WI0300295_Injection Event Record_20160805

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Shrestha; Shristi R
From: Wise, Gary W <[e-mail]>
Sent: Friday, August 05, 2016 3:37 PM
To: Shrestha, Shristi R
Cc: Rogers, Michael; Johnstone, Paul S; Pitner, Andrew; Watson, Edward M
Subject: Notification of scheduled injection - UIC Permit WI0300295 - RBTC Lincolnton NC
Ms. Shrestha,
This is a follow-up to the voice -mail messages I left today. Starting August 15, 2016, Robert Bosch Tool
Corporation and Amec Foster Wheeler are planning to conduct drilling and injection as outlined in Permit
W10300295 at 124 Legionaire Road and 129 Legionaire Road in Lincolnton. If you have any questions or
concerns, please email or call me at 864-552-9676 or Paul Johnstone at 864-552-9626.
Gary Wise
Senior Environmental Engineer, Environment & Infrastructure, Amec FosteeWheeleir
37 Villa Road, Suite 201, Greenville, SC 29615, USA
T [phone] D [phone] M [phone]
aary.wise(cDamecfw.com amecfw.com
amec
foster
wheeler
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W-7 v 3 o D 2qS
INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number W10300295 (UIC)
1. Permit Information
ROBERT BOSCH TOOL - SCOTT PIHLATA
Permittee
FMR LINCOLNTON MANUFACTURING DIVISION
Facility Name
124 LEGIONAIRE ROAD, LINCOLNTON, NC 28092
Facility Address
2. Injection Contractor Information
- GEOLOGIC EXPLORATION, INC
Injection Contractor / Company Name
Street Address 176 COMMERCE BLVD
STATESVILLE NC 28625
City State Zip Code
7( 04 ) 872-7686
Area code — Phone number
3. Well Information
Number of: 'Yells used for injection 17
Well names IW-6-1-IW-6-15,IW-6-19,IW-6-20
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
17
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑x Direct=Push
❑ Hand -Augured ❑ Other (specify)
Please include two copies ofform GW-Ib for each
well installed
Were any wells abandoned during this injection
event?
x❑ Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells 9
I
Please include two copies of the GW-30 for each
well abandoned.
4. Injectant Information
3-D MICROEMULSION (3DME) + NAHCO3
Injectant Type
Concentration 20%+ 18,000 MG/L
If the injectant is diluted please indicate the source
dilution fluid. HYDRANT - CITY WATER SERVICE
Total Volume Injected 3468 GALLONS
Volume Injected per well 204 GALLONS
5. Injection History
Injection date(s) 8/22/16 - 8/26/16
Injection number (e.g. 3 of 5) 1 OF 4
Is this the last injection at this site?
❑ 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
STAN,DAR4M,C+� 1:;�
HE PERMIT.
'� "` 9/30/16
SIGNATURE OF INJECTION CONTRACTOR DATE
KENNY SARGENT
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221 Rev. 07/09

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number WI0300295 (UIC)
l . Permit Information
ROBERT BOSCH TOOL - SCOTT PIHLAJA
Permittee
FMR LINCOLNTON MANUFACTURING DIVISION
Facility Name
124 LEGIONAIRE ROAD, LINCOLNTON, NC 28092
Facility Address
2. Injection Contractor Information
GEOLOGIC EXPLORATION, INC
Injection Contractor / Company Name
Street Address 176 COMMERCE BLVD
STATESVILLE NC 28625
City State Zip Code
( 704 ) 872-7686
Area code — Phone number
3. Well Information
Number of wells used for injection 3
Well names IW-6-16, IW-6-17, IW-6-18
Were any new wells installed during this injection
event?
RI Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells 3
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled x❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include two copies ofform "GW--1b for each
well installed.
Were any wells abandoned during this injection
event?
X❑ Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
6
Please include two copies of the GW-30 for each
well abandoned.
4. Injectant Information
3-D MICROEMULSION (31)ME) + NAHCO3
Injectant Type
Concentration 20% + 18,000 MG/L
If the injectant is diluted please indicate the source
dilution fluid. HYDRANT - CITY WATER SERVICE
Total Volume Injected 612 GALLONS
Volume Injected per well 204 GALLONS
5. Injection History
Injection date(s) 8/19/16
Injection number (e.g. 3 of 5) I OF 4
Is this the last injection at this site?
❑ 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
1NJECTIO AS PERFORMED WITHIN THE
STAN DS A �jT�IN THE PERMIT.
9/30/16
PAUL MCVEY
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221
Form UIC-IER
Rev. 07/09

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number WI0300295 (UIC)
1. Permit Information
ROBERT BOSCH TOOL - SCOTT PIHLAJA
Permittee
FMR LINCOLNTON MANUFACTURING DIVISION
Facility Name
124 LEGIONAIRE ROAD, LINCOLNTON, NC 28092
Facility Address
2. Injection Contractor Information
GEOLOGIC EXPLORATION, INC
Injection Contractor / Company Name
Street Address 176 COMMERCE BLVD
STATESVILLE NC 28625
City State Zip Code
7( 04) 872-7686
Area code — Phone number
3. Well Information
Number of wells used for injection 26
Well names IW-20-1-IW-20-83IW-20-10-Iw-20.27
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 21
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled- ❑x Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include two copies ofform GW-Ib for each
well installed.
Were any wells abandoned during this injection
event?
X❑ Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells 10
J
Please include two copies of the GW 30 for each
well abandoned
4. Injectant Information
3-D MICROEMULSION (3DME) + NAHCO3
Injectant Type
Concentration 20%+ 39,000 MG/L
If the injectant is diluted please indicate the source
dilution fluid. HYDRANT - CITY WATER SERVICE
Total Volume Injected 1820 GALLONS
Volume Injected per well,
5. Injection History
70 GALLONS
Injection dates) 8/15/16 - 9/21/16
Injection number (e.g. 3 of 5) 1 OF 4
Is this the last injection at this site?
❑ 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 ^s PERFORMED WITHIN THE
STANDA L D01J,�'P THE PERMIT.
9/30/16
SIGNATLM OF INJECTION CONTIUtTOR DATE
PAUL MCVEY
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221 Rev. 07/09

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number WI0300295 (UIC)
1. Permit Information
ROBERT BOSCH TOOL - SCOTT PIHLAJA
Permittee
FMR LINCOLNTON MANUFACTURING DIVISION
Facility Name
124 LEGIONAIRE ROAD, LINCOLNTON, NC 28092
Facility Address
2. Injection Contractor Information
GEOLOGIC EXPLORATION, INC
Injection Contractor / Company Name
Street Address 176 COMMERCE RLVO
ST,ATESVILLE NC 28625
City State Zip Code
7( 04) 872-7686
Area code — Phone number
3. Well Information
"Number of wells used for injection 13
Well names IW-25-1, 8,10,12,15,16,17, 21, 22, 24, 25; 26, 27
Were any new wells installed during this injection
event?
X❑ Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells 13
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑x Direct -Push
❑ Hand -Augured ❑ Other(specify)
Please include two copies ofform GW-Ibfor each
well installed.
i
Were any wells abandoned during this injection
event?
X❑ Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells 0
Number of Injection Wells 7
Please include two copies of the GW-30 for each
well abandoned
4. Injectant Information
3-0 MICROEMULSION (3DME) + NAHCO3
lnjectant Type
Concentration . 20% + 21,000 MG/L
If the injectant is diluted please indicate the source
dilution fluid. HYDRANT - CITY WATER SERVICE
Total Volume Injected 1716 GALLONS
Volume Injected per well 132 GALLONS
S. Injection History "
Injection date(s) 8/29/16 - 9/6/16
Injection number (e.g. 3 of 5) 1 OF 4.
Is this the last injection at this site?
❑ 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
STAND S AID UT IN THE PERMIT.
9/30l16
SIG OF INJECTION C047RACTOR DATE
PAUL MCVEY
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221 Rev. 07/09

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number WI0300295 (UIC)
1. Permit Information
ROBERT BOSCH TOOL - SCOTT PIHLAJA
Permittee
FMR LINCOLNTON MANUFACTURING DIVISION
Facility Name
124 LEGIONAIRE ROAD, LINCOLNTON, NC 28092
Facility Address
2. Injection Contractor Information
GEOLOGIC EXPLORATION, INC
,Injection Contractor / Company Name
Street Address 176 COMMERCE BLVD
STATESVILLE NC 28625
City State Zip Code
7( 04) 872-7686
Area code — Phone number
3. Well Information
Number of wells used for injection 13
Well names IW-25-2, 3, 4, 5, 6, 7, 9,11,13,18,19, 28, 23
Were any new wells installed during this injection
event?
X❑ Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells 13
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled x❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include two copies ofform GW-Ib for each
well installed.
Were any wells abandoned during this injection
event?
X❑ Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells 0
Number of Injection Wells 5
Please include two copies of the GW-30 for each
well abandoned
4. Injectant Information
3-D MICROEMULSION (3DME) + NAHCO3
Injectant Type
Concentration 20% + 21,000 MG/L
If the injectant is diluted please indicate the source
dilution fluid. HYDRANT - CITY WATER SERVICE
Total Volume Injected 1716 GALLONS
Volume Injected per well 132 GALLONS
5. Injection history
Injection date(s) 8/29/16 - 8/31/16
Injection number (e.g. 3 of 5) 1 OF 4
Is this the last injection at this site?
❑ 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
jLAI OUT IN THE PERMIT.
t .+ter 9/30/16
SIGNATURE OF INJECTION CONTRACTOR DATE
KENNY SAP -GENT
PRINTNAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221 Rev. 07/09

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number WI0300295 (UIC)
1. Permit Information
ROBERT BOSCH TOOL - SCOTT PIHLAJA
Permittee
FMR LINCOLNTON MANUFACTURING DIVISION
Facility Name
124 LEGIONAIRE ROAD, LINCOLNTON, NC 28092
Facility Address
2. Injection Contractor Information
GEOLOGIC EXPLORATION, INC
Injection Contractor / Company Name
Street Address 176 COMMERCE BLVD
STATESVILLE NC 28625
City State Zip Code
7( 04 ) 872-7686
Area code — Phone number
3. Well Information
Number of wells used for injection 23
Well names IW-27-1- IW-27-12 d IW-27-14 - Iw-27-24
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 23
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled x❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include two copies ofform GW-Ib for each
well installed.
Were any wells abandoned during this injection
event?
X❑ Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells 11
0
Please include two copies of the GW-30 for each
tivell abandoned.
4. Injectant Information
3-D MICROEMULSION (31)ME) + NAHCO3
Injectant Type
Concentration 20%+ 18,000 MG/L
If the injectant is diluted please indicate the source
dilution fluid. HYDRANT - CITY WATER SERVICE
Total Volume Injected 4025 GALLONS
Volume Injected per well 175 GALLONS
5. Injection History
Injection date(s) 9/12116 - 9/16/16
Injection number (e.g. 3 of 5) 1 OF 4
Is this the last injection -at this site?
❑ 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 AS PERFORMED WITHIN THE
STAND S ID PVTIN THE PERMIT.
9/30/16
SIGN F INJECTION CONDLACTOR DATE
PAUL MCVEY
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-IER
Attn: U I C Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221 Rev. 07/09

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number WI0300295 (UIC)
I . Permit Information
ROBERT BOSCH TOOL - SCOTT PIHLAJA
Permittee
FMR LINCOLNTON MANUFACTURING DIVISION
Facility Name
124 LEGIONAIRE ROAD, LINCOLNTON, NC 28092
Facility Address
2. Injection Contractor Information
GEOLOGIC EXPLORATION, INC
Injection Contractor / Company Name
Street Address 176 COMMERCE BLVD
STATESVILLE NC 28625
City State Zip Code
7( 04 ) 872-7686
Area code — Phone number
3. Well Information
Number of wells used for injection 5
Well names IW-14-1 — IW-14-5
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 two copies ofform GW-1 b 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 0
IN
Please include two copies of the GW-30 for each
well abandoned.
4. Injectant Information
3-1) MICROEMUL5ION (3DME) + NAHCO3
Injectant Type
Concentration 33 % + 25,000 MG/L
If the injectant is diluted please indicate the source
dilution fluid. HYDRANT - CITY WATER SERVICE
Total Volume Injected 945 GALLONS
Volume Injected per well 189 GALLONS
5. Injection History
Injection date(s) 9/19/16 - 9/21/16
Injection number (e.g. 3 of 5) 1 OF 4
Is this the last injection at this site?
❑ 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
STAND S AID OUT IN THE PERMIT.
9/30/16
SIG F INJECTION CPVRACTOR DATE
PAUL MCVEY
PRINTNAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-322I Rev. 07/09

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number WI0300295 (UIC)
1. Permit Information
ROBERT BOSCH TOOL - SCOTT PIHLAJA
Permittee
FMR LINCOLNTON MANUFACTURING DIVISION
Facility Name
124 LEGIONAIRE ROAD, LINCOLNTON, NC 28092
Facility Address
2. Injection Contractor Information
GEOLOGIC EXPLORATION, INC
Injection Contractor / Company Name
Street Address 176 COMMERCE BLVD
STATESVILLE NC 28625
City State Zip Code
7( a4 ) 872-7686
Area code — Phone number
3. Well Information
Number of wells used for injection 9
Well names IW-3-1 - IW-3-9
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 two copies ofform GW-Ib 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 0
Number of Injection Wells 0
Please include two copies of the GW-30 for each
well abandoned.
4. Injectant Information
3-D MICROEMULSION (3DME) + NAHCO3
Injectant Type
Concentration 17-34% + 11,000 MG/L
If the injectant is diluted please indicate the source
dilution fluid. HYDRANT- CITY WATER SERVICE
Total Volume Injected 1880 GALLONS
Volume Injected per well 209 GALLONS
5. Injection History
Injection date(s) 9/7/16 d& 9/20/16
Injection number (e.g. 3 of 5) 1 OF 4
Is this the last injection at this site?
❑ 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 AS PRFORMED WITHIN THE
STAND S W;PNTHE PERMIT.
04
9/30/16
SIGNATURE OF INJECTION CON CTOR DATE
PAUL MCVEY
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221 Rev. 07/09

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number WI0300295 (UIC)
1. Permit Information
ROBERT BOSCH TOOL - SCOTT PIHLAJA
Permittee
FMR LINCOLNTON MANUFACTURING DIVISION
Facility Name
124 LEGIONAIRE ROAD, LINCOLNTON, NC 28092
Facility Address
2. Injection Contractor Information
GEOLOGIC EXPLORATION, INC
Injection Contractor / Company Name
Street Address 176 COMMERCE BLVD
STATESVILLE NC 28625
City State Zip Code
C704) 872-7686
Area code — Phone number
3. Well Information
Number of wells used for injection 11
Well names 115V-2 - HSV-4, SV-5, SV-12 - SV-15, sv-19, sv-21, sv-22
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 hvo copies ofform GW-I b 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 0
Number of Injection Wells 0
Please include two copies of the .GW--30 for each
well abandoned.
4. Injectant Information
SODIUM LACTATE (WILCLEAR) + NAHCO3
Injectant Type
Concentration 12% + 8,000 MG/L
If the injectant is diluted please indicate the source
dilution fluid. HYDRANT - CITY WATER SERVICE
Total Volume Injected 3075 GALLONS
Volume Injected per well 25 - 1525 GALLONS
S. Injection History
Injection date(s) 9/20/16 A 9/22/16
Injection number (e.g. 3 of 5) 1 OF 4
Is this the last injection at this site?
❑ 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 AS PERFORMED WITHIN THE
STAND S AIIJ91,THE PERMIT.
!/
` 9/30/16
SIG OF INJECTION CO RACTOR DATE
PAUL MCVEY
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221 Rev. 07/09

6
INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Permit Number W10300295 (UIC)
I. Permit Information
ROBERT 805CH TOOL - 5COTT PIHLAJA
Permittee
FMR LINCOLNTON MANUFACTURING DIVI5ION
Facility Name
124 LEGIONAIRE ROAD, LINCOLNTON, NC 28092
Facility Address
2. Injection Contractor Information
GEOLOGIC EXPLORATION, INC
Injection Contractor / Company Name
Street Address 176 COMMERCE BLVD
STATE5VILLE NC 28625
City State Zip Code
( 704) 872-7686
Area code — Phone number
3. Well Information
Number of wells used for injection 9
Well names IW-10-1 — IW-10-9
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 two copies offorin GW-1 b 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 0
Number of Injection Wells 0
Please include two copies of the GW--30 for each
well abandoned.
4. Injectant Information
3-D MICROEMULSION (30ME) + NAHCO3
Injectant Type
Concentration 20% + 21,000 MG/L
If the Injectant is diluted please indicate the source
dilution fluid. HYDRANT - CITY WATER SERVICE
Total Volume Injected 1125 GALLONS
Volume Injected per well 125 GALLONS
5. Injection History
Injection date(s) 9/8/16
Injection number (e.g. 3 of 5) 1 OF 4
Is this the last injection at this site?
❑ Yes No
1 DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM 1S CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION AS PERFORMED WITHIN THE
STAND DS ATHE PERMIT.
9/30/16
SIG A RE OF INJECTION COIWRACTOR DATE
PAUL MCVEY
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-!ER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221 Rev. 07/09

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A — 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable trell construction permits (i,e. Countj; State. Variance, etc)
3. Well Use (check well use):
❑Agricultural ❑MunicipaUPublic
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (sing]
Olndustrial/Commercial ❑Residential Water Supply (sham
Well:
❑Aquifer Recharge
OAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatina/Cooline
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 08/26/16 Well ID# IW-6-1
50. Well Location: XW ^ 6 - ZO � r K/ -w"q-, a, to,,
ROBERT BOSCH TOOL- NONCD0001154
tjLp,fVj 7 FacilitylOwner Name Facility ID#fifapplicable)
129 LEG(ONAIRE ROAD LINCOLNTON 28092
,rW-Z S - 1 Physinl Address, City, and Zip
2. LINCOLN 00410
County Parcel Identification No. (PIN)
56. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one fatilong is sufficient)
350 29' 17.98" N 810 15' 24.76" `
6. Is (are) the we0(s): ❑Permanent or mTemporory
For Internal Use ONLY:
22 Certification;
Al 09J30/16
7. Is this a repair to an existing well: OYes or ONo
if dutt is a repair, fill ono lUzoim Oren construction Information and esploin the nature of the
repair under #21 remarks section or or the back of this fornL
S. Number ofwells constructed: 1
For multiple h Jnection or ou_Crater supply trells OM.Y roith the same construction, you can
submit one farm.
9. Total well depth below land surface: 46.0 (ft.)
For multiple trolls list a0 depths iflierent (example- 3@200' and 2©10IY)
10. Static water level below top of casing:
If cater krel is obare casing, use '•+"
11. Borehole diameter: 1.5 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, tic)
Signature of Certified Well Contractor
Date
By signing rhos fora, I hereby cerlyj, that rite ureft ft) was (were) constructed to accordance
with 15A NCAC 02C . 0100 or 15A NCAC 02C .0200 Well Construction Standards and drat a
copy of this record has been provided m the trell otrner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of die county
where constructed.
Form GW-1 North Carolina Department of Em•tronment andNatural Resources - Division of Water Quality
Revised Jan. 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295 (UIC)
0rt all applicable well canrtraction permits (i.e. Caurmjt Slaw, I arlanre, era) if knawn
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
El Monitoring ❑ Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
08/24/16
under
5a. Well location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County
Parcel Identification No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwetl field one latflong is sufficient)
35e 29' 17.98" N 810 15' 24.76"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For tntdtiple bjectian or nan-water supply wells ONLY wish the .rank
conrtructlanabandonment. yvtu cansubmil one form.
7b. Approximate volume of water remaining in welt(s): 0-2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
O Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification: �`
��j�.yy �-+.� _ 09/30/16
Signature ofCertified Well Contractor or Well Owner Date
By signing this fornt, I hereby certify that the well(s) teas (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a coPj, of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction recard(s) if amiable. Ror multiple ityection or non -water supply
wells ONLY with the same construction oba"datment you can subntn vile funs.
6a. Well ID#: DPMW-1 y-" I I .
6b. Total well depth: 45.0 (IL)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface:
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft) 10c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E lnnercasing/iubing length (if known): (ft.)
where abandoned.
6g. Screen length (if known): (ft.)
Farm G W-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Brinkley Isaacs
Well Contractor Name (or well owner personally abandoning well on his/her property)
2223-A
NC Well Contractor Certification Number
McCall Brothers, Inc.
Company Name
2- WelI Construction Permittl: 16-9-1 008(lincoln Co)
List all applicable well permlis (ze. Cotmry, State, Variance, Injection, etc.) iflorown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply) .
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling:
A. Date well(s) abandoned: 3-18-16
❑Municipal/Public
ZResidential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
OTracer
❑Other (explain under 7g)
Sa. Well location:
DONALD AVERY
Facility/Owner Name Facility ON (if applicable)
120 LEGIONAIRE RD , LINCOLNTON NC 28092
Physical Address, City, and Zip
LINCOLN - 22467
County
Parcel Identification No. (PIN)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
Pm• multiple injection or non -water supply wells ONLY with the same
construction/abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 90 (gaL)
FOR WATER SUPPLY WELLS ONLY.-
7c. Type of disinfectant used.- HTH Chlorine
7d. Amount of disinfectant used: 6oz
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
❑ Bentonite Chips or Pellets
• Sand Cement Grout
❑ Dry Clay
O Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
Cl Bentonite Slurry
O Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
6oz - HTH CHLORINE
4.5 YARDS CONCRETE
7g. Provide a brief description of the abandonment procedure:
CHLORINATED WELL. GRAVTIY FILL WITH CONCRETE
TRUCK AND CAP.
S. rtilication:
t
3-14-16
ionnature ofCertified We Contractor or Wc11 Owner Date
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2 C .0200 Well Constriction Standards
and that a copy of this record has been provided to the well owner.
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lattlong is sufficient) 9. Site diagram or additional well details:
35.487 316' 81:.256 129' You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL iNSTRL1CTiONS
Attach well construction record(s) if ewailable. For multiple Infection or non-aroler supply
wells ONLY with /lie same construction/abandonment, you can submit one form. 10a For All Wells,. Submit this form within 30 days of completion of well
6a. Well ID#:
6b. Total well depth: 45' (tt )
6c. Borehole diameter: 20 (in.)
6d. Water level below ground surface: 355'
abandonment to the following:
Division of Wafer Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
IOb. For Iniection Wells: In addition to sending the form to the address in 1 Oa
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e Outer rasing length (if known) (ft.) 10c. For Water Supply & Injection W gils: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
611 Inner casing/tubing length (if known): (ft) where abandoned.
69. Screen length (if known): (ft)
Fomr GW30 North Carolina Department of Environment and Natural Resources — Division of Water Resources Revised August 20 B

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit q: W10300295 (UIC)
Ott all applicable teell construction permlts (i.e. County, State, Variance, etc.) lfknmrn
3. Well use (check well use):
OAgricultural
❑Geothermal (Heating/Cooling Supply)
O Industrial/Commercial
Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
OGeothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
OSalinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
4. Date well(s) abandoned: 08/26/16
Sa. Well location:
ROBERT BOSCH TOOL
under
NONCD0001154
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
Far nntliVe infection or non -water supply trelts ONLY with the saute
canrtnicilon'abandonntent, you can subndt one font.
7b. Approximate volume of water remaining in well(s): 0-2 (gal,)
FOR WATER SUPPLY WELLS ONLY:
7c, Type of disinfectant used:
7d. Amount ofdisinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
a Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
O Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide s brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
FacilitylOwnerName Facility lDN(ifapplicable)
129 LEGIONAIRE
8•CertifCatio
ni
hJ+U
ROAD LINCOLNTON 28092
��� �i'� "`^-- 09/30/16
Physical Address, City, and Zip —
_
Signature ofCertified Well -Contractor or Well Owner Date v�
LINCOLN 00410
By signing this form, I hereby cert6 that the well(s) was (were) abandoned in
County Parcel Identification No. (PIN)
accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of dris record has been provided to the well owner.
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one latilang is sufficient)
9. Site diagram or additional well details:
350 29' 17.98" 810 15' 24.76"
You may use the back of this page to provide additional well site details or well
N W
abandonment details, You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLIS) BEING ABANDONED
SUBMITTAL INSTRUCTIONS
Attach well construction record(r) 1f arailabte. For multiple infection or nor -ester supply
wells ONLY triih the same construction'abandnnimit, you can submit our fonts.
10a. For All Wells: Submit this form within 30 days of completion of well
6a. Well ID#: IW-6-1
abandonment to the following:
6b. Total well depth: 46.0 (ft.)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (fit.)
6e. Outer casing length (if known): (ft,)
6E Inner casing/tubing length (if known): (ft.)
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6g. Screen length (if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources— Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on histher property)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple injection or non -crater .supply welts ONLY frith lire sane
cmntrucaon`abatutonrrteut, tau can suhmit aneforrrt.
A - 4226 NC Well Contractor Certification Number 76. Approximate volume of water remaining in well(s): 0_ (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c. Type of disinfectant used:
2. Well Construction Permit#: W10300295 (UIC)
t ;mall applicable well construction permits (i.e. County, State, Variance, etc.) tfknown 7d. Amount of disinfectant used;
3. Well use (check well use):
❑Agricultural OMunicipal/Public
❑Geothermal (HeatinglCooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial . OResidential Water Supply (shared)
Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
C
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
OTracer
08/26/16
under
5a. Well location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDII (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if Weil field, one lattlong is sufficient)
350 29' 17.98" N 81" 15' 24.76" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach n'ell construction record(k) if arallable. For multiple brjection or non -crater supply
wells ONLY iNdt the scone cottstructioaohandotmrent, }au can submit one form
6a. Well ID#: IW-6-3
6b. Total well depth: 46.0 (ft.)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
EI Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
8. Certification:
A',�
09/30/16
Signature of Certified Well Contractor or Well Owner Date
By signing this fora. 1 hereby certify that the wells) was (were) abandoned in
accordance with 15A NCAC 02C.0100 or 2C .0200 ;Yell Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or weil
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
Ift For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
lob. For lniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form Within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6g. Screen length (if known): (ft.)
Forth GW-30 North Carolina Department of Environment and Natural Resources —Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable well coratruction permits T.e. County, State, Variance, etc.) lfknmrn
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
19
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
ElGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
08/25/16
is. Well location:
ROBERT BOSCH TOOL NONCD0001154
FacilitylOwner Name Facility ID# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
Sb. Latitude and longitude in degreestminuies/seconds or decimal degrees:
(ifwell field. one latllong is sufficient)
350 29' 17.98" N 810 15' 24.76"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number orwells being abandoned: r
ror multiple hJecrimr or non -Crater supply iretlr ONLY uvitlr the .ranrr
corutruction'abandmrment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 0-2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout 0 Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentonite Slurry ❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
8. Certification:
X
-:- 09/30/16
Signature ofCertified Well Contractor or Well Owner Date
By signing this fornt, 1 hereby certify that the weills) was (were) abandoned in
accordance with 15A NCAC 01C .0/00 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
�� abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach is -ell conrirucrion records) tforallableror multiple byecrion or non -water supply
wells ONLY "-ith dre sonic constructlmi abandotinrent, you can submit one forin.
6a. Well ID#: IW-6-5
6b. Total well depth: 43.0 (ft.)
6c. Borehole diameter..
6d. Water level below ground surface: (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer easing length (if known): (ft.) loc. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.
where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 Nonh Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit if: W10300295 (UIC)
List applicable arAconstruction permtts (i.e. County, State, Variance, etc.) ifknown
I Well use (check well use):
OAgricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed1oop)
❑Geothermal (Heating/Cooling
❑MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
RIGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
4. Date well(s) abandoned: 08/25/16
under
5a. Well location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDk (itapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(i€well field, one latllong is sufficient) .
35e 29' 17,98" N 81 ° 15' 24.76"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number or wells being abandoned: 1
For nruirple hgecdon or non-uwter supply uetls ONLY iridt the sonic
consirucnan'abandonmew, you can submit one form.
7b. Approximate volume or water remaining in well(s): 0-2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type ofdisinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
El Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount ormaterials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
S. Certification:
% , A,,=- 09/30/16
Signature ofCenifiedWell Contractor orWell Owner Date
By signing this form, 1 hereby certify that the wells) was (were) abandoned in
accordance with 15A NCAC 01C.0100 or 1C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLfS) BEING ABANDONED
Attach it -ell construction records) if aral/able. Fur multiple h jection or iron -crater supply
hells ONLY irtth the satire constnu tion-abandoinnent, )eu can subnth one fornt.
6a. Well IDN: IW-6-7
6b. Total well depth: 46.0 (ft.)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of %veil
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
Job. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-I636
6e. Outer casing length (if known): (ft) loc. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.
whereabandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on hisilter property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit t{: W10300295 (UIC)
List all applicable well cont(ructionperndts (i.e. County, State. Mariance, etc.) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothennal.(Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
Non -Water Suaaly Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
4. Date well(s) abandoned:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
C
ElGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
08/24/16
5a. Well location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility IDN (ifoppliubfe)
129 LEGiONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one latilong is sufficient)
350 29' 17.98" N 810 15' 24.76"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
Far multiple infection ar non -,eater supply trellr ONI.Y midi the rams
conviruction abandonment, you car submit onetorn
7b. Approximate volume of water remaining in well(s): 0-2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
0 Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACEIHYDRATE WITH TAP WATER
tT Certification:
� 09/30M 6
Signature of Cenified Well Contractor or Well Owner Date
By signing this form. 1 hereby certify that the ivell(s) was (were) abandoned in
accordance wilh 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the weH ounern
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLiS) BEING ABANDONED
Aaach well conrtructimr recoWs) if arailable. For multiple injection or nun -sealer supply
wells ON1.Y with the same constniction abandonment, jwu can submit one form.
6a. Well iD#: IW-6-9
6b. Total well depth: 37.0 (ft.)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. For Water Sunnly & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this forth within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.)
where abandoned.
6g. Screen length (if known): (ft)
Form GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple veils
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on hislher property)
A - 4226
NC Well Contractor Certification Number
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
Fur multiple hyechan or non -water supply mulls ONLY trill; the same
constructton'abandontnent, you can Submit one form
7b. Approximate volume of water remaining in well(s): 0-2 (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name
2. Well Construction Permit #:
hkvt all applicable troll construction
3. Well use (check well use):
7c. Type of disinfectant used:
W10300295 (UIC)
permits (.e. County; State, Irarlance, etc.) lfknown 7d. Amount of disinfectant used:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑irrieation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑ Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
under
4. Date well(s) abandoned: 08/23/16
511, Well location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDN (irapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one latllong is sufficient)
350 29' 17.98" N 810 15' 24.76"
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
0 Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g, Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
S. Certification:
-s— 09/30/16
ii,a ""- -
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0100 Well Construction Standards
and that a copy of this record has been provided to the well owner,
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED
Attach well caturruction recard(s) if arailable. Far mu/ople ityecttan or non -water supply
trells ONLY with the same construction'abandonrnem, yan can submit are furnt.
6a. Well 1D#: IW-6-11
6b. Total well depth: 37.0 (ft.)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (ft.)
SUBMITTAL INSTRUCTIONS
I0a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (it) 10c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6L Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Nome
2. Well Construction Permit!/: W10300295 (UIC)
List oll applicable well construrdon permlis (i.e. Cmrnty. Smic, Narlance, era) ifknotwt
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commerc ial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
OMonitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
❑Geothermal (Closed Loop)
4. Date well(s) abandoned:
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
08/23/16
So. Well location:
ROBERT BOSCH TOOL
under
NONCDO001154
Facility/Owner Name Facility IDO (ifopplicabte)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one tat/long is sufficient)
350 29' 17.98" N 810
15' 24.76" W
For Internal Use ONLY.
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For nmhipte lnjecilon or non -[rater supply irells ONLY wbL the saute
construction'abandonment you can submit one form
7b. Approximate volume of water remaining in well(s): 0-2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout 91 Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentonite Slurry ❑ Other (explain under 7g)
IFE For each material selected above, provide amount of materials used:
3/8" PELLETS .20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
8. Certiflca ion:
-:-- 09/30_ /16
Signature of Certified Well Contractor or Well Owner Date N
By signing this jorin. I hereby certify that the ivell(s) was (were) abandoned in
accordance ivith /5A NCAC 02C .0100 or 2C .0200 Wef Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach is -ell courintctinn record(s) 1f arodable. For multiple ttyeettan or ton -water supp(v
1,e11v ONLY with thesanre canstntctiotrabandonenem, you can submitonefonu. 10a For All Wells• Submit this form within 30 da s f camI.,;— n f 11
6a. Well IDk: IW-6-13
6b. Total well depth: 42.0 (ft )
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface:
y o p o o we
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the forth to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
l0c. For Water Supply & Iniection Wells: In addition to sending the form to
6e. Outer casing length (if known): VI the address(es) above, also submit one copy of this forth within 30 days of
completion of well abandonment to the county health department of the county
6E loner casing/tubing length (if known): (ft.)
where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY;
This form can be used for single or multiple wells
1. Well Contractor Information: WELL ABANDONMENT DETAILS
KENNY SARGENT 7a. Number of wells being abandoned: 1
Well Contractor Nome (or well owner personally abandoning well an his/her property) For multiple ityecrion or nail -tracer supply tens olvu with rite same
A - 4226 catntructlon'ahandonment, you can submit oneform,
NC Well Contractor Certification Number 7b. Approximate volume of water remaining in well(s): 0-2 (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c. Type of disinfectant used:
2. Well Construction Permit#: W10300295 (UIC)
List oil applicable u-ell construction permits (.e. Cmmry. State, lioriance, etc.) lfknou» 7d Amount of disinfectant used
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ lndustria I/Commercial
Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
❑Geothermal(Closed Loop)
❑Geothemtal (Heating/Cooling
4. Date well(s) abandoned:
❑MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
ElGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
08/25/16
5a. Well location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility IDN (ifopplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one IntAong is sufficient)
350 29' 17.98" N 810 15' 24.76"
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout El Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide a mount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
8. Certiticah
A,,-=
09/30/16
Signature ol'Cenified Well Contractor or Well Owner
Date
By signing this fonn. 1 hereby certiry dial the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or Weil
abandonment details. You may also attach additional pages if necessary.
CONSTRUMON DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction recard(s) lfavallable. For multiple infection or tnmt tratersupptr
wells ONI.t' with the same cotstnrctionabaudmunem, you cats submit cox Jiwnt. 108 For All Wells Submit this form within 30 da s of corn letion of well
6a. Well ID#:
Y P
IW-6-15 abandonment to the following:
6It. Total well depth: 33.0 (ft.)
6c. Borehole diameter. 1.5 (in.)
6d. Water level below ground surface: (ft.)
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
lob. For iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of Weil
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6c. Outer casing length (if known): (D) 10c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form OW-30 North Carolina Department crEnvironment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4305
NC Well Contractor Certification Number
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7n. Number of wells being abandoned: 1
For multiple hgection or non -water supply wells ONLY with the same
ronstnstion abandonnient, you can subatit one form.
7b. Approximate volume of water remaining in well(s): 0-2 (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name
2. Well Construction Permit #:
t tst all applicable trell cmrvtruction
3. Well use (check well use):
7c. Type of disinfectant used:
W10300295 (UIC)
permits (i.e. CounV, State, lrariance, etc.) Ifbmwn 7d, Amount of disinfectant used:
❑ Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
i%
ElGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
under
4. Date well(s) abandoned: 08/19/16
5a. Well location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility ID# (irapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell Geld. one tat/long is sufficient)
350 29' 15.49" N 810 15' 29.88" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) lfarailable. ror multiple injection or non-voter supply
wells ONI.Y with the sale construction obandonmcm, you can submit one form.
6a. Well ID#: IW-6-17
6b. Total well depth: 28.0 (ft.)
6c. Borehole diameter: 1.5 (in.)
6d. Water level -below ground surface: (ft.)
6e. Outer casing length (if known):
6f. Inner casingitubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
El Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel .
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
8. Certificali
09/30/16
Signature of enified Well Contractor or Well OvW Date
By signing this form, I hereby certify that the ivell(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 )Veil Construction Standards
and that a copy of this record has been provided to the ivell owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of %veil
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division ofWater Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
Form GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2.Well Construction Permit ll: W10300295(UIC)
List all applicable well construction permits (.e. County, State, Variance, etc.) lfknaavt
3. Well use (check well use):
❑Agricultural
❑Geothermal (HeatingiCooling Supply)
❑ lndustrial/Commcrc ial
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
4. Date wells) abandoned:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
08/22116
under
5a. Well location:
ROBERT BOSCH TOOL NONCD0001154
Facility/OwnerName Facility IDN (ifopplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if welt field, one latflong is sufficient)
350 29' 17.98" N 810 15' 24.76"
For Internal Use ONLY:
WELL AQANDONMENT DETAILS
7a. Number of wells -being abandoned: 1
For muhlple injection or non-iramr supply wefts ONLY pith the same
cansirtialar'abandonment, you can submit one fornn.
7b. Approximate volume of water remaining in we11(s): 0-2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Seating materials used (check all that apply):
❑ Neat Cement Grout
El Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
g. Certification:
. _
� 09/30/16
Signature ofCertifred Well Contractor or Well Owner Date
By signing 11ris form. 1 hereby certify that tine ive11(s) was (were) abandoned in
accordance with 15A NCAC 01C .0/00 or 1C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED
Anach well construction recard(s) if available. For multiple ityection or nan-water supply
wells ON1. F with the same you can submit one fornt.
6a. Well IDN: _ _ I W-6-19
6b. Total well depth: 36.0 (ft.)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (ft.)
SUBMITTAL INSTRUCTIONS
10s. For All Wells: Submit this form Within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617.
10b. For Injection Wells: In addition to sending the fort to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (fL) 10c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.lnnercasing/tubinglength(ifknown): (£L) where abandoned.
6g. Screen length (if known): (ft.)
Form OW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information: WELL ABANDONMENT DETAILS
PAUL MCVEY 7a. Number of wells'being abandoned: 1
Well Contractor Name (or well owner personally -abandoning well on his/her property) For nuthiple hVection or non -crater supply wills ONLY with the same
A - 4305 eonstruetlan'abonrdmrment, you can submit one form
0-2
NC Well Contractor Certification Number 7b. Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7a Type of disinfectant used:
2. Well Construction Permit#: W10300295 (UIC)
List all applicable ere!! cointruction permitsT,e. County, State, Parlance, etc) ifknown 7d. Amount of disinfectant used:
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Supply Well:
❑Aquifer Recharge
❑Aqui fer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date wells) abandoned:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stornwater Drainage
❑Subsidence Control
❑Tracer
08/17/16
5a. Well location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ION (ifapplicable)
129 LEGiONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latilong is sufficient)
350 29' 15.22" N 810 15' 20.42"
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout 0 Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
S. Certification- -W �j�
!/ 09/30/16
Signature ofCe tfied Well Contractor or Well Owae Date
By signing this forma I hereby cer16 that the u•ell(s) ivas (were) abandoned in
accordance ivith I5A NCAC 01C .0100 or 1C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details: .
You may use the back of this page to provide additional well site details or well
H abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction recard(s) !f arallable. Far multiple lttyeetio n or non -+rater supply
u•ells ONI,Y tritb the some construction obandonnnent, you con submit care ji n. _ 10a For All Wells • Submit this to within 30 da s of com )etion of well
6a. weil 1D#: I W-20-7
6b. Total well depth: - 50.0 (ft.)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (ft.)
Y p
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply &-Injection Wells: In addition to sending the form to
6e. Outer casing length (if known): {ft.}
the addresses) above, also submit one copy -of this form within 30 days of
completion of weft abandonment to the county health department of the county
6E inner casing/tubing length (if known): (ft.)
where abandoned.
6g. Screen length (if known): (fit,)
Fenn GW-30 North Carolina Department orEnvironment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1. Well Contractor Information: WELL ABANDONMENT DETAILS
PAUL MCVEY 7a. Number of wells being abandoned: 1
Well Contractor Name (or well ownerpersonally abandoning well on his/herpropetty) For nuthiple iteetion or non -water supply hells ONLY with the same
A - 4305
Construction abandonment, you can submit ane form. .
NC Well Contractor Certification Number 7b. Approximate volume of water remaining in wetl(s): 0-2 (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c. Type of disinfectant used:
2. well Construction Permit #: W10300295 (UIC)
List all applicable trell construction perndtr p.e. County, State, variance, etc.) iflmawn 17d. Amount of disinfectant used:
3. Well use (cheek well use):
OAgricultural
❑Geothermal (Heating/Cooling Supply)
❑ Ind ustriaUCommercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal(Closed Loop)
OGeothermal(Heatirtg/Cooling
❑MunicipaVPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Is
RIGroundwater Remediation
OSalinity Barrier
❑Stermwater Drainage
OSubsidence Control
OTracer
OOther (explain under
4. Date well(s) abandoned: 08/17/16
Sa. Well location:
ROBERT BOSCH TOOL NONCD0001154
FacilitylOwner Name Facility IDO orappucab►e)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degreestminutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
350 29' 15.22" N 810 15' 20.42" W
CONSTRUCTION DETAILS OF WELLfSI BEING ABANDONED
Attach well construction record(r) rraradable. Far multiple injection or nan-tracer supply
wells ONLY frith the same cottstructiost abmrdonmetn, you can submit oteform.
6n. Well IDfI: IW-20-11
6b. Total well depth: 50.0 (ft.)
6c. Borehole diameter. 1.5 (in.)
6d. Water level below ground surface: (R.)
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout 0 Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
0 Drill Cuttings
O Specialty Grout
❑ Gravel
O Bentonite Slurry
O Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO .GROUND
SURFACE/HYDRATE WITH TAP WATER
8. Certification• /i�/ �5�6' 09/30/16
Signature oft t led Well Contractor or W1nW Date
By signing this form. 1 hereby certo that the wells) was (here) abandoned fit
accordance muftis 15A NCAC 02C .0100 or 1C .0200 file// Constnictfon Standards
and iltai a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessory.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For lniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this forth within 30 days of completion of well
abandonment to the following.
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center; Raleigh, NC 27699-1636
6e. Outer casing length (if known): (n) 10c. For Water Sootily & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casingliubing length (if known): (rQ where abandoned.
6g. Screen length (if known): (ft.)
Form OW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4305
NC Well Contractor Certification Number
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
i•'or multiple h jecrlan or non -crater supply treNs ONLY +rich the some
comiraetion abandonment, you can submir one fornL
7b. Approximate volume of water remaining in well(s): 0-2 {gat.)
GEOLOGIC EXPLORATION, INC I FOR WATER SUPPLY WELLS ONLY:
Company Name 7c. Type of disinfectant used:
2. Well Construction Permit #: WI0300295 (UIC)
List all applicable moil consiruction perntirs lie. Counrya Stale, Variance, etc.) Y knoum 7d. Amount of disinfectant used:
3. Well use (check well use):
❑Agricultural
❑Geothermal (-iieating/Cooling Supply)
❑ Ind ustrial/Commercial
❑Irrigation
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑MunicipaVPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other I
4. Date well(s) abandoned: 08/17/16
Sa. Well location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDb (if applicable)
129 LEGiONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one Iatfiong is sufficient)
35a 29' 15.22" N 810 15' 20.42"
7e. Seating materials used (check all that apply):
❑ Neat Cement Grout 0 Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS iN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
8. CertiticatiC-/�� w
v09/30/16
Signalurcof ertifiedWellContmctorarWellO Date
By signing this fora, 1 lrereby certo that the wells) ivas (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C ,0Z00 Well Construction Standards
and drat a copy of ills record has beets provided to fire well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anaelr hell constnrction recortl(s) lfavailable. For multiple in)ectlair ar tmn-water supply
nrellsONl.Ytritb the samecmutruction'abamlannient,jimtcan subnrhonefnrnt 10a. For All Wells Submit this form within 30 days of completion of well
6a. Well ID#• IW-20-13 abandonment to the following:
6b. Total well depth: 50.0 ife)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6E Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
l0c. For Water Sunnly & Iniection Wells: in addition to sending -the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
form G W-30 North Carolina Department ofEnvironment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4305 ,
NC Well Contractor Certification Number
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
Far nmltiple injection or non -carer supply trelis ONLY u-ith the same
construction cbondonoteni, y»u can submit one form.
7b. Approximate volume of water remaining in wdl(s): 0-2 (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLYWELLS ONLY:
Company Name 7c. Type of disinfectant used:
2.Well Construction Permit #: W10300295(UIC)
Ust all applicable url/ corntructimt permits (i.e. Corms}; Stare, Variance, eta) ljknmrrt 7d. Amount ordisinfectant used:
3. Well use (check well use):
Water
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑industrial (Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatinr/Cooling
❑Municipal/Public
El Residential Water Supply (single)
❑Residential Water Supply (shared)
¢IGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
[]Tracer
❑Other(explain under
4. Date well(s) abandoned: 08/15/16
5a. Well location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# orapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one IatAong is sufficient)
350 29' 15.22" N 810 15' 20.42"
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout O Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
8. Cert4.ifid�W2.11CZ
�
—IV q
09/30/16
Signaturor or Welt Own Date
By signing this form. I hereby certify that the well(s) was (were) abandoned in
accordance with I5A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been prorided to dre well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
JV abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Anach is -ell construction record(v) if avallabk 1%or mulliple infection or non-mater supply
trel/s ONLY mith the same consiructinmlabandorrnr<nt, yort can subsists one farnr. 10a. For All Wells: Submit this form within 30 days of completion of well
6% Well ID#: IW-20-15 abandonment to the following:
6b. Total well depth: 50.0 (ft.)
6c. Borehole diameter. 1.5 (in.)
6d. Water level below ground surface: (It.)
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Iniection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f. loner casing/tubing Length (if known): (tL) where abandoned.
6g. Screen length (if known): {ft.)
Farm GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Mardi 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name (or well owner personally abandoning well on histiter property)
A - 4305
NC Well Contractor Certi fication Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (U IC)
List all applicable urli construction permits ft. a. County, State, Variance, eta) ifknou•n
3. Well use (check well use):
Water Supply Well:
OAgricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
Olndustrial/Commercial ❑Residential Water Supply (shared)
Olrri tion
Non -Water Supply Well:
OAquifer Recharge
❑Aquifer Stooge and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
0
ElGroundwater Remediation
OSalinity Barrier
❑Stormwater Drainage
OSubsidence Control
OTracer
08/16/16
under
Sit. Well location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID/ (ifopplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one latilong is sufficient)
35" 29' 15.22" N 810
15' 20.42"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7.9. Number rof wells being abandoned: 1
For multiple byeetion or non -neater supply wells ONLY with the some
constructlanwbandanmem, you can submit one form.
7b. Approximate volume of water remaining in well(s): 0-2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
El Bentonite Chips or Pellets
❑ Sand Cement Grout
O Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
O Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide a mount of materials used:
3/8" PELLETS .20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
8. Certitica
09/30/16
Signnlurc o Certified Well Contractor or Well Mer Date
By signing this fora!, 1 hereby certify that tire well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 1C .0200 Well Construction Standards
and drat a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Atiocb well construction recard(r) if araitable. Far inaltiple hyccttmi or Pion -crater supply
irells ONLY with the some consiruchan abandonment, you con submil one forme 10a For All Wells • Submit this form within 30 daY s of corn letion of well
6a. Well ID#: IW-20-17
6b. Total well depth: 50.0 (ft.)
6c. Borehole diameter. 1.5 (in.)
6d. Water level below ground surface: (ft.)
p
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of wel I
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
fie. Outer casing length (if known): (ft.) 10c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Fenn GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2.Well Construction Permit tt: WI0300295 (UIC)
List all applicable well construction permits r.e. Comrr}: State. Variance, era) ifknnvn
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (lieating/Cooling Supply)
❑ industrial/Commercial
Non -Water Supply
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeatinglCooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
EIGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other(explain under
4. Date well(s) abandoned. 08/16/16
So. Well location:
ROBERT BOSCH TOOL NONGD0001154
Facility/Owner Name Facility IDo (irapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No. (PIN) t
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latitong is sufficient)
350 29' 15.22" N 810 15' 20.42"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For nmluple bJection or non -water supply welts ONLY wbh the sane
con truction'obandonnent, you can submit one form.
7b. Approximate volume of water remaining in well(s): 0-2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout 91 Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUNC
SURFACE/HYDRATE WITH TAP WATER
09/30/16
Signature o rtified Well Contractor or Well Owiff Date
By signing this form. I hereby certify that the tvell(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the rveU owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
,W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLIS) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s) if available. For inultiple ityecnan or iroa-water supply
wells ONLY with the sane constructinr abandonareni, you can sithnth one form. 110a For All Welts: Submit this Form within 30 days of completion of well
6a. Well 1DN:
IW-20-19 abandonment to the following:
6b. Total well depth: 50.0 (ft.)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (ft.)
Division or Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: 1n addition to sending the form to the address in 10a
above, also submit one copy of this fort within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
Ge. Outer casing length (if known): (ft.) 10c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (it known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form OW-30 North Carolina Department of Environment and Natural Resources— Division of Water -Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
PAUL MCVEY
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable well consrr ucdon pernits (t.e. County. State, Variance, etc.) ly knatrn
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Well:
IN
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeatingfCooling
4. Date well(s) abandoned:
❑Municipal/Public
OResidential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
08/16/16
5a. Well location:
ROBERT BOSCH TOOL NONCDO001154
FacilitylOwner Nam Facility IDII (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degreesiminutes/seconds or decimal degrees.
(irwen field, one tat0ong is sur icient)
350 29' 15.22" N 81" 15' 20.42"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
79. Number of wells being abandoned: 1
Far multiple lr fecrion or non -water supply wells ONLY with the some
caertrucuon-abandonment, you cat submit one forms.
7b. Approximate volume of water remaining in well(s)t 0-2
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
El Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
O Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3/8" PELLETS 20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
8.Certificatio
09/30/16
Signature f t t Well Contractor or Well r Date
By signing this fora, I Hereby serf fy that tire well(s) was (mere) abandoned in
accordance Wilt 15A NCAC 02C .0100 or 2C .0200 Well Consinvion Standards
and drat a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attacli well cansiructinrr recard(s) ifa allable. For nndtipie htfectiou or tan -water supply
welts ONLY with the sane conatrtictlon obandanttem, you can submit one form. 103 For All Wells Submit thf thi 30 d f 1 f 11
i
6a. Well ID#: IW-20-21
6b. Total well depth: 50.0 (ft )
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (ft.)
is ortn .v
ays o comp et on o we
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. For Wnter Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.
where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources — Division or Water Quality Revised March 2013

