigh, NC 27699-1636

Subject: INJECTION EVENT RECORD
PERMIT WI0700489
SPEEDWAY 8183
502 WEST GREENVILLE BOULEVARD
GREENVILLE, PITT COUNTY, NORTH CAROLINA
DWM INCIDENT NO. 4052
MID-ATLANTIC JOB NO. 000R2713.0A

Dear Ms. Shrestha:

Speedway LLC is pleased to submit the attached Injection Event Record for the Speedway 8183
facility located at 502 West Greenville Boulevard in Greenville, North Carolina. In accordance with
Permit WI0700489, approximately 250-gallons of 2% solution of EnviroClean EC-165 were gravity
injected into existing monitoring wells MW-3, RW-1, RW-2, RW-3, RW-4, and RW-5 on April 9,
2019. If you have any questions or need additional information, please feel free to contact me at
(919)-516-8069 or Trey Marchant with Mid-Atlantic Associates, Inc. at [phone].

Sincerely,

SPEEDWAY LLC

Charles A. Chiara
Environmental Representative

Attachment: Injection Event Record
Speedway LLC

Speedway Office
P.O. Box 1500
Springfield, OH 45501
Telephone [phone]
North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number WI0700489
1. Permit Information
Speedway LLC
Permittee
Speedway 8183
Facility Name
502 West Greenville Boulevard, Pitt County
Facility Address (include County)
2. Injection Contractor Information
Mid -Atlantic Associates
Injection Contractor / Company Name
Street Address 409 Roizers View Ct
Raleigh NC 27610
City State Zip Code
( 919 ) 250-9918
Area code — Phone number
3. Well Information
Number of wells used for injection 6
Well IDs MW-3, RW-1 through RW-5
Were any new wells installed during this injection
event?
❑ Yes ® 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 ® 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
Gravity injection of approximately 250 gallons of 2% solution
of EnviroClean surfactant into existing monitoring wells MW-
3, RW-1, RW-2, RW-3, RW-4, and RW-5 on 4/9/19.
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 2%
If the injectant is diluted please indicate the source
dilution fluid. City of water potable supply
Total Volume Injected (gal) 250
Volume Injected per well (gal) 25 to 50
5. Injection History
Injection date(s) April 9, 2019
Injection number (e.g. 3 of 5) 1 of 1
Is this the last injection at this site?
❑ Yes ® No — TBD will evaluate results.
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OFsMY KNOW EDGE AND THAT THE
INJECTION AS PE RMED WITHIN THE
STAND S L TH PERMIT.
SIG RE O� YlNj-ECTI TRACT DA E
� '
PRINT NkdE OF PEtSON$E!RFORMING 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