WELL ABANDONMENT RECORD -
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 4305
NC Well Contractor Certification Number
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
for atutaple Injection or non-n•ater supply wells ONLY with the sane
construction abondontneu4 ybu can subtalt one fornt.
7b. Approximate volume of water remaining in well(s): 0-2 (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c. Type of disinfectant used:
2. Well Construction Permit N: W10300295 (UIC)
Liss applicable well construction perndts Ae. Cannot. State, Variance, etc.) iflsnomrn 7d. Amount of disinfectant used:
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑industriaUCommercial •
Well:
OAquifer Recharge
OAquifer Storage and Recovery
OAquiferTest
0Experimental Technology
OGeothermal(Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
MGroundwater Remediation
❑Salinity Barrier
❑Slormwater Drainage
❑Subsidence Control
❑Tracer
4. Date well(s) abandoned: 08/16/16
5a. Well location: -
ROBERT BOSCH TOOL NONCDO001154
FacilitylOwtter Name Facility IDN (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout 0 Bentonile Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
O Drill Cuttings
❑ Specialty Grout
❑ Gravel
O Bentonite Slurry
O Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3/8" PELLETS
20 LB
7g. Provide a brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
S. Ccrfificatio
09/30/16
Signature o tified Well Contractor or Well Ow4pF Date
00410 By signing this forn4 1 hereby certo that the tvell(s) was (mere) abandoned in
Parcel Identification No. (PIN) accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner. _
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one lottlong is sufficient) 9. Site diagram or additional well details:
350 29' 15.22" N 81 a 15' 20.42" w abandonYou ment use the back
Youtma ago attach e to additional de additional well site details or Weil
Y p>� necessary.
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(k) if ar atlahle. 1-or multiple tttjecttart or non -crater supply
wells ONLY with the sane construction abaudonmetn, ybu crnt submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a. Well IDN• IW-20-23 abandonment to the following:
6b. Total well depth: 50.0 (ft.)
6c. Borehole diameter: 1.5 (in.)
6d. Water level below ground surface: (ft.)
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center,.Raleigh, NC 27699-1636
10c. For Water Suanly & Iniection Wells: In addition to sending the form to
6e Outer casing length (if known): (f►- the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (FL)
Form GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable well canxtroction pcnuirs (.e. Cotmry, Stoic. irariance, etc.)
3. Well Use (checkwell use):
❑Agricultural
OGeothermal (Heating/Cooling Supply)
❑Industrial/Commercial
Supply Well:
13Aquifer Recharge
OAquifer Storage and Recovery
OAquifer Test
OExperimental Technology
OGeothermal (Closed Loop)
OGeothermal (HeatinpJCoolina
❑MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 08/24/16 Well ID# DPMW-1
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDN (ifappticable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one fattlong is sufficient)
350 29' 17.98" N 810 15' 24.76" W
6. Is (are) the well(s): OPermanent or @Temporary
7. is this a repair to an existing well: OYes or E]No
if dubs is a repair, fill out known well construction informadan and explain the nature of t/w
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: 1
Gar nn ldple injection or non-wotersupply wells ONLY with the sonic construction, you can
submh one jitrnn,
9. Total well depth below land surface: 45.0 (ft.)
Gar multiple wells list all tkpdns ifdierent (example- 3Q200' and 2@ too,)
10. Static water level below top of casing: 30.0 (ft.)
if water level is above casing, use "+"
11. Borehole diameter: 1.5 (in.)
DPT RODS
For Internal Use ONLY:
14. WATER ZONES
FROM To DESCRIPTION
ft.
ft.
Pr. ft.
15. OUTER CASING for multi-cused wens OR LINER tf a licable
FROM TO DIAMETER THICKNESS MATERIAL
ft, fL in.
16. INNER CASING OR TUBING eothermal closed -loon)
FROM TO DIAMETER THICKNESS MATERIAL
Ct. tL in.
ft, fL in.
17. SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
R. ft. in.
n. rt. in.
18. GROUT
FROM TO MATERIAL EMPLACEMENT METHOD &AMOUM17
0.0 It' 45.0 ft. P-L-Da"nowe SLURRY
ft. ft.
ft. ft.
19. SANDIGRAVEL PACK if a livable
FROM TO MATERIAL EMPLACEMENT METHOD
ft. ft.
ft. ft.
20. DRILLING LOG attach additional sheets if necessa
FROM TO DESCRIPTION icotor, hardaevt, scilfroclitype. grain size, etc.
0.0 ft- 45.0 ft. DIRECT PUSH
H. ft.
ft. ft.
It. ft.
ft. ft.
ft. ft.
R. ft.
21. RF31ARKS
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22. Certification:
A"'r 09/30/16
Signature ofCertifred Well Contractor Dale
By signing this farm, 7 hereby ceri jy that ilia well(s) nos (were) constructed in accordance
widt iSA NCAC 02C.0100 or 15A NCAC 02C, 02001Yell Construction Standards and that a
copy ofilds record hos been provided in die troll corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCfIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following .
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13n. Yield (gpm) Method of test. 24c. For Water Supply & Iniection Welts: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name (or well owner personally abandoning well an his/her property)
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable irell consinicUan pernllls (.e. Cauno, State. Variance, eta) ifknau'n
3. Well use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑irri ion
Non -Water Supply Well:
❑Monitorine ❑Recnvary
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
OGroundwater Remediation
❑salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 08/26/16
Sa. Well location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latilong is sufficient)
350 29' 17.98" N 810 15' 24.76" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(t) (f orailable. Far multlpie injection or non -water supply
wells ONLY with the same canstructiomabordanment, you cat subntli one fort.
6a.Well ID#: IW-6-1 q CQ)
Zkv—?_c --,,►, 2- C0"i, J
6b. Total well depth: 46.0 (ft.)
I w-zE-2-1 "ya-h ze. e„w.„j
IOV —2.4 2_6c. Borehole diameter: 1.5 (in.)
LtV - 24. 6d. Water level below ground surface: (ft)
YIP,
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple Infection or non-tmter supply wells 01MY with the .same
conslruellowaba+tionnwnt, you can submit one fort.
7b. Approximate volume of water remaining in well(s): 0-2 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout 0 Bentonite Chips or Pellets
❑ Sand Cement Grout ❑ Dry Clay
❑ Concrete Grout ❑ Drill Cuttings
❑ Specialty Grout ❑ Gravel
❑ Bentonite Slurry ❑ Other (explain under 7g)
7E For each material selected above, provide amount of mnterials used:
3/8" PELLETS 20 LB
7g. Provide R brief description of the abandonment procedure:
POUR PELLETS IN OPEN BOREHOLE TO GROUND
SURFACE/HYDRATE WITH TAP WATER
8. Certification _
A_11�
09130/16
Signature ofCertifred We16Connactor or Well Owner Date
By signing rhis form, I hereby certo that lire well(s) was (were) abandoned in
accordance with 1 SA NCAC 0 2C .0100 or 2C . 0200 Well Construction Standards
and that a copy of ills record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
TW 2� `Sf4O er S ysing le th (if known): (ft) 10c. For Water Supply & Iniection Wells: In addition to sending the form to
y ('( 1 a ra ZI 2 31
the address(es) above, also submit one copy of this form within 30 days of
J Icompletion of well abandonment to the county health department of the county
6E Inner casingltubing length (if known): (ft.
where abandoned.
6g. Screen length (if known): (ft.)
Fonn G W-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL CONSTRUCTION RECORD
This Corm can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable well construction permits (.e. Count),, State, Variance, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Ind ustrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
OGroundwater Remedial ion
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 1
4. Date Well(s) Completed: 09/16/16 Well 1D# IW-27-24
Su. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility 1DN (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees
(if well field, one lat/long is sufficient)
35a 29' 16.26" N 810 15' 27.02"
6. Is (are) the well(s): OPermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or ElNo
/fthis is a repair, fill are known well construction iufarntahan and explain tire nature ofthe
repair under 921 remarks section or on the back of this jornr.
8. Number of welts constructed: 1
For multiple ayecriun or non -water supply wells ONl Y with the same crmstruction, you can
submit ore foray.
9. Total well depth below land surface: 43.0
Far ntuitiple ,cells list all depths lfdoerent (example. 3Q200' and 2(a3100')
10. Static water level below top of casing: 25.0
If water level is above cashes use "+"
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY:
14. WATER
ZONES
FROM
TO
I DESCRIPTION
ft,
ft.
ft.
ft.
15. OUTER CASING for
multi eased wells OR
LINER if o
Ilcable)
FROM
TO
DIAMETER
TNICKNFS9
MATERIAL
ft.
I R.
I in.
16. INNER
CASING OR TUBING(geothermal
dosed -loon)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft.
23.0 it-
0.75 i- I
SCH 40
PVC
ft.
ft
in.
17. SCREEN
FROM
TO
DAMETER
SLOT SIZE
THICKNESS
MATERIAL
23.0 rr.
43.0 ft.
0.75 '-
.010
SCH 40
PVC
ft. I
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENTMETHOD&AMOUNT
0.0 It.
18.0 It,
vomuuoasrnorars
SLURRY
ft.
ft.
ft,
ft.
19.SAND/GRAVEL PACK
Jil'applicablel
FROM
TO
MATERIAL
EMPLACEMENT METHOD
21.0 rt.
43.0 rt•
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING
LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, hardness, saillroclitype, train Sim, etc.
0.0 rr,
43.0 ft-
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
fL
tt.
fL
21. REMARKS
BENTONITE SEAL FROM 18.0 TO 21.0 FEET
22. Certification:
09/30/16
Signature of Certified Well Contractor Date
By signing this form, I hereby certify that rite wells) srox (were) constructed in accordance
Wilt 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that u
copy ofthis recard has been provided to the well ou-aer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells, In addition to sending the form to the address in 24n
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013
27P - 12

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable well construction pernits fl.e. Count, State, Narimrce, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑lndustrial/Commercial
Non -Water
❑Aquifer Recharge
.❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
©Groundwater Remedistion
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 1
4. Date Wel(s) Completed: 09/16/16 Well 1D# IW-27-22
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LINCOLN
Facility ID# (ifopplicable)
LINCOLNTON 28092
00631
County Parcel Identification No. (PIN)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
IS. OUTER CASING for
multi -eased wells OR
LINER if a
licable
FROM
TO
DIAMETER
71HCI:NESS
MATERIAL
ft.
I
16. INNER CASING OR TUBING eothermol dosed -loop)
FROM
I TO
I DIAMETER I
THICKNESS
MATERIAL
0.0 ft'
20.0 fr•
0.75 "
SCH 40
PVC
ft.
I ft.
in
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
20.0 ft.
30.0 "'
0.75 In'
.010
SCH 40
PVC
ft.
t
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
0.0 ft.
15.0 R'
cearwmarurovae
SLURRY
ft,
ft.
ft,
ft.
19. SANDIGRAVEL
PACK iris licable
FROM
TO
MATERIAL I
EMPLACEMENTMETHOD
18.0 R'
30.0 H-
20-40
FINE SILICA SAND
ft,
ft.
20. DRILLING
LOG attach additional sheets if necesaa
FROM
TO
DESCRIPTION Italtur, hardness solUmck rain size. etc.
0.0 ft-
30.0 fL
DIRECT PUSH
R.
R.
R.
R.
ft.
R.
R.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL FROM 15.0 TO 18.0 FEET
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certification:
(if well field one Iotllong is sufficient)
35e 29' 16.44" N 810 15' 27.10" , :11rL1.1 � ?" 09/30/16
Signature of Certified Well Contractor Dale
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or E]No
lfilus is a repair, Jill out knoust well construction iglbrmation and explain the nature of ire
repair under #21 rentorks section or on the back of this form.
8. Number of wells constructed: 1
For multiple igiec tiwt or uou-crater supply wells ONL I' frith the same construction, you can
submit one form.
9. Total well depth below land surface: 30.0 (ft.)
Far in ntltiple rreUs list aft deptlu ifdtTerent (exonnple-1 a 200' and 2Q1001
10. Static water level below top of casing: 25.0 (ft.)
lfurater level is above casing, vise "+"
11. Borehole diameter: 3.25 (in.)
DDT RODS
gy signing this fount. 1 hereby certify that the iretl(v) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15.4 NCAC 02C .0200 Well Construction Standards and itat a
copy aft/us record has been provided to the well turner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quulity, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test, lac. For Water Supply & Iniection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Farm GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013
27P - 11

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2, well Construction Permit#: W10300295 (UIC)
List all applicable well construction permits Q.e, County, State, Variance, etc.)
3. Well Use (check well use):
OAgricultural OMunicipal/Public
OGeothermal (Heating/Cooting Supply) ❑Residential Water Supply (single)
OindusiriatlCommercial ❑Residential Water Supply (shared)
Water Supply
OAquifer Recharge
oGroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal(Closed Loop)
❑Tracer
❑Genthermal (Heatint?1Coolin2 Return)
❑Other texolain under 921 F
4. Date Well(s) Completed: 09/16/16 Well ID# IW-27-20
5a. Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
NONCD0001154
Facility ID# (ifapplicable)
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latliong is sufficient)
350 29' 16.40" N 810 15' 27.10" W
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: OYes or ONO
if this Is a repair, fill ran knoirn well coils tructlmr information and explain the nature of the
repair under 921 remarks sectlatt or an rite back of this form.
S. Number of wells constructed: 1
For multiple hgection or nun•u•ater supply hells ONLY with the some construction, cart can
submit o e form.
9. Total well depth below land surface: 32.0 (ft.)
Fur multiple wells list all depths ifdierent (example- 3@t 2W' will 2Q100')
10. Static water level below top of casing: 25.0 (ft.)
Ifiealer level is above casing, use "+"
11, Borehole diameter: 3.25 (in.)
DPT RODS
For Internal Use ONLY;
14, WATER ZONES
FROM TO I DESCRIPTION
fr. ft.
35. OUTER CASING for Tula taxed wells OR LINER if a tieable
FROM TO DtMETER THICtNESS MATERIAL
R. ft. in.
16. INNER CASING OR TUBING eothermal closed -loop)
FROM TO DIAMETER THICKNESS MATERIAL
0.0 ft 17.0 f' 0.75 In' SCH 40 PVC
ft. R. in.
17. SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
17.0 ft, 32.0 fL 0.75 in. .010 SCH 40 PVC
ft. ft, in.
19, GROUT
FROM TO MATERIAL EMPLACEMENT METHOD& AMOUNT
0.0 f" 12.0 ft' posnmoon"c as SLURRY
ft ft.
ft. ft.
19. SANDIGRAVEL PACK if applicable)
FROM TO MATERIAL I EMPLACEM&NTMETHOD
15.0 ft 32.0 f" 20-40 FINE SILICA SAND
ft. I n.
20. DRILLING LOG fattach additional sheets if necessary)
FROM TO DESCRIPTION color, hardness, soillmic type, grain size etc.
0.0 R• 32.0 ft. DIRECT PUSH
R. iL
ft. R.
ft. ft.
ft. R.
ft. R.
21. REhIARKS
BENTONITE SEAL FROM 12.0 TO 15.0 FEET
22. Certification:
."4"1,,-, 09/30/16
Signature ofCenifred Well Contractor Date
By signing this form. 1 hereby certify that the irell(s) was (were) constructed in accordance
with 1SA NCAC 01C.0100 or lSA NCAC 02C.0200 Well Cotrrtructian Standards and that a
copy of this record has been provided to the well oumer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: " 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply At Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department ofEnvironment and Natural Resources - Division of Water Quality
Revised Jan. 2013
27P - 10

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
list all applicable it -ell construction permits (l.e. County. State. Variance, etc.)
3. Well Usi (check well use):
❑Agricultural
OGeothermal (Henting/Cool ing Supply)
❑industrial/Commercial
Non -Water Supply
❑Aquifer Recharge
OAquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
- ❑Geothermal tHeatinalCooline
❑MunicipaUPublic
❑Residential Water Supply (single)
OResidential Water Supply (shared)
®Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
OTmcer
❑Other (explain under #21 I
4. Date Well(s) Completed: 09/13/16 Well 1D# I W-27-18
Su. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County
Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one Iaillong is sufficient.)
350 29' 15.59" N 810 15' 27.20" W
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or FINo
Y*rlds Is a repair, fill out kaoirti well construction h formation and explain tire namro of die
repair under 021 remarks .section or at the back of tlds form.
8. Number of wells constructed: 1
Far multiple injection or non -water supply wells ONLY with the same construction, you can
subnilt ate form.
9. Total well depth below land surface: 30.0
For inaltiple wells list sill depths Ifdt�erent (example- 3itt 200' aid 2Q100)
2
For Internal Use ONLY: _
14. WATER ZONES
FROM TO I DESCRIPTION
ft, rL
I5.OUTER CASING for multi cased wills OR LINER if a Ilcable
FROM TO DWMETEA THIC7:NE55 MATERIAL
16. INNER CASING OR TUBING eothermal closed -too
FROM TO DIAMETER I THICKNESS I MATERIAL
0.0 n• 20.0 fit• 0.75 in SCH 40 PVC
ft. ft. in.
17. SCREEN
FROM TO DIAMETER SLOTSIZE T1i1CKNESS MATERIAL
20.0 fir 30.0 Ir• 0.75 in 1 .010 SCH 40 PVC
ft. ft. in.
18. GROUT
FROM TO MATERIAL EMPLAMIENTMETHOD&AMOUNT
0.0 It 15.0 ft. Pcism nsaswro ma SLURRY
ft, ft.
ft. ft.
19. SANDIGRAVEL PACK ifs licable
FROM I TO I MATERIAL EMPLACEMENTItIErHOD
18.0 ft- 30.0 ft. 20-40 FINE SILICA SAND
ft. ft.
20. DRILLING LOG attach additional sheets if nerema
FROM TO DESCRIPTION (tutor, lisurdoess, witlrvek type, Xrda sine etc.
0.0 H- 30.0 ft. DIRECT PUSH
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft
ft. ft.
21. REMARKS
BENTONITE SEAL FROM 15.0 TO 18.0 FEET
22. CertificatV i�'v `�`^"'
r 09I30116
Signature of Certified Well Contractor Date
By sibviing this form. l hereby centf that rite well(s) it -as (were) constructed in accordance
with ISA NCAC 02C.0100 or 15A NCAC 02C .0200 Mell Construction S7aalards and that a
copy oftiris retard Itas been provided in die well artier.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10. Static water level below top of casing: 5'0 Division of Water Quality, Information Processing Unit,
If,rater level Is abort! caring, use "t •• 1617 flail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 3.25 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: !n addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013
27P - 9

WELL CONSTRUCTION RECORD
This Corm can be used for single or multiple wells
1. Well Contractor information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List a0 applicable well construction pernrlts p, e. Count}; State, Ifariance, etc.)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (HeatinglCooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Supply Well:
❑Aquifer Recharge
glGroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity, Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
- ❑Tracer
❑Geothermal (Heatin Coolin Return)
❑Other (explain under #21 Remarks
09/13/16
IW-27-16
4. Date Well(s) Completed:
Well ID#
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN ✓ 00631
County Parcel Identification No. (PIN)
5b, Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one latllong is sufficient)
350 29' 15.51" N 810 15' 27.44" W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or 53No
ifthis Is a repair, fill out known well construction information and explain the nature of the
repair ender 421 reworks section or as the back of this form.
S. Number of wells constructed: 1
ror nnitiple injection ar non -water supply walls ONI,Y with the saute construction. )bu can
subtuit one forat.
9. Total well depth below land surface: 33.0 (ft.)
(or multiple welis list all depths ifdyerent (example- 3 n 200' and 2@100')
10. Static water level below top of casing, 25.0 (ft.)
if water love! is above casing, use "+"
11. Borehole diameter: 3.25 (in.)
DPT RODS
For internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
R. It.
ft. ft.
IS. OUTER CASING for multt-cased welts OR LINER If up
licable
FROM TO DIAMETER THICGIVFS5 MATERIAL
ft. R, I in.
16. INNER CASING ORTUBiNG(geothermal closed-loo
FROM TO I DIAMETER I THICKNESS I MATERIAL
0.0 ft, 23.0 ft' 0.75 i° SCH 40 PVC
ft. ft. In
17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
23.0 fl' 33.0 ft. 0.75 '" .010 SCH 40 PVC
ft. tt. in
i9. CROLrr
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
0.0 R' 18.0 IL vommnatxmtme SLURRY
ft. ft.
ft. ft,
19. SANDIGRAVEL PACK if d licable
FROM TO 1. MATERIAL I EMPLACEMEtYI'AtE7'1I D
21.0 fc• 33.0 fL 2040 FINE SILICA SAND
tt. rc.
20. DRILLING LOG attncb additional streets if necessary)
FROM I TO DESCRIPTION Icolor, hardness, s sithock type, grain size, etc.
0.0 ft 33.0 fr- DIRECT PUSH
R. ft.
fL ft.
R. R.
fL ft.
R. ft.
ft. rt.
21. REMARKS
BENTONITE SEAL FROM 18.0 TO 21.0 FEET
22. Certif t lion:
-ram- 09/30/16
Signature o€Certified Well Contractor Date
H3• sibwing this Jarar, i hereby certifJ, drat the well(T) wac (were) constructed in accordance
with ISA NCAC 02C.0100 or 15A NCAC 02C.0200 well Construction Standards and that a
copy r f this record has been provided to the well atvner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NS'TUCTIONS
24a. For All Wells: Submit this form Within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rosary, cable, direct push, etc.)
Division ofWater Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form OW -I North Carolina Department of Environment and Natural Resources - Division of Water Quality
Revised Jan 2013
27P - 8

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit ft: W10300295 (UIC)
List all applicable urll construction pernats (i.e. County. State, Variance, etc.)
3. Well Use (check well use):
❑Agricultural
OGeothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
DAquifer Recharge
OAquifer Storage and Recovery
DAquifer Test
OExperimental Technology
❑Geothermal (Closed Loop)
OMunicipal/Public
DResidential Water Supply (single)
DResidential Water Supply (shared)
10,
OGroundwater Remediation
DSalinity Barrier
DStormwater Drainage
OSubsidence Control
DTracer
DOther (explain under #21 l
4. Date Well(s) Completed: 09/13/16 Well 1D# IW-27-14
Sa, Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LINCOLN
County
NONCD0001154
Facility ID# (ifnpplicable)
LINCOLNTON 28092
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one laillong is sufficient)
35e 29' 15.86" N 810 15' 27.80" W
6. is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: DYes or EINo
tFthis is a repair, fell out known ire/1 construction b1lbratation and explain the nature of the
repair touter 021 remarks section or our the back ofiltis form.
a. Number of wells constructed: 1
Far nndtiple h jection or non•water.supplt, wells ONLY with tire some constrac&m, you can
submit one form.
9. Total well depth below land surface: 20.0 (ft.)
For mnhiple wells list all depths !f thereat (example- J©200' and 2©1001)
10. Static water level below top of casing: 15.0 (ft )
If water level is above cosbrg, use "+"
IL Borehole diameter: 3.25 ' (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use ONLY;
14. WATER ZONES
FROM TOI DESCRIPTION
ft. fL
15. OUTERCASING for multi -cased welts OLINER if a licable
FROM TO DIAMETER TRHICKNESS AfATER1AL
ft. ft. in.
16. INNER CASING OR TUBING eothermat closed -loon)
FROM TO DIAMETER I THICKNESS I MATERIAL
0.0 ft' 15.0 fL 0.75 i" I SCH 40 PVC
m I ft. in.
17. SCREEN
FROM TO DIAMETER I SLOT SIZE THICKNESS MATERML
15.0 ft. 20.0 "' 0.75 r" 1 .010 SCH 40 PVC
ft. ft. In.
18. GROUT
FROM TO MATERIAL EMPLACEMENT MEI'HOD&AMOUNT
0.0 ft. 10.0 ft. rourwmaunateua SLURRY
ft. fL
ft. ft.
19.SAND/GRAVELPAC I{ urn licable
FROM TO MATERIAL I EDiPLACEMENT1%IET1OD
13.0 (t' 20.0 fL 20-40 FINE SILICA SAND
It. ft.
20. DRILLING LOG attach additional sheets if neceseu
FROM I TO DESCRIPTION ttalor, hardness, saltlrock type, grain sizeetc.
0.0 ft- 20.0 fi- DIRECT PUSH
ft. ft.
ft. ft.
ft. ft.
ft. rt.
ft. fL
ft. a.
21. REMARKS
BENTONITE SEAL FROM 10.0 TO 13.0 FEET
22. Certifi 'on:
r 09/30/16
Signature of Certified Well Contractor Date
By signing this form, I Itereby certify that the ❑ ell (s) was (sren.) constructed in accordance
Will 15A NCAC 02C .0100 or 1SA NC4C 02C .0200 {Veil Construction Standards and that a
copy ofthis record has been provided to the troll owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
On. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: in addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-t North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan 2013
27P-7

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit H: W10300295 (UIC)
List all applicable well construction pertails (l.e. Cowuy. State, Variance, etc.)
3. Well Use (check well use):
OAgricultural
OGeothermal (Heating/Cooling Supply)
❑industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal(Closed Loop)
❑Geothermal (Heating/Cooling
❑MunicipaUPublic
OResidential Water Supply (single)
OResidential Water Supply (shared)
tf7Groundwater Remedial ion
❑Salinity Barrier
OStormwater Drainage
OSubsidence Control
OTmcer
under421
4. Date Well(s) Completed: 09/16/16 Well 1D# IW-27-12
5a, Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IOk (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one la01ong is sufficient)
350 29' 15.62" N 810 15' 28.02" W
6. Is (are) the well(s): ©Permanent or OTemporary
7. Is this a repair to an existing well: OYes or EINo
Ifrhis is a repair, fill out known well carstruction information and explain the narurc ofthe
repair tarder 921 remarks xecriar or nn the back- of this foray.
8. Number of wells constructed: 1
For multiple infecNat or non -crater supply wells ONLY with die saute construction, )err can
submh ane farm.
9. Total well depth below land surface: 28.0 (ft.)
For nwhiple wells list all depths if'dii erent (example- 3@7000' and IC100')
10. Static water level below top of casing: 25.0 (ft.)
If water krcl is abore casing, use "+"
11. Borehole diameter: 3.25 (in.)
DPT RODS
For Internal Use ONLY:
14. WATER
ZONES
FROM
I TO
I DESCRIPTION
ft.
ft.
ft.
ft.
15.OUTER CASING for
molti•cased wells OR
LINER if a livable
FROM
TO
DIAMETER
THICt:NES5
MATERIAL
ft.
fit.
in.
16. INNER CASING OR
TUBING(geothermal
closed-looral
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 tt.
18.0 fit
0.75 is
SCH 40
PVC
ft,
I ft.
in.
17. SCREEN
FROM
TO I
DIAMETER
I SLOT SIZE
I THICKNESS
I MATERIAL
18.0 fit.
28.0 fit•
0.75 "
.010
SCH 40
PVC
ft.
ft.
in.
IS, GROUT
FROM
TO
MATERIAL
EMPLACEM ENT METHOD& AMOUNT
0.0 fit•
13.0 it•
PORnAtMDEMMOE
SLURRY
ft,
ft.
ft.
ft.
.19. SANDIGRAVEL
PACK
if a livable
FROM
I TO
I MATERIAL I
EMPLACEMENT METHOD
16.0 fit'
28.0 n
2040
FINE SILICA SAND
ft.
20. DRILLING
LOG attach additional sheets if necessary)
FROM .
TO
DESCRIPTION rotor, hardness, sailirock 'n size, etc.
0.0 fit•
28.0 ft-
DIRECT PUSH
ft.
ft.
«.
ft.
ft.
R.
ft.
ft.
ft.
ft.
ft.
ft.
21. RE51ARKS
BENTONITE SEAL FROM 13.0 TO 16.0 FEET
22. Certif lion:
;���•v�.w.yrr
09/30/16
Signature ofCertified Well Contractor
Date
By signing this form, 1 hereby cerilf' that tire u•ell(s) was (went constructed in accordance
with 15A NCAC 02C.0100 or ISA NCAC 01C.0100 tVell Construction Standards and drat a
copy ofthis record loss been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. ouger, rotary, cable, direct pusli, etc.)
Division of Water Quality, Underground Injection Contra! Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c, For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment rind Natural Resources- Division of Water Quality Revised Jan. 2013
27P - 6

WELL CONSTRUCTION RECORD
This form clip be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
list all applicable we0 consrrucrion permits (i.e. Coun(K Stare, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
OGeothermal (Heating/Cooling Supply)
❑ industrial/Commercial
❑ (rrigal ion
Non -Water SDDDIV Well:
❑Aquifer Recharge
OAquiter Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermat(Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single) .
❑Residential Water Supply (shared)
OGroundwaler Remediation
OSalinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
OOther (explain under #21 F
4. Date Well(s) Completed: 09/16/16 Well 1D# IW-27-10
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility IDN (ifnpplicable)
129 LEGiONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:'
(if well field, one latttong is sufficient)
350 29' 15.85r' N 810 15' 28.40" W
6. Is (are) the welt(s): OPermanent or OTemporary
7. Is this a repair to an existing well: Oyes or EINo
Ifthis is a repair. fill out knorcn irell construction hrforatatiorr and explain the mature of the
repair under 921 rentarkr .section or or the back of thisform.
S. Number of wells constructed- 1
Fier nnrhrple hyectiot or non-n•ater supply irelrs ONLY with the same construction, You can
.submit ane form.
9. Total well depth below land surface: 25.0
Far nadtipte wells list all depths ilrdifj¢rent (uraniple- 3Q200' and IQI00 I
10. Static water level below top of casing: 15.0 (ft.)
If water level is above casing, use "+"
11. Borehole. din meter: 3.25 -(in.)
DPT RODS
For Internal Use ONLY:
14. WATER ZONES
FROM TO I DESCRIPTION
fr. re.
I& OUTER CASING for multi cased wells OR LINER if a It -bit
FROM TO DIAMETER THICKNESS MATERIAL
ft. I fL I in
16. INNER CASING OR TUBING(geothermal closed-Inoni
FROM TO DIAMETER THICKNESS MATERIAL
0.0 1r. 15.0 ft. 0.75 t" SCH 40 PVC
FL ft, in.
17. SCREEN
FROM TO I DtAa1ETER I sLOTSIZE I THICKNESS I MATERIAL
15.0 1t. 25.0 1r• 0.75 In- .010 SCH 40 PVC
ft. ft. in.
18. GROUT
FROM TO MATERIAL EMPLACEM ENT M EMOD Si AMOUNT
0.0 ft. 10.0 f• Pann.twaat7neWE SLURRY
ft. ft.
it. ft.
19. SAND/GRAVEL PACE{ if applicable)
FROM TO MATERIAL EMPLACEMFNTMETHOD
13.0 1" 25.0 1t• 20-40 FINE SILICA SAND
rt. ft.
20. DRILLING LOG attach additional sheets if necessa
FROM I TO DESCRIPTION color, hardn soil/mck type, groin siw, life.
0.0 ft. 25.0 fr. DIRECT PUSH
R. ft.
ft. ft.
fL ft.
ft. iL
ft. ft.
ft. rt.
21. REMARKS
BENTONiTE SEAL FROM 10.0 TO 13.0 FEET
22. Certification: .1j
1#'(,t/Wv{.cw 09/30/16
signature orcenified Well Contractor Date
Hy signing this form. I hereby certify that the ire//(k) ryas (were) constructer/ in accordance
with 1 SA NCAC 02C .0100 or /SA NCAC 02C . 0200 Well Construction Stmularrlr and that a
copy of rlas record har been provided to the ice// owner.
23. Site diagrnm or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control: Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013
` 4=01

WELL CONSTRUCTION RECORD
This form can be used for single or mulfipte wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit N. W10300295 (UIC)
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
OGeothermal (Heating/Cooling Supply)
❑ industrial/Commercial
Non -Water Supply
❑Aquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Healing/Cooling
❑Municipal/Public
❑Residential Waler Supply (single)
❑Residential Water Supply (shared)
00roundwaler Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
OTracer
4. Date Well(s) Completed: 09/16/16 Well ID# IW-27-8
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDN (ifapplicabie)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one latllang is sufficient)
350 29' 16.16" N 810 15' 28.84" W
6. Is (are) the well(s): @Permanent or OTemporary
7. is this a repair to an existing well: OYes or MNo
Ifthix is a repair, fit out knoren shell construction information and explain the nature ofthe
repair under N21 remarks section or on lire back of this fame.
8. Number of wells constructed: 1
For multiple it yreaun or nosh -seater supply wells ONLY with the same construction, you can
submit ate forth.
9. Total well depth below land surface: 22.0 (ft.)
Mor multiple wells list all depths iftli ferent (example- 3@2700' and 1Q1001
inn
10. Static water level below top of casing:
If crater level is above casing use
(ft.)
For Internal Use ONLY:
14. WATER
ZONES
FROM
rO
DESCRIPTION
ft.
ft.
ft.
rt.
15.OUTER CASING for multi -cased wells OR
LINER if a tieable
FROM
TO DIAMETER
THtC&NFSS
MATERIAL
ft.
ft. in
16. INNER
CASING OR TUBING eothermal
closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft'
12.0 tL
0.75 '"
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
12.0 ft.
22.0 tL
0.75 'TM
.010
SCH 40
PVC
ft.
ft.
in.
I S. GROUT
FROM
TO
MATERIAL
EMPLACEMENr METHOD&AMOUNT
0.0 ft'
7.0 fit-
PGMAlDBFNTaeTE
SLURRY
rt.
ft.
ft.
%
19. SANDIGRAVEL PACK
if a licoble
FROM
TO
MATERIAL
KMPIACEMEr1rrAIETHOD
10.0 it-
22.0 t`-
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING
LOG latt2ch additional sheets if necessa
FROM
TO
DESCRIPTION color, hardnen,soitracktype, rain size, fit.
0.0 ft,
22.0 n-
DIRECT PUSH
ft.
ft.
ft,
ft.
ft.
ft.
ft.
ft.
I'L
n.
%
ft.
21. REMARKS
BENTONITE SEAL FROM 7.0 TO 10.0 FEET
22. Certification:
-rr 09/30/16
Signature ofCertified Well Contractor Date
By signing this farm, I hereby certify that the srell(s) was (were) cotcstrhicted hi accordance
with ISA NCAC 02C.0100 or 1 SA NCAC 02C .0200 Mcl1 Cmtstruction Statulards and drat a
copy ofthis record has been provided to the shell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit This form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 3.25 (in.) 24b. For lniection- Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & lniection Wells: In addition to sending the form to
the address(es) above, also submil one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality
Revised )an. 2013
27P - 4

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contactor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
I W all applicable trell construction pernnits (.c. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
OI ndustrial/Commercial
Olrrigation
Non -Water Supply Well:
❑Monitoring.
❑Aquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
OExperimental Technology
OGcothermal(Closed Loop)
❑Geothermal (Heatinp/Cooline
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
L
®Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed; 09/19/16 Well ID# • IW-27-6
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one laviong is sufficient)
350 29' 15.51" N 81e 15' 29.36" w
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
U'tbis is a repair, Jill out la,otnt well construction infonnatht» and explain the nature of the
repair under r 2l renarks.rection or on the back ofthis faro.
8. Number of wells constructed: 1
For nwluple infection or non -crater supply welds ONLP with the same construction, you can
xuboH one fora
9. Total well depth below land surface: 36.0
For multiple welb list all deptlu !fd&rent (example- 3 « 00' and 2©1001)
10. Static water level below top of easing; 25.0 (ft.)
If waver level is above casing, use "+"
11. Borehole diameter: 3.25 (in.)
DPT RODS
For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
ft. fL
ft. ft.
15.OUTER CASING for multi -cased wells OR LINER if a licoble
FROM TO DIAMETER THICKNESS AfATER1AL
ft. ft, in
16. INNER CASING OR TUBING eothermal closed -loan)
FROM TO DIAMETER I THICKNESS I MATERIAL
0.0 ft. 21.0 ft 0.75 In SCH 40 PVC
ft. ft. In.
17. SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
21.0 It• 36.0 f'• 0.75 '" .010 SCH 40 PVC
. ft. ft. in.
IS. GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&A510UW
0.0 ft' 16.0 It' Paim.Aroammm SLURRY
ft. ft.
ft. ft.
19. SANDIGRA VEL PACK fif applicable)
FROM TO MATERIAL 1 EMPLACEMENT M MOD
19.0 ft 36.0 fL 20-40 FINE SILICA SAND
20. DRILLING LOG attach additional sheets if necessary)
FROM I TO DESCRIPTION color, hardnm suiltruck type, grainA etc.
0.0 ft- 36.0 ft- DIRECT PUSH
ft. D.
ft. ft.
ft. R.
ft. ft.
ft. ft.
ft. R.
21. REMARKS
BENTONITE SEAL FROM 16.0 TO 19.0 FEET
21 Certifrratioll't' A,"- 09/30/16.
Signature ofCertified Well Contractor Date
By signing this farm, I hereby certify that the irell(s) tras (were) coturructed in accordance
teeth LSA NCAC 02C.0100 or ISA NCAC 02C.0200 Meg Cotutrucdou Standards and that a
copy ofthis record has been provided to the urll corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form wilhin 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Contra! Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injeclion Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised tan. 2013
27P - 3

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295 (UIC)
List all applicable well construclion permits (i.e. CounO., State, irariance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
Olnduslrial/Commercial
Nan -Water Sunoly Well:
OAquifer Recharge
OAquifer Storage and Recovery
OAquifer Test
OExperimental Technology
❑Geothermal(Closed Loop)
OGeothermal (Heating(Cooling
❑Municipal/Public
OResidential Water Supply (single)
❑Residenlial Water Supply (shared)
OGroundwater Remedialion
OSalinity Barrier
❑Stormwnter Drainage
❑Subsidence Control
❑Tracer
under #21
4. Date Well(s) Completed: 09/19/16 Well ID# IW-27-3
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDM (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lotllong is sufficient)
350 29' 15.92" N 810 15' 29.58" W
6. Is (are) the well(s): OPermanent or OTemporary
?. is this u repair to an existing well: Oyes or i?INo
1f this lc a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: 1
Rar multiple injection or non -water supply wells ONLY with ilia sonic construction, yrou can
suboii orate form.
9. Total well depth below land surface: 30.0 (it.)
rnr ntdriple ieells list all depths ifdii ferenr (e ronrple- 3@200' and 2@100')
10. Static water level below top of ensing: 25.0 (ft.)
If water forel is abore casing, use "+"
11. Borehole diameter: 3.25 (in.)
DPT RODS
For Internal Use ONLY;
14. NYATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
it.
15.OUTER CASING for
multi -erred welts OR LINER if o licable
FROM
TO
DWMETER THtCKNFSS
MATERIAL
tt.
ft.
in.
16. INNER
CASING OR TUBING(geothermal
closed -loop)
FROM
I TO
I DIAMETER I
THICKNESS
MATERIAL
0.0
120.0 fr
0.75 In.
SCH 40
PVC
m
I ft.
in.
17,SCREEN
FROM I
TO I
UILMETER
I SLOT SIZE
I THICKNESS
I MATERIAL
R•
30.0 f'•
0.75 i"•
.010
SCH 40
PVC
n20.0
rf.
ft.
in.
18. GROUT
FROM
I TO
MATERIAL
EMPLACE.MERTMETHOD & AMOUNT
0.0 ft.
15.0 fa
SLURRY
ft.
ft.
ft.
ft.
19, SAND/GRAVEL PACK
if applicable)
FROM
TO
MATERIAL
EMPLACEMFNTMEiHOD
18.0 ft.
30.0 it•
20-40
FINE SILICA SAND
ft,
ft.
20. DRILLING
LOG lattach additional sheets ifnecessa
FROM
TO
DESCRIPTION color, hardness, solVrack type. train sim etc.
0.0 ft.
30.0 ft.
DIRECT PUSH
ft.
ft.
ft.
ft.
R.
ft.
ft.
ft.
fL
rt.
ft.
ft.
21. RENIARILS
BENTONiTE SEAL FROM 15.0 TO 18.0 FEET
22. Certification:
Signature ofCertifred Well Contractor
09130/16
Date
By signing rlrir ford, 1 hereby cerzyy that rite ire//(s) was (were) constructed in accordance
with I SA NC•AC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and drat a
copy ofdtis record has beeir proidded to the well nuvner.
23. Site diagram or additional well details:
You may use The back or this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Witter Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in.24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13s. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Waler Quality Revised Jan. 2013
27P - 2

S
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
For Internal Use ONLY:
14. WATER
ZONES
FROM
TO
I DESCRIPTION
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
ft.
fL
ft.
ft.
15.OUTER CASING for
multirased wells OR 41NER if a
lieabte
FROM
TO
DLNILTER
THtCt:NES5
MATERIAL
ft.
ft.
in.
Company Name
2. Well Construction Permit!/: W10300295 (UIC)
Lust all applicable irell construction permits (i.e. County. State, Ilarlattce etcJ
3. Well Use (check well use):
16. INNER
CASING OR
TUBING eothermal
closed -loon)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft'
25.0 ft'
0.75 In,
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
Water Supply Well:
❑Agricultural OMunicipal/Public
OGeothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Olrri lion
FROM
TO
DIAMETER
I SLOT SIZE
THICKNESS
MATERIAL
25.0 ft-
45.0 fL
0.75 in'
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
0.0
20.0 tL
°°an""°8Q"�'�
SLURRY
Non -Water Supply Well:
❑Monitoring ORecovery
ft.
ft.
Injection Well:
OAquifer Recharge WGroundwaler Remedia►ion
OAquifer Storage and Recovery OStdinity Barrier
OAquif4 Test ❑Stormwater Drainage
❑Experimental Technology OSubsidence Control
OGeothermal(Closed loop) ❑Tracer
OGeolhermal (Heatin Coolin Return) OOther (explain under #21 Remarks)
ft.
ft.
19. SANDIGRAVEL
PACti
if a livable
FROM
TO
I MATERIAL
EMPLACFMENTMETHOD
23,0 It-
45.0 f-
20-40
FINE SILICA SAND
it
20. DRILLING
LOG attach additional sheets if necessary)
FROM
I TO
DESCRIPTION(color. hardness, "ilfruck type, grata size. etc.
0.0 ft-
45.0 ft.
DIRECT PUSH
4. Date Well09/19/16 s) Completed: Well ID!/ IW-27-1
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (inapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
ft.
D.
ft.
ft.
ft
R
ft
n
ft.
it.
rt.
ft.
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one latllong is sufficient)
35 29 15.75 N 81" 15 30.00iW
21. REMARKS
BENTONITE SEAL FROM 20.0 TO 23.0 FEET
22. CertiRc n:
09/30/16
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or allo
Ijthis if a repair, Jill out known irel/ construction information and explain the nature of the
repair under 921 remarks section or on the back ojthiv form.
8. Number of wells constructed: 1
For multiple htjecrion ar mon•nater supply ire//s ONLY irith the xame construction, you can
submit one Jarnn.
9. Total well depth below land surface: 45.0 (ft )
For mulriple wells list all depda Ifdyerent (evample. 3©200' and 2C3a 100')
10. Static water level below top of casing: 25.0 (ft.)
if urtter level is abort caving, use "+"
11. Borehole diameter: 3.25 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Signature orcertifed Well Contractor Date
By signing this farm. 1 hereby certify that Uie well(s) azu (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 {Yell Construction Sramlards and that a
copy of ilAv record has been provided to the irell airner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or Weil
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan 2013
27P - 1

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295 (UIC)
List all applicable utif construction pernihs (i e. County, Stoic, Irarimhce. eta)
3. Well Use (check Avell use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
4. Date Well(s) Completed:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (exDlain under #21 F
09/12/16 WellID# IW-25-27
Ia. Well Location:
ROBERT BOSCH TOOL
FacilitylOwner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LINCOLN
County
NONCD0001154
Facility ID# (ifapplicable)
LINCOLNTON 28092
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iattlong is sufficient)
350 29' 10.40" N 810 15' 21.98" W
6. Is (are) the well(s): faPermanent or ❑Temporary
7. Is this u repair to on existing well: ❑Yes or ONo
If this Ls a repair, fill out known well construction iglbrinmion and explain the nature of the
mpair under #21 remarks section or on the back ofthis form.
8. Number of wells constructed: 1
For multiple injection or wan -water supply wells ONLY with dte same ennsrrudlon, you can
.submit one form,
9. Total well depth below land surface: 40.0 (ft.)
For multiple wells list all depths ifdffle rent (example- 3@200' and 2Qt 100)
10. Static water level below top of casing: 20.0
{/'water level is above casing, use -+"
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY:
14, WATER ZONES
FROM TO I DESCRIPTION
II, ft.
ft. ft.
15.OUTER CASING for multi -cased wells OR L1NER if a lieabte
FROM TO DIAMETER TIi1C1:NESS MATERIAL
D, ft, I in.
16. INNER CASING OR TUBING thermal closed4000l
FROM TO 1 DIAMETER THICKNESS MATERIAL
0.0 fL 25.0 fL 0.75 in' SCH 40 PVC
D, ft, in.
17. SCREEN
FROM TO I DIAMETER I SLOTSIZE I THICKNESS I MATERIAL
25.0 rL 40.0 ft' 0.75 'm 010 SCH 40 PVC
ft. ft, in.
18. GROUT
FROM TO. MATERIAL EMPLACEMENT METHOD& AMOUNT
0.0 ft, 20.0 R' aonnxmeenroma SLURRY
ft. ft.
ft. D.
19. SANDIGRAVEL PACK if applicable)
FROM TO MATERIAL I EMPLAC£MENrMETItOD
23.0 ft 40.0 "' 2040 FINE SILICA SAND
ft, ft.
20. DRILLING LOG attach additional sheets if neeessa
FROM TO DESCRIPTION color, hardaess saivroch type, gr2in sirs, etc.
0,0 ft- 40.0 fl- DIRECT PUSH
ft. ft.
ft. ft
ft. ft.
ft. ft.
ft. ft.
ft. ft.
21. REMARKS
BENTONITE SEAL FROM 20.0 TO 23.0 FEET
22 Certification:
09/30/16
Signature ofCertified Well Contractor Date
By sisning this form, I hereby eert6 that the well(s) was (were) constricted in accorrlanee
with MA NCAC 02C .0100 or ISA NCAC 02C .0200 IVell Construction Standards and roar a
copy ofthis record has been prorided to the well ouder.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 240
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
I3a. Yield (gpm) Method of test: 24c. For Water Suppiv & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. well Construction Permit#: WI0300295 (UIC)
List all applicable well construction permits (.e. Como,, State, Variance, etc.)
3. Well Use (check itvell use):
Water Supply Well:
OAgricultural
❑Geothermal (Heating/Cooling Supply)
O1ndustrial/Commercial
OAquifer Recharge
❑Aquifer Storage and Recovery
OAquiler Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
OSalinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 09112/16 Well ID# IW-25-25
5a. Well Location:
ROBERT BOSCH TOOL- NONCD0001154
Facility/Owner Name Facility I D# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degreeslminutes/seconds or decimal degrees:
(ifwcll field one lottlong is sufficient)
350 29' 10.90" N 810 15' 21.94" W
6. is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: OYes or EIN9
If this is a repair, fill our known well construction informotioa and explain lire mature of die
repair under k21 remarks section or air Cite back of this form,
8. Number of wells constructed: 1
Far urltiple injection or non -water supply yells ONLY frith rite same catistrucdon, lwu can
submit one form.
9. Total well depth below land surface: 25.0
Aor muhiple wells list all depdts ifdycrent (example- 3Q200' and 2@100)
10. Static water level below top of casing: 20.0 (ft.)
tf rrarer erel is above casing, rrse "+
11. Borehole diameter: 3.25
DDT RODS
For Internal Use ONLY:
14, WATER ZONES
FROM TO DESCRIPTION
fL ft.
ft. R.
15.0
CASING for mad I ed wells OR LINER if a Ueable
PROM To DIAMETER THICI:NFSS MATERIAL
R. fr. in
16. INNER CASING OR TUBING(geothermal closed -loon)
FROM TO DIAMETER I THICKNESSA MATERIAL
0.0 ft' 15.0 n 0.75 in SCH 40 PVC .
ft. R. in.
17. SCREEN
FROM I TO DIAMETER SLOTSIZE THICKNESS MATERIAL
15.0 ft, 25.0 ft, 0.75 in. .010 SCH 40 PVC
ft. ft. I.
18. GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
0.0 ft- 10•0 ft- POOLM0800mRE SLURRY
ft. ft.
ft. ft.
19. SAND/GRAVEL PACK fro licable
FROM TO MATERIAL I EMPLACEMENTMETHOD
13.0 rt. 25.0 fL 20-40 FFINE SILICA SAND
ft. ft,
20. DRILLING LOG attach additional sheets if necessa
FROM TO DESCRIPTION color, hardn sail/mck tW, gmin size, etc.
0.0 ft- 25.0 ft- DIRECT PUSH
ft. It.
ft. 1L
ft. Ft.
ft. rt.
ft. ft.
ft. ft.
21. REMARKS
BENTONITE SEAL FROM 10.0 TO.13.0 FEET
22 Certif at'
r , 09/30/16
Signature ofCenified Well Contractor Date
By signing Ibis form, I hereby cert fy that rile rrell(s) eras (were) constructer/ in accartlance
with 1 SA NCAC 01C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy ofthis record has been provided to the nvell rummer,
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Wuter Quality, Information Processing Unit,
1617 Nluil Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e auger, rotary, cable, direct push, etc )
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test' 24c. For Witter Supply & lniection Wells- In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-t North Carolina Department ofEnvitonmcnt and Natural Resources - Division of Water Quality Revised Jan, 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (LIIC)
List all applicable trail catisiructlon pernrtrs 0.e. CormV, State. Mariance, etc.)
3. Well Use (check well use).
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring ❑Recovery J
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
under #21
4. Date Well(s) Completed: 09/12/16 well ID# IW-25-23
Sa. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility ID0 (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latilong is sufficient)
35e 29' 10.97" N 810 15' 21.40" W
6. Is (are) the well(s): OPermanent or ❑Tempurary
7. Is this it repair to an existing well: ❑Yes or E INo
tf ibis Is a repair, fill an known +roll construction inforinationandexplain Cite nature of 1he
repair tntder 911 remarks section or on Ilia back of this form.
8. Number of wells constructed: 1
t ar natlllpte byecOun or non-iratersupply hells ONLY tridr lire same eonstructlnn, you can
sulintit one form.
9. Total well depth below land surface: 49.0
For multiple hells list a0 depths if'dgereta (example,- 3@200' and 1 rt l00)
For Internal Use ONLY(
14. WATER ZONES
FROM
TO
I DESCRIPTION
It.
ft.
ft.
ft.
15. OUTER CASING Lfar
multi -eased wens) OR LINER if a
8cable
FROM
TO
DIAMETER
THICKNESS
t13ATERIAL
-IL
ft.
in.
16. INNER CASING OR
TUBING(geothermal
closed -loon)
FROM
TO
DIAMETER
THICKNESS
ItiATERIAL
0.0 fL
29.0 fL
0.75
SCH 40
PVC
fL
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
29.0 re'
I
49.0 "'
0,75 In'
.010
SCH 40
_PVC
ft.
ft.
I.
I& GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 fe'
24.0 It"
romwmesuso"rtt
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACii
ira llcable
FROM
TO
MATERIAL
EMPLACEatENTMETHOD
27.0 ft'
49.0 ff
20-40
FiNE SILICA SAND
ft.
ft.
20, DRILLING
LOG tattoch
additional sheets if necessary)
FROM
I TO
DESCRIPTION color, hardness soilfrock type, train sire, etc.
0.0 ft.
49.0 ft.
DIRECT PUSH
R.
ft.
It.
I t.
ft.
ft.
re.
ft.
ft.
ft.
fr.
ft.
21. REAIARKS
BENTONiTE SEAL FROM 24.0 TO 27.0 FEET
22. CertiG a ion:
Al' -ram
09/34/16
Signature ofCertifted Well Contractor Date
Hy signing (iris form. l hereby certify that ilia irell(s) any (here) canrtructed it; accordance
with 13A NCAC 01C.0100 or 15A NCAC 01C.0200 Well Cotistrucrion Slandards and that a
copy ofthis record has been prorided to the weld owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10. Static water level below top of casing: 20.0 (ft.) Division of Water Quality, Information Processing Unit,
!f trater level is above casing, use "r" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter:_ 3.25 (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method ut test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form OW -I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295(UIC)
List all applicable ire# construction pernihs (t.e. County, State, lrariance, etc.)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
OGeothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑IndustriaYCommercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitorine nReenvpm
OAquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwnter Drainage
❑Experimental Technology
OSubsidence Control
❑Geothermal (Closed Loop)
OTracer
OGeothermal (Heatin Coolin Return)
OOther (explain under #21 Remarks)
4. Date Well(s) Completed: 09/12/16 Well ID# IW-25-21
.Su. Well Location:
ROBERT BOSCH TOOL
NONCD0001154
Facility/Owner Name
Facility IDN (if applicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latilong is sufficient)
35e 29' 10.95" N 810 15' 21.12" W
6. Is (are) the well(s): laPermanent or OTemporary
7. is this a repair to an existing well: OYes or ErINo
lfthis is a repair, fill out knoirn well construction in formation and explain the nature ofthe
repair wider 12l rennarks section or on the back of this farut.
S. Number of wells constructed: 1
For muhiple injection or non -water supply wells ONLY with the same construction, you can
submit one for"i.
9. Total well depth below Innd surface: 49.0 (ft.)
Far atwltiple wells list all deptics fdpereut (example- 3 ttl 00' and 2 t@100')
10. Static water level below top of casing: 20.0 (ft.)
If water level is abore caving, use "a "
11. Borehole diameter. 3.25 (in.)
DDT RODS
For Internal Use ONLY:
14. WATER ZONES
FROM TO IIESCR[VrION
ft. ft.
rt. n.
IS. OUTER CASING for ?qft cased wells OR LINER (ifup linable
FROM TO DIAMETER THICKNESS MATERIAL
a. rr In.
16. INNER CASING OR TUBING eothermal rinsed -loon)
FROM TO DIAMETER THICKNESS MATERIAL
0.0 rL 29.0 ft• 0.75 in SCH 40 PVC
ft. ft. in.
17. SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
29.0 a, 49.0 "- 0.75 In' .010 SCH 40 PVC
ft. ft. I.
I& GROUT
FROM TO MATERIAL EMPLACEMENTMETHOD&AMOUNT
0.0 ft. 24.0 rt. Ponn "ao"TE SLURRY
ft. ft.
ft. ft.
19.SAND/GRAVEL PACK(ifamilicablel
FROM TO MATERIAL I EMPLACEMENT METHOD
27.0 it' 49.0 rL 20-40 FINE SILICA SAND
It. ft.
20. DRILLING LOG attach additional sheep If necessary)
FROM I TO DESCRIPTION color, hardness, saillrocklM, grnin size, etc.
0.0 ft. 49.0 ft. DIRECT PUSH
ft. ft.
it. ft.
R. R.
rt. ft.
ft. ft.
ft. rt.
21. REMARKS
BENTONITE SEAL FROM 24.0 TO 27.0 FEET
22. Ce •afion:
r 09/30/16
Signature ofConified Well Contractor Dale
8)• signing this form, 1 hereby certify that the welly) tray (here) cattstructed in accordance
with ISA NCAC 02C .0100 or 1SA NCAC 02C .0200 Nell Corutrttction Standards and that a
cap)- afthls recard pas been provided to the well auger.
23, Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For ln(ection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc_)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
139. Yield (gpm) Method of lest: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b, Disinfection type: Amount completion of well construction to the county health department of the county
where constructed.
Form OW-1 I North Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORID
This form can be used for single or multiple welts
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: WI0300295(UIC)
List all applicable well camiruction pernrlls Ae. County. Stare, Yariame. etc.)
3. Well Use (check well use):
OAgricultural ❑Municipal/Public
OGeothermat (Heating/Cooling Supply) ❑Residential Water Supply (single)
Olndustrial/Commercial OResidential Water Supply (shared)
Non -Water Supply Well:
OMonitorinR ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
OGeothermal(Closed Loop)
OGeothermal (Heating/Coal ing Return)
OGroundwater Remediation
OSalinity Barrier
OStormwater Drainage
OSubsidence Control
OTracer
❑Other (explain under #21 Remarks)
09/12/16
IW-25-19
4. Date Well(s) Completed:
Well ID#
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LI NCOLN
00631
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
350 29' 11.15"
810 15' 20.80"
N
W
6. Is (are) the well(s): ©Permanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or ONo
jthis is a repair, fill out known swell construction a formation and explain fire nature of the
repair under 921 remarks section or at; the back afthis form.
8. Number of wells constructed: 1
Fur multiple hrjection or non -water supply irells ONL )' with the .same constraction, yos call
submit one form.
9. Total well depth below land surface: 49.0 (ft.)
Far nitiple wells list all depths if'd*rent (ev nrple- 3 rQ200' and 2 a 100')
10. Static water level below top at casing: 20.0 (ft.)
If water level is abore casing, use
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY;
14. WATER ZONES
FROM TO I DESCRIPTION
ft. ft.
R. R.
15. OUTER CASING far mu used wells OR LINER if a linable
FROM TO DIAMETER THICKNESS htATERLIL
ft. n. In
16. INNER CASING OR TUBING eothermal closed -too
FROM TO DIAMETER THICKNESS MATERIAL
0.0 f' 29.0 ft. 0.75 in. SCH 40 PVC
fL fl. in
17. SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
29.0 ft. 49.0 ft• 0.75 "' .010 SCH 40 PVC
ft. ft. in.
18. GROUT
FROM I TO MATERIAL - EMPLACEMENTMETHOD&AMOUNT
0.0 ft 24.0 ft' °a"'uaear"raWE SLURRY
ft. fL
ft. ft.
19. SANDIGRAVEL PACK it allilliC21110
FROM TO I MATERIAL I EMPLACEMENI'MMIOD
27.0 ft. 49.0 fr' 20-40 FINE SILICA SAND
ft. ft.
20. DRILLING LOG lattoch additional sheets if necessary)
FROM I TO DESCRIrTION color, hardn soillnek type, train size, etc.
0.0 ft. 49.0 ft. DIRECT PUSH
h. H.
tr, ft.
ft, ft.
ft. ft.
ft. ft.
21. REMARKS
BENTONITE SEAL FROM 24.0 TO 27.0 FEET
22. Certiff ion:
r 09/30/16
Signature of Certified We] I Contractor Date
By signing this form. 1 hereby cert fi, that lie re/l(s) was (u•en) cmnstrucied it) accordance
trhG 15A NCAC 02C .0100 or 15A NCAC 02C.0200 Well Catrstructian Siandards and rhar a
copy oftld c record has been provided to the "•ell owner.
23, Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699.1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Sunnly & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
FormOW-1 North Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: WI0300295(UIC)
IJst all applicable well consimcdon pennies (.a. County. State. Variance, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Com mercial
❑ Irrigation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
®Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (exolain under #21 F
4. Date Well(s) Completed: 09/12/16 Well ID# IW-25-17
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID#(ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
350 29' 10.92" N 810 15' 20.46" W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Y'es or 0No
Ifdtis Is a repair, fill out known trell canrtruction h jarnnation and explain the nature rifthe
repair under 921 remarks section or on the back ofthis fornn.
8. Number of wells constructed: 1
Far nraltlple it jertior or nnn-Crater supply +Tells (INI.Y uitb die same constructlan. iron can
submit ono jnnn.
9. Total well depth below land surface: 49.0 (ft.)
For ou riple !Tells list aR rleptler if different (erample- 3@200' and 2 a 100')
10. Static water level below top of casing: 20.0 (ft.)
Ifironerlevelisabove cossig, use "+-
11. Borehole diameter: 3.25 (in.)
DPT RODS
For Internal Use ONLY:
14. WATER ZONES
FROM TO I DESCRIPTION
ft. R.
ft. R.
15.OUTERCASING formulti-casedwells OR LINER Ha Geabla
FROM TO DIAMETER THICKNESS' MATERIAL
Ri I ft. in
I& INNER CASING OR TUBING(geothermal closed-looril
FROM TO DIAMETER I THICKNESS I MATERIAL
0.0 1" 29.0 rt. 0.75 in- SCH 40 PVC
fL I ft, in
17. SCREEN
FROM TO DIAMETER I SLOTSIZE I THICKNESS MATERIAL
29.0 R 49.0 "' 0.75 '" .010 SCH 40 PVC
ft. ft. in.
18. GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
0.0 rt' 24.0 fL raatw+oatnra- SLURRY
ft. ft.
ft. ft,
19. SAND/GRAVEL PACK if n licable
FROM TO MATERIAL EMPLACEMENTMETHOD
27.0 It. 49.0 rt• 20-40 FINE SILICA SAND
ft. R.
20, DRILLING LOG attach additional sheets if necessa
FROM TO DESCRIPTION color, hardness, soi0rnek type, grain size. etc.
0.0 R• 49.0 It. DIRECT PUSH
R. ft.
ft. ft.
ft. ft
ft. ft.
ft. R.
R. ft.
21. REMARKS
BENTONITE SEAL FROM 24.0 TO 27.0 FEET
22. Cer jfication:
09/30/16
Signature ofCertified Well Contractor Date
By signing this form, 1 Hereby cerrh, that the tretl(r) itas (were) constructed in accordance
u4tb 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
copy al'this record has been provided to ilia well oumer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24n. For All Wells: Submit this farm within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24n .
above, also submit a copy of this form within 30 days of completion of welt
12. Well construction method. construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised )an. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
L1st all applicable ,cell constructinn perntils (. e. County, Stare, Varimnce, ere.)
3. Well Use (check well use):
Water Supply Well:
OAgricultural
OGeothermat (Heating/Cooling Supply)
Olndustrial/Commercial
OAquifer Recharge
OAcluifer Storage and Recovery
❑Aquifer Test
OExperimental Technology
OGeothermal (Closed Loop)
❑Municipal/Public
OResidential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remedistion
OSalinity Barrier
OStormwater Drainage
❑Subsidence Control
OTracer
under #21
4. Date Well(s) Completed: 09/12/16 Well ID# I W-25-15
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees
(if well rreld, onedatilong is sufficient)
350 29' 11.01" N 81 a 15' 20.38"
6. Is (are) the well(s): OPermanent or OTemporary
W
7. Is this a repair to an existing well: Oyes or ©No
!f this is a repair, fill out knouvt well construction h farmation and explain the nature of the
repair under #21 renmrks section or or the back ofthisforni.
8. Number of wells constructed: 1
Par multiple injection or non -water supply wa/h ONLY with the some construction, you can
submit one faun.
9. Total well depth below land surface: 49.0 (ft.)
Purr multiple wells list all deptlts Y'dip rent (dromple- 3 rr 100' and 2Q1W)
10. Static water level below top of casing: 20.0 (ft.)
If hater level is above caring, use "+"
11. Borehole diameter: 3.25 (in.)
DPT RODS
For Internal Use ONLY:
14. WATER
ZONES
FROM
TO
DESCRIPTION
tt.
Ct.
fr.
tr.
15.OUTER CASING for multi casnl wefts OR LINER if a ticahle
FROM
TO
DIAMETER
THIChT1FS5 MATERIAL
ft.
ft,
I in.
16. INNER
CASING OR
TUBING(geothermal
closed -loan)
FROM
I TO
I DIAMETER I
THICKNESS
I MATERIAL
0.0 ft.
29.0 f'
0.75 I-
SCH 40
PVC
ft.
%
in.
17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
29.0 ft'
49.0 "'
0.75 1n'
.010
SCH 40
PVC
ft.
ft.
in.
Is. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METIIOD& AMOUNT
0.0 ft.
24.0 ft'
PoRnAraaFl"u""
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK
if applicable)
FROM
TO
MATERIAL I
EMPLACEMENTMETHOD
27.0 f"
49.0 1`
2040
FINE SILICA SAND
ft.
ft.
20. DRILLING
LOG attach
additional sheets irnecessa
FROM
TO
DESCRIPTION color, hardnem soll/mck type, grain size. etc.
0.0 fL
49.0 ft-
DIRECT PUSH
ft.
ft.
rt.
R.
ft.
ft,
ft.
ft.
n.
ft.
rt.
ft.
21. REDIARKS
BENTONITE SEAL FROM 24.0 TO 27.0 FEET
22. Certification:�i' J
��(j��(,(� -�r- 09/30l16
Signature of Certified Well Contractor Date
By signing this farm, l hereby certify that the irell(s) ,vas (mere) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and drat o
copy ofthiv retard Iran been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional weit site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCCIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground trajection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Ruleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Ian. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable well construction permits (i.e. County, State, Variance, etc.)
3. Well Use (check weft use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
OAquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geuthermal(Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
OSalinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other (explain under #21 1
4. Date Well(s) Completed: 09/07/16 Well ID# IW-25-13
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDN (if -applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
For Internal Use ONLY;
14. WATER
ZONES
FROM
TO
DESCRIPTION
rL
ft.
ft.
ft.
15.OUTER CASING for
multi -eased wells OR LINER if a Iicable
FROM
TO
DIAMETER THIC7:NfSS MATERIAL
D.
I
in.
16. INNER
CASING OR
TUBING eothermal
closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 It.
25.0 D•
0.75 "'
SCH 40
PVC
R.
ft.
In.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
25.0 I'
45.0 It.
0.75 irL
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
I TO
MATERIAL
EMPLACEMENTMETIIoD&AMOUNT
0.0 ft'
20.0 it.
P07rnAWWa0MSE
SLURRY
f.
ft.
ft.
ft.
19.SANDIGRAVELPAC 1{ 1'a licable
FROM
TO
MATERIAL
EMPLACEMENraIETIIOD
23.0 It'
45.0 D
20.40
FINE SILICA SAND
tt.
rt.
20. DRILLING
LOG attach additional sheets irnecessn
FROM
TO
DESCRIPTION color, hardness. sui0rack type, grain sietc.)
0.0 R,
45.0 ft.
DIRECT PUSH
R.
ft.
n.
rL
re,
ft.
fL
R.
ft.
ft.
21. REMARKS
BENTONITE SEAL FROM 20.0 TO 23.0 FEET
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certific lion:
(if well field, one Iatilong is sufficient)
350 29' 12.29" N 810
15' 23.74" W .Y
Signature of Certified Well Contractor
6. Is (are) the well(s): EDPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ErINo
If this is a repair, fill out known irell canstrucAon infarntation and explain the nature a) the
repair raider N21 remarks secttan or an the back of this form.
8. Number of wells constructed: 1
Tor multiple injection or iron -water supply wells ON[ Y irith the same construction, you can
submit are farm.
9. Total well depth below land surface: 45.0
For nuthiple irells list all depths if rltg rent (example- 3 200' and 1©100')
10. Static water level below top of casing: 20.0
Ifirater lerel Is abore caving, use "+"
11. Borehole diameter: 3.25 (in.)
DDT RODS
09/30/16
Date
By sighting this form, I hereby certify that the ire/l(s) was (irere) constructed in accordance
with 15A NCAC 01C .0100 or 1 SA NCAC 01C .0100 Well Corectruction Standards and tilt a
copy of this record hay been provided to the hell corner.
23. Site diagram or additional well details:
You may use the bnek of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Qualify, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount completion of well construction to the county health department of the county
where constructed.
form G W-I North Carolina Department of Envitonment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit N: WI0300295 (UIC)
list all applicable u•ed cacstrucrion permis (i.e. County, Srale. Variance, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑lndustrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring ❑Recovery i
❑Aquifer Recharge
DAquiter Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
®Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 921 Rt
4. Date Well(s) Completed: 09/07/16 Well IDN IW-25-11
5a. Well Locution:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
NONCD0001154
Facility ID# (irapplicnble)
LINCOLNTON 28092
Physical Address. City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
For Internal Use ONLY:
14. WATER
ZONES
FROM
TO
I DESCRIPTION
ft.
ft.
IS. OUTER CASING for multi cased wells)OR LINER ita licabte
FROM
TO DIAMETER THICI:NFSS
MATERIAL
ft,
ft. in.
16, INNER CASING OR
TUBING eothermal
closed -loon)
FROM
TO
DIAMETER I
THICKNESS
I MATERML
0.0 R.
25.0 ft.
0.75 1"
SCH 40
PVC
R.
ft.
in.
17, SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
25.0 ft-
45.0 fL
0.75 '"'
.010
SCH 40
PVC
R.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
0.0 it.
20.0 fL
voRnrmos""c" rs
SLURRY
ft.
ft.
ft,
R.
19. SANDIGRAVEL PACK:
if applicable)
FROM
TO
MATERIAL 1
EMPLACEMENT{NETHOD
23.0 f"
45.0 ft-
2040
FINE SILICA SAND
R.
ft.
20. DRILLING
LOG attach
additional abeets ifnecessary)
FROM
TO
DESCRIPTION (color, hardness, soiltmek type. gmin sire, etc.
0.0 ft.
45.0 R.
DIRECT PUSH
R.
ft.
R.
It.
R.
R.
ft.
ft.
ft.
ft.
R.
ft.
21. REMARKS
BENTONITE SEAL FROM 20.0 TO 23.0 FEET
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certification
(if well field, one ladlong is sufficient) 35e 29' 12.22" N81° 15'23.46" WA"'�09/30/16
Signature ofCertified Well Contractor Date
'6. Is (are) thewell(s): OPermaaent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ElNo
Ijthis is a repair, fill nor knnun well constntctiwt inforntarion and expfairr the noture aJ7lte
repair under 421 remarks section or on the back oJ'this Juan.
8. Number of wells constructed: 1
Fin ntnhiple h fec/ion or trot -ureter supply wells ONLY with rite some construction• you can
submit oneJarnt.
9. Total well depth below land surface: 45.0 (ft.)
For nudhiple ire/ls list all depths ifdiifferent (example. 3 « 200' and 2QIW)
10. Static water level below top of casing: 20.0 (fL)
ljn•aer level is above casing, use "+ ••
11. Borehole diameter: 3.25 (in.)
DPT RODS
By signing this forut. I hereby certify that rite well(s) was (were) constnrcred in accordance
with 1 SA NCAC 02C.0100 or I9A NCAC 02C_ 0200 Well Construction Standards and that a
copy ofilds record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24,1
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13u. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List oft applicable well construction pernilis (r.e_ County, State, variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commerc iai
Non -Water Supply Well:
❑Aquifer Recharge
OAquit'er Storage and Recovery
OAquifer Test
❑Experimental Technology
OGeothermal(Closed Loop)
❑Geothermal (HeatinpJCoolinix
4. Date Well(s) Completed:
❑MunicipallPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
©Groundwater Remediation
OSalinity Barrier
❑Stormwater Drainage
OSubsidence Control
OTracer
❑Other (explain under #21 Rer
09/07/16 Well1D# IW-25-9
Su, Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facilitylowner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28002
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one latllong is sufficient)
35e 29' 12.25" N 810 15' 23.12" W
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to on existing well:. ❑Yes or CJNo
lfthis is a repair, fill out known well cocsinrction information and explain the nature of the
repair 'order #21 remarks section or on lire back of this faun.
8. Number of wells constructed., 1
For mrthiple injection or non -water supply wells ONLY with the same construction, Jron call
subunit one form.
9. Total well depth below land surface: 38.0 (ft.)
For multiple tvells list all depths ifdVerenr (example- 3 t©200' and 2@100')
20 0
For Internal Use ONLi':
14. WATER ZONES
FROM I DESCRIPTION
ft. rt.
It. rt.
15.OUTER CASING for multi cased wells OR LINER if a Iieable
FROM TO DIAMETER T7rIC1.NFSS afATEAIAL
rt. ft. I in
16. INNER CASING OR TUBING Ize9thermal elosed400
FROM I TO I DIAMETER THICKNESS MATERIAL
0.0 ". 23.0 ft- 1 0.75 in' SCH 40 PVC
ft. ft. in.
17.SCREEN
FROM TO I DIAMETER I SLOTSIZE I THICKNESS I MATERIAL
23.0 f 38.0 1- 0.75 i" A10 SCH 40 PVC
ft. ft. in.
IS. GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
0.0 D• 18.0 ft POaTLVlaaE"TM E SLURRY
ft. ft.
ft. ft.
19. SANDIGRAVEL PACK if a licable
FROM TO MATERIAL I ETIPLACEMENTMETHOD
21.0 rt 38.0 f6 20-40----r FINE SILICA SAND
ft. rt.
20. DRILLING LOG atmeh additional sheets if necessa
FROM TO DESCRIPTION color, hardness, nalrack t ruin siu. etc.
0.0 ft. 38.0 ft- DIRECT PUSH
ft. ft.
ft. R.-
ft, ft.
% ft.
ft. ft.
ft. ft.
21. REMARKS
BENTONITE SEAL FROM 18.0 TO 21.0 FEET
22. Certification; k..=-
#"'v+�l 09/30/16
Signature ofCertified Well Contractor Date
By signing this farm, I Lerchy cerih, that the rreq(s) ens (mere) co viructed in accordance
wirb 1 SA NCAC 02C . 0100 or 1 SA NCAC 02C .0200 Nell Construction Standards and that a
copy afthis recordhas been provided to the well oo-ner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10. Static water level below top of casing: (ft-) Division of Water Quality, information Processing Unit,
1f unterkt,cl is ahm'e casing, use "+- 1617 Mail Service Center, Raleigh, NC 27699-1617
1. Borehole diameter: 3.25 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. field (gpm) Method of test: 24c. For Water Supply & Iniection Wells: III addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of.Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295(UIC)
List all applicable tell construction permits (,e. Cou ly, Slate, Yarimtce, etc)
3. Well Use (check well use):
OAgricultural
OGeothermal (Heating/Cooling Supply)
OindustriaVCommercial
❑irrigation
Non -Water Supply Well:
OAquit'er Recharge
OAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
OMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
.❑Groundwater Remediation
❑Salinity Barrier
OStormwoter Drainage
OSubsidence Control
OTracer
❑Other (exolain under #21 F
4. Date Well(s) Completed: 09/07/16 Well 1D# IW-25-7
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility 1D0 (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County
Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds'or decimal degrees:
(if well field, one fatilong is sufficient)
350 29' 12.29" N 810 15' 22.72" W
6. Is (are) the well(s): IMPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ®No
If thn• is a repair, fill out known well construciiatt it formtation and explain the nature of the
repair under 921 remarks secilon or an the back of this form.
8. Number ofwells constructed: 1
Far multiple injection or non-tratenmpply wells ON1.Y uVill the same construction, you can
submit one fium.
9. Total well depth below Innd surface: 43.0 (ft.)
For multiple trees list all depths tfdifferent (example- 3�00' and 1Q100)
20 0
For Internal Use ONLY-
14. WATER ZONES
FROM TO I DESCRIPTION
ft. ft.
ft. fr.
15. OUTER CASING for multi -cased wells OR LINER ita liable
FROM TO DIAMETER Tmll:tiNFSS hfATERUL
ft. ft. I in
16. INNER CASING OR TUBING eothermol closed -loan)
FROM TO I DIAMETER I THICKNESS MATERIAL
0.0 23.0 ft. 0.75 1"• SCH 40 PVC
in.
17. SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
23.0 "' 43.0 fr• 0.75 1n' .010 SCH 40 PVC
fL ft. is
Is, GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
0.0 It. 18.0 ft. ronnuroeeuroMre SLURRY
fL ft.
ft. ft.
19.SAND/GRAVEL PACK til'amillicablel
FROM TO MATERIAL I EMPLACEMENTIHETHOD
21.0 "' 43.0 ft. 2040 FINE SILICA SAND
ft. ft.
20. DRILLING LOG attacIt additional sheets If necessary)
FROM TO DESCRIPTION color. hardness, sultirack type, tvin sire. tit.
0.0 n• 43.0 ft- DIRECT PUSH
ft. ft.
rt, tt.
ft. rt.
ft. ft.
ft. ft.
ft. ft.
21. REMARKS
BENTONITE SEAL FROM 18.0 TO 21.0 FEET
22. Certification:A"��
09/30/16
Signature of Certified Well Contractor Date
By signing this form, 1 hereby certify that the wells) iras (were) constructed In accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C .0200 Nell Constniction Standards and that a
Copy offlus record bas been prrrrided to the tell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL 1NSTUCTIONS
241. For All Wells: Submit this form within 30 days OF completion of well
construction to the following:
10. Static water level below top of casing: (ft.) Division of Water Quality, Information Processing Unit,
Ifswterlcrel Ls above casing, use •'+•' 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 3.25 (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12 Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc )
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Ian, 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
list al/ applicable ur/1 construction pernnils (.c. County. State, Variance. etc.)
3. Well Use (check well use):
❑Agricultural OMunicipal/Public
❑Geothermal (Heating/Cooling Supply) OResidential Water Supply (single)
Olndustrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
OMonitorine nRecnvery
❑Aquifer Recharge
®Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
OExperimental Technology
❑Subsidence Control
OGeothermal(Closed Loop)
❑Tracer
OGeothermal (Heating[Cooling Return)
OOther (explain under #21 F
4. Date Well(s) Completed: 09/08/16 Well 1D# IW-25-5
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ]DO (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifweil freld, one ladlong is sufficient)
35e 29' 12.25" N 810 15' 22.58" W
6. Is (are) the well(s): Permanent or OTemporary
7. Is this a repair to an existing well: OYes or ONo
If thin is a repair, fill out knoirn well construction information and explain the nature of the
repair wider #21 remarks section or on the back of this form.
8. Number of wells constructed: 1
For mulriple injection ar non -water supply wells ON1.Y'wirh tlne same construction• you car
submit one form.
9. Total well depth below land surface: 27.0 (ft.)
Far nahiple wells list all depths lfdoerem (example- 3@200' and 2Q1001
10. Static water level below top of casing: 20.0 (ft.)
If water level is above casing, else "+'•
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
H. rt
15. OUTER CASINGI for multi -cased wells OR LINER if a ticnble
FROM TO DIAMETER THICIAVESS MATERIAL
ft ft. I in
16. INNER CASING OR TUBING leeathernoxil closed -loam)
FROM I TO I DIAMETER I THICKNESS I MATERIAL
0.0 rl• 17.0 ft- 0.75 ia• SCH 40 PVC
% I ft. in
17. SCREEN
FROM TO I DIAMETER I SLOTSIZE I THICKNESS I MATERIAL
17.0 R, 27.0 fL 0.75 " 1 .010 SCH 40 PVC
rt. ft. in
18. GROUT
FROM I �TO MATERIAL EMPLACEMENT METHOD &AMOUNT
0.0 ft. 12.0 ft. connuroaaaorme SLURRY
tr. tr.
ft. ft.
19. SAND/GRAVEL PACE if a ticable
FROM TO MATERIAL I
EMPLACEMENT METHOD
15.0 ft• 27.0 ft• 20-40 FINE SILICA SAND
ft. n.
20. DRILLING LOG futhich additional sheets if actress
FROM TO DESCRIPTION rotor, hardness, soi0rack type, gmin size. etc.
0.0 rt 27.0 ft- DIRECT PUSH
rc. rc.
D. rt.
ft. ft.
ft. ft.
ft. R.
ft. ft.
21. REMARKS
BENTONITE SEAL FROM 12.0 TO 15.0 FEET
22. Certification
-s✓ 09/30/16
Signature ofCcrtifted Well Contractor Date
By signing Ilds form, 1 hereby certify that the wells) urns (were) coaeructed in accordance
with 13A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and dial a
copy ofthis record has been provided to the trell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSPUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test:. 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount- completion of well construction to the county health department of the county
where constructed. -
Form OW-1 North Carolina Department ofEnvironment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well ContraciorCertiftcmion Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable ire/1 construction permits P.C. Camay. State, Variance, eta)
3. Well Use (check well use):
OAgricultural ❑Municipal/Public
OGcothermal (Heating/Cooling Supply) OResidential Water Supply (single)
OlndustriallCommercial OResidential Water Supply (shared)
Well:
I OAquifer Recharge
OAquifer Storage and Recovery
OAquiter Test
OExperimental Technology
OGeothermal (Closed Loop)
OGeothermai (Heating/Cooling
©Groundwater Remediation
OSaiinity Barrier
❑Stormwater Drainage
❑Subsidence Control
OTracer
under#21
4. Date Well(s) Completed: 09/08/16 well ID# IW-25-3
5a. Well Location:
ROBERT BOSCH TOOL - NONCDO001154
FacilitylOwner Nance Facility ID9 (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one [at/long is sufficient)
350 29' 12.18" N 810 15' 22.16"
6. Is (are) the well(s): ©Permanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or ElNo
Iftits Is a repair, fill out known well construction information and explain the nature ofthe
repair under #21 remarks section or on the back of this form.
S. Number of wells constructed: 1
For multiple injeciian or non -water supply spells ONLY with the same construction, you can
submit one lbrin.
9. Total well depth below land surface: 40'0 (ft )
For nadtiple irells list all depths ifdgerent (example- 3@200' and 2@100')
Internal Use ONLY:
rol
14. WATER
ZONES
FROM
TO
DESCRIPTION
It.
ft.
rt.
ft.
15.OUTER CASING for multt eased wells OR LINER if n lienble
FROM
TO
DIAMETER THICKNESS MATERIAL
ft.
I ft.
in
16. INNER CASING OR TUBING eothermal closed-loo
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0.0 ft.
25.0 I°
0.75 '"
SCH 40
PVC
It.
I ft.
is
17. SCREEN
FROM
TO I
DIAMETER
I SLOTSIZE
I THICKNESS
I MATERIAL
25.0 It•
40.0 It-
0.75 In.
010
SCH 40
PVC
ft.
ft.
in
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METIIOD & AMOUNT
0.0 ft,
20.0 ft'
PORnAmffTfe
SLURRY
ft.
ft.
ft.
ft.
19. SANDIGRAVEL PACK if applicable)
FROM
TO
I MATERIAL I
EMPLACEMENT METHOD
23.0 fL
40.0 fL
20-40
FINE SILICA SAND
fr.
ft.
20. DRILLING
LOG tattoch
additional sheets If necessary)
FROM
I TO
DESCRIPTION rotor, hardna soil/mck rain3ize,0
0.0 ft, -
40.0 R•
DIRECT PUSH
ft.
R.
ft,
ft,
ft.
ft.
ft.
ft.
ft.
ft.
ft.
h.
21. REMARKS
BENTONITE SEAL FROM 20.0 TO 23.0 FEET
22. Certification:
s�
09/30li6
Signature ofCertifted Well Contractor Date
By .signing this form, 1 hereby certify that the well(i) u•at (were) constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Stondarrlc_and that a
capy oftbis record liar been provided to the it metier.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following,
10. Static water level below top of casing: 20.0
00 Division of Water Quality, Information Processing Unit,
Ifutrier level is above cashig, use '•+"
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 3.25 (in.)
24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method:
construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test:
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount:
completion of well construction to the county health department of the county
where constructed.
Form OW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
list all applicable well construction permits (.e. Coutto,, State, Variance, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
OAquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date Well(s) Completed:
❑Municipalt(Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
OSalinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (exolain under #21 1
09/08/16 Well ID# IW-25-1
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
350 29' 12.18" N 81 a 15' 21.62" W
6. Is (are) the well(s): OPermaneot or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or R]No
Ifthis Is a repair, fill out knotro well construction information and explain the nature of the
repair under 1121 remarks section or on the back of dtis fonn.
8. Number of wells constructed: 1
For multiple it jeetian or non-voter stipply wells 0AILV with the same construction, you can
submit one focal.
9. Total well depth below land surface: 38.0 (ft.)
For nudo ple ivells list all depths ifdWerem (er niple- 3Q200 • and 2Q100'l
10. Static water level below top of casing: 20.0 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY;
I4, WATER ZONES
FROM TO DESCRIPTION
ft R.
ft. ft.
15. OUTER CASING for multi -cued wells OR LINER if n lienble
FROM TO DIAMETER THICKNESS MATERIAL
ft. R. in,
16. INNER CASING OR TUBING(geothermal clmeddoo
FROM TO DIAMETER THICKNESS MATERIAL
0.0 ft. 23.0 fL 0.75 '"• SCH 40 PVC
R. ft. I in.
17. SCREEN
FROM TO DIAMETER I SLOT SIZE THICKNESS MATERIAL
23.0 ° 38.0 rr- 0.75 '°' .010 SCH 40 PVC
R. It.
IS. GROUT
FROM TO MATERIAL EM PIACE51 ENT METHOD & AMOUNT
0.0 ft. 18.0 R• ini,u BEH7onnE SLURRY
ft. R.
ft. f6
19. SAND/GRAVEL PAC(ifamilicablel
FROM TO MATERIAL I EMPLACEMENTIIIElHOD
21.0 ft'-[* ft- 2040 FINE SILICA SAND
ft. I ft.
20. DRILLING LOG attach additional sheets If necessa
FROM 1*0 DESCRIPTION color, hardness, soibrack type, train size, ete.
0.0 ft- 38.0 R• DIRECT PUSH
ft. ft.
ft. R.
R. ft.
ft. R.
ft. R.
ft. R.
21. REMARKS
BENTONITE SEAL FROM 18.0 TO 21.0 FEET
22. Certification:
r 09/30/16
SignattVcfoeitilii&W-ellCaWraclor Date
By signing this form. I hereby cerilfy dial the wells) was (were) constructed in accordance
with 15A NCAC OTC .0100 or IJA NCAC 02C .0200 Well Construction Standards and that a
copy ofthis retard has been provided to die well corner.
23. Site diagram or additional %veil details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Waler Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: M addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form OW.I North Carolina Department orEnvironment and Natural Resources - Division of Water Quality Revised Jan 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable Ire// construction permits P.c. County. Slate, Variance,
3. Well Use (check well use):
❑Agricultural OMunicipal/Public
OGeothermal (Heating/Cooling Supply) OResidential Water Supply (single)
❑industrial/Commercial OResidential Water Supply (shared)
Non -Water Supply Well:
OMonitorinR ORecovery
❑Aquiter Recharge
OAquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
®Groundwater Remediation
❑Salinity Barrier
OStormwater Drainage
OSubsidence Control
OTmcer
❑Other (explain under 921 1
4. Date Well(s) Completed: 09/07/16 Well ID# I W-20-26
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapplicabie)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Pareel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees
(if well field one Iattlong is sufficient)
350 29' 15.92" N 810 15' 21.62"
6. Is (are) the well(s): OPermanent or OTemporary
W
7. Is this a repair to an existing well: Oyes or 0No
If ilits Is a repair, fill out known well construction it forntatiou anal explain the mature of the
repair under 0.21 remarks section or on the back (Y'Ibis firm.
8. Number of wells constructed: 1
For multiple htjection or non -,rater supply wells ONL 1' with the some construction, you cat)
submit anefornt.
9. Total well depth below to ad surface: 50.0 (ft.)
For nuhiple welts list all depths if different (example- 3@200' and 2Q100 )
10. Static water level below top of casing: 25.0 (ft.)
Ifwaterlevel isabove casing, use •'+"
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY.
14. WATER
ZONES
FROM
TO
I DESCRIPTION
ft.
ft.
15.OUTER CASING for multi -cased wells OR
LINER if a lieable
FROM
TO
DIAMETER
THICKNESS
M1tATER1AL
ft.
ft.
in
16. INNER
CASING OR
TUBING teeothermal
cloned400
FROM
I TO
I DIAMETER I
THICKNESS
MATERIAL
0.0 fr
35.0 ft
0.75 �
SCH 40
PVC
rt.
ft
in
17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
35.0 it"
50.0 fr•
0.75 In.
.010
SCH 40
PVC
D.
ft.
in.
S. GROUT
FROM
I TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
0.0 itt.
30.0 R
rannu,oarrranrs
SLURRY
ft.
D.
R.
ft.
19.SANDIGRAVELPACIi
ion licable
FROM
TO
I MATERIAL
EMPLACEMENTMETHOD
33.0 ft'
50.0 ft•
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING
LOG attach additional sheets If aecessa
FROM
TO
DESCRIPTION color, hardness, soi0mck type, grain size, etc.
0.0 fr
50.0 D•
DIRECT PUSH
rt.
ft.
ft.
ft.
ft.
ft.
It.
ft
It.
ft.
D.
e.
21. REMARKS
BENTONITE SEAL FROM 30.0 TO 33.0 FEET
22. Cerf'
09(30/16
Signature ofCertified Well Contractor Date
By signing tliib farms. I hereby eerlfy that rite wells) urns (were) constructed in accordance
with 15A NCAC 01C.0100 or 15A NCAC 02C.0200 lVell Corrsiruction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or Well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Witter Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
form GW-I North Carolina Department of Environment mid Nniuml Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can he used ror single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Centfrcation Number
GEOLOGIC EXPLORATION, INC
Company Nunn
2. Well Construction Permit#: WI0300295 (UIC)
11ctall applicable well cowiructionpernuts (r.e. Catoty, State, variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commerc Lal
❑Irrigation
Non -Water Supply Well:
❑Monitoring
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
OGeothermal(Closed Loop)
❑Geothermal (Heatintr)Coolina
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (exolain under #21 F
4. Date Well(s) Completed: 09/07/16 Well IDk IW-20-24
5a. Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
NONCD0001154
Facility 1139 (irapplicable)
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one laUlong is sufficient)
350 29' 15.98" N 810 15' 21.26" W
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: OYes or E3No
(f ritit is a repair, fill oat known well conttruction brfornration mid explain the nature of the
repair under 921 reararks section or air tire back ofthis faro,
8. Number of wells constructed: 1
For nrulliple h jectian or ran -voter supply bells ONl-Y wirh the .came construction, yvnu call
.cubolt one faro.
9. Total well depth below land surface: 50.0 (ft.)
For multiple We& 101 all depths if diffirent (example- 3@200' mu12 t@100')
10. Static water level below top of casing: 25.0 (ft.)
!f water level & above casing. use •'+ -
11. Borehole diameter: 3.25 (in.)
- DPT RODS
For Internal Use ONLY,
14. WATER ZONES
FROM I TO I DESCRIPTION
rt. M
D. ft.
15. OUTER CASING for multi -cased wells OR LINER if a licable)
FROM TO I DIAMETER THICKPIE55 MATERIAL
ft. fL I In.
I& INNER CASING OR TUBING eothermat closed -loon)
FROM 70 DIAMETER THICKNESS MATERIAL
0.0 f" 35.0 fL 0.75 i" SCH 40 PVC
ft. ft. in.
17. SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS. MATERIAL
35.0 f" 50.0 ft' 0.75 i'r• .010 SCH 40 PVC
ft. I rt. in.
IS. GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
0.0 ft- 30.0 ft' P TlMiDaWCWE SLURRY
ft. ft.
ft. ft.
19. SAND/GRAVEL PACT{ if a licable
FROM TO I MATERIAL EMPLACEMENTMETHOD
33.0 "' 50.0 R 20-40 FINE SILICA SAND
ft. H.
20. DRILLING LOG lattach additional sheets if necessa
FROM TO DESCRIPTION color, hardness, saitfmck rain sift, etc.
0.0 ft' 50,0 -fl' DIRECT PUSH
ft. ft
R. R.
m D.
ft. ft.
ft. &
21. REMARKS
BENTONITE SEAL FROM 30.0 TO 33.0 FEET
22. Certification:
A,,-,
09/30/16
Signature of Certified Well Contractor Date
By sigrting this form, 1 hereby certify that the trell(s) was (were) constructed in accordance
colds 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy afthis record has been provided to the yell owner.
23. Site diagram or additional well details:
You may use the back ofthis page to provide additional well site details or well
construction details You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Witter Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion or -wen
12. Well construction method: construction to the following: .
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-1 North Carolina Department of Environment and Natural Resources - Division or Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can he used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2.Well Construction -Permit #: WI0300295 (UIC)
List all applicable well construction pernrrts fl.e. Counry, Stare, Variance, etc.)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) OResidential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
0Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed: 09/07/16
5a. Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LINCOLN
glGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
WelllD# IW-20-22
NONCD0001154
Facility ION (irapplicabie)
LINCOLNTON 28092
00410
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well Geld, one lat/long is sufficient)
350 29' 16.00" N 810 15' 20.92" W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or E1N9
1f this is a repair• fill out known well construction information and explain the nature r f the
repair raider 021 remarks section or nor the back of This farm.
8. Number of wells constructed: 1
Far nudtiple h#ection or not -water supply wefts ONLY with the sane construction, you can
submit one form.
9. Total well depth below land surface: 50.0 (ft.)
For muhlple wells lisr all depths lldd rent (example- 3@ 200' and 2Q100•)
10. Static water level below top of casing: 25.0 (ft.)
!f wafer level is above casing, use
3 25
For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
ft. ft.
ft. ft.
15.OUTER CASING for multi eased wells OR LINER ifn licable
FROM TO DIAMETER THICt:NF55 aATERIAL
ft. 0. in.
16, INNER CASING OR TUBING 1peothermal closed -loon)
FROM TO DIAMETER THICKNESS MATERIAL
0.0 It- 35.0 rt. 0.75 i" SCH 40 PVC
ft.
17. SCREEN
FROM TO DIAMETER SLOTSIZE I THICKNESS I MATERIAL
35.0 R• 50.0 I'. 0.75 1O' .010 SCH 40 PVC
ft. ft. in.
I& GROUT
FROM TO MATERIAL EMPLACEMEWMETIIOD&AMOUNT
0.0 ft' 30.0 rr- POR:L-000r ME SLURRY
ft. ft.
ft. ft.
19. SANDIGRAVEL PAC s►fifamplicubleW
FROM TO I MATERIAL I EMPLACEMENT a1ETH0D
33.0 I'• 50.0 rt• 20-40 1 FINE SILICA SAND
ft. ft.
20. DRILLING LOG attach additional sheets if necesan
FROM TO DESCRIPTION color, hardness sui0rack type, grain sitp, etc.
0.0 I'• 50.0 1L DIRECT PUSH
rt. R.
ft. ft..
H. R.
ft. ft.
ft. ft
ft. ft.
21. REMARKS
BENTONITE SEAL FROM 30.0 TO 33.0 FEET
22, Certificatio�
-s-- 09/30/16
Signature ofCerti6ed Well Contractor Date
By sigoning ibis forat. I hereby cerrh, Iitat the a'ell(s) was ilivere) constructed in accordance
with 15A NCAC 01C .0100 or 15A NCAC 02C . 0200 Well Cosuructiot Siandarrls and that a
copy o)'rlds record has been provided to the well airier.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: (in.) 24b. For Injection Weld: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction -method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Suonly & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-t North Carolina Department of Environment and Natural Resources - Division of water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT,
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
I Ist all applicable we/1 consrraction pernNts Ae. County, State, Variance, etc.)
3. Well Use (check well use):
For Internal Use ONLY:
ft. ft.
ft. ft.
I ft. I ft. 1 in. I I I
0.0 "' 1 35.0 ft' 1 0.75 1 SCH 40 1 PVC
ft. I ft. I In
❑Agricultural ❑Municipal/Public 35.0 ft' 150.0 R. 0.75 I"' .010 SCH 40
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single) ft. it. fa
❑industrial/Commercial ❑Residential Water Supply (shared) 1&GROUT
Non -Water
OMonitorin
OAquifer Recharge
®Groundwater Remediation
OAquifer Storage and Recovery
❑Salinity Barrier
OAquiferTest
❑Stormwater Drainage
❑Experimental Technology
OSubsidence Control
❑Geothermal (Closed loop)
❑Tracer
❑Geothermal (Heating/Coolin& Retum)
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 09/07/16
Well ID# IW-20-20
5r, Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
51b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latllong is sufficient)
350 29' 16.07" N 810 15' 20.58" W
6. Is (are) the well(s): ©Permanent or OTemporary
7. Is this a repair to an existing well: OYes or Ma
If this is a repair. Jilt our known, well constracilort b formmtion and expla/n the nature oftbe
repair eider 921 retnarks section or on the back of this form.
S. Number of wells constructed: 1
Far nudriple hyection or nate•watersupply wells ONLY with die same construction, you can
submit tee form.
9. Total well depth below land surface: 50.0 (ft.)
For nudtiple wells hit all depila ifelyerenr (example- 3@200' and 2@1001
10. Static water level below top of casing: 25.0
Iftirater Icrel it above casing use "+"
11. Borehole diameter: 3.25 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
0.0 ft. 30.0 R' GORTUNDaFHTIXdTE SLURRY
ft. ft.
ft. ft.
PVC
33.0 f' 1 50.0 " 1 20- 0 FINE SILICA SAND
ft. I ft.
0.0 ft. 50.0 ft.
ft. T.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
PUSH
I BENTONITE SEAL FROM 30.0 TO 33.0 FEET I
22, Certi tion:
09/30/16
Signature ofCenified Well Contractor Date
By signing this forn,, l hereby certify Iltat the trell(s) tress (were) amrstructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 ,yell Construction Standards and that a
copy ofrhis record has been provided m the it -ell awir.
23. Site diagram or additional well details:
You may use the back ofthis page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of Weil
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit 4; W10300295 (UIC)
List all applicable nre6 construction permits (i.e. Caunq% State, Irariance, etc.)
3. Well Use (check well use):
OAgricultural ❑Municipat/Public
OGeothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 I
4: Date Well(s) Completed: 09/07/16- Well ID# I W-20-18
5n. Well Location:
ROBERT BOSCH TOOL NONCD0001154
FacilitylOwntr Name Facility tDfl (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN - 00410
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one hulking is sufficient)
35e 29' 16.16" N 810 15' 20.18" W
6. Is (are) the well(s): OPermanent or OTemporary
7, is this a repair to an existing well: OYes or allo
If this is a repair, fill ova knoirn well construction Information and explain the nature of the
repair under 921 remarks .section or on the back of this form.
8. Number of wells constructed: 1
Ilar muhiple b yeclion ar nan-crater supply wells ONLY with the same construction, )Wu can
submit ane furnt.
9. Total well depth below land surface: 50.0 (ft.)
par mtdtiple treU.s list all depths fdierent (example- 3@?200' and 2Q100q
10. Static water level below top of casing: 25.0
Iftrater level is above casing, use
For Internal Use ONLY:
14. WATER ZONES
FROM TO
DESCRIPTION
ft. ft.
ft. ft.
15. OUTER CASING for multi cased wells OR
LINER tf a
licable
FROM
TO
DIAMETER
THICKNESS
aATERIAL
I"
R.
I is
-
16. INNER CASING OR
TUBING eothermal
closed -too
FROM
I TO
DIAMETER I
THICKNESS
I MATERIAL
0.0 fi•
35.0 ft.
0.75 i"'
SCH 40
PVC
R.
ft.
in.
17. SCREEN
FROM
TO
DLAbIETER
SLOT SIZE
THICKNESS
MATERIAL
35.0 ft'
50.0 R.
0.75 In
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
F7tom
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 R'
30.0 ft'
roatuwaernrontrs
SLURRY
fL
ft.
ft.
ft.
19.SANDIGRAVEL
PAC Ii ifo licable
FROM
TO
MATERIAL I
EMPLACEMENTMETIIOD
33.0 f"
50.0 fL
I
2040
FINE SILICA SAND
R.
ft.
20. DRILLING
LOG attach additional sheep if necessa
FROM
TO
DESCRIPTION (color. hardness, seilrock tym grain sin, etc.
0.0 ft.
50.0 1".
DIRECT PUSH
ft.
R.
ft.
R.
ft.
ff.
ft.
ft.
R.
ft,
R.
ft.
21 REMARKS
BENTONITE SEAL FROM 30.0 TO 33.0 FEET
22. Certification: A"�
09/30/16
Signatuie of Certified Well Contractor Date
Uy signing this form, / hereby certify that the trell(r) tras (ieert) constructer) in accordance
frith ISA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Concrrttction Standards and that a
copy ofthis record has been provided to die well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-16I7
11. Borehole diameter: 3.25 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of thus form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct pushy etc.)
Division of Water Qualify, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-I North Carolina Department of Environment and Natural Resources - Division ofWater Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Nnme
2. Well Construction Permit 4. W10300295 (UIC)
List all applicable areH canstrncHmr pennies (I.e. Cotnry. State. Yarionce, etc.J
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Well:
❑Aquifer Recharge
[]Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatine/Coolina
❑Municipal/Pubhc
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
00roundwater Rcmediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 P
4. Date Well(s) Completed: 09/07/16 Well ID# IW-20-16
52. Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
NONCDO001154
Facility ID# (ifapplicabte)
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees
01'well field one latilong is sufficient)
35e 29' 16.12" N 81 a 15' 19.84"
6. Is (are) the well(s): 131'ermanent or OTemporary
W
7. Is this u repair to an existing well: ❑Yes or ElNo
Ifthis is a repair, fill out known well construction Information and explain the nature ofthe
repair tauter �'21 remarks section or on the back of This form.
S. Number of wells constructed: 1
For n"thiple injection or non -water supply wells ONLY with the sane construction. you can
Submitnnejarn.
9. Total well depth below land surface: 50.0 (ft.)
17or nudtiple wells list all depths ij d yerent (eranple- 9 rr 00 •and 2 r(�t 100)
10. Static water level below top of casing: 25.0
lfwawr krel is above casing, use ••+ ••
11. Borehole diameter: 3.25 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use ONLY:
14, WATER ZONES
FROM TO DESCRIPTION
ft. R.
ft. R.
I5. OUTER CASING for multi -eased wells OR LINER ira ticoble
FROM To DIAMETER TIi1CKNFSS MATERIAL
ft. I A. in.
16. INNER CASING OR TUBING eother ma[ closed-loo
FROM TO DIAMETER THICKNESS
MATERIAL
0.0 f'' 35.0 EL 0.75 i SCH 40 PVC
ft. ft. in
17. SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
35.0 R' 50.0 "' 0.75 i"' .010 SCH 40 PVC
R. ft. in.
18. GROUT
FROM TO MATERIAL EMPLACEMENT NIE7110D& AMOUNT
0.0 ft. 30.0 ft' PORnMOSIDsormE SLURRY
R. R.
19. SAND/GRAVEL PACT{ if a licable
FROM TO F MATERIAL EMPLACEMENTMEIVOD
33.0 ft- 50.0 rt• 20-40 FINE SILICA SAND
ft. ft.
20. DRILLING LOG attach additional sheets if neeema
FROM TO DESCRIPTION color, hardn soatruck type, grain size eta.
0.0 fr• 50.0 fc. DIRECT PUSH
ft. 1L
ft. ft.
ft. R.
ft. R.
21. REMARKS
BENTONITE SEAL FROM 30.0 TO 33.0 FEET
22 Certification:
r 09/30/16
Signature ofcerlified Well Contractor Date
By signing this fore). 1 hemby certyY thor the trell(s) w•as (were) constructed in accordance
it -tilt 1 SA NCAC 02C .0100 or 15A NCAC 01C . 0200 Well Construction Standards and that a
copy ofdtis record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This rorm can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2, Well Construction Permit #: W10300295 (UIC)
List all applicable well constructionperniity fi.a. County, Stare, Parlance, VIC)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑lndustriaUCommercial ❑Residential Water Supply (shared)
Well:
C
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
®Groundwater Remediation
❑Salinity Barrier -
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
[]Other (explain under #21 1
4. Date Well(s) Completed: 09/06/16 Well ID# IW-20-14
So. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDt1(if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Andress, City, and Zip
LINCOLN 00410
County
Parcet Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if wctl field one latilong is sufficient)
350 29' 15.04" N 810 15' 21.70" W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
ifthic is a repair, fill our knoau well construction btforaatlar and explain ilia norure t f the
repair larder 921 rettiorkc section or on the back r f this fora.
8. Number of wells constructed: 1
For multiple itlecrion or non-n•ater supply wells ONLY with the same construction, you can
subndt one form.
9. Total well depth below land surface: 50.0 (ft.)
Par r udliple welk list all depths if dWZreni (eraniple- 3 t©200' and 2@100 )
10. Static water level below top of casing: 25.0 (ft.)
Ifirater level J.r abore caving, use "i-"
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY!
14. WATER ZONES
FROM TO DESCRIPTION
R. R.
15. OUTER CASING for multi -cored wells ONa lMRALFROM TDIAMETER
rt. I R. in
16. INNER CASING OR TUBING factithermal closed-loo
FROM TO DIAMETER I THICKNESS MATERIAL
0.0 It• 35.0 fL 0.75 1n SCN 40 PVC
17. SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
35.0 fQ 50.0 ft'0.75 '" 1 .010 SCH 40 PVC
ft. ft. in.
I& GROUT
FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
0.0 rt. 30.0 R P0RnG D8Vn0MTE SLURRY
R. R.
ft. ft.
19. SANDIGRAVEL PACK(iratiolicablei
FROM TO MATERIAL I EMPLACEMENTMETHOD
33.0 it. 50.0 ft- 2040 FINE SILICA SAND
". IL
20. DRILLING LAG attach additional sheets irnteessu
FROM TO DESCRIPTION (color, hardness, sai0rock type, itrain sire. tie.
0.0 ft. 50.0 ft. DIRECT PUSH
ft, ft.
ft, ft.
R. R.
fL R.
R, ft.
ft. ft.
21. REMARKS
BENTONiTE SEAL FROM 30.0 TO 33.0 FEET
22. Certification:
A""�
09/30/16
Signature ofCenitied Well Contractor Date
By signing this fora, I hereby certify that Ilia ireJr(.c) was (were) cotivinicied in accordance
with 15A NCAC 02C.0100 or ISA'NCAC 02C .0200 {Nell Commicilon Standards and that a
copy ofdrls record liar been provided to die well awner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or welt
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending -the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water SuPDly & Infection Wells: In addifion to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Erivironment and Natural Resources - Division orwater Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit Al: W10300295 (UIC)
List all applicable well construction permits (i.e. County, Srate, 1'arianee, etc)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water
❑Aquifer Recharge
IaGroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
OStormwater Drainage
❑Experimental Technology
❑Subsidence Control
OGeothermal (Closed Loop)
OTracer
OGeolhermal (Heating/Cooling Return)
❑Other (explain under #21 F
4. Date Well(s) Completed: 09/06/16 Well ID# IW-20-12
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one 1814ong is sufficient)
35e 29' 15.23" N 810 15' 21.40" W
6. Is (are) the well(s): ®Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ErINo
hf this is a repair, fill our /mown well construction information and explain the nature of the
repair under d2l remarks section or on the back of this form.
8. Number of wells constructed: 1
1--or multiple ityectiot or non -crater supply wells ONLY with the same construction, you can
submit ore)nrnt.
For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
ft. ft.
e. A.
15. OUTER CASING for multi -cased welts O
FROM DIAMETER RNa IiMRAL
tt. fL in
16. INNER CASING OR TUBING(geothermal closed -too
FROM TO DIAMETER I THICKNESS MATERNL
0.0 !: 35.0 fit 0.75 SCH 40 PVC
ff. I ft in.
17. SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
35.0 R' 50.0 ft' 0,75 "' .010 SCH 40 PVC
ft. ft. in.
J& GROUT
FROM TO MATERIAL EMPLACEIIIE1WI-I HOD&AMOUNT
0.0 r" 30.0 fit' Po"Two maare SLURRY
ft. ft,
ft. ft.
19. SAND/GRAVEL PACK trn licable
FROM TO MATERIAL EMPLACEMENTMETHOD
33.0 h• 50.0 ft. 20-40 FINE SILICA SAND
ft. ft.
20. DRILLING LOG atrocla additional sheets it necessa
FROM TO DESCRIPTION dolor hardnesssoiVrack Cain size etc.
0.0 ft. 50.0 H DIRECT PUSH
n. ft.
ft. ft.
ft. ft.
ft. ft.
ft. rL
ft. n.
21. REMARKS
BENTONITE SEAL FROM 30.0 TO 33.0 FEET
22. Certification:
#Wolllt�A"'-'
09/30/16
SignatureofCertified Well Contmctor Date
B)• signing this form. I hereby centy that the a•ell(t) a•as (irere) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 01C .0200 [Yell Construction Standards and that a
copy of this record has been provided to the n•ell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL iNSTUCTIONS
9. Total well depth below land surface: 50.0 (ft,) 24a. For All Wells: Submit this form within 30 days of completion of well
Far multiple wells list all depthr jdperent (exoaple- 3@200' and 2@100') construction to the following:
10. Static water level below top of casing: 25.0 (ft ) Division of Water Quality, Information Processing Unit,
If water level is above casing, use '4 •'
11. Borehole diameter: 3.25 (in.)
DDT RODS
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, died past), etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13n. Yield (gpm) MIethod of test: 24c. For Water Sunuly & lniection Welts: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county_
whereconstructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Qmlity Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
LW al/ applicable trell construction permits (t. e. County. ny. State, lrartaru c,, etc)
3. Well Use (check well use):
Water Supply Well:
OAgriculturat
❑Geothermal (HeatinglCooling Supply)
O I ndustrial/Commercial
Non -Water Supply Well:
OAquifer Recharge
❑Aquifer Storage and Recovery
OAquiferTest
OExperimental Technology
OGeothermal(Closed Loop)
❑Municipal/Public
OResidential Water Supply (single)
❑Residential Water Supply (shared)
mGroundwater Remediation
❑Salinity Barrier
❑Stormwaler Drainage
❑Subsidence Control
❑Tmcer
❑Other (explain under #21 P
4. Date Well(s) Completed: 09/06/16 Well IDY Ili-20-10
5a. Well Locution:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
For tnternal Use ONLY:
14. WATER
ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING for multi -eased welts OR
LINER if a Bcable
FROM
TO
� DLNtETEA
TII1Ct.TIFS5
bfATER1AL
rL
ft.
I in.
16. INNER
CASING OR PHING eotherwa]
closed loo
FROM
TO DIAMETER I
THICKNESS
I MATERIAL
0.0 "'
35.0 fc' 0.75 in'
SCH 40
PVC
ft.
ft. IR
17.SCREEN
FROM
TO
DAMETER
SLOTSIZE
THICKNESS
MATERIAL
35.0 ft'
50.0 a.
0.75 In'
.010
SCH 40
PVC
ft.
ft.
I.
18, GROUT
FROM
7'O
MATERIAL
EMPLACEMENT METHOD& AMOUNT
0.0 ft.
30.0 ft'
PORMNa6ENTOMTE
SLURRY
ft.
H,
ft.
ft.
19.SANDIGRAVEL
PAC
K ifa licable
FROM
TO
I MATERIAL
EMPLACEMENT METHOD
33.0 rt.
50.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING
LOG otfnch additional sheets If necessary)
FROM
TO
DESCRIPTION color hardaim. olVrock type, grain sizeetc.
0.0 ft.
50.0 It.
DIRECT PUSH
ft.
It.
It.
rc.
ft.
ft.
ft.
ft.
ft.
It.
ft.
It.
2I. REf11ARKS
BENTONITE SEAL FROM 30.0 TO 33.0 FEET
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Cc Eation: A'��(ifwell field one latllong is sufficient)
35e 29' 15.34" N 810 15' 20.98" W
6. Is (are) the well(s): GJPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or Er)No
If ills Is a repair, fill out known well construction tilfortuation mul explain the mitre of the
repair under P21 remarks section or on the back of this jornr.
8. Number of wells constructed: 1
For multiple iglection or non -water supply wells ONLY with the same construction, y014 call
submit one frnr.
9. Total well depth below land surface: 50.0 (ft.)
For niltiple irellc list all depths tfdiiferent (example. 3@200' and 2@ IW')
10. Stutic water level below top of casing: 25.0 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 3.25 (in.)
DDT RODS
Signature of Certified Well Contractor
09/30/16
Date
By signing this jornr. / hereby certify that the well(k) was (wen9 constructed in accordance
trith 15A NCAC 02C.0100 or 1 SA NC'AC 02C .0200 !Yell Comiruction Standarrtr and that a
copy afthis record has been provided is the well oirner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUGTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
I: Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: WI0300295 (UIC)
LlD all applicable feels construction perntits (t.e. County, State, flarionce, etc.)
3. Well Use (cheek well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ IndustriaUCommercial
Well:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Aquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (HeatinglCooling Return)
❑Other (explain under #21 F
4. Date Well(s) Completed: 09/06/16
Well ID# IW-20-8
5a. Well Location:
ROBERT BOSCH TOOL
Fncility/Owner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LINCOLN
County
NONCD0001154
Facility ID# (ifapplicable)
LINCOLNTON 28092 .
00410
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latltong is sufficient)
35e 29' 15.59" N _ 810 15' 19.78"
6. Is (are) the well(s): mPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or E)No
If lltis u a repair, fill out knmrn well construction it formation and explahh the naane of rbe
repair under ti21 remarks section or on lite bock ofthis ftnrni.
S. Number of wells constructed: 1
Far aultiple uyccuon or non-irarer supply wefts ONLY with the same construction, yim can
subnrir are form
9. Total well depth below land surface: 50.0
hor amluple wells list all depihs ifili ferent (example- 3 rt 200' and 1 a 100)
10. Static water level below top of cusing: 20.0
Ifi ester level Is above casing, use "+"
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY;
14. WATER ZONES
FROM TO I DESCRIPTION
R. R.
R. R.
15.OUTER CASING for multi -cased wells
£RUM TO DIAMETERO
ft. R. Its.
INMapiliMIA
L
16. INNER CASING OR TUBING eothermal closed400
FROM I TO I DIAMETER I THICKNESS T MATERIAL
0.0 R. 35.0 fL 0.75 in. SCH 40 PVC
ft. R. In.
17. SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
35.0 ft• 50.0 ft. 0.75 In. .010 SCH 40 PVC
R. I rt, I.
IS. GROUT
FROM TO MATERIAL EMPLACEMENT MLrHOD & AMOUNT
0.0 ft- 30.0 ft' aa"a"°°�„ra rE SLURRY
rL rL
R. ft.
19. SANDIGRAVEL PACK lifapplicable)
FROM TO MATERIAL EMPLACEMENTMETHOD
33.0 fL 50.0 IL 20-40 FINE SILICA SAND
ft. ft.
20. DRILLING LOG (a Is additional sheets if necessary)
FROM I TO DESCRIPTION color, hardn soi0rock type, grain size, etc.
0.0 ft. 50.0 ft. DIRECT PUSH
R. ft.
ft. ft.
R. R.
ft. sL
ft. ft.
ft. ft.
21. RE51ARICS
BENTONITE SEAL FROM 30.0 TO 33.0 FEET
22. Certification: �(r fww,
09/30/16
Signature of Certified Well Contractor Date
Sy signing this form. I hereby cerllfy that llte feel/(s) "ns (were) constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0100 Well Construction Standards and that a
copy afthis retard has beerr provided to due well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 241
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test- 24e. For Water Suonly &Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount- completion of well construction to the county health department of the county
where constructed.
(ft.)
Form O W-1 North Carolina Department ofEnvirciament and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226 -
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit tf: W10300295 (UIC)
Lhi all applicable iveil consinmitmn pvrniIIs (r.e. Couay, Statc, Variance, era)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑IndustriaUCommercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OGroundwater Remediation
OSalinity Barrier
❑Stormwater Drainage
OSubsidence Control
OTracer
Main under 021 Remarks
4. Date Well(s) Completed: 09/06/16 Will IDa IW-20-6
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDN (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(it'well field one Iatnong is sufficient)
350 29' 15.52" _ N 810 15' 20.10" W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: Oyes or E3No
Ifthis is a repair, fill ont knot n we/1 constriction ityarniation and explain the nature ofilre
repair under 421 remarks section or an the back ofthis form.
8. Number of wells constructed: 1
Por muhiple injernon or non-water.supply nrells ONLY with the same construction, you can
Submit one fonu.
9. Total well depth below land surface: 50.0 (ft.)
Par multiple wells list all depths lfdijlerent (eronrp/e- 3Q200' and 1©100')
10. Static water level below top of casing: 25.0 (ft.)
lfwaier level it above caring, use '•+"
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY
14. WATEA ZONES
FROM
TO
I DESCRIPTION
ft.
fL
ft.
ft.
15.OUTER CASING [or multi -cased wells OR
LINER if a tirnbte
FROM
TO
DIAMETER
TNICI:Nlt55 MATERIAL
ft.
ft.
in.
16. INNER
CAS[NC OR
TUBING feeotheranal
closed=loo
FROM
I TO
I DIAMETER I
THICKNESS
I MATERIAL
0.0 It
35.0 It.
0.75 I"
SCH 40
PVC
ft.
ft.
is
17. SCREEN
FROM
TO
DIAMETER
I SLOT SIZE THICKNESS MATERIAL
35.0 R'
50.0 ft.
0.75 "'
.010
SCH 40
PVC
R.
ft.
im
18, GROUT '
FROM
TO
MATERIAL
EMPLACEMENTMETHOD & AMOUNT
0.0 ft'
30.0 It'
SLURRY
ft.
ft.
0.
ft.
19. SANDIGRAVEL PACKorupplicable
FROM
TO
I MATERIAL
EMP-CEMENTMETHOD
33.0 "'
50.0 f"
20-40
FINE SILICA SAND
ft.
ft.
Z0. DRILLING
LOG attach additional sheets if necessary)
FROM
I TO
DESCRIPTION Rohr, bardness, sciltrack type. RMin sire etc.
0.0 D.
50.0 [t•
DIRECT PUSH
a,
rt.
ft.
ft.
D.
ft.
ft.
ft,
It.
ft.
21: REMARKS
BENTONITE SEAL FROM 30.0 TO 33.0 FEET
22. Certific n:
A,,-,
09/30/16
Signature orCertified Well Contractor
Date
Ry signing tints form, I hereby cenig, that the uell(s) tray (were) constructed in accordance
with IJA NCAC 01C .0100 or ISA NCAC 02C .0200 {Yell Corstrucuon Standards and that a
Copy of t/ris record Ims beelr prtnHrletl w the n'CII corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the followmg:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction -to the following:
(i.e. auger, rotary, cable, direct push, e1c.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13u. Yield (gpm) Method of test- 24c. For Water Supply Sc lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295 (UIC)
I.isr all applicable {cell construction perm irs 0.e. Comity, State, Itarionce, eic.J
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
Well:
OAquifer Recharge
OAquifer Storage and Recovery
OAquifer Test
OExperimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (HeatinP-1Cooline
OMunicipal/Public
OResidential Water Supply (single)
❑Residential Water Supply (shared)
013roundwater Remediation
❑Salinity Barrier
OStormwater Drainage
OSubsidence Control
❑Tracer
❑Other (exolain under #21 F
4. DuteWell(s) Completed: 09/01/16 Well ID# IW-6-20
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifappticable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b L ft d d Lo 't d• d
For Internal Use ONLY:
14. WATER
ZONES
FROM
TO
DESCRIPTION
ft.
H.
ft.
ft.
15.OUTER CASING for multi -cased wells OR LINER If a llcnble
FROM
TO DIAMETER THtCt:NE55 MATERIAL
a.
ft. in
16. INNER
CASING OR TUBING eothermat closed-lao
FRONT
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft.
20.0 ft.
0.75 In.
SCH 40
PVC
fL
ft,
in,
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
20.0 It.
25.0 It•
0.75 i"'
.010
SCH 40
PVC
ft.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft'
16.0 ft-
vaansnmateam"
SLURRY
ft.
ft.
It.
ft.
19. SANDIGRAVEL
PACK if a licable
FROM
TO
MATERIAL
EMPLACEMEKIl11ETHOD
18.0 It,
25.0 It.
20-40
FINE SILICA SAND
IL
ft.
20. DRILLING
LOG attach additional sheets 1f necessn
FROM
TO
DESCRIPTION le°tor, hardness soiltreek rain size, ete.
0.0 ft-
25.0 ft-
DIRECT PUSH
ft.
H.
ft.
ft.
ft.
ft.
ft,
ft.
21. REMARKS
BENTONITE SEAL FROM 16.0 TO 18.0 FEET
a field,
u e e I g is u e to egrees/mmutes/seconds or decimal degrees: 22. Certification
(if well field, one lat/toag is sufficient) Jr�I��w'j,
35e 29' 18.84" N 81 ° 15' 26.70" WA'�-
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or ErINo
If this B a repair, fell out known well construction h jnrnwtion and ciplain the nature of'the
repair wider 921 remarks section or on the back ofthis form.
S. Number of wells constructed: 1
For wohiple ityection or nun -water supply wells ONLY with the same construction, you can
nibmit one forme
9. Total well depth below land surface: 25.0 (ft.)
Far multiph wells list all depihs lfdierwa lerample- 3Q200' and 2©I001
10.'Static water level below top ofcasing: 20.0 (ft.)
lfwaver level is above casing, use •• .
11. Borehole diameter: 3.25
D
09/30/16
Signature ofCenified Well Contractor Dale
By signing this form. I hereby certljy cleat the well(s) tray (mere) constructed in accordance
with 15A NCAC 02C,0100 or I.iA NCAC 02C .0200 Well Cmarruction Standards and that a
copy ofthis record 1w; been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
PT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division orWater Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC: 27699-1636
13a. Yield (gpm) Method of test:. 24c. For Water Supply & lniection Wells In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form OW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: WI0300295 (UIC)
list all applicable well carstructlun permits (i.e. Counry, State, variance, etc.)
3. Well Use. (check well use):
OAgricultural
OGeothermal (Heating/Cooling Supply)
❑Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
OAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Municipal/Public
OResidential Water Supply (single)
OResidential Water Supply (shared)
OGroundwmter Remediation
❑Salinity Barrier .
OStormwater Drainage
❑Subsidence Control
OTracer
00ther (explain under #21 1
4. Date Welt(s) Completed: 09/01/16 Well ID# IW-6-18
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
FacitityiOwner Name Facility ID# (ifopplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
Comny Parcel identification No. (PIN)
For Internal Use ONLY<
14. WATER
ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING Ifar multAc,,, wells OR
LINER if a Bcable
FROM
TO DIPILTE.
THICtNESS MATERIAL
It.
B. in.
16. INNER CASING OR
TUBING eothermal
closed -loon)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0.0 ft.
19.0 R•
0.75 i-
SCH 40
PVC
ft.
R.
in
17. SCREEN
FROM
TO
DIAMETER
I SLOT SIZE
THICKNESS I
MATERIAL
19.0 n.
24.0 ft.
0.75 1-
.010
SCH 40
PVC
rr.
IL
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENTMETHOD&AMOUNT
0.0 ft.
15.0 e.
PaanwoaotaNn�
SLURRY
rt.
ft.
ft.
ft.
19. SANDIGRA VEL PACK if applicable)
FROM
TO
MATERIAL I
EMPLACEMENT METHOD
17.0 ft.
24.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING
LOG attach additional sheets if necessa
FROM
To
DESCRIPTION (color, hardness, suillrock type, ernin sirs cit.)
0.0 ft.
24.0
DIRECT PUSH
rt.
fe.
rt.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
n.
ft.
21. REPIARKS
BENTONITE SEAL FROM 15.0 TO 17.0 FEET
Latitude and Longitude in degrees/minufeslseconds or degrees: 22. Certification:
(if
(if well field, one latllong is sufficient)
350 29' 18.89" N 810 15' 26.15" W
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: OYes or ONO
If this is a repair, fill our known well construction injarntatiar and explain the nature of the
repair under 421 remarks .section or an the back of this farm.
8. Number of wells constructed: 1
For multiple hJerdau or non -water supply a e/ls ONLY with the same construction, cart can
subndt one foray.
9. Total well depth below land surface: 24.0 (fL)
For multiple wells list all depths ifdeerent (erample- 3(a)200' awl 2©100')
10. Static hater level below top of casing: 20.0
if water level is above cashig use "+"
11. Borehole diameter: 3.25 (in.)
DPT RODS
Signature ofCenified Well Contractor
09/30/16
Date
By signing this Jonn, I hereby certify that the irell(s) was (uvre) constructed hi accordance
with 13A NCAC 02C .0100 or 15A NCAC 02C .0200 IFel/ Construction Standards and tha a
cony afthis record bas bear provided to the well ouwet:
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of weil
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. au6cr, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699.1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount• completion of well construction to the county health department of the county
where constructed.
Farm GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
For Internal Use ONLY:
Well Contractor Name ft. ft.
A - 4226 ft. R.
NC Well Contractor Certification Number 15. OUTER CASING to,
FROM I TO
GEOLOGIC EXPLORATION, INC rt. I R.
Company Name
2. Well Construction Permit#: W10300295 (UIC)
list all applicable null construction perndts (i.e. County, State, Irarlance, etc.)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Supply
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
4. Date Well(s) Completed: 09/01/16 Well ID#.
Sn. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092.
Physical Address, City, and Zip
LINCOLN 00410
ain under #21
IW-6-16
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one latasing is sufficient)
35e 29' 18.67" N 810 15' 26.02"
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to on existing well: ❑Yes or EINo
If dt/r k a repair, fill out known ire// construction Information and explain the nature of the
repair under 921 remarks section or an the back of this ford.
8. Number of wells constructed: 1
Por mullipla blection or non -water supply wells ONLY with the some construction, )w u can
submit one form.
9. Total well depth below land surface: 22.0 (ft.)
For multiple wells list all depths ifdii ferenu (example- JQ2W' and 1©100)
10. Static water level below top of casing: 20.0 (ft.)
if water level is above casing, use •'+"
11. Borehole diameter: 3.25 (in,)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13s. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
in.
0.0 rL 17.0 iL 0.75 In ( SCH 40 PVC
R. ft. in.
17.0 it. 22.0 r" 0.75 1 010 SCH 40 PVC
ft. % in.
IS. GROUT
FROM TO MATERIAL EMPLACEMENT METttOD&AMOUNT
0.0 fit- 13.0 f" vcanumasxraas SLURRY
ft. ft.
R. ft.
15.0 rL 22.0 it. 20-40 FINE SILICA SAND
R. ft.
0.0 R.
Et.
rr.
ft.
ft.
R.
R.
22.0 ft-
ft.
R.
R.
ft.
ft.
ft.
DIRECT PUSH
I BENTONITE SEAL FROM 13.0 TO 15.0 FEET I
22. Certifica 'o
A"--
09/30/16
Signature of Certified Well Contractor Date
By signing this form, I hereby certify dial the treU(s) was (is -ere) constructed in accordance
with ISA NCAC 01C .0100 or 1 SA NCAC 02C .0100 Well Construction Standards and that a
copy ofthis record has been provided to the well orner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-I617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of'%vcll
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form OW-1 North Carolina Department orEnvironment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicahle +sell construction pernritx (1, a Coany, State, Parlance, etc.)
3. Well Use (check well use):
Water Supply Weil:
OAgricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OMunicipaL/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
mGroundwater Remediation
❑Salinity Barrier
OStormwater Drainage
OSubsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Wells) Completed: 09/01/16 Well ID# IW-6-14
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility 1DN (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
For Internal Use ONLY:
l4. WATER
ZONES
FROM
TO
I DESCRIPTION
ft.
ft.
ft.
ft,
15.OUTER CASING for
could -cased wells OR
LINER if a
Heable
FROM
TO
DIAMETER
THICICNFSS
MATERIAL
ft.
ft,
in.
16. INNER
CASING OR TUBING eathermal closed -loon)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 rc.
22.0 tt•
0.75 in
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
I MATERIAL
22.0 rt.
27.0 rt
0.75 in.
.010
SCH 40
PVC
ft.
ft.
I.
IS. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
0.0 ft.
18.0 ft-
PoRnmoaENMra
SLURRY
ft.
ft.
ft.
R.
19. SANDIGRAVEL PACK
if applicable)
FROM
TO
MATERIAL 1
EMPLACEMENT METHOD
20.0 ft•
27.0 ft•
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING
LOG attoch additional sheeb if necessary)
FROM
TO
DESCRIPTION color, hardness, soillsock gile, grain Am etc.)
0.0 n•
27.0 ft.
DIRECT PUSH
R.
ft.
ft.
0.
ft.
ft.
ft.
tt.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL FROM 18.0 TO 20.0 FEET
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certiftc i n:
(if well field one tatllong is sufficient) �®
35° 29' 18.64" N 810
15' 25.74" W
#UWt&
6. Is (are) the welt(s): OPermanent or OTemporary
7. Is this a repair to an existing well: OYes or EUNo
If tbix is a repair, fUl out known well construction information and explain the nature of the
repair under 921 remarks section or nit tire back of this form.
S. Number of wells constructed: 1
Far nmltiple hyectiom or tron•warer supply wells ONLY with the sonic construction, you can
suhnttt,one frtnu.
9. Total well depth below land surface: 27.0 (ft.)
For multiple wells list all depths j'di&rent (exantpic- 3Q200' and 2 rQ/00')
10. Static water level below top of casing: 20.0 (ft.)
Ifwater level it abm•e casing, use .,+'•
11. Borehole diameter: 3.25 (in.)
DDT RODS
Signature of Certified Weil Contractor
09/30/16
Date
By signing this foray. 1 hereby certify that the trell(s) Bras (were) constructed in accordance
with 15A NCAC 01C .0100 or ISA NCAC 02C .0200 Welt Construction Standards and that a
copy ofilds record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. field (gpm) Method of test: 24c. For Water Sunnly & Infection Wells: 1n addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-t North Carolina Department of Environment and Natural Resources - Division or Water Quality Revised Jam. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
Li.Tt all applicable well comrlructlar perrvits fl e. County-, State. Variance, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatine/Cooline
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 09/01/16 Well 1D# IW-6-12
So. Well Location:
ROBERT BOSCH TOOL NONGD0001154
Facility/Owner Name Facility iDO (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No. (PIN)
51b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees
(if well field one tatllong is sufficient)
35e 29' 18.33" N 810 15' 25.60"
6. Is (are) the well(s): 01'ermanent or ❑Temporary
For Internal Use ONLY:
14. WATER
ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15.OUTER CASING for multi -cased welts OR
LINER if n licablc
FROM
TO
DIAMETER
THtCtNFSS
MATERIAL
ft.
I ft.
is
16. INNER
CASING OR TUBING(geothermal
closid-too
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft'
25.0 ft•
0.75 1n
SCH 40
PVC
ft.
ft.
in
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
25.0 ft
35.0 f'
0.75 "'
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
I TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
0.0 ft'
21.0 ft'
PORTLANa9ENTCWTE
SLURRY
ft,
A.
ft.
ft.
19. SANDIGRAVEL
PAC ft if a licable
FROM
TO
MATERIAL I
EMPLACEMENT METHOD
23.0 ft'
35.0 ft'
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING
LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION color, bardnM soilfrock type, grain sim, eir.
0.0 ft-
35.0 R•
DIRECT PUSH
ft.
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARICS
BENTONITE SEAL FROM 21.0 TO 23.0 FEET
22. Certification:
�vA.=- 09/30/16
Signature ofCenified Well Contractor Date
7. Is this a repair to an existing well: ❑Yes or FINo
lfrlds is a repair, fill out kunirn well construction hiforniatlar and explain the nature ofthe
repair muler 921 remarks section or on the back of this form.
B. Number of wells constructed: 1
Far multiple h jection or non -water supply wells ONLY irith die same constructian, you can
submit ane form.
9. Total well depth below land surface: 35.0 (ft.)
For multiple welts list all depilu ifde rent (example- 3@ 200' and 2 r@( 100')
10. Static water level below top of rasing: 20.0 (ft.)
If crater level is above cashig, use •'+ •'
11. Borehole diameter: 3.25 (in.)
12. Well construction method: _
(i.e. ouger, rotary, cable, direct push, etc.)
DPT RODS
By signing this form• i hereby certify drat the well(s) tras (here) constructed in accordance
with ISA NCAC 02C.0100 or MA NCAC 02C.0200 Well Construction Standards and that a
copy ofthis record has been provided to rite well oirner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional Well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTALINSTUCTiONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Sunoly & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction'Permit #: W10300295(UIC)
List all applicable urll corstrueriotr pernity (i.e. County, State. Variance, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
Olndustrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
OExperimental Technology
OGeothermal (Closed Loop)
4. Date Well(s) Completed:
❑ MunicipaUPublic
OResidential Water Supply (single)
OResidential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
OTracer
00ther (explain under #21 1
09/01/16 Well1D# iW-6-10
So. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tatilong is sufficient)
350 29' 18.20" N 810 15' 25.26" W
6. Is (are) the well(s): OPermanent or OTemporary
7. is this a repair to an existing well: Dyes or E3No
lfthis is a repair, fell out knoru ,cell construction information and erplain the nature ofthe
repair under N 21 remarks section or on the back of this form
8. Number of wells constructed: `
l'or multiple injection or non -rater supply 111e1LT ONLY u•hlt the same construction• you can
submit one form.
For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTION
ft.
ft.
ft.
R.
15. OUTER CASING for
multi-cused wells) ORLiNER ifa
livable
FROM
TO
DIAMETER THICKNESS
MATERIAL
ft.
1 D.
I In
16. INNER
CASING OR
TUBING(geothermal
closed-10011)
FROM
TO
DIAMETER
THICItNFSS
MATERIAL
0.0 ft'
25.0 rt.
0.75 i"
SCH 40
PVC
ft.
ft.
in.
17.SCREEN
FROM
TO
DIAMETER
I SLOTSIZE
I THICKNESS
MATERIAL
25.0 rf
35.0 n.
0,75 '"'
1 .010
SCH 40
1 PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft'
21.0 fir.
co"Lmneem""m
SLURRY
ft.
ft.
ft.
ft.
19.SAND/GRAVEL PACK(if
Malleable)
FROM
I MATERIAL
EMPLACEMENTRIEI'HOD
23.0 a•
35.0 ft.
1 2040
FINE SILICA SAND
ft.
I ft.
20. DRILLING
LOG lattach
additional sheets if necema
FROM
I To
DESCRIPTION eobr, hardness, soiUrork rain size etc.
0.0 It.
35.0 ft•
DIRECT PUSH
cr.
tt.
ft.
ft.
n.
ft.
ft.
ft.
ft.
ft.
2I. REAIARKS
BENTONITE SEAL FROM 21.0 TO 23.0 FEET
22. Certification:
A"-�
09/30/16
Signature ofCertifred Well Contractor Date
By signing this form, 1 hereby verb that Ilia u•ell(s) was (were) constructed in occordance
frith 1SA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
copy of this record has been provided to die Tell owner.
23. Site diagram or additional well details: i
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
9. Total well depth below fund surface• 35.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
hor multiple cells list all depths iffiferent (example- 3 a@200' and 2Q1001 .construction to the following:
10. Static water level below top ofcasing, 20.0 (ft.) Division of Water Quality, Information Processing Unit,
ljrater level is above casing. use " i " 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 3.25 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
24b. For Infection Wells; In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY- 1636 Mail Service Center, Raleigh, NC 27699-1636
Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
130. Yield (gpm) the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contactor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Nark
2. Well Construction Permit #: W10300295 (UIC)
List all applicable Civil consiructlan pernrily (I.e. Coutny. Stare, Variance, etc)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
UNW
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Harrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 09/01/16 Well ID# IW-6-8
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDO (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees
(if well hold. one tattling, is sufficient)
350 29' 18.29" N 810 15' 24.70"
6. Is (are) the well(s): ©Permanent or ❑Temporary
For Internal Use ONLY.
14. WATER
ZONES
FROM
TO
I DESCRIPTION
rt.
ft.
ft.
ft.
IS. OUTER CASING for
multi -cased wells OR LINER if a liwble
FROM
TO
DIAMETER THtC1:NF55 MATERIAL
R.
R
in
16. INNER
CASING OR TUBING faeotherM21
closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft.
31.0 ft.
0.75 1O
SCH 40
PVC
fL
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
31.0 it'
46.0 "
0,75 in'
.010 ,
SCH 40
PVC
ft.
ft.
I.
I8. GROUT
FROM
TO
MATERIAL
EMPLACEMENT MErIIOD & AMOUNT
0.0 fL
27.0 f"
vosumos"rtowre
SLURRY
R.
ft.
R.
ft.
19. SAND/GRAVEL PACK
if applicable)
FROM
TO
I MATERIAL I
EMPLACEMENT METHOD
29.0 ft.
46.0 ft.
20-40
FINE SILICA SAND
ft.
R.
20. DRILLING
LOG attach additional sheets if neeess
. FROM
I TO
DESCRIPTION cotor, hardnem soiltrack type, train sizeetc.
0.0 ft.
46.0 ft.
DIRECT PUSH
ft.
ft.
ft.
ft.
R.
ft.
ft.
ft.
R.
R.
R.
R.
21. REIIIARKS
BENTONITE SEAL FROM 27.0 TO 29.0 FEET
22. Certification: �A"'arW 09/30/16
Signature of Certified Well Contractor Date
7. Is this a repair to an existing well: ❑Yes or ❑No
If this Ls a repoir, fill out known well construction information and explain the nature of the
repair under 921 remarks section or on the back ofthis form.
8. Number of wells constructed: 1
For muhiple h fcerion or non -water supply irells ONLY with the same construction, you can
submit one form(.
9. Total well depth below land surface: 46.0
For multiple irells list all depils ifdifferetu (example- 3Ca 200' and 1Q/00)
10. Static water level below top of casing: 20.0 (ftJ
lfirater level is above casing, use "+"
11. Borehole diameter: 3.25 (in.)
DPT RODS
B3• sigtring this form, l hereby certify drat the ire//(s) a -as (mere) comoructed in accordance
with 15A NCAC 02C .0100 or 1 SA NCAC 02C .0100 Well Construction Standards and that a
copy ofthis record bas been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of wail construction to the county health department of the county
where constructed.
Form O W-I North Carolina Department of Envirotiment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
For Internal Use ONLY:
I ft. I ft. I in. I I I
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable troll rnnctrarttar permiis (i.e. Count).. Stare, Variance. ere,)
3. Well Use (check well use):
16. INNER CASING OR
TUBING leeothermul
clwed400
FROM
TO
DIAMETER
THICKNESS
MATERIAL
tL
31.0
0.75 so
SCH 40
PVC,
ft.
f6
in.
17. SCREEN
Water Supply Well:
❑Agricultural OMunicipal/Public
•Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑Irrigation
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
I MATERN
31.0 ft'
46.0 ft'
0.75 `"
.010
SC"40
PVC
ft.
ft.
;n
I& GROUT
FROM
TO
MATERIAL
EMPL4CEMENTMETHOD &AAt01
0.0 ft.
26.0 ft'
POnn-mm"ENTar6TE
SLURRY
Non -Wafer Supply Well:
❑ Monitoring ❑Recovery
ft.
ft.
Iniection WMI- t
It.
ft,
❑Aquifer Recharge ®Groundwater Remediation
❑Aquifer Storage and Recovery OSalinity Barrier
❑Aquifer Test OStormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
OGeothermal (HeatinglCooling Return) ❑Other (explain under #21 Remarks)
19.SANDIGRAVEL
PACK
if a citable
FROM
TO
MATERIAL
I EMPLACEMENT METHOD
29.0 fL
46.0 ft'
20-40
FINE SILICA SAND
ft.
ft
20. DRILLING
LOG attach
additional sheets if necessa
FROM
TO
DESCRIPTION color, harduw.%suittrvck type, grain sue.ett.
0.0 ft.
46.0 tL
DIRECT PUSH
4. Date ell(s) Completed: 09/06/16 Well IW-6-6
511. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDN (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
ft,
ft.
ft
ft
ft.
ft.
R,
ft.
it.
ft.
D
Physical Address, City, and Zip
LINCOLN 00410
County Parcet Identification No. (PIN)
i
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one laillong is sufficient)
350 29' 18.11" N 810 15' 24.44" W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or ElNo
If flits 1s a repair, fill our knout well construction information and crplain the native of the
repair under k21 remarks .section or on the back of this form.
8. Number of wells constructed: 1
1--or multiple h fection or not -crater supply wells ONLY with the same construction, you can
Submit one farm.
9. Total well depth below land surface: 46.0 (ft.)
For nultiple welis Jim all depihs lfdWeren1(example• 3@(D200' and 2 01 GO)
10. Static water level below top of casing: 20.0 (ft )
If tearer level is above casing, use "* "
11. Borehole diameter: 3.25 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
I BENTONITE SEAL FROM 26.0 TO 29.0 FEET I
09130/16
Signature ofCertified Well Contractor Date
By signing this form. I hereby certify dint the well(.) tras (were) co irucied in accordance
witb ISA NCAC 02C,0100 or 15A NCAC 02C.0200 Well Construction Standards and drat a
copy ofthls record hav been provided in the well owner,
23. Site diugram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
22. CertitX��
Form OW-1 Noah Carolina Department of Environment and Natural Resources - Division of Waler Quality Revised Ian. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permittl: WI0300295 (UIC)
List all applicable trell construction permits (ee. County, Starr, I�artance, etc,)
3. Well Use (check well use):
❑Agricultural OMunicipal/Public
❑Geothermal (Heating/Cooling Supply) OResidential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
®Groundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
OTracer
❑Other (explain under t121 1
4. Date Well(s) Completed: 09/06/16 Well IDII IW-6-4
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001164
Facility/Owner Name Facility IDN (il'appficable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell Geld, one fat/long is sufficient)
350 29' 18.09" N 810 15' 24.22" W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or 0No
!f difs Is a repair, fill out known well construction byornmean and explain the nature of the
repair under 921 remarks section or on the back of this form.
8. Number of wells constructed: 1
For inrdtiple injection or iron -water supply wells ONI.I' with dte same construction, you can
.crthnih one form.
9. Total well depth below land surface: 42.0 (ft.)
Far iultiple wells Art all depths if dijf�renr (example- 3trr 200' and 2©100)
10. Stolle water level below top of easing: 20.0 (ft.)
if ureter level Is above casing, use "+"
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY:
14. WATER
ZONES
FROM
TO
I DESCRIPTION
ft.
rt.
ft,
rt.
15. OUTER CASING for
multi -eased wells OR LINER Kra applicable)
ROM F
TO
DIAMETER
THICI:NFSS
MATERIAL
fit.
ft.
in.
16. INNER CASING OR
TUBING eothermat
closed-loo
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft.
27.0 H•
0.75 1'�
SCH 40
PVC
H.
H.
in
17. SCREEN
FROM
TO
DIAMETER
I SLOTSIZE
THICKNESS
MATERIAL
27.0 tt•
42.0 ft'
0.75 .'a
.010
SCH 40
PVC
1t. I
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENTMETHOD&AMOUNT
0.0 ft.
22.0 ft'
POanAMaeWOMrE
SLURRY
H.
M
ft.
ft.
19. SAND/GRAVEL
PACK if n ficable
FROM
TO
MATERIAL
EMPLACEMENT METHOD
25.0 ft'
42.0 ft•
2040
FINE SILICA SAND
ft.
ft
20. DRILLING
LOG attach additional sheeb irnecessa
FROM
I TO
DESCRIPTION color, hardn sorUreck type, grain size, etc.
0.0 ft
42.0 ft-
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
R.
a.
H.
H.
ft.
H.
rt.
21. REMARKS
BENTONITE SEAL FROM 22.0 TO 25.0 FEET
22. Certification:
A-'t' A.� os/aals
Signature of Certified Well Contractor Dale
By signing this fornt, 1 hereby certify dial the irell(s) itas (were) constructed in accordance
with I5A NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy ofthis record has been provided to Kite well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct pusti, etc.)
Division of Water Quality, Underground Injection Central Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) 141ethod of test: 24c. For Water Supnly Sr Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan, 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable troll caustrureilan permits (I.e. Cranny, State, Mariance, etc)
3. Well Use (check well use):
OAgricultural
❑Geothermal (Heating/Cooling Supply)
O industrial/Commercial
❑Aquifer Recharge
OAquifer Storage and Recovery
OAquifer Test
OExperimental Technology
❑Geothermal (Closed Loop)
OGeothermal (HeatinPJCoolina
❑Municipal/Public
OResidential Water Supply (single)
❑Residential Water Supply (shared)
®Groundwater Remediation
❑Salinity Barrier
OStormwnter Drainage
OSubsidence Control
OTraccr
❑Other (explain under 421 F
4. Date Well(s) Completed: 09/06/16 Well ID# IW-6-2
Sa. Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LINCOLN
County
NONCDO001154
Facility tDtt (if applicable)
LINCOLNTON . 28092
00410
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if welt field, one fat/tong is sufficient)
35e 29' 17.88" N 81 ° 15' 23.60"_ _ W
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or ONO
If ddx U a repair, fill out known well construction information and explain rbe to o ure of the
repair under k21 remarks section or air the back of rhls form.
8. Number of wells constructed: 1
ror multiple itlecilon or non -water supply wells ONLY with the same construction, you call
.cubmil one form.
9. Total well depth below land surface: 45.0
1--or nudtiple wells list all deptu if dgerent (example- 3Q200' and 2 tQ100')
10. Static water level below top of casing: 20.0
lfwater level is above casing, nse
11. Borehole diameter: 3.25 (in.)
DDT RODS
For Internal Use ONLY;
14. WATER ZONES
FROM TO I DESCRIPTION
15.OUTER CASING(for malti-casedWells) ORL[NEA run
livable
FROM TO DIAMETER THICAT�(ESS MATERIAL
fa ft, I ire
IC INNER CASING OR TUBING eothermal dosed -loan)
FROM I TO DIAMETER I THICKNESS MATERIAL
0.0 f6 30.0 ff' 0.75 i" I SCH-40 PVC
ft. ft. In.
17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
30.0 h, 45.0 ft. 0.75 i"' .010 SCH 40 PVC
ft. I ft. in.
Ia. GROUT
FROM TO MATERIAL EMPLACEMENT METHOD &AMOUNT
0.0 ft' 25.0 ft' "a"n"'aeem"T" SLURRY
ft. ft.
ft. ft.
19. SAND/GRAVEL PACK(irapplicablel,
FROM TO MATERIAL I EMPLACEMENTME H D
28.0 fL 45.0 "' 20-40 FINE SILICA SAND
ft. It.
20. DRILLING LOG attath additional sheets if necessary)
FROM TO DESCRIPTION color, hardaess, sail/ruck type, grain size, etc.
0.0 ft- 45.0 n- DIRECT PUSH
tt. tt.
D. fa
ft. ft.
It. ft.
ft. H.
21. REMARKS
BENTONITE SEAL FROM 25.0 TO 28.0 FEET
22 Certification:."t
A,'-,
09/30/16
Signature ofCertified Well Contractor Date
Ry signing t&v furni, 1 hereby t enifi• that the well(s) uas (were) constructedin accortiance
with 15A NCAC 02C .0100 or 15A NC'AC 02C .0200 11'ell Courstruciian Standards mud that a
copy of this record has been provided to the irell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL 1NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Witter Supply & Iniection Wells: In addition to sending the form to
the address(cs) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple well
1. Well Contractor Information:
PAUL MCVEY
For Internal Use ONLY'
14.WATERZONES
FROM
TO
DESCRIPTION
Well Contractor Name _
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
W10300295 UIC``
2. Well Construction Permit /f: 1
List all applicable it -ell construction permits (i c. County. Stare, irariance, etc.J
3. Well Use (check well use):
R.
fL
ft.
ft.
15. OUTER CASING(for ult-eased Ou GahbAlTe
FROM1f
TO
DIAMTwRells
TRS
RIAL
rt.
I ft.
I in
16. INNER
CASING OR TUBING(geothermal
elused-lop)n
FROM
DIAMEER
T
THICKNESS
MATERIAL
ft.TO
rL
rn
rt.
ft.
is
❑Agricultural ❑MunicipaUPublic ft. ft. in
❑Geothermal (Heating/Cooling Supply) ❑Residential Water SuPP1Y (single)'ft. ft. t2
❑industrial/Commercial ❑Residential Water Supply (shared) 18 GROUT TO MATERIAL EMPLACEM EKi
Non -Water Supply Well: ❑ ztion 0.0 rI 36.0 ft' PumL-0eEH TE SLURRY
tt. ❑Monitoring ❑Recovery ft.
Iniection Well: ft. ft.
❑Aquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
OStormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under #21 Remo
4. Date Well(s) Completed: - 09114/16_
Well ID# IW-27-24
ba. Well Location:
ROBERT BOSCH TOOL
NONCD0001154
Facility/Owner Name
Facility ID4 (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County Parcel Identification No. (PIN)
00631
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(irwell field, one tatllong is sufficient)
35' 29' 12.17" N 81' 15' 21.84"
6. Is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well. OYes or ONo
Ifthis is a repair, fill out knotrn well construction information and explain the nature ofilte
repair under „ 2/ remarks section or an the back of this form.
8. Number of wells constructed: 1
For andtiple igjecuon or nun- -oiersupply wells O,VLJ' frith the same construction, }'nu can
submit one farm.
9. Total well depth below land surface: 36.0 (ft
For maniple trells fist all deptlur ifdifferenl (example- 3©200' and 20a /Of)
10. Static water level below top of casing: (ft
If hater lure/ is abore coring, use ••+"
11. Borehole diameter: 1.5 (in.)
®�3f!
sheen
0.0 rr 36.0 rt. I DIRECT PUSH
ft. it.
ft. tt.
ft. ft.
i ft. ft.
ft. rt.
22. Certifica •
09/30/16
Signature o ertsfted Well Contractor Date
B3• signing this form. I hereby certyr that die trell(s) u-as (i•ercf constructed in accordance
wuh 15A .NCAC 02C.0100 or 15A ArAC 02C.0200 M ell Construction Stardardv and that a
copy of this record has been provided to the it -ell arner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of %veil
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Sen•ice Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction -method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc )
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 1Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24e. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion, of well consintction to the county health deparimcnt of the county
Where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources — Division or Water Quality Revised Jan. 2013
27a - 24

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295 (UIC)
List all applicable cell construction permits (.e. County, State, Variance, etc)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
❑ Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
4. Date Well(s) Completed: 09/12/16
5a. Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name Facility 1Dh (ifappticable)
129 LEGiONAIRE ROAD LINCOLNTON 28092
gGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage .
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
WellID# iW-27-16
Physical Address, City, and Zip
LINCOLN
County
NONCDO001154
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one tat/long is sufficient)
35a 29' 15.49" N 81 a 15' 29.88" W
6. Is (arc) the well(s): ❑Permanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or EINo
lffids is a repair. fill out knoirrr ire// construction information and explain the nowre off/te
repair under 921 remarks section or on the bock of this font.
S" Number of wells constructed: 1
For authiple it ffectiotr or non•irater supply ire/Ls ONLI' frith the same construction, ),no can
sahmir ant fttmi.
For Internal Use ONLY-
14: WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
f"
is. OUTER CASING (for multi-cascdwells) OR LINER (1172P Rcabl
FROM
TO
DIAMETER THICKNESS
MATERIAL
ft.
ft.
in
IC INNER CASING OR TLWING eothermaf dosed -Too ' '
FROM
TO I DIAMETER
THICKNESS
MATERIAL
ft.
ft. in
Ct.
ft. in
17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS MATERIAL
ft.
ft
in.
i
in
1
18. GROUT
FROM
TO
MATERIAL
EMPLACEMEW METHOD&AMOUNT
0.0 M
32.0 Cr'
I ronrw:oacvrame
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK if applicable)
FRONT
TO
MATERIAL
£MPLACEMUNTMETHOD I
ft.
ft.
1
ft.
ft.
.20. DRILLING LOG attach additional sheets if necessary)
FROM
To
DESCRIPTION rotor hardness. so,Urark , rain:ire, err.
0.0 ft.
32.( ft
DIRECT PUSH
ft.
ft.
ft.
ft.
i
ft.
rt.
ft.
ft.
ft.
ft.
.21. REMARKS -
1
1
22. Certific` �E
09130I16
Signature ofCenified Well Contractor Date
HP signing this form. I hereby cent yy that the ire/i(s) ryas (were) constructed in accordance
frith IJA NCAC 02C.0100 or I5A NCAC 02C.0200 Well Coicstruction Sim?tiords mid that a
copy of This retard has beet? provided to the n•e/l owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessaty.
SUBMITTAL INSTUCTIONS
9. Total well 0 depth below land surface: 32.
p (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
I'or nmhiple wells list all depi/ts ifd fferent (exoniple- 3Q200' and 2 rt 100') construction to the following:
10. Static water level below top of casing: (ft.) Division of Wuter Quality, Information Processing Unit,
lfroterlerells above casing, use -4- 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For lniection Wells: In addition to sending the form to the address in 24.1
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method- construction to the following:
(i.e. auger, rotary, cable, direct push, etc )
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Ylethod or test; 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type. Amount: completion of well construction to the county health department of the county
where constructed.
Form Gr W-I North Carolina Department of Erivironment and Natural Resources- Division of Water Quality Revised Jan. 2013
27a - 16

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
INC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295 (UUIC)
List all applicable trell consiractionpermits (.e. County. State, lrariance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring ❑Recovery t
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heating/Cooling
013roundwater Remediation
❑Salinity Barrier
❑Stormwuter Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #2J T
4. DateWell(s) Completed: 09/12/16 Well ID# IW-27-17
Sa. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility IDk (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County
Parcel Identification No. (PJN)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
I DESCRIPTION
ft.
tt.
ft.
ft.
15. OUTER CASING ffor wells) OR LINER if n Gcable}
FROPi TO
T211tt;cosed
DAaETER THICI:NFS5
MATERIAL
{L fr.
in,
.16 INNER CASING OR TUBING - eothermal"closedloo n
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
iR
ft.
I ft.
iR
17.SCREEN"
FROM
TO
DLIMETF.A
SLOTSIZE
THICKNESS
MATERIAL
ft.
ft.
ft.
ft.
iR
18. GROUT
FROM TO
MATERIAL
EMPLACENIENralE liOD&AatOUNr
0.0 tr' 28.0 a'
voa-aexrore,te
SLURRY
ft. I ft.
ft. ft.
19. SANDIGRAVEL PACK if applicable) -
FROM
TO
MATERIAL I
ENIPLICEMENTNIEr1100
fL
ft.
ft.
ft.
20 DRILLING
LOG attach"additional sheet if_T1VliC532rYJ
FROA1
TO
DESCRIPTION (color, h-tinesr, roill-ck type. gri. siu, elr.
0.0 ft-
28.0 ft
DIRECT PUSH
ft.
If.
ft.
ft.
fr.
ft
ft.
ft.
ft.
R.
21 REMARKS
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certifies
(if well field one latnong is sufficient)
350 29' 15.49" N 81 a 15' 29.88" W 09/30/16
Signature of Certified Well Contractor Date
6. Is (are) the well(s): ❑Permanent or fdTemporary ny signing thisJorm, I hareby cerlyJ that the wells) was (were) constructed in accordance
with 15A NCAC 02C .010(I or 15A NCAC 02C.0200 M11 Conviruetior Standards and that a
7. Is this a repair to an existing well: ❑Yes or EINa copy oftlr/s record has been provider( io the troll aumer.
ythis is a repair, Jill ma known well eoutruction Information and etplahn the nature (+flhr
repair under 4'21 rentorkr section or on lire back of this farni. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8. Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
l=or multiple iry'eclian or tion-water suppit• wells ONLY witli the same construction. )ntr cal
submit one form. SUBMITTAL I NST UCTIONS
9. Total well depth below land surface: 28.0
p (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
har mahiple wells list a// depths ifdifferent (example- 3@9200' and 2(a31001 construction to the following:
10. Static water Level below top of casing: (ft) Division of Water Quality, Information Processing Unit,
lfwutcr level is above caving, use "+-- 1617 Mail Service Center, Raleigh, NC 27699-1617
11.Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: in addition to sending the form to the address in 24,1
DPT RODS above, also submit a copy of this form within. 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of -this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form OW- I Nona Carolina Department of Environment and Natural Resources - Division of Waler Quality Revised Jan. 2013
27a - 17

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
L Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295 (UIC)
List all applicable irell construction permits (i. e. County, Store, Variance. etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercia I
Non -Water Supply
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑AquiterTest .
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatinp/Cooline
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
CT'mcer
❑Other (explain under #21 F
4. Date Well(s) Completed: 09/12/16 Well
5a. Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LINCOLN
County
ID# IW-27-18
NONCDO001154
Facility IDd (ifapplicable)
LtNCOLNTON 28092
00631
Panel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one larAong is sufficienQ
35" 29' 15.49" N 81 a 1529.88" W
6. Is (are) the well(s): ❑Permanent or IaTemporary
7. Is this a repair to an existing well: CYes or ElNo
Ifthis is a repair, fill out known well cmusinuBon information and explain the nature ofihe
repair under # 21 remarks section or on the back orthis form.
8. Number ofwelts constructed: 1
Fnr multiple byectlon or non-n•oter supply wells ONLY with the same construction. yvtu can
submit one f"mi.
9. Total well depth below land surface: 32.0 (ft.)
For nuduple• +rclls list all depths i(diffvrenr (example- 3 n 700' and 2@100)
10. Static water level below top of casing:
f a•mer level is abore casing, use -4. -
IL Borehole diameter: 1.5 (in.)
DDT RODS
For Internal Use ONLY:
14. WATER ZONES -
mom
TO
DESCRIPTION
fL
ft.
ft.
fL
I5:OUTERCASING foriaulticasedwe1k10RLINEA(if o licabk
FROM
To
DIAMETER
T1IICrL`YE55
MATERIALft.
ft.
in
-16. INNER CASING OR TUBING e.therqurdmed-!oo
FROM
TO
D1AMEIER
THICKNESS
AfATERIAL
ft.
(L
in.
ft.
ft.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in
ft.
D.
in.
18: GROUT
FROM
TO
MATERIAL
EMPLACEbt E\TME171OD&AMOUNT
0.0 ft.
32.0 It.
roRsumaert E
SLURRY
ft.
ft.
ft.
h.
19. SAND/GRAVEL PACK
if applicable)
FROM
TO
MATERIAL
EMPLACEMEJiTMETHOD
ft.
ft.
ft.
ft.
20. DRILLING
LOG attach additional sheets if necesiia-
FROM
TO
DESCRIPTION cob,, hardacss, soiVrock , rain siu. etc.
0.0 ft.
32.0 ft-
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
It.
ft.
Cr.
21. REMARKS
22. Certifi n:
09t30l16
Signature o Certified Wdl Contractor Date
Hv signing this forni, I hereby certify that the well(n) rrar (acre) constructed in aceortlance
with 114 NCAC 02C .0100 or 15A NCAC 02C _0200 Well Construction Standards and that a
copy ofthis record har been provided to due ire/1 rurner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary•.
SUBMITTAL INSCUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
I3a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sendmgihe form to
the address(es) above, also submit one copy of this form within 30 days of
13b, Disinfection type: Amount- completion of well construction to the county health department of the county
Where constructed.
Form GW-1 North Carolina Department of Environment and Nniural Resources - Division of Water Quality Revised Jan 2013
27a - 18

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1, Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name -
2. Well Construction Permit9: W10300295 (UIC)
List all applicable uvll construction hermits (i. e. County, Slate. Variance. etc)
3. Well Use (check well use):
ClAgricultural OMunicipal/Public
DGeothermal (Heating/Cooling Supply) OResidential Water Supply (single)
❑industrial/Commercial OResidential Water Supply (shared)
Non -Water Supply Well:
OMonitoring
ORecovery
Injection Well:
OAquifer Recharge
OGroundwater Remediation
OAquifer Storage and Recovery
OSalinity Barrier
OAquiter Test
❑Stormwater Drainage
OExperimental Technology
❑Subsidence Control
OGeothermal (Closed Loop)
OTricer
OGeothermat (HeatinvjCooling Return)
001her (explain under #21 Remarks)
4. Date Well(s) Completed: 09112/16 Well IDit IW-27-19
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
FacilitylOwner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip -
LINCOLN 00631
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one IaUlong is sufficient)
35' 29' 15.49" N 81 a 15' 29.88" W
6. Is (are) the well(s): ❑Permanent or (OTemporary
7. is this a repair to an existing well: ❑Yes or ONo
60his it a repair, Jill out known u•a11 construction information and explain the nature nJ7he
repair under 921 remarks section or a): the back ofrhir jorn.
8. Number of wells constructed: 1
For multiple injection ar nor -crater supple' wells ON1.Y ri'irh doe .cane construction, Jnu Carr
subnit one form.
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
.. fL
_
d5. OUTER CASING for multi evsed wens OR LINER ifs Iicabh,
FROM TO
DIAMETER
TNICf:NFSS
MATERIAL
ft. I ft.
in
-A6: INNER CASING OR TUBING Jg6titheiTnal closed-loo
FROM
TO
DIAMETER 1
THICKNESS
MATERIAL
ft.
ft.
is
ft.
ft,
in
17. SCREEN
FROM
TO
DIAMETER.
SL'OTSIZE
TIiICKNFSS
I MATERIAL
It.
ft:
is
ft.
ft.
is
I GROUT
FROM
TO
MATERIAL
EMPLACEMENTMETIIOD&AFfOUNr
0.0 ft-
37.0 fit'
va"T— -c'ns
SLURRY
ft.
rt.
ft.
ft.
19. SAND/GRAVEL PACK if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft.
ft.
.20. DRILLING LOG attach
additional sheets ifnecessa .. -
FROM
TO
D£SCRIFI'1DN color, hardness, saiVro<k rein size, efc)
0.0 ft-
37.0 ft-
DIRECT PUSH
ft.
ft.
ft.
ft-
Ft.
ft.
ft.
it.
fL
ft.
it.
ff.
-21 REMARKS- -
22- Ceriifica
osr3otl s
Signature of Certified Well Contractor Date
By signing tins jorn, I hereby certiyy that the weU(s) Bras (were) consinicted in accardance
u•ilh 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Consinicrion Standards and that a
copy ofthis record has been provided to dre well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL iNSTUCTIONS
9. Total well depth below land surface: 37•0
(ft.j 24a- For All Wells: Submit this form within 30 days of completion of well
Fur multiple welts list all depths ifdirerem (acaniple- 3 r(t 200' and 2@ 100`)
construction to the following:
10. Static water level below top of casing:
(ft-) Division of Water Quality, Information Processing Unit,
1fi ater level is abore casing. use "+-
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.•5 (in.)
24b. For Injection Wells: In addition to sending the form to the address in 24a
DPT RODS
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method:
construction to the following:
(i.e. auger, rotary, cable, direct push, eta)
Division of Water Qualitv, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a.-Yield (gpm) Method of test:
24c. For Water Supply & lniection Wells: In addition to sending the form( to
the address(es) above, also submit one copy of this form within 30 days of
13b.-Disinfection type: Amount
completion of well construction to the county health department of the county
where constructed.
,Farm GW-1 North Carolina Department of Enviromnent
and Natural Resources -Division of Water Quality Revised Jan. 2015
- -
27a - 19

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
.PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit 9: W10300295 (UIC)
List all applicable nr/l construction perntits (l.e. Counq: State, trariance, eta)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑lndustrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatinn/Cooline
4. Date Well(s) Completed: 09/13/16
®Ground% ater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 421 F
Well ID9 IW-27-20
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility lDh (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one fatflong is sufficient)
35° 29' 15.49" N 81 a 15' 29.88" W
6. Is (are) the well(s): ❑Permanent or l2Temporary
7. Is this a repair to an existing well: ❑Yes or 0No
if this is a repair, fill our known meR construction information and a plait: the nantre tfrdte
repair under 421 remarks .section ar on the back of this farm.
8. Number of wells constructed: 1
Gor muliiple infection or non-u-mrr supply nrells ONLY nr/th dte same caaaruerion, you can
submit mreform.
9. Total well depth below fund surface: 32.0
For anthiple wells Iisi all depths ifdifferent (example- 3@200' and 2@100?
10. Static water level below top of casing:
If nroter level is obare casing, use ^+ -
11. Borehole diameter: 1.5 (in.)
DDT RODS
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft,
ft.
Ft.
fL
15. OUTER CASING for multi -cased welts OR LINER 1f a Gcable
FROM
TO
DIAMETER Tk[ICtJVF55
MATERIAL
ft.
fL
in,
16. INNER CASING OR TUBING eotherrnn[ elwed-too
FROM
TO
DIAMETER
T'HtCK1+iESS
MATERIAL
ft.
ft.
in'
ft.
fL
is
17. SCREEN
TO
DIAMETER
SLOTSIZE
THICKNESS MATERIAL
7FROM
j ft.
ft.
in.
ft,
ft.
in.
.18. CROUT
FROM
TO
MATERIAL
E.MPLACENIENT METHOD&AMOUNT
0.0 ft•
32•0 ft'
t9rtn RFm-TE
SLURRY
ft.
ft.
ft.
ft.
'19. SANDIGRAVEL PACK of applicable?
FROM
TO MATERIAL EMPLACEM&YTMETnorl
ft.
ft.
-2Q DRILLING
LOG launch additional sheets if necessary) '
FROM
TO
DESCRIPTION color hardness, soill-cht , sirs sirr etc,
0.0 ft.
32.0 ft.
DIRECT PUSH
ft.
ft,
n.
fL
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certiftca ' Y
09/30116
Signature of ertified ttiel! Contractor Date
Hv signing this form, 1 hereby cerlyi, that the nrell(v) was (irere) conuracted in accordance
frith 15.4 NCAC 02C .0100 or 15A NCAC 02C.0200 Well Cotutr action Siondards and that a
copy oftbis record has been prorided to the well ouvier.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within, 30 days of completion of well
' 12. Well construction method: construction to thd-foliowing
(i.e. auger, rotary, cable, direct push, etc )
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13n. Yield (gpm) Nlethud of test: 24c. For Witter Sunoh• & lniection Wells: In addition to sending the form, to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I Nonit Carolina Department of Environment and Natural Resources - Division, of Water Quality Revised lan. 2013
27a - 20

WELL CONSTRUCTION RECORD
This form cum be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Cer.ification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
Listall applicable hell construction permits (re. County, Store, Variance. ere.
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commere ial ❑Residential Water Supply (shared)
'Von -Water Supply Well:
❑Monitoring \ ❑Recovery
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 421 P
4. Date Well(s) Completed: 09/13/16 Well 1D# IW-27-21
So. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in dcgrees/minutes/seconds or decimal degrees:
(ifwelt field, one iot/long is sufficient)
35' 29' 15.49"
81 a 15' 29.88"
N
W
6, is (are) the well(s): ❑Permanent or - iOTemporary
7. Is this a repair to an existing well: ❑Yes or ®No
lfthis is a relarir, fro nut knwrn irell construction rr farmation and explain the nature of ibe
repair under d 21 rentarkr section or an rite back of this form.
8. Number of wells constructed: 1
For atuhiple ityection or non-tmtersupplP ivells ONLY iritb the same construction. )nu can
submit one Jiu m.
For Infernal Use ONLY:. '
.14. WATER ZONES -
FROM
To
DESCRIPTION
ft.
I ft.
15.OUTER CASING formulti-cared wefts OR LINER ifa licable
FROM
I TO
I MATERIAL
ft.
I ft.
ih
IC INNER CASING OR TUBING(geothermal closed-ioo
FROM
TO
I DIAMETER I
THICKNESS
I MATERIAL
ft.
it.
Ia
ft.
it,
in.
17. SCREEN
FROM I
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
It. I
ft.
in.
I& GROUT
FROM
I TO
MATERIAL
EILIPL\CEMEYt'FILTHOD&AMOUNT
0.0 It.
32.0 re.
�niruos�raas_=
SLURRY
ft
tt.
ft.
tt.
19. SANDIGRAVEL PACK ifa licable
FROM
TO
MATERIAL
EMPL\CEMENTMEMOD
it.
ft.
ft.
ft.
20.: DRILLINGLOG arm It sidditional sheets if necessary)
FROM
TO
DFSCRtPTJON solar hardn soiVrnck tofu stu, ela)
0.0 it.
; 32.0 ft-
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
fr.
.21. REi17ARKS -
22. Certificati
�) /
09/30/16
Signature ofCeniFied Weil Contractor Dale
By signing this form, I hereby certify this the irell(s) +vas (were) constructed in accordance
frith 15.4 NCAC 02C .0100 or 15A NCAC 02C.0200 Well Conriructioa Standards and that a
copy ojrhis rrenrrl has been pmvidrd m the urU nu•ner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
9. Total well depth below land surface: 32.0 (ft-) 24s. For All Wells: Submit this form within 30 days of completion or well
Trr multiple hells list all depths ifdif&reut (example- 3 200' and 2Q100') construction to the following:
10. Static water level below top of casing: (ft.)Division of Water Quality, Information Processing Unit,
fuater hire/ is abni•e caring, use -" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition, to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Alail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount completion of well construction to the county health department of the county
where constructed.
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan 2013
- = 27a - 21

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor None
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List a71 applicable tic// mnstruetion permits (t.e. Comm! State, Variance, ere)
3. Well Use (check well use):
Water Supply Will:
❑Agricultural - OMunicipal/Public
OGeothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
Olndustrial/Commercial ❑Residential Water Supply (shared)
Olrri tion
Non -Water Supply Well:
❑Monitoring ORecovery
❑Aquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
OSalinity Barrier
❑Aquifer Test
OStormwater Drainage
❑Experimental Technology
OSubsidence Control
❑Geothermal (Closed Loop)
OTracer
[]Geothermal (Heating/Cooling Return)
❑Other (explain under 921 Remarks)
4. Date Well(s) Completed: 09/13/16
Well IDF, IW-27-22
5a. Well Location:
ROBERT BOSCH TOOL
NONCD0001154
FacilitylOwner Name
Facility IDN (if -applicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
PhysicntAd&css, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one laulong is sufficient)
35° 29' 15.49" N 81 a 15' 29.88" W
6. Is (are) the well(s): ❑Permanent or MTemporary
7. Is this a repair to an existing well: ❑Yes or ONo
Ifthis is a repair, fill out knower well construction infin-matiun and explain the nature arthe
repair under 921 rennarkr .section or on the back of this form.
S. Number of wells constructed: 1
For methiple injection or non -water supply trells ONLi' with Ilse saner construction. emu con
suhruir. ore Jamr.
9. Total well depth below land surface: 29.0 (ff.)
For nnthiple it -ells list all depth,; ifdii ferent (example- 3@200' ord 2Oz 100'i
For Internal Use ONLY:
ft. ft.
ft. ft.
rt. I ft. I in. I I I
I ft I ft. I I. I
L ft. ft. I in.
ft, ft.
0.0 ft. 129.0 f4 ronnvoarxranae SLURRY
ft. I ft.
MA
0.0 ft- 29.0 11- DIRECT PUSH
ft. ft.
It, ft.
fl. ft.
21. REMARKS
22. C�t:
5��` 09/30/16
Signature o Certified Well Contractor Date
By signing Ntis funn. 1 herchy certify !liar the well ft) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 1.5,4 NCAC 02C .0200 Nell Construction Standards and that a
copy of ilds record hat' been prarided to lire well turner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10. Static water level below top of casing: (ft.) Division of Wafer Quality, Information Processing Unit,
lfwaterlevel is above casing, use 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
DPT_ RODS above, also submd a cop), of this form within 30 days of completion of well
12. Well ctsnstructibu method: construction to the following:'
(i.e. auger, rotary, cable, direct push, etc) following
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 ,Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of ilte county
where constructed.
Form GW-I North Carolina Dcpagn c-at or Environment and Natural Resources - Division of Water Quality Revised Ian. 201=
27a - 22

WELL CONSTRUCTION RECORD
This form can be used for single or multrp)e wells
1. Well Contractor Information:
PAUL MCVEY
Well Contmctor.Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: WI0300295 (UiC)
Lim all applicable well consrruction pennits Cc e. County, State, erarimree, era)
3. Well Use (check well use):
❑Agricultural
OGeothermal (Heating/Cooling Supply)
❑ industrial/Commercial
1n i $ation
Non -Water Supply Well:
OAquiter Recharge
OAquifer Storage and Recovery
❑Aquifer Test
OExperimental Technology
OGeothermal (Closed Loop)
OGeothermal (Heating/Cooling
OMunicipal/Pubbc
OResidential Water Supply (single)
OResidential Water Supply (shared)
©Groundwater Remediatton
OSalinity Barrier
OStormwater Drainage
OSubsidence Control
❑Tracer
OOther (explain under 4211
09/13/16
IW-27-23
4. Date Well(s) Completed:
Weil 1D#
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/owner Name (
Facility 1Dk (ifapplicable)
129 LEGiONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LiNCOLN
00631
County
Parcel identification No. (PIN)
For Internal Use ONLY:
1J, WATER ZONES
FROM
TO I DESCRIPTION
ft.
ft. 1
1
ft.
ft,
-15. OUTER CASING for multi -cased wells) OR LINER if u ticobk
FROM I TO
OtAaIETER THICKNESS
:1ATERIAL
ft. I ft.
I in.
J
e
16. INNER
CASING OR TUBING eothermal'closed-loo
FROM
TO DIAMETER
THICKNESS
I MATERIAL
ft.
ft. in.
ft.
ft. in.
17. SCREEN
FROM
TO
DLAMETER
SLOTSIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
I& GROUT
FROM
I TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
0.0 ft..
39.0 ft.
PGHTJNOa1nYllF
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK if applicable)
FROM
TO
I MATERIAL I
EM?IACEMEIYTMETHOD
ft.
ft.
ft.
ft.
20. DRILLING LOG attach additional sheets if ndcessa
FROM
TO
DESCRIPTION It.kr, bardrn u niilf.ck M1 n)n sire, etc.
0.0 ft
39.0 R,
DIRECT PUSH
ft.
Ft.
fr.
tt.
t
-
i
ft.
ft.
St.
ft•
a.
n.
21. REMARKS
i
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certificati
(if well field one ladlong is sufficient)
350 29' 15.49" N 81 a 15` 29.88" W 09/30/16
Signature ofCenirted Well Contractor Date
6. IS (are) the well(s): ❑Permanent or OTemporary By signing riris form I hereby certf that the re/l(s) vas (were) constructed in accordance
with MA NCAC 01C .0100 or 15.4 NCAC 02C .0100 Well Construction Standards and that a
7. is this a repair to an existing well: ❑Yes or ONo copy oftlds record Iran been provided to the n•el1 owner.
jtlds is a repair, fill out known well construction information and explain the nature oflIx
repair under k21 remarks secdon or an the back of this form. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
S. Number of wcps constructed; 1 construction details. You may also attach additional pages ifnecessary.
r ar un driple injection or not -wafer supply wells ONLY with the same construction, you can
submit onefonm SUBMITTAL iNSTUCTIONS
9. Total well depth below land surface: 39.0 (ft.) 242. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdgereni (example- 3Q200' and 2Q1001) construction to the fDllowing�
10. Static water level below top of easing: (ft.) Division of Water Quality, Information Processing Unit,
/frrater level is above casing, use +'• 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1'S (in.) 24b. For Injection Wells: 1n addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a.' Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
73b: Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Envircirtment and Natural Resources -Division of Water Quality Revised Jan.2013
27a-23

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
INC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well"Construction Permit N: W10300295 (UIC)
List all applicable hell convtruction perildis ii.e. Comity. State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Ivfunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remedial ion
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
4. Date Well(s) Completed: 09/13/16 Well ID4 I W-27-15
Sa. Well Location:
ROBERT BOSCH TOOL NONCDO001154
FaciiitylOwner Name Facility ID9 (ifnpplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
Eor lntertel Use ONLY:
- 14:.WATER ZONES - - -
FROM
TO
DESCRIPTION
ft.
ft.
ft,
ft.
15. OUTER CASING (fur multi-c:ucd wells) OR -LINER if a licable
FROM
TO DIAMETER THICN:NESS
1 MATERIAL
fit.
rt. in.
1b: INNER CASING OR TUBING eothermal dined -loon)
FROM
TO
DIAMETER I
TAtc"E55
MATERIAL
rt.
ft.
in
ft.
R.
In
17. SCREEN. .
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
fL
In.
-
ft.
ft.
in
18. GROUT
FROM
I TO I MATERNAL
EMPLACEMENT METHOD &AMOUNT
0.0 It'
26:0 R. POA1WaaaarldTE
SLURRY
ft.
ft.
ft.
ft.
' 19: SAND/GRAVEL PACli If a m libic.. - -
FROM
TO MATERIAL I ENS PLACEMENT ME 11OD
ft.
ft.
ft.
ft.
-.20.'DRILLING-LOG (attach additional sheets if necessary) -
FROM
TO -
DESCRLMON tnlor, hadri—, soiL/m,k tv , ruin sin•, Nr.
0.0 ft.
26.0 ft-
DIRECT PUSH
ft.
ft,
ft.
fL
ft.
It.
ft.
R.
ft.
ft.
-21. REMARKS - -
i
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one latllong is sufficient)
22. Certitica '
35' 29' 15.49" 81 a 16 29.88n
09130/16
Y W
-
Signature of CeniSed WellContractor Date
6. is (are) the well(s): ❑Permanent or OTemporary -
By signing this farm. 1 hereby certify that tire n•ell(.v) tray (were) constructed in accordance
Wilt 15ANCAC 02C.OlOO ar 15.4 NC.4C O2C.020O iVell Cansiruction Standardv and drat a
7, is this a repair to an existing well: ❑Yes or ENo
copy tfthis record has beenprorided to the it -ell imner.
. if this is a repair, Jill out knon7r it -ell construction brfornurtion and esnlain the nature of tiro
repair under 421 remarks section or on the back of this farm.
.
23. Site diagram or additional well details:
1
You may use the back of this page to provide additional well site details or well
8. Number of wells constructed:
construction details. You may also attach additional pages if necessary.
Tnr multiple it jection ar tratr-water srpply veils.NLY with fire same cnnsrractian. you can
Submit aneform.
SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 26'0 (ft)
24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list a1! depths 1jd!&rent (example- 3@260' and 2Q101
construction to the following:
10. Static water level below top of casing: (f(,)
Division of Water Quality, information Processing Unit,
1(tivierlerel aabore casing, live ~ "
1617 Mail Service Center, Raleigh, NC 27699-1617
IL Borehole diameter: 1.5 (in.)
24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS
above, also submit a copy of this form Within 30 days of completion of well
12. Well construction method:
construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test:
lac. For Water SuDDIv, & Iniection Wells: !n addition to sending the form to
_
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount:
completion of well construction to the county health department of the county
where constructed.
`Form GW-1 North Carolina Department of Environment and Natural Resources —Division of Water Quality Revised Jan. 2013

SWELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable Ire// contraction permits (t.e. Caurrry, State, Variance, etc.)
3. Well Use (check well use):
Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercia!
OIrrigation
Supply Well:
❑Aquifer Recharge
OAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeatinvJCoa!inlz
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundivater Remediation
CSalinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 921 1
4. Date Well(s) Completed: 09/13/16 Well ID# IW-27-14
Sa. Well Location:
ROBERT BOSCH TOOL NON CDO001154
Facility/Owner Name Facility ID# (ifapplicab!e)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Andress, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field. one lattlong is sufficient)
35a 29' 15.49" N 81 a 15' 29.88" - W
6. is (are) the well(s): ❑Permanent or VTemporary
7. Is this a repair to on existing well: ❑Yes or EINo
If this it a repair. fell out kno,vei bell ce"viruction it /a loation and explain the mature rube
repair under 421 ren!arkr section or on the back r f Ibis farm.
8. Number of wells constructed: 1'
For nniitiple it jeelion or noir-hater supply bells ONLY with the same construction, you can
submit one ruin.
9. Total well depth below ]and surface: 20.0
For inuhiple mells list all depths ifdperent (example- 3 n.20D' and 2 rr 100`l
10. Static water level below top of casing:
if rrater level it ahmre casing, use "+"
11. Borehole diameter: 1.5 (in.)
DPT RO
Far internal Use ONLY: `
I
14 WATER ZONES
TO
DESCRIPTION
ft.
17
ft.
tt.
ft.
15. OUTER CASING (formulti-casedwells)OR LINER i[a lieablel
FROM
TO
DIAMETER THICKNESS
hlATERLIL
rt.
ft.
I in
MANNER
CASING OR -TUBING
Ikeothermal closed -loon)"
FROM
TO
DIAMETER
THICKNESS
h7ATERLILL
ft.
ft.
1M
fi.
fr.
in.
t
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERML
ft.
ft.
i n.
ft.
ft.
in.
I&: GROUT
FROM
TO
MATERIAL
I EMPLACEMENTMETHOD&AMOUNT 1
0.0 ft.
20.0 ft.
voars-ao'-E
SLURRY
ft.
ft.
_..
ft.
ft.
- 19.-SANDIGRAVEL PACIit!f a `-licab!EL: - -
FROM
TO
_
MATERIAL I
EMPLACEMENTMETHOD
ft.
I ft.
rt.
fr,
20. DRILLING LOG attach additional sheets ifnecessarv)
FROM
TO
DESCRIPTION celar hardamz 3oi0reek tv , nia size,
0.0 ft-
20.0 rt.
DIRECT PUSH
ft.
ft.
ft.
ft.
rt.
H.
ft.
ft.
ft.
ft
i
ft.
fr.
21.REMARKS..
22. Cerfifica ' "
09130116
Signature of Certified Well Contractor Date
BY signing this form, I herebv certt y that the well(s) eras (were) cmarrructed in accordance
trith 15A NCAC 02C'.01W or IJA NCAC 02C.0200 Nell Canrtnection Sta!alards and ilrai a
rapt' of this record fear beer, pruitirled to the well corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
.(ft.) 24n. For All Wells: Submit this form within, 30 days of completion of I,vcll
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 tNlAil Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24.1
IDS above, also submit a copy of this form within 30 days of completion of we€1...
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc }
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY- 1636 41ai1 Service Center, Raleigh, NC 27699-1636
13o. field (gpm)' Method of test 24c. For Water Supply & Iniection Wells: In addition, to sending the form to
the address(es) above, also submit one copy of this fora within 30 days of
13b. Disinfection type: Amount completion of well constriction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Envuonmenl and Naltual Resources - Division of Waier Qualrty Revised inn. 2015
27a - 14

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Cenification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List aN applicable +eel/ constntetinn permits (1'.C. Comrry, State. Variance, etc)
3. Well Use (check well use):
water supply weft:
b Agr icultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ lrrlgatlon
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
LLNon -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatinp_/Cooling
4. Date Well(s) Completed:
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
Main under #21 Remarks
09/14/16 Well1D# IW-27-12
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDk (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LI N COLN 00631
County' Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one Iat/lonP, is sufficient)
35a 29' 12.17" Y 810 15' 21.84" W
6. is (are) the well(s): ❑Permanent or OTTemporary
7. Is this a repair to an existing well: ❑Yes or 0No
1f this is a repair, fill out known ere/l eanstruclion information and explain the nature of the
repair under .421 remarks seclion or on the back ajthis form.
8. Number of wells constructed: 1
Far multiple h jection or non -water supply wells QNLY with the same construction. )nu can
submit one farm.
9. Total well depth below land surface: 26.0 (ft.)
For multiple wells list all depths i diirenr (example- 3 t( 200' and 1 a 100.)
10. Static water level below top of casing:
if water ILrel is abare casing. use '•+ ••
11. Borehole diameter: 1.5 (in.)
DDT RODS
For Internal Use ONLY:
14. WATER ZONES
FROM
TO , DESCRIPTION
ft.
ft
ft.
ft.
:15.OUTER CASING for multi -cased wells OR LINER ifa ticable
FROM
TO
DIAMETER
THtCi:NFSS
MATERIAL
'ft.
rt.
in.
16. INNER CASING OR.TUBING eotberm.1 closed -loop). "
FROM
TO DL1M1f EfER
THICKNESS
I MATERIAL
III.
ft. in.
ft.
ft. in.
17. SCREEN
.
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
ft.
rt.
in.
ft.
ft.
in.
18. GROUT'
FROM
I TO
MATERIAL,
EMPLACEMUNT ME ILOD&AMOUNT
0.0 rL
26.0 rt.
'°a:wouEural;t
SLURRY
ft.
ft
ft.
ft.
19. SAND/GRAVEL PACK iFa ticable
FROM
TO
aIATERLIL
EMPLACEMENTMETHOD
ft.
ft.
ft.
ft.
20.-DRILLING. LOG attach additional sheets if aecessa
FROM
TO
DESCRIPTION color, hardntm soiVrock tv rain size, etW
0.0 ft.
26.0 ft.
DIRECT PUSH
ft.
ft.
ft.
ft.
D.
ft.
fr.
tt.
R.
ft
it.
tt.
21. REAlAARKS - -
22. Certification:
76y 5:�'F 09/30/16
Signature of ell Contractor 1VDate
By signing this fornt. l hereby certify that the irell(s) iras ("•ere) constructed in accordance
with 15A NCAC 01C.0100 or 15A NCAC 01C.0200 IPeil Catutmetion Standards and that a
copy ajthis record has been provided to rite ire It owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBIt•11TTAL INSTUCtIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-I636
13u. Yield (gpm) ;Ylethod of test' 24c. For Water Supply & Injection Wells: In addition to sending the Form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount completion of well construction to the county health department of the county
where constructed.
- _ - --- -Fti. GW-I North Carolina Depanaxnt of Environment and Natural Resources - Division of Water Quality Revised Jan 2013
_: - 27a-13

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable well construction permits ri.e. Couniy, State, Variance. etc.)
3: Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Ccothermal (Heating/Cooling
4. Date Well(s) Completed:
❑MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
9
Groundwater Remediation.
❑Salinity Barrier
❑Stormwgter Drainage
❑Subsidence Control
❑Tracer
❑Other (exolain under 921 R
09/14/16 WellID# IW-27-11
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address City, and Z:tp
LINCOLN
County
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient.)
35' 29' 15.49" N 810 15' 29.88" W
6. Is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this it repair to an existing well: ❑Yes or FINo
If this is a repair, fill our known well construction infornroriort and explain rise nutury of the
repair under ?1 remarks see0on or on the back ofihisform.
9. Number of wells constructed: 1
For multiple it jection or non•irater supply hells ONLY with the same construction, you can
Submit omform.
9. Total well depth below land surface: 33.0
har midiiple hells list all deptlu ifdi,(jererri (example- 3@200' and 2@100)
10. Static water level below top of casing: (ft-)
Iftrater/crelisaborecosing. use
11. Borehole diameter: 1.5 (in.)
12. Well construction method: DPT RODS
(i.e. auger• rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:.
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
Ft.
rt.
ft.
15. OUTER CASING for mutti-tased wens OR LINER ifa amble
FROM
TO DIAMETER THICHNE55
MATERIAL
ft.
ft. in.
16.'INNER CASING OR TUBING eothertiiirl closed too
FAOM
TO
DIAM1SEtER TtifCh"`7FS5
MATERIAL
ft.
ft.
in. 1
1
rt.
ft.
is
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
T111CR.NESS
MATERIAL
ft.
ft.
in.
ft.
It.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMEhTMEiHOD&.AMOUNT
0.0 .ft•
33.0 f"
"onnumsm"o"Ta
SLURRY
ft.
ft.
ft,
I ft.
19.SANINGRAVELPACK(if applicable)
FROM
I TO
I MATERIAL
EMPLACEMEtiTMETHOD
Ct.
ft.
ft.
ct.
20. DRILLING
LOG attach additional sheets ifnecessary)
FROM
TO
DESCRIPTION Icalar, hardness, saillmck ri rain sire, etc.
0.0 ft.
33.0 ft.
DIRECT PUSH
tt.
Ft.
R,
ft.
ft.
ft.
ft.
ft.
. 21. REIUARKS
22. Certifies '
09/30/16
Signature of eni6ed Well Contractor Date
By signing 11tis forty. 1 hereby certify that the n•e0(.T) a•as (here) eanstnicied in accordance
,,-hit I.iA N(:4(' 02C .0100 or 15.4 NCAC 02C_' .0200 If clt Consrnrctiarr Standards antiArnt a
copy nf7his recortl has been provided u) the u•ep otrner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following: `` '/'
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of iveli construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Naiwal Resources - Division of Water Quality Revised Tarr. 2013
27a - 12

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
L Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
-- -GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit 9: W10300295 (UIC)
List all applicable Irel1 consuuctimt permits (i.e. Canny: Stale, !variance, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Gcothermnl (Heating/CoolingSupply)
❑ Ind ustrial/Commercial
Nan -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
ClAquifer.,Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heating/Cooling.
❑Muni6pal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Traccr
❑Other (explain under g21 F
4. Date Well(s) Completed: 09/14/16 Well ID# IW-27-10
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name
Facility ID,' (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
Countv
Parcel Identification No- (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one )at/long is sufficienq
350 29' 15.49"
81' 15' 29.88"
N
W
6. Is (are) the well(s): ❑Permanent or (OTimporary
7. Is this it repair to an existing well: ❑Yes or E)No
IIfihls is a repair, fill out known well construction information and explain the nature pJrlie
repair under T 21 remarks section or on the back of this form.
8. Number of wells constructed: 1
I'or andtiple itgection to non -water supply n•e//s ONLY with the saute construction, you cau
submit ape fwnt.
9. Total well depth below land surface: 24'0 (ft.)
Mar multiple wells list all depths iiftlijfreat (example- 3,tt 200' and 2@100')
For Internal Use ONLY: ,
14. WATER ZONES
FROM
TO 1 DESCRIPTION
ft.
ft.
H.
ft.
15. OUTER CASING for
mutt! -eased wdS) OR LINER if a licable)
FROM
TO
B,M 'ER
THICKNESS
MATERIAL
fc-
fr-
in.
16. INNER CASING OR TUBING eothermal closed-loop)FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
rt.
is
ft.
ft.
is
17. SCREEN
FROM
To
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
ft.
ft.
in,
ft.
ft.
in.
IS GROUr.'
FROM
TO
MATERIAL
EMPLACEMEhTME VIOD .ic AMOUNT
0.0 ft-
24.0 ft-
aognJrnarx prose
SLURRY
ft.
ft.
R.
ft.
SANDiGRAVEL PACK if a lieoble ' - -
FROM
TO f MATERIAL EMPLACEMEYr MErfIOD
D.
ft. i
ft.
fL
20. DRILLING
LOG attach additional sheets if aecessa )
FROM
TO
DESCRIPTION (color, hordness, WVrock lype, rain s"Ixe, err.
0.0 ft-
24.0 ft-
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
It.
21. REMARKS
22, Certification ) (� � :
09/30116
Signahlre ofCerti d We11 Conimetor Date
Hy signing Ibis form, 1 hereby certif}, that the n-eU() was (were) consirucied in accordance
with. ISA NCAC 02C .0100 or !SA NCAC 02C .0200 )Yell Construction Standards and that a
copy of this record has been provided io the Iran owner.
23. Site diagram or additional well details:
You may use the back of this page to,provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10- Static water level below top of casing; (ft.) Division of Water Quality, Information Processing Unit,
y'water /eivi is above casing, use '•+" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS' above, also submit a copy of this form within 30 days of completion of Weil
i2 Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) i►'lethod of test: 24c. For Water Supply & Iniection Wells: !n addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount completion of well construction to the county health department of the county
_ -- - where constructed.
--Form G W-t \forth Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Jan. 2013
- _- — 27a - 11

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable reen catrstruction permits f.e. County, State. Ilariance, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑industrial/Commercial
❑Irrigation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aoui£er Storage and Recovery
❑ An Li fer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeattriWCoolimt
❑it•Sunicipal/pubfic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
0-Groundwater Remediation
❑Safinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
4. Date Well(s) Completed: 09/15/16 Well
Sa. Well Location:
ROBERT BOSCH TOOL
ain under .#21
I W-27-9
NONCDO001154
Facility/Owner Name Facility ID9 (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip -
LiNCOLN
00631
For Internal Use ONLY.
14, WATER ZONES ;
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
-15. OUTER CASING (for multi-cused:welis OR LiNER`lifa lirt6te
FROM To
DL4METER Tff. l'M
Mal,
rt. ft.
in.
"16J1NNER CASING OR TUBING eothe9m dined -too
FROM
TO
DIAMETER TftiCKNFSS
MATERIAL
ft.
Et.
in- '
i
ft.
ft.
in. j
17.:SCREEN
FROM
=
TO
DIAMETER I SLOTStZE I THICKNESS I MATERIAL
ft.
ft.
in.
ft.
ft.
in
-I& GROUT
FROM
TO
;4tATER1AL
E69Pt_4CEM&YT MEi7IOD.&.1A40U'YF
0.0 rr'
23.0 Et
Pon waarmuere
SLURRY
R.
ft
tr.
ft.
19, SANDIGRAVEL PACK(if not lienble
FROM
TO
I MATERIAL I
EMPLACENENTMETHOD
ft.
ft.
ft.
ft.
20. DRILLING
LOG;tattach
odditiount sheep if rmceisarvl
-:
0.0 ft 23.0 fr• DIRECT PUSH
ft. ft.
rr. fr.
ft. ft
ff. Et.
21. REMARKS
County Paicel identification No (PIN)
5b. Latitude and Longitude in degrees/minutes?seconds or decimal degrees: 22. Certilicatio
(ifwell field, one W/long is sufficient.)
35° 29' 15.49" N 81 ° 15' 29.88" W 09/30116
Signature of Certified Well Contractor Date
6. Is (are) the w'ell(s): ❑Permanent or ®Temporary By signing This form, I hereby certify that the well(v) iras (were) constructed in accordance
tritlt 1SA NCAC 02C .0100 or I SA NCAC t)2C .4200 lVell Comimcrion Stoudards and drat o
7. Is this a repair to an existing well: GYes or EINo cap} ofthis record has been provided to the troll owner.
Ifthis is a repair fill out knoun irell canstnrctron irrfonrwtion and explain the nature of the
repair under521 remarks section or on the back rfihisfbrnt. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or welt
&. Number of wells constructed: 1 construetion details. You may also attach additional pages if necessary.
For mubipife it tection or non-u•ater.suppty x•ells ONLY trith the same construction, wJa call
submitaneform. SUBMITTAL INSTUCTIONS
9. Total well depth below land surfuce: 23.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For "adriple wells As/ all deplin yrdiirent (ernmple-.iq�D_7t70' atul 2@100') construction to the following:
10. Static water level below top of casing: (ft.) Division of Water Quality, Information Processing Unit,
�ru•oter les•el is abn;•e casing, use 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For lniection Wells: In addition to sending the form to the address in 24a
©PT RODS _ above, also submit a copy of this form within 30 days of completion of well
1L Well construction method: construction to the following;
(i.e. anger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Muil Service Center, Ruieigh, INC 2 7699-I636
13a. Yield (gpm) Method of test; 24c. For Water Supply & Iniection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
13b. Disinfection type: :mount
where constructed
Form GWA 'worth Carolina Department of Environment and Natural Resources — Division of Waicr Quality Revised Jan. 2013
27a - 10

WELL _C- ONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIG)
_ U.sr all applicable hell cotsirucdna permits (i. e. Court% State, Variance, etc)
3. Well Use (check well use):
Water Supply We11:
❑Agricultural
❑Geothermal (Heat irg/Cooli ng Supply)
❑ lndustrial/Commercial
❑Nlunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
LNon-Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heating/Cooling
®Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (exolain under #21 F
4. Date Well(s) Completed: 09/15/16 Well 1D# iW-27-8
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (if applicable)
129 LEGiONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
Countv
00631
Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwcll field one lat/lonp, is sufficient)
35o 29' 15.49" N 810 15' 29.88"
6. Is (are) the well(s): ❑Permanent or 107femporary
7. is this a repair to an existing well: ❑Yes or 0No
lfdriv is a repair, fill our kiwis -it swell cottsirnction it farniatiwr mul explain lire nature ofilm
repair under 021 remarks section or on the back ofthir jorm.
8. Number of wells constructed: 1
For nwhiphe it jection or non -water supply si ells O.N1 Y with the same construction, you can
subntir oaefarm.
9. Total well depth below land surface: 22.0 (ft.)
For nniltiple'rells list all depths if d yferem (example- 3 rt 200' acid IQ1IXY)
For Internal Use ONLY:
la: WATER ZONES
FROM
To
DESCRIPTION
D.
ft.
ft.
f4
15. OUTER CASING for multi -coved welt) OR LINER ifn livable -
kKUN
TO
DIAMETER
T1110'air"
MATERIAL
fl.
ft.
Sn.
776. INNER CASING OR TUBING Neotbernmit closed-loo
FROM
TO
DIAMETER I
THICIGNFSS
MATERIAL
ft.
ft.
in.
ft.
rt.
in.
-17. SCREENFROM
TO
DIAMETER
SLOT SIZE
TIHCKNESS
MATERIAL
ft.
ft.
in.
"
It.
ft.
in.
`..GROUT
FROM
TO
MATERIAL
EAIPLAC&MEhT SI ETIIOD&AMOUNT
0.0 ft.
22.0 ft'
SLURRY
rL
ft.
ft.
ft.
19. SAND/GRAVEL-PACK (if applicable)
FROM
TO T MATERM.I. EMPLACEMENT1%IETIIOD
ft.
ft.
ft.
It.
20. DRILLING
LOG attach additional sheep if r ecessn
FROM
TO
DESCRIPTION mlur, hand..., soiVrvrk , nin sift, rtr.l
0 0 ft.
22.0 'ft-
DIRECT PUSH
ft,_
rf.
it
i
I
ft.
R.
ft.
ft.
ft
21. REIIARKS -
22. Certification
A/
o9/30/16
Signature afCenified Well Contractor
Date
By signing this jorm. 1 hereby certif}• that the well(s) star (were) cotsirucied In accordance
with iSA NCAC 02C .D100 or h5A NCAC 02C .0200 Well Construction Standards and that a
copy oflhis record has been provided to rite hell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24u. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10. Static water level below top of casing:
(ft.) Division of Water Quality, Information Processing Unit,
If uaterlevel is above casing, use ••+ ••
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.)
24b. For Infection Wells: In addition to sending the form to the address in 24a
DPT RODS
above, also submit a copy of this form within 30 days of completion of well
. Well construction method:
construction to the following:
(i.e. anger, rotary, cable, direct push, etc..) -
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
- 13a. Yield (gpm) Method of test:
24c. For Water Suppiv & Iniection Wells- In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
- - Jib, Disinfection type: Amount
compl:tion of welt construction to the county health department of the county
Avhere constructed.
_ - _ Form GW-t North Carolina Department or Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
'Fitis form can be used for single or multiple welts
I. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name -
2. Well Construction Permit #: Wi0300295 (UIC)
List all applicable well construction permits (i.e. County. State, Irariance, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ 1nd ustrial/Commercial
Olrri tion
Non -Water Supply Well:
`OAqui(er Recharge
OAquifer Storage and Recovery
O Aq ui fer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OMunicipal/Public
OResidential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
OSalinity Barrier
OStormwater Drainage
OSubsidence Control
OTracer
DOther (explain under 921 f
09/1 55/16
IW-27-7
4. Date Well(s) Completed:
Well ID#
5a. Well Location:
ROBERT BOSCH TOOL
NONCD0001154
Facility/Owner Name
Facility IDX (ifapplicabte)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LiNCOLN
00631
County
Parcel identification No. (PIN)
5b Latitude and Ion ilude in de rees/minut
o d d . 1 d
g g e sec n s or coma egrees.
(ifwell field, one fiat/long is sufficient)
350 29' 15.49" N 81' 15' 29.88" W
6. Is (are) the well(s): OPermanent or IOTemporary
7. is this a repair to an existing well: OYes or E1No
lfthts /s a re/aiq fill nut knnvn e•c1l ransrnnction inrforatation and erpfain tlr_• nature ufrhe
repair under # 51 remarks .section or on the back of tlMs faun.
8. Number of wells constructed: 1
Mor multiple byertion or non -water supply wells ONLY n•ith the some construction, you can
submit one form.
9. Total well depth below land surface: 25.0 (ft.)
Por multiple wells list all depths if(klerent (esamp/e- 3@700' and 3 rt lMs')
10. Static water Level below top of casing: (ft.)
If water level is abore rasing, Ise "
IL Borehole diameter: 1.5 (in.)
12. Well construction method: ' DPT-RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13n. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:.
ft, I ft.
ft ft.
16. INNER CASING OR TUBING eotheniial closed -loop)
FROM TO I DIAMETER THICKNESS blATMIAL
ft. fL I in.
ft.' ft. in.
17 SCREEN
FROM TO DIADCETER SLOTSIZE T111CK,NISS I MATERIAL
ft. ft. in
ft. ft. in
0.0 ft- 25.0 ft' wanwoarxsawre SLURRY
ft. CL
ft. ft.
19. SAND/GRAVEL PACK if a lRicable
T FROM O btA7ER1 AL EMPLACEhIENTbIETHOD
ft. ft.
ft. ft.
0.0 ft. 25.0 ft. DIRECT PUSH
ft. ft.
fr. ft.
ft. ft.
ft. Ic.
ft. R.
it. I ft.
21. REMARKS - -
22. Certifcatio
J ;�*// (��
09/30/1 S
Signnnlreof a fed WeIF Contractor Date
By signing this form. I hereby certify /liar the vell(s) n•as (were) constructed in accordance
with 15AVCAC 02C.0100 or i5A VCAC 02C.0200 Well Construction Standards and that a
copy aftiris record has been provided to the is -ell awner.
23. Site diagram or ndditional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL iNSTUCI IONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the ioflowing:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, INC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above; also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form rjW-I North Carolina Depariman of Environment and Natural Resources — Division of Water Quality
27a - 8
Revised Jan. 201 3

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wefts
1_ Well Contractor information:
PAULMCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable ire// construction permits (i.e. County, State, Variance, etc%
3. Well Use (check well use):
Water bupply Well:
❑Agricultural
❑Geothermal (HeatingiCooling Supply)
❑ I ndustria l/Com mere is l
❑lrrieatlon
Non -Water Supply Well:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Injection Well:
❑Aquifer Recharge OGroundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 09/16/16 Well IDN IW-27-6
5a, Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility 1139 (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
Counts Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latilong is sufficient)
350 29' 12.17." N 81 a 15' 21.84" W
6. Is (are) the well(s), ❑Permanent or ®Temporary
7. is this a repair to un existing well: ❑Yes or ONO
if this is a repair, fill al"known me/l convvruction injimnation and explain the nature oftbe
repair under k21 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or non-teuier supply trells 01111.Y wills the same construction, you can
submit one farm,
For lntemal Use ONLY:
14. WATER ZONES - -
FROM
TO
DESCRIPTION
rt.
ft.
(t.
ft.
15. OUTER CASING for multi -cased wells) OR LINER if i licable
FROM TO DIAMETER
THICKNESS
MATERIAL
rL fL in.
-
-16. INNER CASING ORTUBINC(geothermal closed -loon)_
FROM
TO
DIAMETER
THICKNESS
I MATERIAL
ft.
R,
in.
ft,
ft.
in
-17. SCREEN .: .
FROM I
TO I
DIAMETER
J SLOTSIZE
I THICKNESS
I MATERIAL
fL
-fL
in -
it.
ft.
iR
18. GROUT
FROM
TO MATERIAL
EaIPLkCEMENr t iETHOD & AMoLiNT
0.0 H'
3$.0 ft ' n" xiaa'°^°iE
SLURRY
_ 1t.
ft.
fL
ft. j
19. SAND/GRAVEL PACK if a hp 'cable3
FROM TO MATERIAL EM1IPLACE1tENTMETHOD
ft.
fr.
. t
IL
- fL
20. DRILLING LOG (attach additional sheets if necessary
FROM
TO
I DFSCRIPI'tON color, hnrdnev.011m k type. itmin size, rrc. i
0.0 fL
35.0 ft-
I DIRECT PUSH
ft.
Ft.
i
n.
n.
7t.
ft.
i
21-RENIARKS
22. CertiDratio
09/30/16
Sigrmtttte o r led ell Contractor Date
by signing this furnt. I hereby certify that the treft t) was (it -ere) constructed in accordance
trill; ISA NCAC 02C.0100 or ISA NCAC 02C .0200 Nell Construction Standards and that a
cups' afthit record /tax hear provided In the rreH owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary-
SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 35.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple trells list all depths iif li ferent (example- J_700' and 251007 construction to the following:
10. Static water level below top of casing: (ft.) Division of Water Quality, Information Processing Unit,
lfirater level is above casing, use '•+ •• 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b, For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.c. auger, rotary, cable, direct push, etc )
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form C. W-1
North Carolina Department of Environment and Natural Resources - Division of Water Quahry
27a - 7
Revised Ina. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
1. Well Contractor Information:
PAUL MCVEY
14. WATER ZONES -
FROM
TO
DESCRIPTION
ft.
rL
Well Contractor Name
A - 4305
ft.
ft.
NC Well Contractor Certification Number
S.'OUTE&CASING (for multi -cased welts) OR LINER ifn livable)
FROM
TO DIAMETER THICI:IVESS
MATERIAL
GEOLOGIC EXPLORATION, INC
fL
rt. in.
Company Name
-
I6,'INNER CASING OR TUBING eothermof closed -log -
W10300295 UIC
FROM
TO
DIAMETER
I THICKNESS
I MATERIAL
fL
ft.
in"
Z. Well Construction Permit #: ��
" List ail applicable u•e/l construction perntils (i.e. County. State, Narlance. etc.)
ft.
ft.
in
3. Well Use (check well use):
V. SCREEN
Water Supply Well:
FROM I TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑Municipal/Public
ft. ft. in
❑Geothermal (Heat inglCool ing Supply) ❑Residential Water Supply (single)
ft. tL is
❑industrial/Commercial ❑Residential Water Supply (shared)
18. GROUT
❑irri ation
FROM TO MATERIAL EMPLACEMENT METHOD& AMOUNT
0.0 f`' 32.0 ft" '° n^�BE 1enrE SLURRY
Non -Water Supply Well:
❑Monitoring ❑Recover'
rL fs.
Injection Well:
ft. ft.
❑Aquifer Recharge OGroundwater Remediation
19. SANDIGRAVEL PAC! if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier
FROM TO MATERIAL EMPLACEMENTMETHOD
R R
OAquifer Test ❑Stormwater Drainage
fit. ft.
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
20. DRILLING LOG Inttuch additional`sheets if eeeessnrr
FROM TO DESCRIPTION robe, hardnev, "Wrorx tyr, c-1. sk.. rtr.
❑Geothermal (Heating/Cooling Return) ❑Other (explain under 921 Remarks)
0.0 ft- 32.0 ft" DIRECT PUSH
09/16/16 IW-27-5
f`. ft.
4. Date 1VeI!(s) Completed: Well 1DN
ft. ft.
Sa. Well Location:
ft. ft.
ROBERT BOSCH TOOL NONCD0001154
ft ft
Facility/Owner Name Facility IDk (il'applicable)
rt. fL
129 LEGIONAIRE ROAD LINCOLNTON 28092
rt
Physical Address, .Address, City, and Zip
21; REMARKS. -
LINCOLN 00631
County Parcel Identification No. (PIN)
ib. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
'issufLciente
22. Cerfi6cati
(ifwellfield, one fat/long
35' 29' 15.49" 81 a 15' 29.88"
09/30116
N W
Signature o C ified Well Contrm:tor Date
6. Is (are) (he well(s): ❑Permanent or OTemporary
y b f j j, () (were) N signing � this form, 1 herrb • certify Allot the urll s teas irerr constructed ire atrnrdoaee
u-itb i5A NCAC 01C.0/00 or 15.4 NCAC 01C.0100 iven Cotxrimcueot Standards and char a
7. Is this a repair to an existing well: ❑Yes or EINo copy ofthis record has been prorided to the welt owner.
Ifthis is a repair, fill our known iwell construction inibrrvalion aitd explain the nature oJ7he
repair antler 01 reararks.section nr art the back ofthisform. 23. Site diagram or additionul well details:
You may use the back of this page to provide additional well site details or well
1
8. Number of wells constructed: construction details. You may also attach additional pages if necessary.
For multiple it jrction or nan-n•ater supply wells ONLY with the sane construction, tau can
submit one fume. SUBMITTAL I NSTU CTIONS
9. Total well depth below land surface: 32.0 {ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For nwhiplr wells list all depths ifd�ererit (example- 3 rt 200' and 1 rt 100') constriction to the following:
10. Static water level below top ofcasing- (It,)
Division of Water Qualih',.Information Processing Unit,
If water level is above cushig, use -+-
1617 Xlail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Injection Wells: ' In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well ,
12. Well construction melhtG&- construciit n'io the following:
(Le. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Wafer Supply & Injection Wells: In addition to sending the form to
the
address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
- where constructed.
Form G W-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Reviscd Jan. 2013
27a-6

WELL CONSTRUCTION RECO"
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295. (UIC)
List all applicable well canstractiotn perniiu (I.e. County, State, lrarionce. ctc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ 1 ndustri ai /Commercia l
Non -Water Supply Well:
❑Aquiter Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
GExperimental Technology '
GGeothermal(Closed Loop)
4. Date Well(s) Completed:
❑MunicipallPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
under #21
09/15/16 ♦itellID# IW-27-4R
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facilitylowner Name Facility ID# (if -applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County
Parcel Identification No. (PIN)
ar Internal llsc ONLY-
14. WATER
ZONES
FROM
TO
DESCRIPTION
fr.
ft.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LfNER if a licabte
FROM TO
DIAMETER TNK:KNFSS
AfATERLiL
ft. I f4
in.
16. INNER CASING OR TUB1tiG he at closed -too
FROM
TO DfAM E1'ER
THICKNESS
MATERIAL
ft.
rc in.
m
R, in.
11. SCREED
1
FROM
TO
DLAMETER 1 SLOTSIZE
THHCKNESS
MATERIAL
ft.
ft.
ft.
ft.
Is. GROUT
FROM
TO
MATERIAL
EAIPLACFNIENThIETiIOD&,LNIOUrfr
0.0 ft'
17.0 ft.
oasrNmavrtanE
SLURRY
ft.
ft.
It.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO MATERIAL
EMPLACEit1E:YTMETIIoli
ft.
ft..
. 20. DRILLING
LOG attach additional sheep if necessary - - -
FROM
i TO
I DESCRIPTION Irolar, hanlness. sniitruck type. t.i. size. Nc.
0.0 ft•
17.0 ft.
DIRECT PUSH -
ft.
CL
ft.
ft.
ft.
ft.
ft.
ft.
R.
ft.-
ft.
V.
21. REMARKS
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certification
(if we118eld, one tatilong is sufficient)
35' 29' 15.49" 81 a 15' 29.88" �� 09/30116
Signature afCerti and Weit Contractor Date
6. Is{are) the well(s): ❑Permanent or Temporary
7. is this a repair to an existing well: ❑Yes or E1No
if this is a repair, fill out knourt we/1 constructian informatian and explain the nature t fthe
repair under R 21 remarks section or mi the back of this form.
8. Number of wells constructed: 1
Fur awkiple injection ar nan-+rater supply hells ONLY with the scone construction, }rJu can
submit one form.
9. Total well depth below land surface: 17.0 (ft.)
For multiple ivells list all depilss ifditferem (example- SOa 20' and 2 r@100)
10. Static water level below top of casing:
If iraier krel is abore casing, use
15
By signing this form, I herchy certify that Ilse well(s) was 6verej constructed in accordance
with ISA NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards, and that a
cony ofilds recard has been provided to the irell oirncr.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of ,.vell
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-16I7
11. Borehole diameter: (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of %%,oil
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Alethod of test 24c. For Water Supply .& Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount,• completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Eavironment and Natural Resources - Division or Waier Quality
27a - 5
Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
t. Well Contractor Information:
PAUL MCVEY
For Internal Use ONLY,
14swATER ZONRS
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
ft,
fL
15.OUTERCASING:(foemulti-cased.welts)OR'LI1
FROM
TOI DIAMETER THIC
ft.
I I, I;n.
Company Name
W10300295 UIC
2, Well Construction Permit ft: � �
Lin all applicable, n'ell construction permits (i.e. Caunly, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural OMunicipallPublic
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (Single) 1 )
ge
❑industrial/Commercial - ❑Residential Water Supply (shared)
Olrri anon
16..INNERCASING 'ORTUBINC eothermalefos,
FROM
TO
DIAMETER
THtC
It.
R.
in
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
ft,
ft.
ft.
ft.
in
18. GROAT
FROM
To
MATERIAL
EM
ft.
15,0 I't.
MRT—V.Lwcia
Non -Water Supply Well:
❑Monitoring ❑Recovery
ft.
ft.
Injection Well: ;'
ft.
ft.
❑Aquifer Recharge
glGroundwater Remediation
❑Aquifer Storage and Recovery
OSalinity Barrier
❑Aquifer Test
OStormwater Drainage
❑Experimental Technology
OSubsidence Control
OGeothermal (Closed Loop}
OTracer
Geothermal (HealinglCooling Return)
❑Other (explain under 921 Remarks)
4. Date Well(s) Completed: 09/15/16 Well ID# IW-27-4
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility IDP (if applicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, acid lip
LINCOLN
00631
County
Parcel Identification No. (PIN)
ft. I ft.
ft. I ft.
T111CKNESS T —MATERIAL
PL4CEMEhT hIETIM & AMOU;
SLURRY
EMPLACEMENT dI MOD
•SSary} _
0.0 ft. 15.0 ft- DIRECT PUSH
fE, ft.
ft. £t.
ft. Ct.
ft. ft.
ft. IR.
1 21. REAIARKS I-- -1
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certificat
(ifwell field, one Im/iong is suf eient)
35a 29' 15.49" N 81 a 15' 29.88" W 5 � � 09/30116
Signature of Certified Well Contractor Date
6. Is (are) the well(s): ❑Permanent or 1OTemporary 5, l y Cl t `
U si min this fain; ! ltereb certify that the well s was were' rnnstnrcted in arcordarrcc
with 114 NCAC 02C .0100 or 15A NCAC 02C .0200 lyel/ Canximctior; Standards and that a
7. Is this a repair to an existing well: OYes or [7lNo copy ofthis record has been provided to the itrhl airner.
lfthis is a repair, fill aut known well cuastruction it formotion and explain the nature ofrhe -
repair under f21 remarks section ar ott the back oftlus form. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8. Number of wrtls constructed: 1 construction details. You may also attach additional pages ifnecessary.
Far mnhiple irfecuon or noit-tvater supply erelis ONL It u•i& the same constraction, you con
submitonejrrm. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 15.0 (ft.) 24a: For All Wells: Submit this form Within 30 days of completion of well
For multiple welts list a// depths ifdierem (example- S r(�i 200' mid 2 tr.l00:) construction to the following:
10. Static water level below top orcasing• at,) Division of Water Quality, Information Processing Unit,
tfirater level is above casing, use -+- 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of Well
12. Well construction method: "' " "" ` construction to the following:-' • "' '
(i.e. auger, rotary, cable, direct push, etc.)
Division or Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method oftest: 24c. For. Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount- completion of well construction to the county health department of the county
Where constructed.
Form GW-I North Carolina Department ofEavirotinrent and Natival Resources - Division ofWater Quality Revised Jan. 2013
27a - 4

WELL CONSTRUCTION RECORD
This form con be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
For lommitl Use ONLY -
14. WATER ZONES
FROM
TO
DESCRIPTION
Well Contractor Name
A ' 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
ft.
ft.
15. OUTER CASING (for multi-cmed wells) OR LINER (iftip licable
FROM
TO
I DIAMETER THICKNESS
MATERIAL
Tr.
It.
in
Company Name
W10300295 (UIC)
2. Well Construction Permit #:
• List all applicable trelt consrrucoan permits (t e. Caunty, State, Irariance, etc.)
3. Well Use (check well use):
16. INNER CASING'OR TUBING eotherural closed -loon)
FROM
TO
I DIAMETER I
THICKNESS
TIMATERIAL
fa
ft.
in
17. SCREEN
Wit ter Supply Well:
❑Agricultural ❑hlunicipaUPublic
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commcreial ❑Residential Water Supply (shared)
❑Irri Lion
FROM
TO
D41MMR
SLOTSIZE
THICKNESS
11,1ATERIAL
it.
Tr.
in
is. GROUT
FROM
TO
MATERIAL
EMPLACEMENT' MMIOO&AMOUNT
0.0 ft.
29 0 It'
POnnfNa FMGN E
SLURRY
Non -Water Supply Well:
❑Monitoring ❑Recovery
ft.
ft.
Injection Well:
❑Aquifer Recharge GfIGroundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwnter Drainage I
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑other (explain under #21 Remarks)
09/16/16 IW-27-3
4. Date Well(s) Completed: Well 1D#
Sa. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility ]DO (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
ft.
ft.
19. SAND/GRAVEL PACK if applicable)
FROM
TO NIATERIAL
EMPLACEMENTMETHOD
ft.
tt.
'
ft.
D.
M DRILLING LOG attach additional sheets ifnetessa
FROM
TO
DESCRIPTION color, hnrdnas soiVmck minsze etc.
0.0 It.
29.0 ft-
DIRECT PUSH
rt.
ft.
ft.
ft.
ft.
ft
ft.
ft.
ft.
ft.
Physical Address, City, and Zip
LINCOLN 00631
21: REMARKS
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one ladling is sufficient)
35a 29' 15.49" N 81 a 15' 29.88" W
6. is (are) the well(s): ❑Permanent or (OTemporary
7. is this a repair to an existing well: ❑Yes or EINo
(this is a repair, fill out known well construction information and explain lire nature ofdie
repair under 921 remarks section or on the back of this foray.
S. Number of wells constructed: 1
/nor turdtiple iugeeiion or non -crater supply wells ONLY with the sonic eonstraction, 1you can
.submit are form.
9. Total well depth below land surface: 2g'0 (ft-)
1-or multiple wells liar all depths if dierent (exannple- 3 a 100' and 2 1 rXPI
IO..Static water level below top of casing: (ft.)
lfwater /ere/ is above casing, use "r
11. Borehole diameter: 1.5 (in)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) !Method of test:
13b. Disinfection type: Amount:
22. Certiticati ,IVY 6/
09/30/16
Signature ofCenified Well Contractor Dale
HP signing this fare; 1 hereby certifj, drat the well(s) was (were) constructed in accordance
with 15.4 NCAC 02C .0100 or 1.5.4 NCAC 02C .0200 ;Yell Construction Standards and that a
copy oflhis record has been prorided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Witter Supply & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised Jan. 2013
27a - 3

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
For Internal Use ONLY:
14. WATER ZONES
Well Contractor Name ft. ft. _
A - 4305 ft. ft.
NC Well Contractor Certification Number '15rOUTER `CASING for multi -cased wens OR LINER if a "iiticable
FROM TO DIAMETER TH1CI:NESS MATERIAL
GEOLOGIC EXPLORATION, INC ft. ft. in.
Company Name I& INNER CASING OR TUBING eothermol closed-hro
VtI10300295 //UIC FROM Ino
DIAMETER TxICtiNFSS hIATERlAL
2. Well Construction Permit #: 1 � ft.In`Liftallapplicable ercliconstructionpermits 0.e. Caunt}', Store. larrance. etc) I, in.
3. Well Use (check well use): SCREEN
CAgricultuml
❑Geothermal (Heating/Cooling Supply)
C lndustrial/Commercial
OIrrigation
Non -Water Supply Well:
❑Aquifer Recharge
CAquifer Storage and Recovery
C Aquifer Test
OExperimental Technology
0 Geothermal (Closed Loop)
CMunicipal/Public
❑Residential Water Supply (single)
CResidential Water Supply (shared)
©Groundtaater Remediation
-OSalinity, Barrier
CStormwater Drainage
CSubsidence Control
CTmcer
CGeothermal (Heating/Cooling Return) ❑Other(explain under 921 Remarks)
4. Date Well(s) Completed: 09/16/16 Well ID# IW-27-2
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
FacilityiOw•na- Name Facility MAI (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
ft. I in.
fi. ft. In.
IS. GROUT
FROM TO MATERIAL EMPLACEM ENT Mar110D&AMOUNT
0.0 ft• 30.0 1 - Poo nva ssaTo are SLURRY
ft. ft.
ft j ft.
20. DRILLING LOG (atin h additional sheets irnecessarv)
FROM TO I DESCRIPTION (color, hardans, s flJ-ck t , rain sim etc.
0.0 n. 30.0 ft. DIRECT PUSH
ft. ft.
ft. ft.
ft. ft. '
ft, ft.
ft. ft.
ft. ft.
2I. REMARKS ,
County Parcel Identification No. (PIN)
Sb. Latitude Lind Longitude in degrees/minutesfseconds or decimal degrees:
(ifwell field, one tatflong is suircient)
22. Certificatia
35° 29' 15.49" 81 a 15' 29.88"
09/30/16
��,
Signature ofCertnfied N'etl Contractor Cate
6. Is (arr) the well(s): CPermaneut or laTemport ry
i3v signing this )afar, !hereby certif}' that the e•r/l(s) was (Litre) constructed in urrnrdartcr
7. Is this a repair to an existing well: - ClYes or ONo
with 154NCAC 02C.0100 or 15A NCAC 02C.0200 lv11 Cortstnrnion Standards and flat a
copy aphis record hat been provided to the irell owner.
lfdds is a repair, fill our knutrn well construction h fanualion and e-rplaiu the nature <f the
repair toukr =21 rentarks.cection or on the back r rMir form_
23. Site diagram or additional well details,
1
You may use the back of this page to provide additional well site details or well
8. !number of wills constructed:
construction details. You may also attach additional pages if necessary.
Tar ntuhiple ir:/rrtrnrt or non-rratersuppl}' ++'ctLs nNl.}'+t•itlr the sunrcransrnrctinr., yYrr ran.
,subntitone Jorm,
SUBMITTAL INSTUCTIONS
9. Total well 0 depth below land surface: 30.
P (ft.)
241. For All Wells: Submit this form within 30 days of completion of well
Tar nnthiple yells iisr all depths ijds&rew (example- 3@20' and 2(!y100'.)
construction to the following:
Ili. Static water level below top of casing: (ft.)
Division of Water Quality, Information Processing Unit,
lf'uafer level isabove casing, use
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (ia}
24b. For Injection Wells: In addition to sending the form to the address in 24a
DPT RODS `
above, also submit a copy of this form within 30 days of completion of well
I.,. -Well construction method: " ` '
construction to the following: -
{i.e. auger, ratan', cable, direct posh, etc.)
Division of water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13n. Yield (gpm) P•lethod of test:
24c. For Water Supply & Iniection Welts: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of '
13b. Disinfection type: Amount
completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Depatimerrl ofEnvironment and Natural Resoumes — Division of Water Quality Revised Ian. 2013
27a - 2

WELL CONSTRUCTION RECORD
This form can be used for single or multiple Welts
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Namc
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit It: W10300295 (UIC)
List all applicable well construction permits (i.e. County, Start', Irariance, etc.) .
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test -
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeatinWCooline
For internal Use ONLY,
ft. I ft.
ft. I R.
ITER CASING Ifor multi -cased wells) OR LINER
TO DIAMETER TIIICKNE
f4 ft. iR�
NER CASING OR TUBING lgeothermlit clued-tc
TO DIAMETER THICKNE
R. ft. IR
ft. ft. iR
BEEN
TOI DlAmrrER SLOT SIZE
ft. ft. in.
ft, ft. in.
0.0 ft• 33.0 f`' °°"i1AN08�"°�E SLURRY
ft. ft.
ft. I ft.
OGroundwater Remediation 19. SAND/GRAVEL PA(
❑Salinity Barrier FROM TO
ft. R.
❑Stormwater Drainaee R ft.
❑Subsidence Control
i 20. DRILLING LOG (art
❑Tracer cannt I •rn
4. Date Well(s) Completed: 09/06/16 Well IDN
Sa. Well Location:
ain under 921
IW-25-27
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility tDk (ifapplicabie)
129 LEGIONAIRE ROAD LINCOLNTON 28092
1 0.0 ft. 1 33.0 ft, I DIRECT PUSH I
Physical Address, City, and Zip 2I
LINCOLN 00631
County Parcel Identification No. (PIN)
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
A. ft.
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one IsUlang is sufficient)
22, Certifi n:
35' 29' 15.49" 81' 15' 29.88"
09/30/16
N W
Signature of Certified Well Contractor V Date
6. Is (are) the well(s): ❑Permanent or ❑Temporary
$ ci mite t/ris nrnt, / hrre�Y ceril that ehe well s teas (were eor:xtnrcteu in accordance
y f f' (J )
with 15A NCAC 02C.0100 or 15A NCAC 02C-0200 It -'ell Construction Srondards and that a
7. is this a repair to on existing well: ❑Yes or hINo
copy orthis mcard bar been provided to the well nit -tier,
lfilds is a repair jilt our knnirn well cnnstrurtimt Information and explain the nature oftbe
repair under �21 rernarLi section or nit the backofi/tisfartn.
23. Site diagram or additional well details:
1
You may use the back of this page to provide additional well site details or well
S. Number of wells constructed:
construction details. You may also attach additional pages if necessary.
For multiple it jceriort or nort-iraier.tupply n•ells ONLY with the same construction, you can
submit one farm.
SUBMITTAL INSTUCTI ONS
9. Total well 0 depth below land surface: 33.
p (ft.)
24n. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifdoerenr (example- 3r@200' and 2Q100')
construction to the following: '
10. Static water level below top of casing: (ft.) Division of Water Quality, Information Processing Unit,
/firoier /erel is above eating, rise "+" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24.1
DPT RODS above, also submit a copy of this form within 30 days of completion of Weil
17. Well construction method: construction to the following:'
(i.e. auger, rotary, cable, direct push, etc )
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test' 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy o1 this form wahm 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department or the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
'Phis form can be used for single or multiple wells
1. Weil Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable well construction permits (i.e. County, State. Vartan re. etc.)
3. Well Use (check well use):
Sister SUDDIV Well:
El Agricultural
OGeothermal (Heating/Cuoling Supply)
❑industrial/Commercial
Olrfigr'tbon
GMunicipal/Public
❑Residential Water Supply (single)
0Residential Water Supply (shared)
Non -Water Supply Well:
❑ Monitoring oRecovery
❑Aquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
OSalinity Barrier
❑Aquifer Test
05tormwater Drainage
❑Experimental Technology
❑Subsidence Control
OGeothermal (Closed Loop)
OTracer
013cothermal (Heating/Cooling Return)
❑Other (explain under 421 P
4. Dnte Well(s) Completed: 09/16/16 Well ID# IW-27-1
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees
(if well field, one Inviting is sufficient)
35' 29' 15.49" N 810 15' 29.88"
6. Is (are) the well(s): OPermanent or IOTemporary
W
7. Is this a repair to an existing well: ❑Yes or E INo
Ifthis is a repair, fill out known well construction information and explain the nature q/'the
repair under °21 remarks .section or (;it the back of this farm.
8. Numbcr of wells constructed: 1
Fier muldphe ityeciion or matt -water supply trelis ONLY with the some cansirnetion, you can
.mbotit one farm.
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING for multi-cused wells) UR LINER if a licable
FROAt
TU
DIAMETER
THICKNESS
MATERAAL
ft.
ft.
in
:16. INNER CASING OR TUBING geothermal
clmed-loo
FROM I TO
I DIAMETER
THICKNESS
MATERIAL
ft. I ft
in.
ft. I - ft
itr.
17. SCREEN.
FROM
TO I
DIAMETER
I SLOTSIZE-1
THICKNESS
I MATERIAL
ft.
ft.
in.
ft.
R.
in.
I& GROUT.
FROM
TO
I MATERIAL
I EMPLACEMLNTMErHOD&AMOUtY17-
0.0 ft.
45.0
OWE
SLURRY
ft.
ft.
ft,
ft.
.19. SANDIGRAVEL PACK] )f 6 licable -
FROM
TO MATERIAL EMPLACEMENTMETHOD
ft.
ft.
It.
ft.
20. DRILLING
LOG attach additional sheets i(necessu -
FROM
TO
DESCRIPTION (valor, hardness, sgiVrack t rnin fare, etr,
0.0 ft.
45.0 ft-
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS - - -
22. Certificatio
09/30/16
Signature -of a ud N'e8 Contractor Date
By .signing this form, 1 hereby certify that the irell(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C.0200 Nell Cowiniction Standards and that a
copy ofdiix record has been provided to the irelh owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 45.0
(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
Far nnthiple irclhs list all depths ifdierent (example- 3@200' and 2@100')
construction to the following:
10. Static water level below top of cusing:
(ft-) Division of Water Quality, Information Processing Unit, _
lfwarer level is above casing, use "+"
'1617 Mail Service Center, Raleigh, NC 27699-I617
11._Borehole diameter: 1.5
(in.)
246. For lniection Wells: In addition to sending the Form to the address in 24a
DPT RODS
above, also submit a copy of this form within 30 days of completion of wi:11
12. Well construction method:
construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
'
Division of Water Quality, Underground Injection Control Program,
'
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test:
24c. For Water Suooh' & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount
completion of well construction to the county health department of the county
_.
where constructed.
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013
27a - 1

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
PAUL ib1CVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
Lisl all applicable'rell consnmaian pernitis #.e_ County. Stale, lrariance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑ Munic ipal/Public
❑Geothermal (HeatinglCoohng Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
❑ lrri gation
Non -Water Supply Well:
❑ Monitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed:
09/01/16 WellID# IW-25-26
5a, Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility tD# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Andress, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
fL
ri.
Ii
is. OUTER CASING for multi -cased wells) OR LINER if a cable
FROM
TO I DIAMETER
THICKNESS
MATERIAL
ft.
ft, Iin.
16. INNER CASING OR TUBING he
-1 clmed-bo )
FROM
TO
rDIAMETER
THICKNESS
MATERIAL
ft.
ft.
_ in.
-
ft.
ft.
in.
-
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
ft.
ft.
in,
ft.
it.
irn
IS. GROUT
FROM
TO
MATERIAL
FNIPLACEMENTMEfHOD&AMOUNT
0.0 ft.
2g.0 ft-
aornwastnroMrE
SLURRY
ft.
ft.
R.
ft.
l9.SAND/CRAVELPACIi{ifa Gcable
FROM
TO
MATERIAL
EMPLACEMEIYTME HOD
ft.
ft.
ft.
ft.
20. DRILLING
LOG attach additional sheeb if necessary)
FROM
TO
DESCRIPTION caloq hardness, willrock rain A.. etc.)
0.0 ft
28.0 ft
DIRECT PUSH
ft.
ft.
-
rt.
ft.
ft.
ft.
ft.
ft.
ft.
ft
21. REMARKS
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: , 22. Certili on:
(ifwetl field, one ]at/long is sufficient)
350 29' 15.49" N 81' 15' 29.88" `Y 09/30/16
Signature Certified Well Contractor Date
6. Is (are) the well(s): ❑Permanent or 10Temporary
7. Is this u repair to an existing well: ❑Y'es or EINo
Ifthis is a repair, fill out known well cautruction information, and erplahr the nature of the
repair under 921 remarks .section or an the back of this form.
S. Number of wells constructed: 1
For multiple fryecrion ar non -crater supply u•elis ONLY with the same construction, you can
submit ane farm.
9. Total well depth below land surface: 28.0 (ft.)
Ear andiiple we113 list all depths ifili ferent (example- 3Q200' and 2-^a@16VI
10. Static water level below top of casing:
lj'hraier level is above cashig, tac '•+ ••
]1.. Borehole diameter: 1.5 (in.)
By signing ibis fora, 1 hereby certify drat the tivil(s) ryas (were) carsimcred in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the troll owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBIVIMAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-16I7
24b. For infection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY- 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Welts: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount- completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Jail. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit 4: W10300295 (UiC)
List all applicable well consiructiorn peratits (i.e. Cotmly, Store, Variance. etc.)
3. Well Use (check well use):
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
Oinduslrial/Commercial
❑Residential Water Supply (shared)
Olrri lion
Non -Water Supply Well:
❑Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
©Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑ Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
OTracer
❑Geothermal (Heating/Cooling Return)
OOther (explain under f/21 Remarks)
4. Date Well(s) Completed: 09/01/16 Well ID# IW-25-25
.5a, Well Location:
ROBERT BOSCH TOOL NONCDO001154.
FacilitylOwner Name Facility 1Df1(ifanplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PINt
5b, Lutitude and Longitude in degrees/minuteslseconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
35e 29' 15.49" N 81 a 15' 29.88" AV
6. Is (are) the welt(s): ❑Permanent or [OTemporary
7. Is this a repair to an existing well: ❑Yes or ❑ e,
If this is a repair, fill out known ire11 consinicrion ht(orniatinn and explain the nature ofthe
repair under 1121 reniorkt' section or on the back of rhif form.
8. Number of wells constructed: 1
For nnihiple itjectior, or non -water supply nrfJs ONLY irilh the sane construction, }»u can
submit one form.
9. Total well depth below land surface: . 28.Q (ft.)
Far multiple welh list all depths ifdijjerent (esantp)e-
10. Static water level below top of casing.
1f hater level is abore casing, use " t "
11. Borehole diameter: 1.5 (in.)
DPT RODS
For Internal Use ONLY;
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ff.
ft.
ft.
'.: & OUTER CASING for inutti cased wNls OR
LINER tf a livable
FROM
TO DWMETER
THtCIC/+iFSS MATERIAL
ft.
f4 in.
16. INNER CASING OR TUBING eotherniiil closed -too )'
FROM
TO
DIAMETER THICRNFSS
MATERIAL
ft.
ft
in.
ft.
17.SCREEN
FROM
TO -
DIAAIEfER
SLOTSIZE
I THICKNESS
I MATERIAL
ff.
ft.
in.
ft.
ft.
in.
118. GROUT "
FROM
TO
MATERIAL
EMPLACEMENTMETHOD&A:MOUNT
0.0 ft•
28.0 ft'
vOH1W naENTIXaTE
SLURRY
D.
fL
ft.
ft.
19. SANDtCRAVEL'PACIi if applicable)
FROM
TO
MATERIAL
EMPLICEMENTMETHOD
ft.
Ft.
ft.
ft.
20. DRILLING LOG attach odditiona! sheets if necesann
FROM
TO
DE5CRIY7'fON color, hardness, soiUmck type, train sin, etc.
0.0 ft.
28.0 ft.
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
I.
ft.
ft.
Ft.
21: RENTARKS - -
22. Certificate �, l
09130116
Signature ofCenified Well Contractor /T Date
Hy signing this forth. I herehv certify that the hell(.) tras (were) constri clod in accardatree
widr 15A NC AC 02C .0100 or I5A .NCAC 02C .0200 Well Cnnstraction Standards and that a
copy ofilds record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of weil
construction to the following:
(ft.) Division of Water Quality Information Processing Unit,
1617 NMI Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of %veil;
12. Well construction method: construction to the: following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of En •ironment and Natural Resources - Division of Wnter Quality Revised J:ut 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor information:
PAUL MCVEY
For internal Use ONf.y.
Well Contractor Name ft. ft.
A - 4305 ft. ft.
NC Well Contractor Certification Number .15. OUTER CASING for mutti-cased wells Of
FROM TO _I DIAMETER
GEOLOGIC EXPLORATION, INC rt. R. I in.
Company Name I&INNER "CASING ORTUBING eothermal
WI0300295 (UIC) FROM _ I TO DIAMETER
2. Well Construction Permit it: tt. ' ft. in.
11t1 all applicable irell consinictior permits 1i. e. County, State, l'ariance, etc.)
ft, ft,
3. Well Use (check well use): 17: SCREEN
Water Supply Well: FROM TO wAmETER I SLOT;
❑Agricultural ❑Municipal/Public ft. ft. in.
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single) ft. tr. in.
❑Industrial/Commercial ❑Residential Water Supply (shared) I& GROUT' Tr ......
Non -Water Supply Well:
❑Aquifer Recharge '
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
FA
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Geothermal (Heatmg(Coolin Return) ❑Other (explain under 421 Remarks)
4. Date Well(s) Completed: 09/01/16 well ID# 1W-25-24
Sa. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility ID# (ifepplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
0.0 ft• 49_0 fc• von tAAOeE rc ne SLURRY
tt. rt.
tt. fr.
19. SAND/GRAVEL PACE if applicable)
FROM TO MATERIAL EMPLACEMENTMkTHOD
ft. rt.
ft. ft.
70. DRILLING LOG. (attuih additional sheets if neeessa
FROM TO DESCRIPTION (color ha will—k type. Cmin fizz, etr.
0.0 ft- 49.0 ft- DIRECT -PUSH
ft. ft.
ft. ft.
ft. ft.
ft. it.
e. ft. -
ft. ft.
County Parcel Identification No. (PiN)
ib. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if>.•22. Certificati
ell field, one fat/longffi long is sucient)
35 29'12A 7 i N 810
15 21.84'�Y 09/30/16
Sigrtahue orCenihed Well Contractor Date
6. Is (are) the well(s): ❑Permanent or 10Tempoirary
$v xigning this faro,. ! hereby certify that the u•e11(r) was (were) constructed in accordance
irid; 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Canstructior Standards and that a
7. Is this a repair to an existing well: ❑Yes or ElNo copy ofthis record has been prori led to the irel/ miner.
1f this is a repair, fill our known it -ell consiniction information and erplain Elie nature of1he
repair under'9.21 remarks secrian or am fire back afthis farm. 23. Site diagram or additional well details:
You may use the back of this page to -provide additional ,NTII site details or well
8. Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For mulriple injection or non -water supply hells ONLY with the same construction, you can
submil oneform. SUBMITTAL INSTUCTIONS
9. Total well depth below land -surface: 49.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For muhiple irehr list all depihs ij'dijjerew (example- 3 rr 200' and 2 n 100') construction to the following:
10. Stutic water level below top ofcasing: (ft.) Division of Water Quality, Information Processing Unit,
1f naterleml is above casing, rue "+" 16I7 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For lniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & lniection Wells. In addition to sending the form to
i the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
- Form OW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 201-

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
For Internal use ONLY:
MWATER ZONES
FROM
TO
DESCRIPTION
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
ft.
ft.
rL
rt.
15. OUTER CASING for multi-ca§edw•ells DA LINER of a lieablr
FROM
TO DIAML7ER THFChT1E55
MATERIAL
ft.
ftin
Company Name
WI0300295 UtC
2. Well Construction Permit #: )
L(.ri all applicable it -ell con iruction permfts (i,c. County, State. )variance, etc,) -
'
3. Well Use (check well use):
161NNER
CASING OR.TURING eotherinal dised-16ii
FROM
To
DIAMLPER
THICICNFSS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
-17. SCREEN.'
Water Supply Well:
❑Agricultural ❑Municipal/Pubhc
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
0 Ind ustrial/Commerc W ❑Residential Water Supply (shared)
❑irrieation
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS MATERIAL
ft.
ft.
ft.
in.
I
GROUT70
FROM
MATERIAL
EMPLACEMENT M1fETHOD&AMOUNT
0.0 rr.
490 It'.
.
)'aaTIANaBE0.TOKTE
SLURRY
Non -Water Supply Well.
❑Monitoring ❑Recovery
ft.
ft
Injection Well:
❑Aquifer Recharge OGroundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under 921 Remarks)
I9. SANDIGRAVEL PACK(if applicable)
FROM
TO
MATERIAL
EMIPLACEMENTMETHOD
ft.
rt.
fr.
ft.
20.'DRILLING
LOG attach additional sheep irriccess:ilyli
FROM
TO
DESCRIPTJON(color,hordnc= sniff—k rafa sin etr.
0.0 It-
49.0 It-
DIRECT PUSH
08/31/16 IW-25-23
Date Well(s) Completed: Well ID#
Sit, Well Location:
ROBERT BOSCH TOOL NONCDO001154
Faeility/OwnerName Facility IDk(ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
ft.
- ft.1.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
ZI: REMARKS
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one lat long is sufficient)
35" 29' 15.22" N 81 a 15' 20.42" W
6. Is (are) the well(s): ❑Permanent or GdTemporary
7. Is this a repair to an existing well: ❑Yes or EINo
if thi.v is a repair, fill out known: well consirricnan nyorn)ation and explofn the nature (J the
repair under 921 rewarkr section or on the back nfthis forni.
S. Number of wells constructed: 1
For mnhiple hyertion or nun -ureters upp4, "•elh. ONL 1' with the same construction, arm entt
sobradi one forn).
9. Total well depth below land surface: 49.0
Ivor andriple wells list all depilis ifdierent (erantple- 3 rt 200' and 2Cn7100')
1U. Static water level below top of casing: (ft.)
tt'irater lei•e/ is above casing, use "+"
11. Borehole diameter: 1.5 (in.)
12. Well`constrbetion method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc_)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
22. Certification:
(rt/1n/lk,;r-
09/30/16.
Signature of Certified Well Contractor Dale
Hy signing this form, I hereby cert fi, that the ire/t(s) was (mere) constructed ire accordance
with 15A NCAC 02C .0100 or 154 NCAC 01C.0100 {fell Comiruction Standards and )flat a
copy rfthis record has been provided to the well oirtier.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. Far All Wells: Submit this form within 30 days of completion of well
constmction to the following:
Division of water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above:, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: 1n addition to sending the form to
the.address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW.I Nonh Carolina Department of Environment and Natural Resources - Division of Waier Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable u•eil construction permits (i a Cofntty. Stare, Parionce. era)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (HeatingiCooling Supply) ❑Residential Water Supply (single)
❑IndustriallCommercial ❑Residential Water Supply (shared)
❑Irrl tion
Non -Water Supply Well:
❑ Iblonitoring ❑ Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under 421 Remarks)
4. Date Well(s) Completed: 09/01/16 well IDk IW-25-22
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility 1D# (itapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County Parcel Ideutificalion No. (PIN)
130631
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if welf field, one tat/long is sufficient)
35' 29' 12.17" N 81' 15' 21.84" W
6. is (are) the well(s): ❑Permanent or IOTemporary
7. is this n repair to an existing well: ❑Yes or EDNo
]this is a repair, fill out known well construction in/amiatian and erplain rile nature q/'rhe
repair under 921 remarks section or on Cite back of this farrn.
13. Number of wells constructed: 1
For multiple h jection or non-irarer supply hells ONLY frith rlte sane construction, you can
subtuir one form.
9. Total well depth below land surface: 49.0 (ft-)
For andriple wells list all depths ifdijjerent (exantplc- 3@200' and 2©1001
10. Static water level below top of casing: (ft-)
If waver level is above casing, use "+"
11. Borehole diameter: 1.5 (in.)
12. Well construction method: DPT RODS
(i.e. auger, ronrry, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) tMethud of test:
13b. Disinfection type: Amount:
For Internal Use ONLY;
14. WATER ZONES
ft. I ft.
15. OUTER CASING for mutti-cawd'wel0
FROM T TO DIAMETER
ft.
16. INNER CASING OR TUBING fpcother
FROM TO DIAMETER
ft. ft. in.
ft. I ft. in.
17. SCREEN
ft. ft. in, j
ft. ft, fa I
18. GROUT
FROM TO MATERIAL EMPLACEHtENThl EftroD&AMOUNT
0.0 ft 49.0 ft• a annwaaflnrprurE SLURRY
ft. ft.
ft. it.
ft. ft.
ft. ft.
20.
0.0 ft- 49.0 1t• DIRECT PUSH
ft. ft. .
ft. rt.
ft. ft.
ft. ft.
ft. ft.
ft. ft. !
22.Certif run: ;����,��
J09/30/16
Signature ofCertifred Well Contractor Dale
By signing ibis form, ]-hereby certt& that the u•el!(sj is -as (ver l conuructed in accordance
with 15A NCAC 02C.0100 or I5A NCAC 02C.0200 Well Construction Standards and that a
copy afthis record has been provided to lite well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCfIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:'
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24.1
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable well construction permits (i.e. County. State, Variance, era)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating(Cooling Supply)
❑ Industrial/Commercial
Well:
C
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
®Groundwater Remediatioh
❑Salinity Barrier
❑Stormwater drainage
❑Subsidence Control
❑Tracer
❑Other (explain, under 921 F
08/31116
o
IW-25-21
4. Date Well(s) Completed:
Well ID#
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
County
Parcel Identification No. (PIN)
5b Latitude and Lon itude in d /m'nut
/ d d ' I d
For Internal Use ONLY:
ft. ft
R. ft.
". ft. in
16. INNER CASING ORTUBINC eothermal closed -too
FROM! TO DIAMETER 771ICKNESS MATERIAL
ft. ft. in.
ft. ft. in.
17. SCREEN
FROM TO DIAMETER SLOTSIZE THICtWESS MATERIAL
ft. ft. in.
ft. ft. in.
aR:cnnrrr '
0.0 f[' 49.0 ft. MRRXVart ITE SLURRY
ft. fc.
19. SAN VIGRA V EL PACK I it annlicnble)
W
91
tL
ft.
0.0 ft' 49.0 ft DIRECT PUSH
ft. ft.
ft. ft.
D. ft.
ft. ft.
ft. ft.
ft. ft.
21. REMARKS
g egrees t es sec n s or cc ma egrees.
(irwell field, one latllong is sutlicient,
22. Certificatio
35° 29' 12.17" 81 ° 15' 21.84"
09/30/16
N
��,
�-
Signature o t id Wcl1 Contractor Date
6_ is (are) the well(s): ❑Permanent or rzTemporary
By signing this form, l herrbe cerittty that the nell(t) is -as (here) cantrructea in accordance
u-ith 15A NCAC 02C,0100 or 15A NCAC 02C.0100 Well Construction Standards and that a
7. Is this n repair to an existing well: ❑Yes or EONo
copy of'this record has been prorided to the n'ell miner
lfdds it a repair, fill our knmrr trell cottstructian ittfimnatian and explain the nature
afthe
repair under 921 retnorktsection or on the back ofthis form.
23. Site diagram or additional well details.
1
You may use the back of this page to provide additional well site details or well
8. Number of wells constructed:
construction details You may also attach additional pages ifnecessary.
1•ar nruhiple injection or non•u•aler supplS' n•ellt ONLY with the sunic construction,
you con
submit onefitrm.
SUBMITTAL INSTUCTIONS
49'0
9.Total well depth below land surface:
(ft.)
24a. Fur All Wells. Submit this form within 30 days of completion of well
Far multiple wells list all depths ifdi rent (exautple- 3r+200' and 2 MY)
construction to the following::
10. Static water level below top of casing-
(ft.)
Division orWuler Quality, information Processing Unit,
lfn•ater level is abate casing. use •'+
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.)
24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS "
above, also submit a copy of this form within 30 days of completion of well
i2. Well construction method: " '
construction to the following:
(i.e. auger, rotary, cable, direct push, tic.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 ,Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test:
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount:
completion of well construction to the county health department of the county
Where constructed.
Form GW-I North Carolina Deparimcra of Environment and Natural Resources - Division orwalcr Quality P.eyised J:m. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multipte wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC `
Company Name
2. Well Construction Permit 4: W10300295 (UIC)
List all applicable well construction permits (i.e. Caurrty, State. Variance, etc.)
3. Well Use (cheek well use):
Woter supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heatingicooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatina/Cooline
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed- 08/31/16 Well ID# IW-25-20
5a. Well Location:
ROBERT BOSCH TOOL
_NONCD0001154
Facility/Owner Name
Facility ID# (ifapplicable)
129 LEGIONAiRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
County
Parcel Identification No. (PiN)
For internal Use ONLY;
14. WATER ZONES
FROM
TO
DESCRIPTION
Cr.
ft.
ft.
ft.
15. OUTER CASING for malti-cased welts OR LINER if a licabk
FROM
TO
DIAMETER TIIICt:NFSS
MATERIAL
Ft.
I rt.
I in.
-16. INNER CASING OR TUBL*IG eothermat closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft
in.
ft.
ft.
in
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
TIIICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in
13. GROUT
FROM
I TO
MATERIAL
ENIPLACE.Nli'YTIl1ET110D&A1[OUN T
0.0 ft
49.0 ft'
PnRTL-riff�r:..rt;
SLURRY
ft.
ft.
R.
It.
19. SAND/GRAVEL PACK if a licable
FROM
TO aATERIAL EHPLACEM ENT METHOD
ft.
rr.
ft.
20. DRILLING
LOG (attachadditionalsheib if aecestn
FROM
TO
DESCRIPTION color, hardness, soiUmck type. grain size, etc.
0.0 ft
49.0 It.DIRECT
PUSH
ft.
ft.
ft.
ft.
ft.
ft.
It.
fL
Ft.
ft.
ft.
ft.
21. REMARKS
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certification-
(ifwell field, one ladlong is sufficient) '
350 29' 15.22" N 81 a 15' 20.42" W 09/30/16
Signature ofCeniried Well Contractor Date
6. Is (are) the well(s): ❑Permanent or ®Temporary
By signing this form. I hereby crrtf' that the it-ell(r) u•trs (to -ere) constructed in accordance
trith 114 NCACO2C.D100 or /5A NCAC 02C.0200 Well Catistruction Standards and 1/rm a
7. is this a repair to an existing well: ❑Yes or ❑No copy of'this record has been provided to die irell owner.
ljdris is a repair, fill out known well conslnrction information and explain dre nalure rf tine
repair under @ 21 remarks section or an lire back ofthisfarm. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
S. Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
rar multiple injection or non -water supply wells ONLr trith the sane construction, you can
submironejornn. SUBMITTAL INSTUCTiONS
9. Total well depth below land surface: 49.0 M.) 24a. For All Wells: Submit this form within 30 days of completion of well
Far nruhiple wells list all depths r(dijjerent (example- 5 rr 700' and 2Q100) construction to the following:
10. Static water level below top of casing:
(ft.) Division of Water Quality, Information Processing Unit,
ftrater level is ahor•e caring, use --"
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.)
24b. For Iniection Wells. In addition to sending the form to the address in 24a
DPT RODS
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method:
construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test:
24c. For Water SUDDIy & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount:
completion of well construction to'the county health department of the county
where constructed.
Form G W- I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This farm can be used for single or multiple wells
For Internal Use ONLI':
1. Well Contractor Information:
KENNY SARGENT
14.WATERZONES
FROM
TO
DESCRIPTION
Well Contractor Name
ft.
ft.
A - 4226
ft.
ft.
NC Well Contractor Certification Number
15. OUTER CASING for multi eased welts OA LINER if n
licable)
FROM
TO D4lM Er•ER
THIC7CtiFS5
MATERIAL
GEOLOGIC EXPLORATION, INC
rL
ra in
Company Name
16: INNER
CASING OR TUBING eothermsl
closed -loon)
FROM
TO
DIAMETER
THICKNESS
I MATERIAL
r� r�
2. WGIi CDnSiraetl0n Permit N: V V it t /tt10300295 (UIC)
fL
ft.
IIL
bist all applicable irell constructior, permits (.e. Goan i,. Slate. Irarionce, etc.)
ft.
ft.
in.
3. Well Use (check well use):
17. SCREEN
Water Supply Well:
FROM
TO
DIAFIEI'ER
SLOTSIZE
THICKNESS I MATERIAL
ft.
ft.
in,
OAgricultural ONlunicipal/Public
ft.
ft.
in.
OGeothermal (Heating/Cooling Supply) OResidential Water Supply (single)
18. GROUT -
Oindustrial/Commercial DResidential Water Supply (shared)
Olrri lion
FROM
TO
MATERIAL
EMPLlCEMENTMETDOD&AMOUNT
0.0 ft-
49.0 ft'
POanANaatni biE
SLURRY
Non -Water Supply Well:
Olvfonitoring DRecovery
ft.
ft.
Injection Well:
ft.
It.
OAquifer Recharge OGroundwater Remediation
19. SANDIGRAVEL PACK ifs ficablei
DAquifer Storage and Recovery OSalinity Barrier.
FROM
TO
MATERIAL
EMPLACEMENTMEiHOD
ft.
ft.
QAquifer Test DSIDrmwatef Drainage
DExperimental Technology OSubsidence Control
ft.
ft.
20. DRILLING
LOG (attach additional sheets irnecessa
OGeothermal (Closed Loop) ❑Tracer
FROM
TO
DESCRIPTION (color, hardmns, s.W-k tr, ruin tint Ic.1
0.0 ft-
9.9.0 IL
DIRECT PUSH
OGeothermal (Heating/Cooling Return) OOther(explain under 921 Remarks)
08/31/16 IW-25-19
4. Date Well(s) Completed: Well IDN
ft. ft.
R, ft.
5a. Well Location:
ft ft
ROBERT BOSCH TOOL NONCDO001154
ff. rr.
Facility/Owner Name Faciliry 1Dk (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
ft. ft.
e ft
Physical Address, City, anti Zip
LINCOLN 00631
21. REMARKS
County Parcel Identification No. (PIN)
5b. Lutitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwetl field, one latllong is sufficient,
35' 29' 15.22" N 81 a 15' 20.42" �v
22. Certification:
�- 09/30/16
signanue orcenified Well Contractor Date
6. Is (are) the well(s): ❑Permanent or IaTemporary
By signing this junL 1 hereby certfy that the a'el/(s) ass (n•ere) constructed in occrrrlance
- 7. Is this a repair to an existing well: Oyes or ONo
n-ith 15A NCAC 02C .01011 or /SA NCAC 02C .0200 Well Coturmciian Standar cis and chat a
copy ofthis record hat been prorided m the n-ell an-ner.
if this is a repair, fill mu knatrn well canstructitin information wid explain the nature of the
repair tinder i121 remarks section or ors the back afthis farm.
23. Site diagram or additional well details:
8. Number of wells constructed: 1
You may use the back of this page to provide additional well site details or well
construction details, You may also attach additional pages if necessary.
1•-or multiple infecrian or txm-water supply u•el/,s ONL1'„•ith the ,came crnstracdon, you can
submitoneformt.
SUBMITTAL iNSTUCTIONS
9. Total well depth below land surface: 49.0 (ft,)
24a. For All Wells: Submit this form within 30 days of completion of well
For nndriple irrl/s list all depilrs ifiiilf rem (example- 3G, Yffi' and 2@/001
construction to the following:
10. Static water level below top orcusing• (ft.)
ifiraterlere) isabore caring, are "-
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.)
24b. For lniection Wells: In addition to sending the form to the address in 24a
DPT RODSabove, also submit a copy of this form within 30 days of completion of well
.
12. Well construction method: construction to the folldwisig:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY.•
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) ;Method of test: 24c. For Water Supply & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department orEnvnonnxnl and
Natural Resources- Divisior. orwnter Quality Revtsed Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
-- Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable cell construction permits (%.e" County. Stale. Variance, etc)
3. Well Use (check well use):
Witter Supply Well:
❑Agricultural ❑Municipal/Public
OGeothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
O Monitoring
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
OExperimental Technology
❑Geothermal(Closed Loop)
OGeothermal (Heating/Cooling Return)
lZIGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks
4. Date Well(s) Completed: 08/31/16 Well ID# IW-25-18
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
County
Parcel Identification No. (PIN)
4b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if"well field, one falliong is sufficient)
35o 29' 15.22"
810 15' 20.42"
N
W
6. Is (are) the well(s): ❑Permanent or IOTemporary
7. Is this a repair to an existing well: OYes or ElNo
lfdds is a repair• fill out known well construction information, and explain fire nature ofthe
repair under �21 remarks section or an the back ofthis form.
8. Number of wells constructed: 1
nor multiple hyticuon or ton-watersupply u•cl/s ONLY with the same construction• you can
subnrin one form.
Fur Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
n
ft.
ft.
.15. OUTER CASING far multi-caseMEd wells) OR LINER If a licahlel
FRONT
TO
DIATER
THICKNESS MATERIAL
fr.
n.
I in
16. INNER CASING OR TUBING(geothermal closed -loon)
FROM
TO
I DIAhIETER
THICKNESS
MATERIAL
ft.
in.
ft.
fL
in
17..SCREEN
FROM
TO
DIANIETER SLOTSIZE
THICKNESS
MATERIAL
ft.
n_
in.
ft.
ft.
in
18. GROUT
FROM
TO
MATERIAL
EINIPLACEMENTMEMOD & AMOUNr
Q 0 fr.
49.0 ft.
Poumu+oauroroTE
SLURRY
It.
ft.
ft.
ft.
19. SAND/GRAVEL PACK if 2policablel
FROM
TO
MATERIAL I
EMPLACEAIEYr'METHOD
ft.
ft.
fr.
20. DRILLING
LOG attach additional sheersLif necessary
FROM
TO
DESCRIPTION color, hantnen, sailtruck typ,, z-ia sire, rlc.l
Q 0 ft-
49"0 " H•
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
n.
ft.
fr.
ft.
ft.
ft. I
ft.
21 REMArRKS -
22. Certification:
-r- 09/30116
Signature of'Cenified Well Contractor Date
By signing rots farm• 1 hereby certify Aral file trell) u•as (here) constructed in accordance
with 1$4 NCAC 02C.0100 or ISA NCAC 07C.0100 irell Cairsiruction Standards and that a
copy ry"I is record has been provided to the well an•ner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCPIONS
9. Total well depth below land surface: 49.0 (ft.) 24a. For All Wells: Submit this form_ within 30 days of completion of well
For mnJriple wells list all depths if d�erent (example- 3 200' mid 2 rt 100') construction to the following:
10. Static water level below top of casing: (ft,) Division of Water Quality, Information Processing Unit,
Ifaaterlevel Isabove casing, use '+" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole din meter. 1.5 24b. For lniection Wells: In addition to sending the form to the address in 24a
12- DPT RODS above, also submit a copy of this form within 30 days of completion of well
1 construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) 1llethod of test: 24c. For Water Supply & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed -
Form GW-1 North Carolina Department of Environment and Natural Resources— Division of Water Quality Revised lvl. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
For Internal Use ONLY_
I J
J4.WATER ZONES
FROM
To -
DESCRIPTION
Well Contractor Name
A - 4305
NC Well Contractor CeniGcation Number
GEOLOGIC EXPLORATION, INC
ft.
ft.
ft.
ft.
15. OUTER CASING for multi clued wells t3A LINER iCa Iieable
FROM
TO
BIAh1ETER
THICI+"VESS
MATERIAL
ft.
m
is
Company Name
W10300295 tUIC)
2. Well Construction Permit #: \
List all applicable well construction permits (i.e. County. Stare, Irariance. erm)
3. Well Use (check well use):
16 INNER CASING OR TUBING JLetttherzaW closed-loorill
FROM
TO
DIAMETER
TH]CICNESS
htATERtAL
ft.
ft.
in.
ft.
ft.
is
M SCREEN
Water Supply Well:
❑Agricultum), Municipal/Public
❑
❑Geothermal (HeatineJCooiing Supply) ❑Residential Water Su 1 senelQ
Supply { , e)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑ lion
FROM
To
DIAMETER
SLOTSIZE
TEHCKtFSS
MATERIAL
R.
ft
in
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&,UtrOU NT
0.0 ft.
49.0 ft'
'°xn raora«Ar,
SLURRY
Non -Water Supply Well:
❑Monitoring ❑Recove ry
ft.
ft.
Injection Well:
❑Aquifer Recharge VOGroundwater Remediation
❑Aquifer Stork Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) QTracer
❑Geothermal(Heatin Coolie Return) ❑Other(explain under 921 Remarks)
ft.
It.
19. SANDIGRAVEL PACK(if a licable
FROM
TO
MATERIAL
EMPLACEMENTMETHOD
ft.
ft.
ft,
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
To
DESCRIPTION(-]-. hord.m, soitfrvck typ., data :ae, ore.
0.0 ft-
49.0 ft-
DIRECT PUSH
4. Date \l'eJl(s) Completed: 08/31/16 Weil ID# IW-25-17
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility IDA'(if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
ft,
ft.
Ft.
ft.
R
Cf
rt.
rt.
Physical Address, City, and Zip
LINCOLN - 00631
21:REMARICS -- - -
,
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one fat/long is sufficient)
35' 29' 12.17" N 81' 15' 21.84" W
6. is (arc) the weil(s): ❑Permanent or 13Temporary
22 Certiri a:
09/30/16
Signature ofCenified Well Contractor Date
!t � si Din � 11ts form, 1 lien certr that the trell s oar (were) rnarstntned in accordance
} S f bj f () 1 `
with 15A NC1C 02C .0100 or 15A NCAC 02C 0?00 Well Construction Standards and drat o
T. Is this a repair to an existing well: ❑Yes or E€No
lj rhis is a repair, fill ono known well construction it lbrmotion and explain tlx, noutre afthe
repair under '21 remarks ..ecuon or on the lack of this ff)rnt,
8. Number of wells constructed: 1
For multiple itlectimt or non -+rater supply irells ON6Y with the same construction, you can
submit one form.
9. Total well depth below land surface: 49.0 (ft.)
For multiple wells list all depths ifdierew (example- 3 d^c 00' and 2@ 100)
10. Static water level below top of casing: (ft.)
ljlrater level is above casing, ase
11. Borehole diameter: 1.5 (in.)
-I2. Well construction methtid:' DPT RODS
(i.e. anger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY" WELLS ONLY:
13a. Yield (gpm) Method of test:
13b."Disinrection type: Amount:
coat' ofilds record has been provided to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTALINSTUCTtONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above; also submit a copy of this form within 30 days of completion of well
construction to the following- -
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water SuoDiv & Iniection Wells: €n addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form OW -I North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1- Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit it: W 10300295 (UIC)
List all applicable irell construction permits (t. e. Carmry; State, Variance, etc)
3- Well Use (check well use):
Water Supply Well:
OAgricultural OMunicipal/Public
OGcothermal (Heating/Cooling Supply) 0Residential Water Supply (single)
(]Industrial/Commercial OResidentiai Water Supply (shared)
Olrriealion
Non -Water Supply Well:
OAquifer Recharge
OAquifer Storage and Recovery
OAquifer Test
OExperimental Technology
OGcothermal (Closed Loop)
rrl.. Groundwater Remedialion
OSalinity Barrier
❑Stormwater Drainage
OSubsidence Control
OTracer
OOther (explain under #21 I
4.Date ltiell(s)Completed: 08/31/16 Well ID# IW-25-16
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDl! (irappticable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County 'Parcel Identification No. (PIN)
5b Latitude and Longitude in de rees/minutes/sec onds or d . 1 d
e g ectma rgrees.
(itwelt field, one ladlong is sufficient)
35' 29' 12.17" 81 a 15' 21.84"
N
W
6. Is (are) the well(s): OPermanent or �Temporaty
7. Is this a repitir to an existing well: OYes or E1No
J"thfs is a repair, fill out knorra well convowcuan hilbrmation atrl explain the
nature ofthe
repair under #21 remarks section or mi the back ofthis form.
1
S. Number orwells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you cat)
submit one form.
49.0
9. Total well depth below land surface:
(ft.)
For multiple wells list all depths ifdii Brent (example- 3C200' and 2 a 100')
10. Static water level below top of casing:
(ft.)
If water level is above casing, use '•+ •'
11. Borehole diameter: 1.5
DPT RODS
12. Well construction method:
(ire. auger, rotary, cable, direct pustt, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
136. Disinfection type: Amount:
For Inter" Use ONLY.
ft. rL
ft. ft.
15.01UTER CASING for multi cased welts OR LINER if u ticuble
FROM TO DIAMETER T111Ch'NES5 MATERIAL
16. iNNER-CASIrNC OR TUBING eathermal closed-loa
FROM I TO DIAMETER T11ICKNESS MATERIAL
ft. It. in.
rt. ft. in.
FROM •`�y'TO
DIADIECER
SLOTSIZE
I THICKNESS
MATERIAL
ft.
ft
in.
ft.
ft.
in.
-
I S. GROUT
FROM
TO
MATERIAL
EMPLICEM£Nr MET110D& AMOUNT
0.0 f"
49.0 D.
PartTIANDarIRCNTE
SLURRY
It.
ft
ft.
ft.
i
19. SANDICRAVEL PACK if applicable)
FROM
TOI
MATERIAL
Eb1PLACEht EM1TMEruOD
Ft
ft.
It.
ft.
0.0 ft 49.0 ft I DIRECT PUSH
It. it.
rt. 3t
ft. ft.
ft. ft.
ft ft.
ft. rt.
22. Certification:
401
09/30116
Signalnrc ofCcrtiMci Well Contractor Date
By signing this farm, I hereby certify that the erc0(s) was (were) constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Krell Construction Standards and that a
copy oJ'this record has been provided to the +cell ananec
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site, details or well
constriction details You may also attach additional pages if necessary.
SUBMITTAL INSTUCTiOtNNS
24a. For All Wells. Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program.
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed_
Forst GW-1 North Carolina Department of linviroumeal and Natural Resources — Division of W ater Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
W10300295 (UIC)
Larall applicable well consiruciionrxraiitr (i.e. count)" State, Variance, etc)
3, Well Use (check well use):
Water Supply Well:
OAgricultural
❑MunicipallPublic
OGeothermal (Heating/Cooling Supply)
OResidential Water Supply (single)
OlndustriallCommercial
OResidential Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
OGroundwater Remediation
OA,Iuifer Storage and Recovery
OSalinity Barrier
OAquifer Test
OStofmwater Drainage
❑Experimentai Technology
❑Subsidence Control
OGeothermal (Closed Loop)
OTracer
OGeothermal (Heating/Coolie Return)
' OOther (explain under 921 Remarks)
4. Date Well(s) Completed: 08/31I16 Well ID# IW-25-15
Sa. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one let/long is sufficient.)
350 29r 12.17" N 810 15r 21.84" W
6. is (are) the well(s): DPermauent or MTemporary
7. Is this u repair loan existing well: Oyes or KINo
litlik is a repair, fr/I out known well consin+ction information anti espiain the nature ofthe
repair ander #21 remarks sertion or an the buck of this fiurm..
8. Number of wells constructed:
hirr medtiple hniecrirrn nr non-arater.nrppir ucllc ON! Y widr tfe saute u+nstructirrn, yore can
saF,nrir erne tuner.
9. Total well depth below land surface: 49.0 (iL)
For multiple wells list all depths it'dri ferenr lerontple- 3t@200' arnl a a1i00')
10. Static water level below top of casing: (ft.)
if water ler el is above coring, rue "+ •'
11, Borehole diameter: 1.5 (in.)
12. WeI11-construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY-
ft. ft.
ft. ft.
ft.
I e,
I in. I
IC INNER
CASING OR TUBING euthermnt cEtxied lao
FROM
TO
DIAMETER THlCh"YESSMATERIAL
ft.
ft.
17.SCREEN
FROM
TO
DIAMETER
I SLOTSIZE
I THICKNESS
MATER
ft.
rt.
in.
ft.
ft.
I& GROUT
FROM
TO
MATERIAL
EMPLICEREEh'i'MEl-HOD&AM
0.0 1"
49.0 ft'
eoann+maenarre
SLURRY
ft.
ft.
ft.
ft.
19 SANDIGRAVEL PACK if applicable),
FROM
1 TO
MATERIAL EMPtAcF_m EN-rmE HOD
fs.
Et.
ft.
ft.
l
21I. DR1LLlitiG
LOC {nttac5"additional sheets if necesaarr)
FROM
TO
DESCftIl'TJON Jr.l.it hardnns r6t'mrk t rain s-. r
0.0 it.
49.0 ft-
DIRECT PUSH
R.
fL
it.
ft.
ft.
ft.
ft.
ft.
ft.
fL
ft.
ft.
21. REMARKS"
22. Certif-ts
09130/16
Signature of Certified Well Contractor Dale
R), signing this form, I hereby ccrtifp that the well(i) it as (tr•em) constructed in accordant,
crilh 15.4 NC4C 02C .0100 or 15.4 NCAC 02C.0:00 Irell Caulnrctiarr Standnrdr and that a
copy ofthir record has been prar•ided to the rrell owner.
23, Site diagram or additional well details:
YOU may use the back of this page to provide additional well site details or wet{
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: 4n addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following: _
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Suaniv & lniection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
i
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division, ofWuter Qualiry Revised )an- 20I;

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Weil Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Cenification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
Lilt all opplicable well consirticiiat permits (l. e. County. Stare, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Well:
❑Aquif r Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
ZGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date.Well(s) Completed: 08/29/16 Well ID# IW-25-13
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility IDk ("ifappticabbe)
—129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one latltong is sulHcienQ
35a 29' 15.22" N 810 15' 20.42" W
For Internal Use ONLY:
" Id: WATER ZONESFROM
TO
DESCRIPTION
it.
it.
15. OUTER CASING (for mutt* -cored welts)OR LINER if applicable)
FROM TO
DIAME(ER Tt11C1:N£SS MATERIAL
(r. ,
I is
16. INNER CASING OR TUBING eothermat closed -lop
DIAMETER
THICKNESS
MATERIALft.
7�E
in.ft.
is
17: SCREEN
- - -
FROM
TO
DL111ETER
SLOTSIZE
THICKNESS
MATERIAL
ft.
ft.
in.
-
ft.
ft.
in
18. GROt1I
FROM
TO
MATERIAL
EMPLACEMENTMETtiOD&AMOUNT
0.0 rt•
47.0 ft'
vo—o3rs+ToraTs
SLURRY
ft,
ft.
It.
ft.
19. SAND/GRAVEL PACK: if a licable
FROM
TO !(ATERIAL EMPLACEMENTMETHOD
ft.
ft. l
ft.
ft.
i
.20:. DRILLING LOG attach additional sheets irneces3a
FROM
TO
DESCRIPTION rotor, hardness, ssilinnk type, grain sire, eta)
0.0 it.
,47 0 ft.
DIRECT PUSH
R.
fL
ft.
tt.
ft.
ft.
ft.
I ft.
ft.
ft.
ft.
Et.
21. REMARKS
22. Certification:
A�
� 09/30l16
Signature ofCcnified Well Contractor Date
6. Is (are) the well(s): ❑Permanent or ❑Temporary
H • signingthis anal, ! Ircreb • cent* that dx Ire!! s +eas *rare carrrtn+cted in accordance
I ) ly t f) l )
with !JA JVCAC 02C .0100 or !SA NCAC 02C .0200 Well Construction Standards and that a
7. Is this a repair to an existing well: ❑Yes or . E1No
cony ofdris record has been prorided to the well otener.
Ij"fit is is a repair, ft11 nut kitown hell construction h jormotinn and drplabi the nature of the
repair under f21 remarks section or at: the back ofthis form.
23. Site diagram or additional well details:
1
You may use the back of this page to provide additional well site details or well
8- Number of wells constructed:
construction details. You may also attach additional pages if necessary_
Aar amhiple injection or non -water supply wells OtVLY with the same canstrilednn, you earl
submit onafori .
SUBMITTAL INSTUCTIONS
9. Total well depth below land sulfate: 47'0 (ft.)
24a• For All Wells: Submit this form within 30 days of completion of well
1--or multiple hells list all depths (fdioerent fesample- Jr't,•200' and 2.@100')
construction to the following:
10. Static water level below top of casing: (ft.)
Division of Water Quality, Information Processing Unit,
ljanteelevel is above casing, ute "a "
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.)
24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS
above, also submit a copy of this form within 30 days of completion of u211
12. Well construction method:
construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) lilethod of test:
24c. For Water Suooiv & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount,
completion of well construction to the county health department of the county
where constructed.
- Form GW-I North Carolina Department of Environment and Natural Resources —Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295 (UIC)
List all applicable trel1 ctuzstruction ptrnritr (t.e. County, State, Pariance, ere.)
3. Well Use (check well use):
Water Supply Well:
❑Agricahural OMunicipai/Public
❑Geothermal (Heating/Cooling Supply) OResidential Water Supply (single)
Dindustrial/Commercial ❑Residential Water Supply (shared)
Dirri • tion
Non -Water Supply Well:
OMonitoring ❑Recovery
Injection Well:
OAquifer Recharge OGround--ater Remediation
-
DAquifer Storage and Recovery OSalinity Barrier
DAquifer Test OStormwater Drainage
DExperimental Technology OSubsidence Control
DGeothermal(Closed Loop) OTracer
t7Geothermal (Heatin Conlin&Return) OOther (explain under 921 Remarks)
4- Date Well(s) Completed: 08/29/16 Well IN IW-25-12
5a-Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility !D# (ifapplicabte)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
-5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well fick-one lat/long is sufficient)
35a 29' 15.49" N 81 a 15' 29.88" W
6. Is (arc) the well(s): OPermanent or IOTemporary
7. Is this a repair to an existing well: DYes or E3No
lythis a a repair, fill our kno,rn well catrstraclion h formation and "plain the nature if the
rt pair under °21 remarks section or t:n the back t f this form.
8. Number of wells constructed: 1
1-ir multiple h jecrioi or not,-x•ater sapply wells € ,,VLY with the same construction, you can
submir true farm.
9. Total well depth below land surface: 42.0
Far multiple wel/x list all depths ifdijferetit (example- 3 f700' a? oil 2 @1001
10. Static water level below top of casing:
f nwier level is above casing use `+
11. Borehole diameter:
For Internal Use ONLY;
14. WATER ZONES
FROM
To
I DESCRIPTION
ft,
ft.
Ct.
ft.
15.OUTER CASING for multi -eased welts OR LINER if a Ficahle
FRObi
TO
I-AMETER I THICKNESS
dATERIAL
ft.
f4
I in
16.INNER
CASING OR TUBING (geothermal dosed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
f4
ft.
in.
ri.
ft.
17.SCREEN-:
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
bATERIAL
ft.
ft.
in.
ft
ft..
in.
18, GROUT
FROM
To
MATERIAL
E.MPLACEMEriTMETHOD&AMOUNT
0.0 ft.
42.0 rt'
MFnfHW:aµ�M
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK: if a 'licable -
FROM
TO
MATERIAL Ea1PLACEMENTMETH01i
ft.
ft.
j
E
tt.
€t.
20 DRILLING LOG attach additional sheets if necessary
FROM
TO
DESCRIPTION (color, hardness, 9611—ktype, grninsiu_oc_)
0.0 ft.
42.0 ft.
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
Ct.
I
I
ft.
fL
ft.
ft.
21 RErifARKS"
22. Certi6cat'
09,30116
Signature hied WcR Contractor Date
Hy.slgning this fornt, 1 hereby certo, that the trcll(s) ryas (were) roast acted in accordance
with ISA NCAC 02C.0100 or iSA NCAC 02C.0200 iVe11 Cotstnrction Standards aid that a
copy ofihis record has been provided to the well owner,
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTALiNSTUCTIONS
(ft.) 24a. For All !Yells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Wafer Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-16I7
24b. For Iniection Wells: In addition to sending the form to the address to 24a
above, also submit a copy of this form within 30 days of completion of well
__.... _.. 12. Well construction method; DPT RODS construction to the following:
(i.e. auger, rotary, cable, direct push, etc )
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY !YELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method or test: 24c. For Witter Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy or this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
u'nere constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Qualiry Revised San. 201 i

WELL CONSTRUCTION RECORD
This form can use used for single or multiple wells .
I. Well Contractor Inrormartion:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable nrell conrrruciion perntirs f.e, Cotinn. State, Iranance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
O Ind ust rial/Com merc is l
Supply Well:
❑Aquifer Recharge
OAquif'er Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OMunlcipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
lZIGround,,vater Remediation
OSalinity Barrier
❑Stormwater Drainage
OSubsidence Control
OTracer
OOther (explain under 9211
4. Date Weil(s) Completed: 08/29/16 Well ID4 IW-25-11
Sa. Nell Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LINCOLN
County
NONCD0001154
Facility ID# (if applicable)
LINCOLNTON 28092
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one laulong is sufficient)
35a 29' 15.22" N 81 a 15' 20.42" W
6. Is (are) the well(s): ❑Permanent or 0Temporary
7. Is this a repair to an existing well: OYes or ONo
IJ'tlds is a repair. Jill out known it -ell construciton inforniatiou and explain the nature of the
repair under 421 remarks section or on the back of tha form.
8. Number orwells constructed: 1
For multiple injection or Iron -eater supple melts ONLY frith the same construction, you can
submit one form.
9. Total well depth below land surface: 48.0 (ft.)
For muhiple wells Avi all depthr if dierent (example- Jr
200' and ? tt IGO')
10. Static water level below top of casing:
If tracer lerel Is above casing, rare "+"
11. Borehole diameter: 1.5 (in.)
DPT RODS
For Intermit Use ONLY.,
14. WATER ZONES
FROM TO DESCRIPTION
fr. ft.
15. OUTER CASING far multLicasTedEells)Olicable)
Tw
FROM R R SI MATERIAL
ft. I is
16.-INNER CASING OR TUBING eothermal closed-loo
FROM TO DIA:'11 EfER THICKNESS ISIATERtAL
ft. rL I is
ft. ft. in,
17. SCREEN
FROM TO DIAMETEA SLOTSIZE THICKNESS MATERIAL
ft. rL In.
ft. ft. in.
18. GROUT
FROM TO MATERIAL EMPLiCE.MENr METHOD& AMOUNT
0 0 ft. 48.0 f" na-Gaol-E SLURRY
rt. H.
ft. ft.
19. SAND/GRAVEL PACK if a licable
FROM TO MATERIALI &'1IPLICEMENTM1IETHOD
ft. ft.
ft. ft.
29. DRILLING LOG lattach-additionalsheetsirneeessarv)
FROM TO DESCRIPTION color. hardne= solUrack type, grain sim, etc.
0.0 ff• 48.0 ft. DIRECT PUSH
ft. ft.
ft. ft.
ft. ft. '
ft. ft.
ft. R.
rt. H.
- 21 REMARKS
22. Certification:
r 09/30/16
Signature of Certified Well Contractor Date
By signing; this fornr, I hereby certify that the trellis) vas (were) constructed in accordance
,ri16 15.4 VCAC 02C .01W or ISA NCAC 02C _ 0?00 Well Crntsrruclion Standards and that o
copy ofghis record has been provided to the yell corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL iNSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the fallowing:
Division of Water Quality, Information Processing Unit,
1617 Itilail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of wYi1
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Waler Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply Sc Iniection Wells: 1n addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Enviroament and Natural Resources - DIVISina of Water Quality Revised Jan 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wets
1. Well Contractor Information:
PAULMCVEY
For Internal Use ONLY:
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
6.
ft.
ft.
ft.
15.OUTER CASING for multi -cased welts OR LItVER if a liq!
PRDM
ro
DIAMETER THICKNESS
ht
a
rL
im
Company Name
2. Well Construction Permit #: W10300295 UIC)
List all applicable ,cell construction permits (he County, State. Variance, eta)
3. Well Use (check well axe):
MANNER CASING OR
TUBING 'eothernnal closed-loo
FROM
TO
DIAMETER THICKNESS
ht
R.
ft.
in.
1
ft.
ft,
in. '
17. SCREEN
Water Supply Well:
QAgricultural ❑MunicipaUPublic
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
Qlndustrial/Commercial QResidential Water Supply (shared)
Qlrrieation
FROM
To
DIAMETER
I SLOT SIZE
Ttt[cKN
ft.
717
En
ft. I
ft.
to
13. GROUT
FROM
To
MATERIAL
EhiPL\CEMEKf hll
0.0 ft.
47.0 fL
rortnwoewrovre
SLURRY
Non -Water Supply Well:
QMonitoring QRecovery
tt.
tt,
Injection Well:
❑Aquifer Recharge OGroundwater Remedistion
❑Aquifer Storage and Recovery❑Salinity Barrier
❑Acuifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal {Closed Loon) ❑Tracer
❑Geothermal Hcatin Coolin Return) ❑Other(explain under#21 Remarks)
19. SAND/GRAVEL PACK lira ticable
FROM
TO
M1tATERIAL
EMPLACEME
ft
D
Ft.
ft.
20. DRILLING
LOG nthch additional sheets if necessary
FROM
TO
DESCRIPTION(c.la, hardness,"ithvckt
0.0 ft,
47.0 f4
DIRECT PUSH
4. Date Well(s) Completed: 08/29/16 Well ID# IW-25-10
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
ft.
ft.
tt
ft
ft
ft
Physical Address, City, and Zip
LINCOLN 00631
11. REMARKS
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certificati
(ifwell field, one latlong is sufficient)350 29' 15.49" N 81 a 15' 29.88" «, 09/30/16
Signature ofC ruffed Well Contractor Dale
6. is (are) the well(s): ❑Permanent or OTemporary 1 f } O
B � signing � this orn+, ! hereby eerh drat the well s rhos },ere' connrurtrrl in accordance
trim, ISA NCAC 02C.0100 or 15A NCAC 02C .0200 Well Courfmction Standordr and that a
7. Is this it repair to an existing well: ❑Ycs or ©No copy oftbis record has been provided to the u•e/1 ou-ner.
If this is a repair, fill out knorn +cell carstruedun information and explain I&- nature of the
repair under 921 raniarkc section or on the Jack of this form. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
B. Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
Mor nrdtiple i+lecuon or nou-ureter supply u•e/Js avLY with tme sane construction, ytm can
.suhowor+efortit. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 47.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
l-itr nndtiple Wrlh /irt all depths ifdierent (example- 3Q200' and 2 tt J0w) construction to the following:
10. Static water level below top of casing: (ff.) Division of Water Quality, Information Processing Unit,
Ifuuter level is obare casing, use "+- 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 240
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12.-Well construction method: construction to the following:
(i.e. anger, rotary, cable, direct push, e1C.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY \YELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13u, Yield (gpm) Method of lest: 24c. For Water Surwiv & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
ttihere constructed.
Form OW-1 North Carolina Department of Environmenl and Natural Resources - Division, of Water Quality Revised tart. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Weil Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W103002955 (UIC)
Lisi all applicable uel/ construction permits ri.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (HeatingiCooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Aquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormtvater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal(Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 08/29116
Well 1D# I W-25-9
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility IDk (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one ladlong is sufficient.)
35a 29' 15.22" N 810 15' 20.42" W
6. is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or, IZ1No
If this is a repair, fill out known well construction information and explain the nature of the
repair under 921 remarks section or on tire back of this fornr,
8. Number of wells constructed: 1
For multiple injection or non -water supply wells O:YLY with the some construction, wa can
submit one farm.
9. Total well depth below land surface: 44.0
hor multiple wells list all depths ifdri au (exanrple- 3a00' and 2C3a 100'1
10, Static water level below top of easing:
(f water lerel is above casing use '•+-
11. Borehole diameter: 1.5 (in.)
DPT RODS
For Internal Use ONLY;
14. WATER ZONES
FROM TO DESCRIPTION
ft. ft.
rL a.
15. OUTER CASING for multi -cased welts
rt. O
FROM RRCapplicable)
)
e. DIAMETERinMATERIAL
16. INNER CASING OR TUBING frcvthermal clmed-loo
FROM TO DIAMETER THICKNESS MATERIAL
ft. I ft. in.
ft. I ft. in
17. SCREEN
FROM TO DIAMETER SLOT SIZE. THICKNESS MATERIAL
ft. ft. in.
rt. ft. in.
-18..GROUT - FROM I TO MATERIAL I EMPLACEMENTMETHOD&AMOUNT
I
0.0 r1- 44.Q ft. roanwaaEtn fi SLURRY
ft. rt.
ft. ft.
19. SAND/GRAVEL PACE if n" licable
FROM TO MATERIAL FNIPLACEMe:YTMETHOD
R. ft,
R. ft.
20. DRILLING LOG attach additional sheets if necesia y)
FROM TO I DESCRIPTION color has loos, saittrack type, tmirisiu.,1.1
0.0 I• 44.0 ft- DIRECT PUSH
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
21. REMARKS - -
22. Certification:
' r"'l
-s-'- 09/30/16
Signature of Certified Well Contractor Date
By signing this form, I hereby certify that the well(s) eras (rere) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Consrruction Standards and that a
cant' afthi.s record has been provided to the sre// owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion ofwell
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Witter Sunoly & lniection Wells: In addition to sending the form to
the address(es) above, also submit One copy of this form within 30 days of
13b. Disinfection type: Amount- completion of well construction to the county health department of the county
where constructed.
(ft.)
Form OW-1 North Carol inn Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAULMCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name .
2. Well Construction Permit #: WI0300295 (UIC)
List all applicable gall construction permits ( e. County, Slate, Variance, etc)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
OGeothermal (Heating/Cooling Supply) OResidential Water Supply (single)
Oindustnal/Commercial ❑Residential plater Supply (shared)
Non -Water Supply Nell:
OMonitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
OExperimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatin&Coolina
VlGround%atcr Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
OTracer
❑Other (explain under #21 1
4. Date Well Completed: 08/29/16
Well ID# IW-25-8
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility IDtt (ifapphcable)
12-9 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
Cor:nty
Parcel Identification No. (PIN)
51b. Latitude and Longitude in de rees/minutes/seconds
or decimal d
g egrees.
(if -ell field, one lat/long is sufficient)
350 29' 15.49" N 81 a 15' 29.88" W
6. Is (are) the well(s): OPermanent or @Temporary
7. Is this a repair to an existing well: ❑Yes or EINo
If this is a repair, fill our known well construction information and explain the ratan of the
repair render ° 21 rentarks.scetion or an The hack of this form.
8. Number of wells constructed: 1
tar multiple ityection or non-water.supply wells aNl.)' will, he sumo construction, }'tta call
submit one form.
9. Total well depth below land surface: 37.0 (ft.)
For multiple we//.r list all depihs if(lyTerent (exaneple- 3@200' and 2Q100')
10. Static water level below top of casing: (rt.)
lfwater level is above casing, use "+ -
IL Borehole diameter: 1.5
12, Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Plethod of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
ft. ft.
ft. ft.
15. OUTER CASING for multi -eased wells OR LINER !if a lieable)
FROM TO DIAMETER THICKNESS P9 MATERIAL
fa ft. in.
16. INNER CASING OR TUBING eatherma) closed -loop)
FROM TO DIAMETER I THICKNESS MATERIAL
ft. ft. in.
ft. ft. I.
£t. ft, in,
ft. ft. in.
.OUT
0.0 ft. 37.0 It, troanraa s¢n opt
it. ft.
ft. ft.
19. SAND/GRAVEL PACK (if applicable)
'ROM TO MATERIAL
Ct. ft.
e. L ft.
V. DRILLING LOG (attach additional shcets if
EA£PLACEAI ENT ME
SLURRY
0.0 ft- 37.0 ft- DIRECT PUSH
ft. (t.
ft. Ct.
ft. ft.
ft. rt.
ft. rL
rt. ft.
21. REMARKS
22. Certi6rati
09/30/16
Signature of ihed Well Contmotor Date
By signing this fornt, I hereby certtfy that the well(s) was (mere) constructed in acconlance
with ISA NCAC 02C .0100 or 15.4 NCAC 02C .0200 Well Construction Standards and that a
copy olthis record has been provided it) the we/l corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quulity, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program.
1636 Moil Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form: CiW-I ' Nonih Carolina Department of Environment anti Natural Resoe es - Disision of Water Quality Rcvised Jan 2013

WELL CONSTRUCTION RECORD
This lbrm can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
INC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name 2. Well Construction Permit #: W10300295 (UIC)
List all applicable well cousrruction permits (1.e. Count). State, Variance, etc)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
Dirri Lion
Non -Water Supply Well:
❑ Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑::Aquifer Test
❑Experiment..d Technology
❑Gcothermai (Closed Loop)
❑Gcothermai (Heating/Cooling
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 421 1
4. Date Well(s) Completed: 08/30/16 Well 1D# IW-25-7
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one latilong is sufficient)
35a 29' 15.22" N 81 a 15' 20.42" W
6. Is (ere) the well(s): ❑Permanent or ®Temporary
7. Is this a repair to an existing well: ❑Yes or ElNo
)this is a repair.fill out knomn weN construction information and explain tire nature ofrlte
repair under "21 rrurarkv section or on the back of this form.
S. Number of wells constructed:- 1
Par ran ld#e injection or non -water supply wells ONLY with tine same ennstruciinn, }ant can
subatil one faral.
9. Total well depth below land surface: 43.0 (ft.)
For multiple trells Art all depths ifdgerent (example- 3 tt 200' and 2 t1 10o')
For Internal Use ONLY,
14: WATER ZONES '
FROM
To
DESCRIPTION
Fi.
ft.
Ir-
ft-
'15. OUTER CASING for multi=cased wells OR LINER if a ticabte
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
'ft.
in,
16. INNER CASING OR TUBING geothermal
clmed-lop
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in
ft.
ft.
17. SCREEN.:
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS I MATERIAL
ft.
ft.
in
ft.
ft.
in
-I& GROUT
FROM
I TO
MATERIAL
EMPLAC&HE'YTN18TIiOD&ANIOUNT
0.0 ft.
43.0 rt-
na:w na rtsc sre
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM To MATERIAL I EMPLACENIENTMET1101)
ft. ; ft. t
- 20. DRILLINGLOGattach additiouat sheeh if necessa _ -
FROM
TO
DESCRIPTION color. hardism sailfrock t et rain sir, r.
0.0 ft.
43.0 ft.
DIRECT PUSH
It.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
{L
ft.
ft.
21. RENIARKS
22. CertiGc lion:
-sue- 09/30/16
Signature of Certified Well Contractor Date
By signing this form, I hereby certify that the u•ellev) nav (were) constructed in accordance
with 15A NCAC 02C, 0100 or ISA NCAC 02C. 9200 Well Construction Standards cord that a
cop), ofthis record hav been provided to tire is corner,
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details: You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following
10. Static water level below top of easing: (ft.) Division of Water Quality, Information Processing Unit,
lfwaterlevel is above casing, use 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For lniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of "A`ater Qualify, Underground Injection Contra! Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
On. Yield (gpm) Method of test: 24c. For Water Supply & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
_- =<13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
- -Form GW-t Nonh Carolina Department of Environment and Natural Resources -Division of Wat r Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This farm can be used for single or multiple wells
For internal Use ONLY
1. Well Contractor Information:
KENNY SARGENT
14, WATER ZONES
FROM
TO
DESCRIPTION
Well Contractor Name
ft.
fL
t
A - 4226
ft.
ft.
NC Well Contractor Certification Number
IS; OUTER CASING for
multi -cased we OR LINER fifinip li
GEOLOGIC EXPLORATION, INC
FR�f'To
DIAMETER
THICKNESSRSATERIAL
fL
in
Company Name
"16 INNER
CASING OR TUHING eothetmafda:ed-too
W10300295 UIC
FRORt
TO
DIAMETER THICIuNE55
MATERIAL t
2. Welf Construction Permit #: � �
List all applicable it construction permits (I e. C'nnnly, State, Farionce, etc.)
3. Well Use (check well use):
"17. SCREEN."
Water Supply Well:
FROM TO DIAMETER I SLOTSIZE THICKNESS MATERIAL
OAgricultural ❑Municipal/PubLc
fL ft. in.
OGeothermal (Heating/Cooling Supply) OResidential Water Supply (single)
ft. ft. in.
Oindustr ial/Commercial []Residential Water Supply (shared)
18. GROUT
"lion
FROM TO MATERIAL ERiPLiCEM ENT METHOD & AMOUNT
Non-
Non- Wafer Supply �i'ell:
0.0 It. 40.0 ft- "'" 40°¢acvtre SLURRY
❑Monitoring DRecovery
ft. fa
-injection Well:
ft. ft.
OAvuifrr Recharge OGroundWater Remediation
19, SANDIGRAVEL- PAC K-(ifa l;eablr
❑Aquifer Storage and Recovery ❑Salinity Barrier
FROM TO MATERIAL EMPLACERtEN7'RILTH011 t
fr. fr.
❑Aquifer Test OStormwater Drainage
OExperimental Technology OSubsidence Control
DGeothermal(ClosedLoop) OTracer
20. DRILLING LOG attach additional sheets if necesst - --
FROM TO DESCRIPTION (color, hardow, railtroditype, rd is SrG, etc.)
OGeothermal (Heating Cooling Return) 00ther (explain under 921 Remarks)
0.0 ft- 40.0 ft. DIRECT PUSH
08/30/16 IW-25-6
ft. ft.
4. Date Well(s) Completed: Well ID#
Su. Well.Location:
ROBERT BOSCH TOOL NONCD0001154
FncilitylOwnet Name Facility IDk (ifapplicable)
,
129 LEG€ONAIRE ROAD LINCOLNTON 28092
ft ft
ft. ft. t
Physical Addicss, City, and Zip
LiNCOLN 00631
21. REMARKS
County Parcel Identification No. (PIN)
-
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
22. Certific t"on
(ifweU feel$ bunting is sufficient)
35' 29i 15.22" 81 g 15' 20.42"
����� 09/30/16
N W
Signature o{Certified Well Contractor Date
6. Is (are) the well(s): GPermanent or (]Temporary
B � signing .this foray, 1 hereby dear the Ezell s mar(it-ere) constructed in accordance
y g I y Y (j
with 15A NCAC 02C.0100 or 15.4 NCAC 02C.0200 Well Construction Srandarztr and drat a
7. Is this it repair to an existing well: OYes or .+ i No copy ofrh& record Iran been provided to the Ere/1 mvner"
/frhis is a repair, fill any knoErn well cotstruction information and mploin the nature ofthe
repair tinder 921 renarks .section or on the back ofthis form. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
1
$. (Number or wells constructed: construction details. You may also attach additional pages ifnecessary.
l�or itnihiple injection or non-a•ater.supply wells Oft`1.1' with the same construction, you can
subnit one form. SUBMITTAL IINSTUCTIONS '
9. Total well depth below land surface: 40.0 (ft.) 24a. For All !hells: Submit this fora, within 30 days of completion of :yell
Par rnnhiple welts list all depila ifdi ZJ reut (exanprle- 3 a 200' and 2©100.) construction to the following:
10. Static water level below top of casing: (ft.)
Division of Water Quality, Information Processing unit,
lfw•aier leml is above caring; ,ere '•+••
1617 Mail Service Center, Raleigh, INC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of wets
aPT RODS
- 12.1Ve11-cansfructiunmethod: _ construction
to the fallowing: -------_-.-- •- -
(i.e. auger, rotary, cable, direct push, etc.) -
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test. 24c. For Water Supply & lniection Wells: In addition to sending the form to
the
address(es) above, also submit one copy of this form within 30 days of
13h. Disinfection type: Amount: completion
of well construction to the county health department of the county
where constructed.
Form G W-I North Carolina Deparimcat of Environment and Natural Resources - Division. of Water Quality Reviscd Jan. 201

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit& W10300295,(UIC)
List all applicobh Well coMtnruion permits (r.e. Counry State. Variance, etc.)
3. Well Use (check well use):
water bupply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
❑Monitoring
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatina/Cooline
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 08/30116 Well IDk IW-25-5
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name - Facility 1DF (ifnppucabie)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County
Parcel Identification No. (PIN)
For Internal Use ONLY,
14. WATER
ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft
15. OUTER CASING far mutti-cnaed wells "OR LINER if a licuble
FROM
TO
DLIMETER
THIC"r-s";
MATERIAL
H.
ft.
I in
16. INNER
CASING OR TUBING- eothermul closed -lop
TO
DIAMETER
THICKNESS
MATERUL
7'"Elf-'
ft
ft.
in
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS MATERIAL
fL
ft.
rn
D.
ft.
in.
18. GROUT - -
FROM
TO MATERIAL
EMPLIC&HE:YT METHOD & AMOUirT
0.0 ft.
27.0 ft. GaRnNDBFtaaMTE
SLURRY
ft.
fr.
ft,
ft. I
19. SAND/GRAVEL PACK if applicable)
FROM
TO
AIATERIAL I
RMPL%CEMENT1%lMlOD
ft.
ft.
ft.
ft.
20: DRILLLNG LOC tattuch additional sheets if necessa
FROM
TO
i DESCRIPTION (color, hardness.-saillrock type, emin sim, el[:1
0.0 ft
27.0 f'
DIRECT PUSH -
ft.
ft.,
ft.
ft_
ft.
ft.
ft.
ft.
ft.
ft,
ft.
H.
21. REMARKS -
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Cc
rt
(if well field, one )aUlong is sufficient J F
35' 29' 15.22" N 81" 15'.20.42" W
Signature of Certified Well Contractor
09/30/16
Date
6. is (are) the well(s): ❑Permanent or LDTemporary j $ f y 1i f) / )
i B • sr tin This orm, 1 hereby corn that the ire/l s Was tiers etnrrtructed in accordance
rrirlr 15.4 NCAC 01C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
7. Is this a repair to an existing well: ❑Yes or ❑No copy ofthis record has been provided to the well owner.
If this is a repair, fill out known is -ell construction information and explain the nature of t1w
repair under 921 remarks section or on the back of this form. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8. Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
Por nmlliple hVection or nun -water supply wel/s 01VL P with the same construction, j ou can
subnritonefirnn. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 27.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of s,�EII
1--or multiple wells list all depths ifdii ferem (example- 3 rt 200' and 1 ar1,100') construction to the following-
10. Static water level below top of casing: VL) Division of Wafer Quality, Information Processing Unit,
If rrwer Jerej is above casing, use "7 " 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary; cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Nlail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) ivIethad of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
- 13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
- - _ - -- • Form GW-! NorthCarolina Department of Environnienl and Natural Resaures -Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For internal Use ONLY
1. Well Contractor Information:
KENNY SARGENT
14. WATER ZONES
FROM TOI
DESCRIPTION
Well Contractor Name
ft. fl.
A - 4226
ft. ' fL
NC Well Contractor Certification Number
15. OUTER CASING I for multi-cmed'w-ellsj OR LINER ifapplicable)
FROM
TO DIAMETER THIC"Ess
MATERIAL
-
GEOLOGIC EXPLORATION, INC
le-7ft,
. in. i
Company Name
16.INNER CASING OR TUBING ecothermal closed-loa
2. Well Construction Permit t#: W 10300295 ( U I C)
List all applicable n'ell conNirucilon rerntirS C.e. Corn n" State, Yariancc, etc,)
-
3. Well Use (check well use):
-"
FROM TO
DIAMETERin.
KN
THICKNESS
M ATERIAL
fL ff.
ft. I ft.
I
im
17..SCREEN
Water Supply Well:
FROM
TO
DtAM=R
SLOT SIZE
THICKNESS MATERIAL
ft.
ft.
in,
❑Agricultural ❑Municipal/Public
e.
rr.
in.
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑lndustriaf/Commercial ❑Residential Water Supply (shared)
'
Dirrigation
Is:CROUT -
FROM
TO
I MATERIAL
EMPLACE,'tiMETROD&AAIOUNT
0.0 fr
'
30.0 " ft'
vounwonemo re
SLURRY
Non -Wafer Supply Well:
ft.
It
i
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge OGroundw•ater Remediation
= 19. SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
FROM
TO
MATERIAL
EMPLACEhIF-NTNIETHOD
ft.
it,
ft.
I ft.
-20. DRILLING
- ) "
LOG atbt h additional sheets if necessa.
❑Geothermal {Closed loop} ❑Tracer
FROM
TO
DESCRIPTION (color, h4rdnCSS lets r5el t iaim Si3[, lrC.
0.0 ft-
30.0 ft
DIRECT PUSH
❑Geothermal (Heat in Coolin Return) ❑Other (explain under 921 Remarks)
4, Date Well(s) Completed: 08/30/16 Well IDW IW-25-4
ft. ft.
;t• ft.
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
it.
rt. rt.
Facility/Owner Nar;x Facility iD,1 (if applicable)
129 LEGIONAIRE ROAD LiNCOLNTON 28092
ft, ft.
ft. rr.
Physical Address, City, and Zip
LINCOLN 00631
21. REPIARKS °- - - -
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
field, one tatlong js sufficient,cient) 35a 29' 15.22" N 81' 15'20.42" 'sv09t301113
#IA A"-::!;22. Certification•(ifwell
6. Is (are)the w•ell(s): ❑Permanent or I2Tcmpurar ,
7. Is this a repair to an existing well: ❑Yes or E N'o
11(this is a repair fill out knotrn rrch construction it f+rmation and erploin the +moire of the
_ repair under'121 remarks section or an t+e back ofthis fora+.
Signature of Certified Well Contractor Date
By s+gning Ilia form, 1 hereby certify that the srell(s) scar (were) constructers in accordance
sNth I5A NCAC 02C .0100 or 15A NCAC 02C.0200 Well Contraction Standards and that a
caRi, ofthis retard hav been provided to the well burner.
23. Site diagram or additional well details:
I- Number wells constructed: 1
Far nndtiplr ittyection or nmr-srater.+'urrlp wells UNd•Y rrilJr t+e Santa consTruction. }nu con
suhntir mtc lhrm.
You may use the back of this -page to provide additional well site details or well
construction details. You may also attach additional pages if necessary -
SUBMITTAL INSTUCTIONS
9, Total well depth below land surface: 30•0 (ft-)
' 1•i+r ninhiple wells list all depths ifdiferent (example- 3@200' and 2@100')
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following: -
- 10. Static water level below top of casing: (it,}
If aster level is abm•e casing, sere ..+.,
Division of Water Quality, information Processing Unit,
1617 Mai! Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.)
24h. Fur Injection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
- --• 12. Will construction method: - • - - - - - .- construction to the following:-"-
. (i.e. auger, rotary, cable, direct pash, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Suooiv ad Injection Wells: In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and
Natural Resources - Division of Waler Quality Revised '-an. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contactor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name '
2. Well Construction Permit#: WI0300295 (UIC)
List all applicable ire/l consiruction permits p, Counq; State. Yarlmrce, etc.)
3. Well Use (check well use):
}Pater Supply Well:
❑Agricultural ❑Municipal/Public
013cothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
❑lrrl ation
Non -Water Supply Well:
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Expetimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatme/Cooline
L
OlGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (exDlain under #71 F
4. Date Well(s) Completed: 08/30/16 Well ID# IW-25-3
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name - Facility ID# (irappiicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees
(ifwell field, one tat/long is sufficient)
35' 29' 15.22" N 81 a 15' 20.42"
6.15 (are) the well(s): ❑Permanent or IOTemporary
W
7. Is this a repair to an existing well: ❑Yes or 0No
if ilds is a repair, fill out known well caarimation information and explain the nature of the
repair under #11 remarks section or all the back of this forni.
8. Number of wells constructed: 1
1--or inuhiple byeciion or non -ewer supply yells ONLY with the same construction. 3»u can
submit ane form.
9. Total well depth below land surface: 37.0 (ft.)
For multiple welly list all depths ifdifferent (example- 3C200' cord 2Q100)
10. Static water level below top of easing:
If voter level is above casing, use '•+
11. Borehole diameter: 1.5
DPT RODS
For hu-nal Usc ONLY',
1 f. 1VATER ZONES
FROM
TO
DESCRIPTION
fir.
fir_
R.
R.
1-4. OUTER CASINC for multi-cwedwefig) OR LINER ifa ticabte
FROM
7O
DIrAM ETER
THICKNESS
MATERIAL
16ANNER CASING OR7UBING eothermal dosed-loo )
F'RORt
TO
DIAMETER 1
THICKNESS
MATERIAL
ft.
I fL
in.
fL
ft.
ism_.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
IMATERIAL
R.
f4
in.
ft.
ft.
in.
18. GROUT
FROM
TO MATERIAL
EMPLACEMENTMETHOD&AMOUNT
0.0 ft.
37.0 It. omw,aaomrnx e
SLURRY
ft. ,
R.
R.
A9.-SAND/GRAVEL PACK if u - livable
FROM
TO
MATERIAL
EMPLACEHt E"r7'NIMOD
ft.
fL
ft.
ft.
- 20. DRILLING LOG altrich ndditio"i sheets if necessa )
FROM
TO
DESCRIPTION color, ha,dne= soiVmck type. Xmin siu, etc.)
0.0 fl•
37.0 ft-
DIRECT PUSH
ft.
R.
ft.
fL
R.
ft.
ft.
ft.
rt.
It.
ft.
tr.
21. REMARKS -
22. Certification: !tt,
09l30li 6
Signature of Certified Well Contractor Date
BY sigtring this form, 1 hereby certify that the vell(s) was (ircre) constricted in accordance
will; JJA NCAC 01C .0100 or 15A NCAC 02C.0100 Well Construaian Standard, and that a
cony afthis record has been provided to the veil oumer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Witter Quality, Information Processing Unit,
1617 itilail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e- auger, rotary, cable, direct push, etc ) .
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
I3a.'Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
_ 13b. Disinfection type: Amount- completion of well construction to the county health department of the county
where constructed.
• - Form G W-1 North Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contrnctor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit It: W10300295 WIC)
Lim all applicable well construction permits (.e. CounrF, State, Variance, etc.)
3. Well Use (check well use):
Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
❑irrigation
Non -Water Supply Well:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Aquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
13Geothermal (Heating/Cooling Return)
❑Other (explain under 921 R
4--Dale Well(s) Completed: 08/30/16
Well 1D# I W-25-2
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/owner Name Facility ID9 (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LiNCOLN 00631
County Parcel Identification No (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwcll field one lot/long is suiLcient,
35' 29' 15.22" N 81 a 15' 20.42" W
For Internal Use ONLY:
14. WATER ZONES
FROM
T
I DESCRIPTION
ft.
fL
fL
rL
15.- OUTER CASING for multi -eased wells ORLINER ifa Iieable
FROM
TO DIAMETER THICKNESS MATERIAL
I.
I ft. I in.
16. INNER
CASING OR TUBING eothermal dosed -too
FROM TO
DIAMETER THICKNESS
MATERIAL
ft. ft
in.
ft. ft.
in 1
1
17.SCREEN
FROM
TO
DLILMETER
SLOT SIZE
THICKNESS I MATERIAL
ft.
ft.
• ft.
ft.
in.
IS. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD& AMOUNT
0.0 ft.
40.0 fl'
rarircMOSE ME
SLURRY
ft.
ft.
ft.
ft.
19. SANDIGRAVEL PACK: if applicable)
FROM
TO
1 MATERIAL
E1+IPLACEM&NTMErHQD
ft.
ft.
ft.
ft.
-20. DRILLING
LOG attach additional sheets if necessary
FROM
TO
DESCRIPTION {calor, hardnen, saiVrxk rain size. etc.
0.0 fL
40.0 rt.
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
- ft.
ft.
ff.
fi.
ft.
21. REMARKS
22.Cifi[atio�
Signature of Certified Well Contractor
09/30116
Date
6. Is (are) the well(s): ❑Permanent or IOTemporary } f J f U ( )
N � signing this pine, / hereby cult that the +tell s nos u'cre conrtrucrrrl in nrcnnlarcr
with 15A NCAC 02C .0100 or 15A NCAC 02C• .0200 iV elf Conrtnrcrion SraruJardr and that a
7. 1s this a repair to an existing well: ❑Yes or ONo ccpoj• rfrhlr record has been provided to the +cell owner.
fins is a repair, fill out known well crntsimctiar infurnratiou and csplain Ilse nature of the
repair under 01 re+narkrsectior, or on the back rfiltis for n. 23. Site diagram or additional well details:
You may use the back of this page to provide additional Weil site details or well
8. Number of wells constructed: 1 construction details. You may also attach additional Pages if necessary.
rar multiple ONLY +rith the same construction. Jvu can '
submit onefr>rnr. SUBMITTAL iNSTUCTIONS
9. Total well depth below land surface: 40.0
For multiple +relLr Aw all depths if -different (eronrple- 3 n 20' and 2 r@r 10')
10. Static water level below top of casing:
lfu•aerlerel &above casing, use
11. Borehole diameter: 1.5 (in.)
DPT ODS
(ft,) 24u. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Wafer Quality, Information Processing Unit,
1617 1\'12il Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: R construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 \Mail Service Center, Raleigh, NC 27699-I636
13a. Yield (gpm) Method of test: 24c. For Water Supply 3 Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Depariment of Environment and Natural Resources - Division of Water Quality Re6sed Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAULMCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit il: W10300295 (UIC)
List all applicable well construction permits (i.e. County. State. Variance, etc.)
3. Well Usr (check well use):
❑Agricultural ❑ Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑lndtistrial/Commercial ❑Residential Water Supply (shared)
Nan -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
QlGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 921 F
4. Date Well(s)Completed: 08/29/16 Well ID# IW-25-1
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility IDS (uf applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one latAong is sufficient)
35' 29' 12.17" N 81 a 15' 21.84" W
For Internal Use ONLY.
14. WATER ZONES "
FROM
TO
I DEsCRirTto`i
ft.
rt.
ft.
ft.
15. OUTER CASING fliar mutt! -as ced wells OR LINER if n licnble .
FROM
TO
DUMErEA
THICKNESS
MATERIAL
ft.-
ft.
is
ER CASING OR TUBING eothermal closed-loa l
TO
DIAMETER
TIUCKNESS
M1IATERIAL
rt.
tJ7.SCREEN
ft.
in.
ft.
rt.
in.
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL..
R,
in
ft.
ft.
in,
18. GROUT
FROM
TO
MATERIAL
EIIIPLACEMENTAIMOD&AMOUNT
0.0 ft.
31.0 ft.
rOR's-OSEWMiE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK if a licable
FROM
TO
MATERIAL
EMPLACE11mENrmEn10D
ft.
fr.
ft.
ft.
20. DRILLING LOG attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color. hantn soiVrxic tvp,, gralasim..I.J
0.0 ft•
'31.0 ft-
DIRECT PUSH
ft.
ft.
rt.
ft.
ii.
ft.
ft.
ft.
ft.
h.
ft.
tr.
21. REMARKS
22. Certifi on:
09/30/16
Signalure ofcertified Well Contractor
Date
6. Is (are) the well(s): ❑Permanent or ®Temporary
By signing this form, ! hereby certify that the ire/l(s) u•as (here) cmtsrructed in acconlanm
udth IjA NCAC 02C .0100 or ISA NCAC 02C.0200 Wei/ Canstrrtction Standard, alit/ that a
7. is this a repair to an existing well: ❑Yes or FINo copy ofihis record has been provided to rite n•etl anuses
lfthis is a repair, fill out known well construction information and explain lire twture nfthe
repair under ,'.21 remarks section or on the back afthi.r form. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
S. Number of wells constructed: 1 construction details. You may also attach additional pages ifnecessary.
Far multiple injection or non-n•atersupply rcells ONLY with rite same eanstructinn, pit can
Subaruanefrnnt. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 31.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For sindriple wells list al/ depths ifd rent (crample- 3@200' and 2 ct 100') construction to the following:
10. Static water level below top of casing:
Ifu:aler level is above casing. use •'- -
11. Borehole diameter: 1.5
DPT RODS
(ft-) Division of Water Quality, Information Processing Unit,
1617 Nlajl Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
t' completion of well construction to the county health dcpartment of the county
>:. :i-13b. Disinfection type: Amount: where constructed.
.Form GW-[ North Carolina Department of Environment and Natural Resources -Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable it -ell construction permits (.e. County=. State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
[]Agricultural
❑GeothermaL(Iieating/Cooling Supply)
❑industrial/Commerc ia1
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
4. Date Well(s) Completed:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwster Remediation
❑Salinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other (exviain under #21 I
08/16/16 Well ID# IW-20-27
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minuteslseconds or decimal degrees:
(ifweil field, one tainting is sufficient)
35a 29' 15.22" N 81 a 15' 20.42" W
For Internal Use ONLY_
Signature ofCcrtified Well Contractor Date
6. Is (are) the well(s): ❑Permanent or 0-Temporary
R si irin = dtu ornt, l hereby corn t1+ar tlne wells a•as wereconstructed in accordance
J F f 1 O {
iridr I5A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Canatruction Standards and that a
7. Is this a repair to an existing well: ❑Yes or PJNo
copy ofthis record Gar been provided to the well owner.
lftlris is a repair, fill nut known well canstniction i+ifornnation and explain the now" ofthe
repair under P21 remarks section or air the hack tJ7hir form.
23. Site diagram or additional well details:
1
You may use the back of this page to provide additional well site details or well
R. Number of wells constructed:
construction details. You may also attach additional pages if necessary.
' rar nudtlple it jectian or non -+eater supply wells ONLY with the come construction, you cat
subinitaneform.
SUBMITTAL INSTUCTIONS
50.0
9. Total well depth below land surface: (ft.)
24a. For All Wells: Submit this form within 30 days of completion of well
ror iultiple wells 11rt a// depths iy'dif rent (exatnnpie- 3't 200' and 2@100')
construction to the following:
10. Static water level below top ofcasing: (ft.)
Division of Water Quality, Information Processing Unit,
lfwaier level isabae casing, use '= '
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter; 1.5 (in.)
24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS
above, also submit a copy of this form within 30 days of completion of well
12: Well construction method:
construction to the following: - -
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 ivlail Service Center, Raleigh, NC 27699-1636
13a. field (gym) Method of test:
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form Within 30 days of
13b. Disinfection type: Amount:
completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised Jan. 20 i 3

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Wei Contractor Name
A - 4305
NC Well Contractor Ccnification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permitth WI0300295 (UIC)
Lis(oll applicable bell construction pernri[r (11.e. Count.;,. State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
OAgricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industiial/Commercial
Non-W a ter Supply
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeatinP./Coolina
❑MunicioaUPublic
❑Residential Water Supply (single)
OResidential Water Supply (shared)
oGroundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain tinder €t21 1
4. Date Well(s) Completed: 08/18/16 Well IDN IW-20-26
So. Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LINCOLN
County
NONCD0001154
Facility IDk (inapplicable)
LINCOLNTON 28092
00410
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lalilong is sufficient)
35e 29' 15.22" N 810 15' 20.42" W
6. Is (are) the well(s): ❑Permanent or 10Tenlporary
7. is this a repair to an existing well: ❑Yes or ®No
!f this is a repair, fill am knoirn mall construction i+ formation and explain the tmn+ro of the
repair under 921 remarks section or an the back of this famr.
8. Number of wells constructed: 1
For nmltiple injection or man -water supply irells ONLY irith the same construction, you can
submit one form.
9. Total well depth below land surface: 50.0
Far multiple n-ells fist all depats ifdifferent (example- 3Q200' and 2 rr 100')
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
rr.
ft.
{
15. OUTER CASING for multi -eased wells OR LINER if a llcnble
FROM
TO
DIAMETER
TftICKNFSS
MATERIAL
ft.
I ft.
.. it,
16.INNERCASINGORTUBINC eothermafdmed-loo
FROM
TO
DI". LTF.R I
THICKNESS
MATERIAL
ft.
fL
I in.
ft.
fL
in
17. SCREEN
FROM
TO -
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
ft.
ft.
in
ft.
ft.
in.
I& GROUT
FROM
I TO
I MATERIAL
EAIPLACEM ENT A,ETIIOD&.LNIOU"fr
0.0 fl.
50.0 ft
PJA1XaaENTr{iiE
SLURRY
ft.
ft.
19. SANDIGRAVEL PACK-
if applicable)
FR0:1I
TO
MATERIAL
EIIPLACEMENTMETHOD
ft.
ft.
ft.
-ft
--20:'DRILLING
LOG attach additional -sheen if necesw
FROM
TO
{ DESCRIPTION knlor, hsrdaa s HI-k type. rain uar, efr.
0.0 ft-
50.0 fl•
DIRECT PUSH
ft.
ft.
ft.
H
tt.
ft.
ft.
ft.
h.
fL
n.
e.
21. REMARKS.
22. Certific• n:
09/30/16
Signature o 'ertified Well Contractor Date
py signiug lilts flml, I hereby certify than Cite irell(s) rcas (were) constructed in accordance
with IjA NCAC 02C .0100 or 154 NCAC 02C .0200 Well Co struction Standards and thin a
copy of this record has been prornled to the it -ell owner,
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUC IONS
24a. For All Wells: Submit this form within 30 days of completion of %vell
construction to the following:
10. Static water level below top of casing: (ft.) Division of Wuter Quality, Information Processing Unit,
Ij'irater /ere/ is above caring, use - I " 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Infection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division ofWater Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: I636 :[nil Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test- 24c. For Water Suopiv & Iniection Wells: In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
136. Disinfection type: Amount:
where constructed.
.-_ Form GW-I North Carolina Department of Environment and Nalrn:d Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
Thu form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #. WI0300295 (UIC)
List aH applicable nel1 construction permits (i.e. Courny, State, Irariance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑ Indust rial/Commercial ❑Residential Water Supply (shared)
❑ Irri eat ion
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
015roundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 921 F
4. Date-Well(s) Completed: 08/16/16 Well ID# IW-20-25
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID/1 (ifapplic.2ble)
129 LEGiONAIRE ROAD LINCOLNTON 28092'
Physical Address, City, and Zip
L19COLN 00410
County
Parcel Identification No. (PiN)
Sb. Latitude and Longitude in degrees/minutes/Seconds or decimal degrees -
(if -ell field, one IsYlong is sufficient)
35' 29' 15.22" N 81 a 15' 20,42" W
6. Is (are) the well(s). ❑Permanent or DTemporary
7. is this a repair to an existing well: ❑Yes or E1No
trims is a repair, fill our lomtrn cell construction information and explain the nature ofthe
repair under 421 remarks section or on the back of this fain.
8. Number of wells constructed: 1
For nndtiple injection or non -crater svpply n•ells ONLY with the same canstructinn, )•on can
submit one frrrni.
9. Total well depth below land surface: 50.0
For multiple wells list all depths ifdiffereni (example- 3 t`r}t 200' and 2 a 1003
10. Static water level below top of casing:
If eraser level is above eosing. use " + -
11. Borehole diameter: 1.5 (in.)
DPT RODS
For Internal Use ONLY
14. WATER ZONES -
FROM
TO
DESCRIPTION
ft.
ft.
rL
fr.
15. OUTER CASING for�nalti cased weiis ORLINER (ifu
licable
FROM
TO
DIAMETER THI . ESS
MATERIAL
I.
I ft.
I in
16; INNER CASING OR_TUBING eothermat closed-loc )
FROM
TO
DIAMETER I
THICKNESS
MATERIAL
ft,
ft.
in.
ft.
&
in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSME
THICKNESS
MATERLIL
ft.
fL
in.
fL
ft.
in.
.18. GROUT
FROM
TO
MATERIAL
EMPLACEMENTMErHOD&AMOUNT '
0.0 ft•
50.0 ft'
rDRTVNDaareNTE
SLURRY
iL
ft.
ft.
ft.
19.SANDIGRAVELPACIi ifa licable
FROM
TO
MATERIAL
EMPLACEaf ENT M ETHOD
ft.
rt.
rt.
ft.
20. DRILLING
LOG athirh additional sheets if necessary) -
FROM
TO
DESCRIPTION (rotor, hardness. soiltruck ruin size, etc.
0.0 fL
50.0 ft-
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22, Certitic
09/30/16
Sigrmturc ofCettified Well Contractor
Date
Hy signing this jorne, 1 hereby cerlIfy that the uell(s) was (were) mrn'tructed in accordance
witlt 1SA A'CAC 02C .0100 or 15A NCAC 02C_ 0200 Well Construction Standards and that a
cop)' ofthis record bar been provided to the ire/l ou-nen
23. Site diagram or additional well details:
You may use the back of this page to provide additional welf site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTiONS
(ft.) 24a. For All Wells: Submit this form within 30 days or completion of well
construction to the following
(ft-) Division of Water Quality, Information Processing Unit,
1617 Nlail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
1`2. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,' Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test.• 24c. For Water Supply & Injection Wells: ►n addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
136. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment mid Natural Resources - Divisiou of Water Quality Revised Jan 20I3

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable well cotutructian permits (t.e. County, State, Irariat¢e, etc)
3. Well Use (check well use):
ryarerauppty vteu:
❑ Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Commercial
❑irrigation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geotheimal(Closed Loop)
❑Geothermal (HeatinuJCoolina
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
0Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other (exptain under #21 F
4. Date Well(s) Completed: 08/18/16 Well ID# ' IW-20-24
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapphcable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one latllong is sufficient)
35' 29' 15.22" ,N 81 a 15' 20.42" W
6. Is (are) the w•ell(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ❑No
Y'this is a repair, fill out knou-n troll coutruction information and explain the nauire ofilte
repair under k 21 rentarkc section or on the back of this form.
8. Number of wells constructed: 1
Far nnldple injection or non -tracer supply wells ONLY frith the sane construction, you cmr
sabnit acre form.
9. Total well depth below land surface: 50.0 (ft.)
For nndliple wells lint all deptlu ifdifferent (example- J r@i 200' and 2 r(r)10)
10. Static water level below top of casing:
If crater level Ls above casing, ate "+"
11. Borehole diameter: 1.5 (in.)
For Internal Use ONLY'
14. WATER ZONES
FROM
TO
DESCRIPTION
Cr.
ft.
I&OUTERCASING Ifor
multi -cased wells) OR LINER ifa Ilcable)
FROA7
TO
DIAMETER
THICMiESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING eothermal cloned=too
FROM
TO
DIAMETER
THICIG*IEss
MATERIAL
«.
ft
is
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
TRICIONESS
MATERIAL
ft.
M
it,
ft.
ft.
in.
1& GROUT
FROM
I TO MATERIAL
ENIPtAC:ENIENr'METHOD&AMOUNT
0.0 «.
50.0 «' von w oot, towte
SLURRY
ft.
«.
ft.
&
19.SANDIGRAVELPACK ifapplicable)
FROM
I TO
MATERIAL
F_%IPLACZ%1LNTAIETHOD
ft.
ft.
20. DRILLING
LOG attach additional sheeti ifneeesaary
FROM
TO
DESCRIPTION (color. hardness, soiVrock min siu, ttc.l '
0.0 fr.
50.0 ft-
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
«.
«.
21. REMARKS
22. Certifies '
I -el 09/30/16
Signature o enified Well Contrnctar Date _
By signing this furnt. I hereby certrj}' that the trell(r) ryas (tverej constricted in accordance
midi i5A NCAC 02C.0100 or MA NCAC 02C.0200 We// Cotutruction Siandards'ond that a
copy ofthis record /vas been provided to the ireil ouarei
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water SuDDiv & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
= where constructed.
- - - - - Form GW-t North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 20 13

- - -- _ 12. Well construction method: _
(i.e. auger, rotary, cable, direct push, etc.)
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable well construction permits (l.e. County, State, Variance, eta)
3. Well Use (check well use):
OAgricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Aquifer Recharge
[]Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OGeothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGround\,ater Remediatjon
OSalinity Barrier
OStormwaler Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 08/16/16 Well ID# IW-20-23
$a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Faciliiv/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
ib. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field one lat/long is sufficient)
350 29' 15.22" N 81 a 15' 20.42" `Y
For Internal Use ONLY:
14. WATER ZONES '
FROM
'f'OI
DESCRIPTION
ft.
ft.
3L
ft
15. OUTER CASING ftir mulh-as wets OR 4INER if a licablt
FROM
TO DIAMETER THICKNESS
MATERIAL
rt.
ft. in.
16. INNER
CASING OR
TUBING eatherma] closed -loop)
FROM
I TO
I DIAMETER I
THICKNESS
MATERIAL
ft.
rt.
in.
ft.
ft.
in
17. SCREEN '
FROM TO
DIAMETER
SLOTSIZE
THICKNESS MATERIAL
ft. r4
in.
fc. fL
in.
- 19: GROUT , -
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
0.0 ft'
50.0 fi.
PaallNaarlaONnE
SLURRY
ft.
fL
ft
ft.
19. SA AVPACK if a licabfe -
MATERIAL
ENtPLACEMENTMErHOD
,NDIOR,EL
ft.
rt.
20. DRILLING
LOG attach additional sheets if necesso y
FROM
TO
DESCRIPTION (color, hardness, sollh-Ittype. grain size. etc.
0.0 ft-
50.0 f-
DIRECT PUSH
ft.
ft.
ft,
ft.
ft.
ft.
ft.
rt.
ft.
ft.
ft.
rt.
21. REMARKS
22. Ccrtif on:
09/30/16
Signature ofCcrtificd Well Contmetor Date
6. is (are) the w•ell(s): OPermanent or OTemporary By signing this form. I herehe cent' than the ire//(.$) uos (were) contracted in accordance
with I SA NCAC 02C .010d or ISA NCAC 02C,0200 1 fell Corvtruction Stondords and tltot o
7. Is this a repair to an existing well. OYes or ONo copy ofthis record has been prorided to the well on ner.
I(this is a repair, fill our knon•n well construction it jarwation and explain the nature afthe
repair under 421 remarks section or an the buck ofdris farm. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8. Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For nrnhiple ityeerian or non -crater sunuoly wells ONLY n'ith the same construction, you con
submit oneform. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 50.0 (f .) 24a. For All Wells: Submit this form within 30 days of completion of well
For iultiple irellt list all deprbs ird�erem (etmmple- 3 rt100' oral ? rt 1IXY) construction to the following.
10. Static water level below top ofcasing:
If crater level is obare casing, use "+"
11. Borehole diameter: 1'S (in.)
DPT. RODS
(ft) Division of Water Qualih•, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following: _
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Nlethod of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within, 30 days of
136. Disinfection type: Amount: completion of well construction to the county health department of the county
Where constructed.
Form GW-I North Carolina Department of Environment and Naitual Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC_ EXPLORATION, INC
Company Name
2. Well Construction Permit 9: W10300295 (UIC)
list all applicable well cansrruciinn permits (t e. County, State, Variance, etc)
3. Well Use (check well use):
❑Agricultural OMunicipaliPublic
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑ Indust rial/Commercial
❑Residential Water Supply (shared)
❑Uri lion
Non -Water Supply Well:
❑Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
©Groundwater Reinediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
OStormuater Drainage
❑Experimental Technology
❑Subsidence Control
liGeothermal(Closed Loop)
OTracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under P21 Remarks)
a. Date Well(s) Completed: 08/18/16 Well ID# lW-20-22
So. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDY (i f applicable)
129 LEGIONA1RE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
35° 29' 15.22" N 81 ° 15' 20.42" W
6. Is (are) the well(s): ❑Permanent or ®Temporary
7. Is this u repair to an existing well: Oyes or 0No
lfihis is a repair, full out knmtvu well construction i» forntatian and explain the nature ofthe
repair under 4421 rentarky section or nn the back of this form.
g. Number of wells constructed: 1
For multiple injection nrnon-utter supply wells rlrvl.Y,,ilh the same construction. You can
submit onefnrm.
9. Total well depth below land surface: 50.0 (ft.)
For multiple irel/s list all depths tfdiereni (erample- 30200' and 2Q100)
10. Static water level below top of casing: (ft.)
If enter lerel is above casing, use -+ "
11. Borehole diameter: 1.5
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZONES
ft. ft.
ft. ft.
ft. I ft. in.
16. INNER CASING OR TUBING(geothermal doted -lop
FROM TO DIAM EI'EA TIIICKNFS$ -MATERIAL
ft. ft is
ft. ft. in. -
R. I ft I in. I I ( 1
ft. I ft. I in. I I I�
0.0 ft 50.0 ft' P°"°arn,oar SLURRY
ft. I rt
ft. I ft,
tt. ft.
ft. ft.
20. DRILLING LOG attach additional sheds if necessary)
FROM TO DESCRIPTION color, hardness, saiUr°sk fv calm sin. ttr.
0.0 fL 50.0 ft. DIRECT PUSH
ft. ft. I
ft. ft. '
ft. ft.
ft. ft.
ft. R.
ft. ft.
22. Ce%fifin:
09/30/16
SigaatmeofCcrtiftedWell Contractor - Date
By signing this form. 1 hereby certify that the ,retils) was (here) constructed in accordance
with 13A NCAC 02C .0100 or 1 SA NCAC 02C . 0200 Well Contruction Siandarrty and ilia/ a
copy afth{s record has been provided to the hell corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 ,Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: !n addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW.I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Weli Contractor Information:
PAULMCVEY
Well Contractor Name
A'- 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
Lixt all applicable Ire// consirriction permits (i.e. Counq. Store. I$riance, etc.)
3. Well Use (check well use):
Water Supply Well:
OAgricultural ❑Municipal/Public
OGeothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial OResidential Water Supply (shared)
Non -Water Supply Well-,
❑Monitorine I-1Rerrivery
❑Aquifer Recharge
DAquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
DGeothermal (HeatinQ/Coolinp
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other (explain under #2 t F
4. Date Well(s) Completed: 08/16/16
Well ID# IW-20-21
Sa. Well Location:
ROBERT BOSCH TOOL
NONCD0001154
Facility%Owner Name
Facility IDb (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON
28092
Physical Address, City, mid Zip
LINCOLN
00410
County
Parcel identification No. (PIN)
5b. Latitude and Lon itude in de rees/minutes/sec
d d . I d
g g on s or cc ma egrees.
(irwell field, one lat/long is sufficient)
35a 29' 15.22" N 81 D 15' 20.42" W
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: Dyes or 23No
lfthis is a repair, fill out known well construcrion iaformatian and explain the nature nfilic
repair under #21 remarks securn or on the back of this form.
8. Number of wells constructed: 1
For mnitilge infection or nun -water supply wells O1vl.Y ivim the some construction, you can
submit oneform.
9. Total well depth below land surfuec: 50.0 (ft.)
For multiple welis list all depths ifdierent (example- 3Q2(X)' and 2 rt 10')
10. Static water level below top of casing: (ft.)
y'i ater /erel is above casing, toe "+
11. Borehole din meter: 1.5 (in.)
12. Well construction method- DPT RODS
(i.e. auger, rotary, cubic, direct push, etc)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For internal Use ONLY:
rt.I rG
ft. fG
ft. i ft. I in. I 1
16. INNER (CASING OR TUBING eother 6afciosed-loo
FROM I TO DIAMETER THICKNESS MATFRLIL
ft. ft, in.
ft. Ct. is
17. SCREEN
FROM TO -DIAMETER SLOTSIZE THICKNESS MATERI
ft. ft, in
ft. ft. in
13. GROUT
FROM TO I MATERIAL BMPLACEASENrrtE77io5&Aat1
0.0 It, 50.0 It' PDRnlnDatn rM7E SLURRY
ft. tt.
ft. Ct.
fr. I ft.
ft. I ft.
0.0 ft• 50.0 It.
ft. ft.
ft. ft,
ft. ft.
ft. ft.
ft. ft.
ft. I ft.
DIRECT PUSH
22. CcrtiSc n:
09/30116
Signature orCertified Well Contractor Date
By signing thisform. 1 hereby certify that the well(s) was (were) consimcted in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Nell Cinutruction Standards and that r
cony of ills record has been provided to the hell ouvrer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Nluil Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24.1
above, also submit a copy of this form within 30 days of completion of well
construction to the following: -
Division of Winter Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & lniection (Yells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well constriction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION,- INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable well ctastraction permits (i.e. County, Stale, lrarionce, etc)
3. Well Use (check well use):
water supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ ridustrial/Commercial
Olrrication
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal tHeatinzfCooline
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGround-, ater Remediation
❑Salinity Barrier
❑StofmNatef Drainage
OSubsidence Control
❑Tracer
❑Other (exolain under 421 f
4. Date Well(s) Completed: 08/18/16 Well 1D# I W-20-20
5a. Well Locution:
ROBERT BOSCH TOOL
NONCD0001154
Facility/Owner Name
Facility 1D# (irappiicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and -Zip
LINCOLN
00410
Countv
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seronds or decimal degrees:
617well field one lat/long is sufficient)
350 29' 15.22"
81 a 15' 20,42"
N
IV
6. Is (are) the well(s): ❑Permanent or ldTemporary
7. Is this a repair to an existing well: OYes or ElNo
If this is a repair, fill out known well construction information oral explain the nature of dte
repair under 421 remarks section or an the back ofillis farm.
8. Number of wells constructed: 1
fur mrrhiple injection ar non -:rater supply ire//s ONLY will. the same construction, you can
submit oneform.
9. Total well depth below land surface: 50.0 (ft,)
hbrmuhiple welts list all depths ifdiereni (example- 3 200' and.2 100')
10. Static water level below top ofcasing: (ft.)
If'u,aler level it above casing, use - -
11. Borehole diameter: 1.5 (in.)
DDT RODS
For Internal Use ONLY;
14. WATER ZONES
FROM TO DESCRIPTION
ft.
ft.
15. OUTER CASING for multi -cased welh) OR LINER if a i licabk)
DIAMETER TRICICNM
MATERIAL
It.
;a
NG OR TUBING t eothermat cicsed-loo '
DIAMETER Tf11CHPtESS MATERIAL
2.11SCREEN
ft.
in
DIAMETER
SLOTSIZE
TllICKNESS
MATERIAL
ft.
in.
ft.
ft.
in.
18. GROUT .
FROM
TO I MATERIAL
EMPLACEMENTMEt71OD&AMOUVI7
0.0 ft.
50-0 rt• inn woserc to
SLURRY
ft.
it.
ft.
ft.
19:SANDIGRAVELPACK ifa licable - -
FROM
I TO MATERIAL EMPLACEMENT METHOD
ft.
fr.
20. DRILLING LOG jintach additional sheets'if necessary)
FROM
TO
DESCRIPTION cabr, hardness, soiUrock rain size. Nr.
0.0 rt-
50.0
DIRECT PUSH
ft,
ft.
_
ft.,
ft.
1
rt.
ft.
ft.
rt
ft.
ft.
Tt.
21. REMARKS
E
22. Certific
09/30116
Signature ol'Certifted Well Contractor
Date
By signing this form, I hereby certify that the u•ell(s) uas (here) constructed in accordance
with 15A NCAC 02C . 0100 or 15A NCAC 02C . 0200 Well Construction Starulardv and that a
copy ofthis record has been provided to the nrell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
tab. For Iniection Wells: In addition to sending the form to the address In 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Sunoly & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
I
Form GW-1 Nona Carolina Department of Eavironment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:.
1. Well Contractor Information:
PAUL MCVEY
J4. WATER ZONES
FROM
TO i DESCRIPTION
Well Contractor Name
fL
ft.
A - 4305
ft.
rL
NC Well Contractor Certification Number
15. OUTER: CASING foe multi cased welts OR LINER "if a ticoblei
GEOLOGIC EXPLORATION, INC
FROhI
TO
DIAMETER TFnCiu^tESS
i
MATERIAL
ft.
ft.
I I.
Company Name
16 INNER CASING OR TUBING eatheiTriaiclosed-loon)
tt (1
WI0300295 UIC
FROM I TO DIAMETER
MATERIAL
ATERIAL
Z. Well Construction Permit #: � �
ft.
List all applicable well cointniction perndts il.v. County, Stoic, Variance. etc.)
ft. ft. in.
3. Well Use (check well use):
17. SCREEN
Water Supply Well.
FROM
TO
D4IUETER
SLOTSIZE
I THICKNESS
I hIATERIAL
❑Agricultural ❑AlunicipaJPublic
ft.
R.
iry
❑Geothermal(Heat inglCoolin Supply) ❑Residential Water Supply (single)
ft.
ft.
Olndustrial/Commercial ❑Residential Water Supply (shared)
IS. GROUTDirr
FROM
TO
MATERIAL
EMPLAC-MENr METROD&AMOUNT
on
Non -Water Supply Well:
0.0 rr
50.0 ft-
M.M-D9Evra IIrE
SLURRY
❑ivionitaring ❑_ Aecavery
rt.
ft.
Injection Well:
I ft.
R.
OAquifer Recharge OGroundwater Remediation
19_ SANDIGRAYELPACIi if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier
€RDiv!
TO
MATERIAL EMPLACENIENTMEMODrt
tr
OAquiler Test OStormwater Drainage
❑Experimental Technology OSubsidence Control
ft.
fr.
OGeothermal (Closed Loop) OTracer
`20. DRILLING
LOG fattnch additionnl sheets if necesso. -
FROM
To
DESCRIPTION tcolur, hard.-, seillmo k tyM g-in sin err.)
E}Geothermof (Heatin Coolie Return) OOther (explain under 921 Remarks)
0.0 ft-
50.0
DIRECT PUSH
08/16/18 IW-20-19
it.
rt.
4. Date Well(s) Completed: Well ID#
ft
rt
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
ft.
ft.
FacilitylOwner Name Facility IDN (ifapplicable)
129 LEGIONAiRE ROAD LINCOLNTON 28092
ft.
ft.
ft. ft.
ft.
Physical Address, City, and Zip
LINCOLN 00410
1l: REMARKS
County -' Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
22. Certifica '
(:fwelt field one lat/long is sufficient)
35e 29' 15.22n 81 a 15' 20.42"
09/30/16
N W
-
Signature ofCortilied Well Conimctor Date -
6. Is (are) the well(s): OPermanent or OTemporary
Y signing � rhrs ornr, I hereb erne that the welt s uas acre ` rnnsrructer( in accordance
} K f y fy /� 6-re)
j
with 154 NCAC 07C.0100 or JSA NCAC 02C.0200 Well Construction Standards and that a
7. Is this a repair to an existing well: OYes or ®No
cope afthis record hav been provided to the treA owner.
Ifthis is a repair, fill not known well construction irrforniation and erplain the nature of the
repair under P21 remarks section or on the back <fthis form.
23. Site diagram or. additional well details: ,
1
You may use the back of this page to provide additional well site details or well
8. Number of wells constructed:
construction details. You may alsb attach additional pages if necessary.
Far nruhiple hyeeda r erne-u•ater.vupply:'•ells QrtiLY loth fire same canstrucrion, pnn can
subwironeform.
SUBMITTAL INSTUCTIONS
50.0
9. Total well depth below land surface: (ft.)
24a. For All Wells: Submit this form within 30 days of completion of well
Fnr nuhiple u•el,ir livt oil depihv ifdifferent (example- 3 u 300' and 3 rr 1011')
construction to the following:
10. Static water level below top of casing: (ft.)
Division of Water Quality, Information Processing Unit,
Ifn•arer lerrl is abore casing, use "+-
1617 Mail Service Center; Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.)
24b. For infection Wells: In addition to sendine the form to the address in 24a
DPT RODS
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method:
construction to the following: -- - `- -•--
(i.e. auger, rotary, cable, direct push, etc)
Division of Witter Quality, Underground Injection Control Program,
FOR WATER SUPPLY !YELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-I636
13a. field (gpm) Method oftest-
24c. For Water Supply & Injection Wells: In addition to sending the form to
I he addresses) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount:
completion of well construction to the county health department of the county
Where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quahty Res•ised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for Single or multiple wells
1, Well Contractor Information:
PAULMCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2.Well Construction Permit ##: WI0300295(UIC)
List all applicable well construction permits (i.e. Couny% State. Variance, etc)
3. Well Use (check well use):
Water Supply Well:
OAgriculturaf
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Nan -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OGeothermal (Heatin?/Cooling
Oblunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
VICTroundwater Remediation
OSalinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (exolain under 921 f
4. Date Well(s) Completed: 08/18/16 well IDq 1W-20-18
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
FacilitylOwner Name Facility ID9 (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County
Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well Geld one Millong is sufficient)
35` 29' 15.22" N 81 ` 15' 20.42" W
6. Is (are) the well(s): ❑Permanent or ©Temporary
7, is this a repair to an existing well: OYes or ONo
lflhis Is a repair. fill out known trell construction information and explain tilt, nalnre offhe
repair under 921 remarks section or on the back of this form.
S. Number of wells constructed: 1
For multiple ilyection nr nun-trater-supnly trells ONl_I' with the same construction, yaa can
submit nne form.
9. Total -well depth below land surface: 50.0
For multiple wells list all deprlts ifdi,(fereni (esaniple- 3Q200' and 2 rt 100')
10. Static water level below top ofcosing:
if hater level is above casing, use ••+'•
11. Borehole diameter: 1.5 (in.)
DDT Roos
For internal Use ONLY;
14. WATER ZONES _ -
FROM
TO 1 DESCRIPTION
ft.
15. OUTER CASING(Tar multi=cased wilts} OR LINER if a licahle)
FROM TO
DIAMETER
THICKNESS
MATERIAL
ft. R,
I in
16.INNER CASING OR TUBING igeothermal closed -hip )
FROM
TO
I DIAMETER I
TI1_1C_K_N_M____1
MATERIAL
ft.
17. SCREEN'
FROM
"
TO DIAMETER SLOTSIZE THICKNESS MATERIAL
ft.
{t.
ita.
ft.
rr
in.
1S.GROUT -
FROM
I TO MATEAIAAL
EMPLACEMENTMETHOD&AMOUI
0.0 ft
50.0 rt epRn waaexncxre
SLURRY
tr.
ft. I
ft.
It.
19. SANDIGRAVEL PACK if a licable \
FROM
I TO MATERIALI
£MPLACEML,'rT,ttETuOD
R.
fr.
rt.
PDRILLING
LOG attach -additional sheets ifnecesso
TO
DESCRIPTION (color, hardnea, wiVruck rain size, or.)
50.0 fl-
DIRECT PUSH
ft.
ft.
ft.
It.
ft.
ft.
ft.
B
ft.
ft.
fk
ft.
i
21. REhIARKS
22. Certificm
09/30/16
Signature of Certified Well Contractor Dale __--�—
Hy signing this form, 1 hereby cerlif tbai the well(s) a -as (were) consirucled in accordance
rrith 1$4 NCAC 02C .0100 or ISA NCAC 01C 0200 Well Construction Standards and that a
copy of"this record has been provided to the irell owner,
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages.if necessary.
SUBMITTAL INSTUCTIONS
(ft.) 24a, For All Wells: Submit this form within 30 days of completion of well
construction to the following
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 240
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Contra] Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAULMCVEY
For Internal Use ONLY,
Well Contractor Name ft. m -
A - 4305 ft. ft.
NC' Well Contractor Certification Number .15. OUTER CASING foe mieltitased wells OR LINER if a Gcabt
FROM12 TO DIAMETER THICKNESS MA
GEOLOGIC EXPLORATION, INC Ct. ft. is
Company Name 16. INNER CASING OR TUBING(geothermal do>ied-lao 1
W10300295 (UIC) FROM 1 TO DIAMM
ETER THICKNESS 1 A
2. Well Construction Permit #: tt. fr. in
List all applicable well construction peratlts r.e. County, State, Variance, elcj
ft. ft. in.
3. Well Use (check well use): 77BCREEN
Water Supply Well: FROM TO DIAMETER SLOTSIZE 'THICKNESS
❑Agricultural ❑MtmicipallPublic ft. ft. in
OGeothermal (Heating/Cooling Supply) ❑Residential Water Supply (single) tr. ft. in
i
OlndustriailCommercial ❑Residential Water Supply (shared) S18 GROUT
— ......... ----- . _--
Non-Water Supply
OAquifer Recharge
OGroundwater Remediahon
OAquifer Storage and Recovery
❑Salinity Harrier
0Aquiler Test
OStorm%vater Drainage
QExperimental Technology
❑Subsidence Control
OGeothermal (Closed Loop)
OTracer
OGeothermal (Heating/Cooling Return)
00!her (explain under #21 Remarks)
4. Date Well(s) Completed: 08/'16116
Well ID# IW-20-17
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility IDk (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical .Address, City, and Zip
LINCOLN
00410
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in deareesiminuteslseconds
or decimal de reel*
0.0 ft. 5().() ft. waruvaarxransre SLURRY
Ct. ft.
ft. ft.
19. SANDIGRA6'EL PACK if applicable)
FROM TO MATERIAL EmP1ACEMENTMETHOD
ft, ft.
tt. ft. t
-20, DRILLINC.LOG tattach-additionafshsets ifnrreu—l.
0.0 ft.
1 5M ft,
ft.
E ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rr.
21. REMARKS
.
DIRECT PUSH
(ifwetl field, one laillong is sufficient) e g 22. Certificatio .
35a 29' 15.22" N 81' 15' 20.42" , 09/30/16
Signature of a led Weli Contractor Date -
6. Is (are) the we11(s): OPermanent ar fr7Temporar} By signing this form, 1 lrerebr cerrify that the well(() was ficerei constructed in accordance
with 15A NCAC 02C .0100 ar 15A NGC 02C.0200 Well Caratruciia 3 Standards and drat a
7. Is this a repair to an existing well: OYes or I_INo cane aftlds record rat been prnrided to the +cell viewer.
If this is a repair• fill our known well concsrnction inrfortrtatian and explain the nature ofthe
repair under 121 renrarkr section or on tire back orrhisfarni. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
F Number of wells constructed: I For multiple it jedion or nun-warrr,rupply +rrdls ONLY with thesame construction.rrinn, you can
construction details. You may also attach additional pages if necessary.r:
xubmir one form. SUBMITTAL I NSTU CTI ON S
9. Total well depth below land surface: 50.0 (ft,) 24a. For All Wells: Submit this form within 30 days of completion of well
lror multiple srells list all depths ifrl rent (example- 3trr^42W' and 2@100'i construction to the following:
10. Static water level below top of casing: (ft.) Division of Wafer Quality, Information Processing Unit,
If water level is chore casing, rise -• " 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT. RODS. above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the followings,
(i.e. auger, rotary, cable, direct push, etc }
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount cotrpletior. of well construction 10 the county health department of the county
t%�Iere constructed.
Form GW-t Nortlt Caroima Department of Environment and Nalural Resources — Division of Water Qtraliy - Revised Jan 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
L Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
LIT/ all applicable well construction permits (i.e. County. State, Variance, etaJ
3. Well Use (check well use):
❑Agricultural ❑Mtmicipal/Public
❑Geothermat (Heat inglCool ing Supply) ❑Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑(Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatinr)Cooline
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 08/18116 Well 1D# IW-20-16
a"a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
r-acilitylOwner Name Facility ID4 (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Ph.3ical Address, City, and Zip
LINCOLN
County
00410
Parcel identification No. (PIN)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
R.
ft.
FL
ft.
15. OUTER CASING for multi -cased wills) OR LINER if a licabte
FROM TO
DIAl1t LTER
TFi1CIJVESS
MATERIAL
ft. ft.
I in
16. INNER CASING OR TUBING tothermal awed -too
FROM TO
I DIAMETER I
Tt11CKNFSS
I MATERIAL
ft. ft.
in,
ft. 1 ft.
is
17.SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS MATERIAL
fL
ft.
in.
ft.
ft.
in
is. GROUT
FROM I TO
MATERIAL
EAfPLACEMEJYTMEniOD.4AAIOUrfr
0.0 ft. 50.0 ft.
M,m_aa.n«..E
SLURRY
ft. ft.
ft. ff.
19. SANDIGRAVEL PACK if a licabte
FROM
TO SIATERLIL
EMPLACEMENT lltEMOD
ft.
A.
It.
ft.
20. DRILLING LOG attach addidonal sheetb if necessarA -
FROM
TO
DESCRIPTION mtar'hurdrtess, soac itlrk type, griii. si:e, etc.
0.0 rr.
50.0 fit
DIRECT PUSH
ft.
ft.
ft.
R.
ft.
ft.
ft.
ft.
ft.
rr.
21. REMARKS
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 Cer ' tion•
(if welt field, one lat/long is sufficient)
350 29' 15.22" N 81' 15' 20.42" W 09/30/16
Signattue of Certified Well Contractor W Date
6. Is (are) the well(s): ❑Permanent or 47Temporary By signing; Via farm, I hereby cerirfy that the wells) ryas (were) constructed In accordorce
frith 15.4 NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a
7. is this a repair to an existing well: ❑Yes or 0No copy of dris record has been provided to the meal owner.
Tibis is a repair, fill out known well construcliou information and explain the nature rfdie
repair under 921 ramarkc section or opt die back ofdtia fornn. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8. Number ofwells constructed: construction details. You may also attach additional pages ifnecessary.
For oulliple injection or non-tvater supply mells ONLY mith the sane construction, iron can
subnit one)brnt. SUBMITTAL INSTUCTIONS
9. Total well depth below In ad surface. 50.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For nmltiple ive0.s list all depths ifdijjereni (example- 3@D200' and 2©100') construction to the following:
10. Static water level below top of casing: (ft.) Division of Water Quality, Information Processing Unit,
Ifirater level is above casing, usr ,+" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For lniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount' completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources -Division ofWater Quality Revised Jan. 2013

WELL: CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable +ref/ construction permits ri.e. Co otty, State, t'ariance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑industrial(Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
®Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormy ester Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
RGeothermal (HealinVCoolin& Return)
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 08/15/16
Well ID# IW-20-15
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
FicilitylOwner Name
Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
For Internal Use ONLY•
14. WATER'ZONES
ft. fL
IS: OUTER'CASING (for. rnulti-eased welts) OR LINER if ape,
lieobte
FROM TO DIAME FR 1 THICtO MMATERIAL
ft. I ft. in
16.:INNER CASING OR'TUBING(geothermal closed -loon)''
FROM I TO DIAMETFR i-HICKNFSS MAT.J.
fL ft. in
ft. ft. in.
ft. I
ft. I
in.
ft. I
ft.
in,
A8}.GROUTFROM
TO
MATERIAL
I EMPLACERIFTT METIIOD & AMOFr,T
0.o ft.
50.0 ft.
SLURRY
ft.
ft.
ft.
ft.
19. SANDIGRAVEL PACK(if applicable),
FROM
TO
MATERIAL EMPLACEMEM1TMETHOD
ft.
ft.
ft.
ft.
0.0 ft.
ft.
ft.
ft.
ft.
ft.
ft.
50.0 ft.
ft.
R.
ft.
ft.
ft.
ft.
Physical .Address, City, and Zip 21. REIIIARIKS _
LINCOLN 00410
County Pnrcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22, Certf on:
(if well field, one latlong is sufficient)
35° 29 15.22"20.42" W
6. Is (are) the well(s): ❑Permanent or ' IOTemporary
7. Is this a repair to an existing well: ❑Yes or 91No
lfthis is a repair, fill out knotra u-ell ranstruetion information and explain the mature afore=
repair tattler 921 remarks .sectiar or an the back of this form.
9. Number of wells constructed: 1
Far nwhiple 41jectinn or non-xatersa,'Ply wells OA%Y with thr sonic construction. jwu cat
serhant one form.
% Total well depth below land surface. 50.0 (ft.)
Fnr ntuhiple ur(Ls list al( deptts ijdiffereat (example- 5@200' and 2@ 00 _)
10. Static water level below top of casing:
If wairr lerel is attore casing. are "+
11. Borehole diameter. 1.5 (in.)
12. Well construction method: -QPT MODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
DIRECT PUSH
09130/16
Signature ofCertHied Well Contrncior Date
Hv signing this form, l herebv certify that the it ells) irav (here) constructed ;it accordance
n•ith 15A NCAC 02C . 0100 or 15A NCAC 02C .0200 11 ell Cotsfmction Siondards anel that a
copy ofthis record has been pravided to the orAau,ner '
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of Weil
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 hail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, INC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Forst GW-I Nonls Carolina Department of Environment and Natural Resources — Division. of Water Quality Revised Jan. 7013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
PAUL MC.VEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2.Well Construction Permit 9: WI0300295 (UIC)
List all applicable "'ell construction peraitt (i. e. C'oumty, Slate, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (HeatingiCooling Supply)
❑ industrial/Com mere is 1
Water Supply Well:
C'
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Gcothermal (Heatine/Coolina
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwaler Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 1
4. Date Well(s) Completed: 08/17/16 Well IDN IW-20-14
So. Well Location:
ROBERT BOSCH TOOL NONCDO001154
FacilitylOwner Name Facility iDR (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
Courtly
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one Lai/long is sufficient)
350 29' 15.22" _ N 81 a 15' 20.42"
6. Is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Y"es or ElNo
1f lhis Is a repair, fill out known well construction in foraatiorr and explain the namim of ibe
repair under k11 remarks section or of t1;e back of this farm.
8. Number of wells constructed: 1
For multiple injection or non-;rater.sapply hells ONLY with fire same construction, yort can
submit are farm.
9. Total well depth below land surface: 50.0 (ft.)
For multiple'reps list all depths ifdifjerem (example- 3@200' and 2@100')
10. Static water level below top of casing: (ft.)
V'u-arer level is above casing, use "+ -
11. Borehole diameter: 1.5
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY,
14. WATER ZONES
FROM
TO
DESCRIPTION
h.
ft.
rt.
ft.
15."OUTER CASINO (tor multi -cased wells OR LINER if a licable
FROM
TO
DIAMETER
THICKIVFSS
MATERIAL
ft.
I I ft.
I in.
16. INNER CASING OR TUBING eothermal closed -loop)"
FROM
TO DIAMETER
T11SC1iNESS
MATERIAL
(t, in.
ft. in.
17. SCREEN "
FROM
TO
DIAMETER
SLOTSIZE
TIIJCKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
I & GROUT
FROM
TO
MATERIAL
EtIPLACEMENTD1EMOD&AAtOI)NT
0.0 ft.
50.0 ft'
raaruxaatnrtanE
SLURRY
ft.
ft
ft.
ft.
19. SANDIGRAVEL PACK
if 2opliciablel
FROM
TO
MATERIAL I
EMPLACEtitENTAlETHOD
ft.
: 20. DRILLING
LOG attochhddlt(onaI sheets if necessa
FROM
TO
DESCRIPTION Icolar, hardnev, sail/reek min star ell)
0.0 ft-
50.0 ft-
DIRECT PUSH
fit.
A-
ft.
ft.
ft.
R.
ft.
ft.
ft.
ft.
ft.
21-. REMARKS "
22,Certificafi
09/30/16
Signature of Certified Well Contractor Date . .
By signing this form, I hereby certify that the ire//(s) was (here) constructed in accordance
'Pith I5A NCAC 01C .0100 or 15.4 NCAC 01C .0200 Sell Construction Standardr and that a
copy ofthis record has been provided in the irell onrner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of Well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following
Division of Water Quality, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water SuoDly & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
Avhere constructed.
F orn G W-I North Carolina Department of Environment and Natural Resources - Division or Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit4: W10300295 (UIC)
Litt all applicable irell consrntetron permits (i e. County, Stare, Irarionrce, ere)
3. Well Use (check well use):
NN'aler Supp14 Well:
❑Agricultural ❑MunicipaliPublic
❑Geothermal (Heating/Coming Supply) ❑Residential Water Supply (single)
Olndustrial/Commercial ❑Residential Water Supply (shared)
Supply Well:
FlAquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
A
[Z)Ground%ater Remediation
❑Salinity Barrier
OStormwater Drainage
OSubsidence Control
OTracer
QGeothermal (HeatinglCooling Return) ❑Other (explain under g21 Remarks)
4. Date Well(s) Completed: 08/17/16 Well IDk IW-20-13
ia. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility 1D# (ifapplicabte)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well Geld one tat/long is sufficient)
35a 29' 15.22" N 81 a 15' 20.42" «,
6. is (are) the wetl(s): ❑Permanent or IOTemporary
7. Is this a repair to an existing well: OYes or E1No
/rfhis is a repoin fill out knarr, well construction information and explain tire nature ofthe
repair under tf 21 remarks section or anthe back (f this farm.
S. Number of wells constructed: 1
For multiple infection or non-water.cnrrply wells ONLY with the same construction, you cat
subrnir. one farm.
7. Total well depth below land surface: 50.0 (ft.)
For multiple wells list all depths (different (example- 3 @200' and 2Q100')
10. Static water level below top of casing: (ft.)
6(crater /are/ is above casing, use "+"
11. Borehole diameter: 1.5 (in.)
12.'Well construction method: DPT RODS-
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13h. Disinfection type: Amount:
Forinternal Use ONLY:
ft. ft.
ft. ft.
ft.
I ft. I in.
I
16;-INNER CASING OR.TUBING tothbrata! eyed=too
FROM
TO
DIANIE['ER 7HICKITFSS
MATERt
ft.
ft.
in. I
ft,
ft.
in. l
17. SCREEN
.
FRONT
TO I
DIAMETER
I SLOT SIZE
THICKNESS
ft.
ft.
in.
ft.
ft.
in.
18. GROUT "
FROM
TO
MATERIAL
EMPLACEMENTM€THOI
0.0 IT.
50.0 ft
PoB L4 aBEMalC E
SLURRY
ft.
ft.
ft.
ft.
19. SANDIGRAVEL PACK if o Iicablel
FROM
TO
MATERIAL I
EMPLACEMEKThll
tc.
ft.
ft,
ft.
10. DRILLING
LOG tataach additional sheets if nrcessa
FROM
TO
DESCRIPTION (color, hardn said—k tyM, ra
0.0 It.
50.0 ft-
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
R.
ft.
ft.
ft.
ft.
r.ocBs,sorrc
ft.
22. Certifiratio101-
09/30116
Signature of CeritGed Well Contractor Date
By signing this form, / hereby cerrrf3' that the rrell(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy ofthis recoil has been prorided to the well oirnec
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition, to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following;
Division of Water Quality, underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department Of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resourecs— Division of valor Quality Revised )an. 2013

WELL, CONSTRUCTION RECORD
This form can be used for single or multiple wells
L Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
'GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable, well construction permits (I. a. Comny, State, Variance, rtc.)
3. Weil Use (check well use):
Water Supply Well:
OAgriculturai
❑Geothermal (Heating/Cooling Supply)
O Industrial/Commercial
❑ Irrigation
{Non -Wafer Supply Well:
OAquifer Recharge
OAquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
OGeothermal (Closed Loop)
❑Geothermal (lieating/CoolinQ
OMunicipal/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
OGroundwater Remediation
OSalinity Barrier
❑Stormwater Drainage
OSubsidence Control
OTracer
00ther (explain under #21 F
4. Date Well(s) Completed: 08/17/16 Well ID# IW-20-12
aa. Welf Location:
ROBERT BOSCH TOOL NONCDOOD1154
Facility/Owner Name Facility ]DO (ifappliMble)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
. - Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if welt Field, one ladlong is sufficient)
35' 29' 15.22" N 81 a 15' 20.42" NNt
6. Is (are) the we11(s):.OPermanent or ®Temporary
7. Is this a repair to an existing well: Oyes or ®No
Ifthis It a repair, fill out lamwn well consimcliaa it jorntadat and explain the nature nfNie
repair corder 121 mitiorki, section or air llte back ofthis form.
S. Number of wells constructed: 1
Mar multiple hyeciion or non-iratersupply wells ONLY with the Santa construction, )'nu can
subnia one form.
9. Total well depth below land surface: 50.0 (ft.)
For multiple wells list all depths lfd fferein (example- 3� 00' and 2 r@1001
10. Static water level below top of casing:
If water lerel is above casing, use "+" -
11. Borehole diameter: 1.5 (in.)
DPT ROD
For internal Use ONLY.,
14. WATER ZONES
FROM
To
nESCRIPTION
ft.
ft
ft.
ft.
IS. OUTER CASING formalt'--ad welts OR LINER if a licable)
FROM .
TO
DIAMETER
THIC144ESS
MATERIAL
ft,
I ft,
in.
16. INNER "CASING DR T TING eothermal closed -loop)
FROM
I TO
DIMNErER
THICKNESS
MATERIAL
R,
rt.
in.
ft.
ft.
17.SCREEN
FROM
TO
D41DIEfER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in
IS. GROUT.
FROM
TO 1 MATERIAL
1 EMPLSCENIENTMET110D&AMOUNT
0.0 ft.
50.0 ft- von W oarnr nrE
SLURRY
ft.
ft•
ft.
ft.
19. SAND/GRAVEL PACK if a licable
FR0:1t
TO
I MATERIAL
EMPL\CEMENI'MUMOD
ft.
.20.DR1LLING,LOG attachadditionalshie isifneeessn -
FROM
TO
DESCRIPTION color, hasdaess saiy"& rain sire.etc.
0.0 ft•
50.0 rt•
DIRECT PUSH
ft.
ft.
ft.
ft
ft.
ft.
ft.
ft.
ft.
fr
ft.
ft
21. REMARKS
22.CertiftcatiR/
09/30/16
Signature ofCenified Well Contractor Dale
b), signing this farm. I hereby certify )bat the well(s) was (here) constructer) in accortbnce
with 15A NCAC 02C.0/00 ar 15A VCAC o2C.020o Well Construction Slandot%& and -that a
copy ofthis record has been prorided ra lire well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 242
S above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 tLlaii Service Center, Raleigh, NC 27699-1636
13s. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-t North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
For Internal Use ONLY:
Well Contractor Name fr. fr.
A - 4305 rt. ft.
NC Well Contractor Ceniication Number 15.OUTER CASING for multi -cased wells
FROM I TO I DIAMETER
GEOLOGIC EXPLORATION, INC ft. A. in.
Company Nnme 16. INNER CASING OR TUBING �eother
41M1,P
2. Well Construction Permittr: W 10300295 U 1 C FROM ft. To Dft. in.
list oft applicable trelf construction permits (i.e. Counly, State, Yarionee, etc.) ft. ft. in.
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑irrigation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
I utieotnermal (Heatmg/uming Return) ❑Other (explain under N21 Remarks)
4. Date Well(s) Completed: 08/17/16 Well ID9 IW-20-11
Sa. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID9 (ifapplicable)
129 LEGiONAiRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LiNCOLN
00410
ft. ft. in
i
ft. ft. is
18. GROUT' .
0,0 ft, 50.0 "' WRn1JaaEHfQVrE SLURRY
ft. ft. —
tt. ft.
19. SANDiGRAVF,L PACK of annlicablet
ft, I ft.
ft. I ft.
0.0 ft-' 50.0 fr- DIRECT PUSH
ft. ft.
ft. ft.
ft. ft.
rc. ft.
ft. ft.
ft. rr.
Caunty Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 Certifc
zln
(if -ell field, one fat/long is sufficient)
35a 29' 15,22" N 810 15' 20.42" W 09/30/16
Signature of Certified Well Contractor Date
6. is(are) thewell(s): ❑Permanent or t'7iTempomry
fJV s"igltiJlg this farm, 1 hereby certtfj, ilia; the ere)/(s) u•as (here) constructed in accordance
wills 15A NCAC 02C.0100 or iSA NCAC 02C .0200 Well Cortvruciian Standards and drat a
7. Is this a repair to an existing well: ❑Yes or E1No copy ardris record has .been provided to the well owner.
Jf Ibis is a repair, fill out knou•r, srel( rnrsrrucrion information and r plohi the nature ofthe
repatr under ; 21 ren arks section or on the hack r f rltk form. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8. Number of wells constructed: 1 construction, details. You may also attach additional pages if necessary.
For nuuhiple hyection or non -ureter supply rvefLs ONLY with the snare evastractinn, Jvu cur
submit one forms. SUBMITTAL INSTUCi'IONS
9. Total well depth below land surface: 50.0 (m) 24n. For All Wells: Submit this form within 30 days of completion of well
Fur maltlple wells list all depths ifdg rent (c aurple- 3@4200' and 20100') construction to the following:
10. Static water level below top of casing: (ft-) Division of Water Quality, Information Processing Unit,
##"sorer level is above casing, use ••+'• 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: DPT RODS_ construction to the following:
(i.e. auger• rotary, cable, direct push, etc.) _
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, ,NC 27699-1636
13s. Yield (gpm) Method of test' 24c. For Water Suppiv & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of-
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GA'-1 North Carolina Department of Erivirunment and Natural Resources — Division of water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
A. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construc don PermitN: W10300295 (UIC)
List all applicable well construction permits (i.e. County, Slate, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agriculturai ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑ Indust rialiCommercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
-- - . .
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Re
Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
under 921
4. Date Well(s) Completed: 08117/16 Well 1DN IW-20-1-0
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility ID# (ifapplitable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN ,
Countv
004t0
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degreeslminutesisceonds or decimal degrees:
(ifwell Field, one latilong is sufficient.)
350 29' 15.22" N 81 a 15' 20.42" W
Fur Internal Use ONLY:
-1d.`WATERZONES
FROM
TO
I DESCRIPTION
ft.
ft
ft.
ft
15. OUTER CASING for multi -cased wells) OR LINER if a Scabte
TO
DIAMETER THIChTIFSS
MATERIAL
Z16.-ININER
ASING OR TUBING eothermal closed-lopTO
DIAMETER I
THICKNESS
MATERIAL
ft.
ft.
•iu.-
.!
17. SCREEN
TO
DIAMETER
SLOT SIZE THIMNESS
MATERIAL
7ft.
ft.
fL
in
18. GROUT
FROM
TO MATERIAL
Ei1PLACEMENr A1F.THOD GAMOU
0.0 ft•
50.0 rt' wxnwaaorw ate
SLURRY
ft.
R.
ft.
ft.
19. SAND/GRAVEL PACK if upplicabictI
FROM
TO I MATERIAL
EAIPLACLSILNTAIE7110-� D
M
ft.
ft.
" ft.
t
20. DRILLING
LOG JaHncti niiditionalsheets ifnei:63aryi.--
FROM
TO
Df3CRtPr10N (rotor, ha,dnm, soiVrock r9in siu, ett.i
0.0 It.
50.0 rt•
DIRECT PUSH -
ft.:
ft
l
ft.
ft.
ft.
-n.
ft.
rt.-
ft.
rr.
21. REMARKS
22. Certific•.1
7f/ ?!�'_
09/30/16
Signature ofcertified Well Contractor
Date
6. Is (are) the well(s): ❑Permanent or OTemporary b), signing this form, I hereby ceriify that the ire/1(s) was (hero) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0300 Well Construction Standards and that a
7. Is this a repair to an existing well: ❑Yes or ❑No copy ofilus record has been provided to the weir owner.
1f this is a repair, fill out knouvt ire// construction inforaimiair and explain dic nature of tlm
repair under 921 remarks section or on the hack oftltis farm. 23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8. Number of wells constructed: 1 construction details. You may also atlach additional pages if necessary.
For multiple h jection or urn -water s: pply u•e11.s ONLY with the same construction. you can
subndivaefrunt. SUBMITTAL 1NSTUCTIONS
9. Total well depth below land surface: 50.0 (ft) 24a. For All Wells: Submit this form within 30 days of completion of Well
For multiple wells list all depths ifdij%rent.(example- 31rt 200' and 2 rt 1001 construction to the following:
10. Static water level below top of casing:
1j'uater-lerel is above casing, use '•+
1 I. Borehole diameter: 1.5 (in.)
DDT RODS
(ft-) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b, For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion OI wYll
12. Well construction method: construction to the following:
(Le. auger, rotary, cable, direct push, etc )
Division of Water Quality, Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water SuoDiv & Iniectitin Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-i North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

s�
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAULMCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #.1: W10300295 (UiC)
ist all applicable well construction perarlis (r.e.
County, State. Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Municipal/Public
QGeothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
O Industrial/Commercial
OResidential Water Supply (shared)
Olrrigation
Non -Water Supply Well:
OMonitoring
ORecovery
OAquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
OSalinitv Barrier
OAquifer Test
❑StormHater Drainage
0Experimental Technology
OSubsidence Control
❑Geothermal (CIosed Loop)
❑Tracer
QGeothermal (Heating/Cooling Return)
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 08/18/16 Well ID# iW-20-8
5a. Well Location:
ROBERT BOSCH TOOL
NONCDQ0011.54
Facility/Owner Name
Facility IDd (irapplicnble)
129 LEGIONAiRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00410
County_
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latlong is sufficient),
350 29' 15.22" N 81 a 15` 20,42" W
6. Is (are) the well(s): OI'ermanent or 10Temporary
7. Is this a repair to an existing well: Oyes or ©No
if chic is a repair, Jill out known well construction irrfornraion and explain rite nature ofibe
rcpoir under r.'21 remarkr section or on the back of'this farm.
8. Number of wells constructed: 1
Far nn.lvple injertiou ar man-u•atersupply vcl/s ntYLY with the same construction, }vrn can
.submit one form.
9. Total well depth below land surface: 50.0 (ft.)
For multiple wells list all depths if different (esonPle- i @200' and 2@100')
10. Static i1•ater level below top of casing: (ft.)
ifwater level is above casing use "-r
11. Borehole diameter: 1.5 (in.)
12. Well construction method: - DPT_.RODS -
(i.e. auger, rotary, cable, direct push, etc)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY:
14. WATER ZONES - - - - - -
ft. I ft. I in I
NER CASING OR TUBINGIreatbermid closind4rio
TO V1,01E2'ER I THICKNESS I MATERIAL
ft. ft. in
fL ft. is
REEN
TO D1AISIE FR SLOT SIZE THICKNESS I MATERI
ft. ft. in.
ft. ft. in
:OUT
TO I MATERIAL EIMPLACEMENTMETHOD&AM(
0.0 ft' 50 0 ft. acnna o rJra ss SLURRY
rt. tL
ft. ft.
S9: SAND/GRAVEL PACK ifn licable _
FROM TOMATERIAL EMPLACEM ENTMETt10DY0.
ft. ft, I
1
ft. ft.
20. DRILLING LOG (attach additional sheets ifnecesstiml
Q Q It. 1 50.0 It. DIRECT PUSH I
rr. ft.
D. ft.
ft. ft.
ft. ft.
ft.
- 21. REl4IARt{S
22.
Q 09/30/16
Signature of Certified Well Contractor Dale
BY signing this forme I hereby certifi� that the it ell(s) tray (itere)constructed in occorilarnce
with 15A NCAC 02C .0100 ar 154 1e°CAC 02C .0200 il'ell Construction Standartic and that a
copy of'this record has been provided to the well nuolir.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction. details You may also attach additional pages ifnecessary.
SUBMITTALINSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-16I7
24b, For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the billowing:
Division of Water Quality, Underground Injection Control Program,
1636 1tlail Service Center, Ruieigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the country
where constructed.
Form CiW-I North Carolina Department of Environment and Natural Resoaces - Division of Water Quality
Revised ;an.2©13

WELL CONSTRUCTION RECORD
This form can be used' For single or multiple wells
t. Well Contractor Information:
PAUL MCVEY_
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable well cmutrucrion permits fl.e. Counrv, Slate, Variance, etc•..)
3. Well Use (check well use):
Water Supply Well:
OAgricultural
OGeothermal (Heating/Cooling Supply)
O I nd ustria I/Commercial
Non -Water
Well:
OAquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal (Closed Loop)
OGeothermal (HeatinWCoollne
OMunicipal/Public
OResidential Water Supply (single)
OResidential Water Supply (shared)
®Groundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 f
4. Date Well(s) Completed: 08/17116 Well 1D4 IW-20-7
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDk (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is Sufficient)
35' 29' 15.22" N 810 15' 20.42"
6. Is (are) the well(s): OPermanent or OTemporary
7. is this a repair to an existing well: Oyes or ®No
if this is a rapair, fill out knotrit well catutnretion jrformation and explain the nature of ille
repair under 921 remarks section or at the back of this f rm.
S. Number or wells constructed: 1
Trr multiple it fecdoa or non-n•aler supply irells ONLY tvftb the Sallie canstructinn, 3au call
srbalil ane famt.
9. Total well depth below land surface: 50.0
ror multiple irells list all depths ifdd rent (esanrple- 3Q200' and 2kt 100')
For Internal Use ONLY:
14. WATER ZONES - -
FROM TO
DESCRIYr10N
ft. ft.
ft. ft.
i
= IS. OUTER CASING far multi -erred svelte OR -LINER if 6 licable -
FROM 70
DWMETER
TI1ICI:NESS
MATERIAL
ft. I ft..
in.
16_ INNER CASING OR TUBING r eothermal closed-loo)
FROM
TO
DWMLTER
THIC]:NFS5
MATERIAL
ft.
ft.
In.
R.
ft.
in.
17. SCREEN.
FROM
TO
DIAMETER
I SLOTSIZE
THICKTiFSS
MATERIAL
ft.
ft.
in.
ft.
ft.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD& AMOUNT)
0.0 ft•
50.0 ft.
GattTLV aaENtGVTE
SLURRY
ft.
ft.
ft.
it.
19..SANDIGRAVELPACK (if a licable-
FRO!sl , TO
MATERIAL
F.MPLACEMENTMEPHOD
ff. tr.
.
i
ft. ft.
" 20. DRILLING LOC (attach additionalsheetsif neoe
FROM
TO
DESCRIPTION (color, hill da , sisal-k rain sine, eta) "
0.0 ft.
50.0 ft.
DIRECT PUSH
ft.
ft.
r1
n.
H.
fL
ft.
+f"t
R.
21.-RE¢IARICS
22. Certilicafio
t3��
09/30/16
Signature ofCenified Well Contractor Date
By signing this form, 1 hereby certify that the well(j) was (were) constructed in accordance
with 194 NCAC 02C .0100 or MA NCAC 02C .0200 Wefl Construction Standards anti that a
copy ofthis record hav been provided to the ire0 miner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10. Static water level below top of casing: (g,) Division of Water Quality, Information Processing Unit,
lfiraterlerel is above casing, use - +" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
I3a. Yield (gpm) Method of test' 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount- completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be stied far single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Nurtitter
GEOLOGIC EXPLORATION; INC
For Internal Use ONLY:
Its: WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15: OUTER -CASING for multi -cased welts OR LINER (if a-licable l
FIIOU TO
DLAM El ER THFCl:NE55 titATERtAL
ft. Ct
is
Company Name n t � 1
2. Well Construction Permit #: YY10300295 UIC+)
List all applicable teell construction permits (i.e. County, State, Variance, etc)
3. Well Use (check well use):
l
;16_ INNER CASING OR TUBING oeathermal closed -loon)
FROM
I TO
I DIAMETER I
TRtCFCNESS
MATERIAL
it.
rt.
ea
f(.
ft
to
17. SCREEN
Water Supply Well:
❑Agriculturel OMunicipallPubljc
❑Geothermal (HeatinglCooline Supply) OResidential Water Supply (single)
❑industriallCommercial ❑ResiderVal Water Supply (shared)
❑Irrj anon
FROM I To
DIAMETER
SLOT SIZE
THICKNESS i MATERIAL
ft. ft.
in.
ft. ft.
(tL
IR GROUT
FROM
TO MATER[AL
EMPLACEMENT' METHOD&A'1fOUt'rt'
U p It-
50.0 ft. "'aT waeaapar
SLURRY
Nan -Water Supply Well:
❑Monitoring ❑Recoveryry
ft,
ft.
Injection Well:
❑Aquifer Recharge oGroundwater Remediation
❑Aquifer Storage and Recovery OBarrier
❑ApuiferTest OStormwaterDrainage 1
OExperimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) OTracer
OGeothermal (Heatin JCoDlmg Return) ❑Other (explain under g21 Remarks)
ft.
It.
19. SANDIGRAVEL PACK fifariplicablel
FROM
TO
MATERIAL
EMPLACEMENTMETHODSalinitY
ft.
fr.
'
Ct.
ft.
20::DRILLING'LOG
attach
additional sheets if necessary)- -- - _ -
FROM
TO
DESCRIPTION (color, hardness soiVrvekt ruir. siu, cic.
0.0 It-
50.0 ft.
DIRECT PUSH
4. Date Well(s)ell(s) Completed: 08/17116 Well ID# -" IW-20_6
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility 1D# (iCapp{icab{e}
129 LEGIONAIRE ROAD LINCOLNTON 28092
tt.
ft.
ft.
rt.
R.
ft.
ft,.
fi.
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
Sb Lat tud d L
-.21. RFAIARKS- - - -
-
t e an o gt u e It egreeslminuteslseconds or decimal degrees:
(ifivelt field, one Istfiong is sufficient.)
350 29' 15.22" N 810 15' 20.42" W
6. Is (are) the well(s): OPermanent or CdTemporary
7. is this it repair to an existing well: Oyes or EJNo
If this is a repair, fill out known hell constnictiott hilarnimian and explain the nature nflhe
repair under M21 reinarks section or on the back of this form.
S. Number of wells constructed: 1
For nndiilne itq'erlion or non-tralersnpplV wells ONLY ieith the some consiniction, you can
submit nne finny.
9. Total well depth below land surface: 50.0 (ft.)
For timlliple uvils list all depths ifriifferent (eromple- 3 rr Yi0' any! 24@VIOT)
10. Static water level below top of casing: (ft.)
frivoler level is obare easitrg, use -+"
11. Borehole diameter: 1.5 (in,)
it. Well construction method: DPT.RODS
(i.e. anger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection hype: Amount:
22. Certification•
09/30/16
Siynauae afcern led Well Contractor Date
Ry .signing this form, i hereby certify that the )rell ft) vi•ar (mere) eotrrtructed w accnnloncc
trill, 15d NCAC 02C -. 0100 or iSA HCAC 02C .0201) Well Co—iructior, SionJoniv and that a
copy ofthis record has been provided to the reel/ owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBrIMITTAL INSTUCTION3
24a. For All Wells: Submit this form within 30 days of completion of well
consirtiction to the following:
Division of Water Quality, Infurnultion Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-I617
24b. For lniection Wells: In addition to sending the form to the address in 241
above, also submit a copy of this form within 30 days of completion of well
constriction to the following:
Division of Water Quality, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-t North Carolina Department of Envirounicut and Natura€ Resources — Division of Watcr Quality Reviser. Jan. 1.013

WELL CONSTRICTION RECORD
This form can be used for single or multiple wefts
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well'Construction Permit #: WI0300295 (UIC)
Lear all applicable well construction permits 0 e. County. State. trarimree, etc)
3. Well Use (check well use):
❑Agricultural - ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑14lonitorina ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OGroundwater Remediation
❑Salinity Barrier ,
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 f
4. Date Well(s) Completed: 08/24/16 Well IDk IW-6-20
in. Well Location:
ROBERT BOSCH TOOL NONCDO001154
FacifityiOwner Name Facility ID# (ifapplicati1c)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
5b. Latitude and -Longitude in degrees/minutes/seconds or decimal degrees:
(ir welt field, one latltong is sufficient)
350 29' 17.98" N 81 a 15' 24.76" W
6. Is (are) the we9(s): ❑Permanent or ®Temporary
7. Is this a repair to an existing well: ❑Yes or ©No
tfilds is o repair, fill ota known well construction injormaiiatt and explain fire nmrtre afdm
repair under m21 rentorks secilou or on the back of this jbrna
8. Number of wells constructed: 1
Par multiple it jecurni or nan-irarer.supph, tredls 01v1.Y with the same construction, You cut?
submit ane form.
For Internal Use ONLY:-
14. WATER ZONES -
FROM
TO
DESCRIPTION
ft.
ft.
r1
a1
15. OUTER CASING (for multi-cusett wells) OR LI ER ifa tinble
OTO FRM
DIAMETER Till ChTIFSS
MATERIAL
ft. ft.
in
J&INNER CASING ORTUBING eothermatehned-loa
FROM
TO
DIAMETER
TIIICKNFSS
MATERIAL
fL
ft.
in.
ft.
ft.
in.
t7. SCREEN
-
FROM
TO
DIAMETER
SLOTSIZE
THICf:NESs
MATERIAL
fL
ft.
in. 11
ft.
Cr.
in
. l8: GROUT - - - -
FROM TO
MATERIAL
EMPLACEAIF-VI METNOD&AMOUNT
0.0 r` 28.0 ft.
runwaa["ra.:e
SLURRY
ft. fL
ft. € ft.
- 19.SAIND1GRAVELPACK ifa livable)
FROM
TO MATERIAL
EMPLaCEMENTMETHOD
ft.
fl.
t
t
ft.
It.
-20. DRILLING LOG lattach additional sheets if necessa
FROM
TO
1 DFSCRIPTION (cot.,, hardness, roill-k type,Main sir,, etc
0.0 r`•
28.0 f`•
DIRECT PUSH
ft.
ft.
fL
ft.
ft.
It.
ft,
ft.
ft.
ft.
ft.
n.
21. REMARKS
22. Certification:
� 09l30/16
!rs „" __
Signature of Certified Well Contractor Date
By signing this form, 1 hereby certit6, that the ueell(y Bras (were) constructed in accordance
mhlt 15A NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and dear a
copy ofthis record has been provided to the well ausner. .
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 28.0 (ft.) 24a, For All Wells: Submit this form within 30 days of completion of well
1--or nmltiple urells list all depths ifdijiarent (example- 3 fit( 200' an12 tQ100`) construction to the following:
10. Static water level below top of casing: (ft.) Division of Water Quality, Information Processing Unit,
If aster /ere/ is abore casing use "+ •• 16I7 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For lniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: !n addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount; completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan, 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
INC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
Z. Well Construction Permit #: W[0300295 (UIC)
List all anplica8le well construction perntitr (i.e. Caunty, State. Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
OGeothermal (Heating/Cooling Supply)
Olndustrial/Cammere ial
Supply well:
OAquifer Recharge
OAcuifer Storage and Recovery
OAquifer Test
OExperimental Technology
OGeothermal (Closed Loop)
OMunicipal/Public
OResidentiaf Water Supply (single)
OResidential Water Supply (shared)
0Groundwater Remediation
OSalinity Barrier
OStormwater Drainage
❑Subsidence Control
OTracer
❑Other (explain under 921 11
4. Date Welf(s) Completed: 08122116 Well ID'N I-6-1
Sa. Well Locution:
ROBERT BOSCH TOOL NONC€?0001154
Facility/Owner Name Facility IDli (ifapplicabic)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
Counh•
00410
Parcel Identification No. (PiN)
Sb. Latitude and Longitude in degrees/minuiesisecunds or decimal degrees:
(if well field, one fatllong is sutTicieni)
350 29' 17.98" Nr • 81 a 15' 24.76" W
6. is (are) the well(s): OPermanent or OTemporary
7. is this a repair to an existing well: OYes or ©No
Ij'11ris it a repair, fill out knoi:n ive11 corzstnrction information and etplarn the nature aJ7he
repair undeer i/21 renrarkr.rection or art the bark tfthisfarm.
9. Number of wells constructed: 1
Fnr muhiple ityectron or non -[rater supply it,ellr ONLY :rill: the sane eansirucrian. You can
Submit one fornt.
For Internal Use ONLY:
14 warER zoNEs
FROht
TO
DESCRIPTION
Et.
tt,
ft.
ft.
15.-OUTER CASING for multi -cased welts OR L{NER if a Iigbte
FROM TO
DIAMETER
TH1CIflV ESS MATERIAL
rt. ft
in.
16.. dNNER CASING OR TUBING eothertnal ctosed-toit - ,
FROh1
TO
DIAMETER THICIilYESS r`fATERAt L
fi.
ft.
in. 1
ft.
ft.
in. 1
i
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNM
MATERIAL
ft.
ft.
in.
ft.
fL
in.
I& GROUT
FROM
TO
MATERIAL Fh1PL4LCEMENT METHOD &ANtOUYT
0.0 fe'
36.0 rt`
eon marirezrf SLURRY
fL
fi.
I
ft.
ft.
19. SANDIGRAVEL PACK: lif unplicablel-
FROM
TO
MATERL4LI EMPLACEMEti'TME HOD
ft.
( ft.
l
ft,
rt.
20. DRILLING-
LOG attach additional sheets if necessary - -
FROM
TO
DESCRIPTION color, hardness, soitimck tv rain size- etc.
0.0 ft-
36.0 rt.
DIRECT ?USN
ft.
ft.
ft,
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
3
22. Certification:
Signature of Certified Well Continctor
03/30/16
Date
Py signing this fora{ 1 herehl• certify that the irell(,t eras (uerel comirucied in accordance
irith 15A NCAC 02C .0100 or f 5A NCAC 02C.0200 1Felr Construction Starrdardr and than a
cap), arthll record has been provided to the irell nutter
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 36.0 (ft,) 24a. For All Wells: Submit this form within 30 days of completion of weff
For inithipte tretis fist all depths fdi(jerent (example- 3@200' and 2r,@100:) construction to the following:
10. Static water level below top of casing: (ft,) Division of Water Quality, Information Processing Unit,
tfiraterlerel isahore caring, use •'+" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
-12. Well construction method: construction to the following:
(Le, auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
f3a. Yield (gpm) Method of test: 24c. For Water Supply Sc luiection Wells: 1n addition to sending :he form to
the addresses) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Enwronmeni and Natural Resources — Division of Water Qunlihy Reriscd Jan 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A - 4305
NC Well Contractor Certification Number
OEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all onplicable well construction permits (h. Cnunrv, Store. Variance, etc.)
3. Wrll Use (check well use):
Water Supply Well:
DAgricultural
C:Geothermal (Heating/Cooling Supply)
industrial/Commercial
Non -Water Supply Well:
0Aquifer Recharge
DAquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑1vlunicipal/Public
❑Residential Water Supply (single)
GResidential Water Supply (shared)
C
OGroundwaler Remediation
❑Salinity Barrier
❑Sformwater Drainage
OSubsidence Control
OTracer
❑Other (explain under #21 F
4. Date Weil(s) Completed: 08/19/16 Well ID# IW-6-17
,a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility ID# (ifappficable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Idenlification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(iftvell held one fat/long is sufiicient)
`2r0 70' 1 r, A0" N A10 1 r" 70 RA"
6. Is (are) the well(s): ❑Permanent or IOTemporary
W
7. is this a repair to an existing well: ❑Yes or ONo
I'Ih& is a repair, fill out known well construction infarntation and explain the nature ofilre
repair under 921 remarks.section or on the back ajthis form.
8. Number of wells constructed: 1
For multiple injection or non -water supply :rel/s ONLY with the same consiruction, )Uu can
submit one form.
9. Total well depth below land surface: 28.0 (ft.)
For multiple welds list all depAts iifVerent (example- 3@200' and 2 r(i 100')
10. Static water level below top of casing: (ft.)
if water level is above casing use ".
11. Borehole diameter: 1.5 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, eta-)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLY.
14. WATER ZONES
FROM
TO
DFSCRwnON
ft.
ft.
I& OUTER CASING for multi cased welts OR LINER fir a tienbk)
FROM
To DLiMETER
TIfICKNESS h'AT6.1
ft.
ft. in
16:3NNER CASING OR TUBING eotheimal cioaed loo
Fit061
TO
DIAMETER THICICNES.S
MATERIAL
ft.
ft.
in
17. SCREEN
FROM
TO
DIAMETER
SIATSIZE
THICK"Im
MATERIAL
ft.
H.
in.
ft.
ft.
in.
19.-GROUT -
MATERIAL
Eh1PLACEMEN .IIETIIOD&AMOUNr0
ft' °°�n" °�ra"�
SLURRY
MFROMI
re.
ft.
L PACK if alicable
I MATERIAL 1 EAIPLACEVIEN'TMETHOD
ft. ft.
ft. ! ft.
20. DRILLING LOG fattach additional sheefi ifnecessary)
FROM ': TO
DESCR1PTtON cvlar, haninm, saiVrxk rain siu, etr.'
0.0 It' 28.0 ft-
DIRECT PUSH
ft. j ft.
1
ft. i ft
I
ft. ft.
ft. ft.
ft ft.
ft..
21. REMARKS
I
22. Certincatio
09/30/16
Signature o ell Cantrador Date
14y signing this form, 1 hereby terrify that ate well(r) Iras 6,erc) constructed in accordance
u•itlr 15A 1VCAC 01C.0100 nr 15A NCAC o1C .02o0 ivell Comiructian Standards and that a
copy of ills record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 flail Service Center, Raleigh, NC 27699-1636
lac For Water Snriyiy & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form G W-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
PAUL MCVEY
Well Contractor Name
A = 4305
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit k: WI0300295 {UIC)
List all applicable well construction permi[s (Le, County. State, Variance, etc)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (HeatinglCoa[ing Supply)
❑ IndustriaVCommercial
❑MtmicipaVPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquiler Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (HeatinelCooline
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Contra[
o ❑Tracer
❑Other (explain under #21 1
4. Date Well(s) Completed: 08/19/16 Well ID# iW-6-16
5u. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facilityl(1wricrName Facility ID# (inapplicable)
129 LEGIONAIRE ROAD LiNCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No (FIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one latdlong is sufficient) -
35a 29' 12.17" N 81' 15' 21.84" W
6. Is (are) the welt(s): ❑Permanent or [OTemporary
7- Is this a repair to an existing well: ❑Yes or EINo
if this is a repair, fill out known well cwutruction information and esplahr the nature ofrhe
repair under # 11 remarks section or an the back of this form.
B. Number ofwells constructed: 1
Far nluhiple it jecticm or non -water supply wells ONL 1' with the same contraction, you cart
submit nee firm.
9. Total well depth below land surface: 21.5 (ft.)
hor mudriple wells list all depths ifdloireni (example- 3 200' and 2@100')
1
For In[errat Use ONLI'.
by signing this form, 1 hereby ceri!& that the wells) was (is -ere) constructed in accordance
frith IjA NCRC 01C .0100 or 15, NCAC 02C .0200 Well Construction Standards and that a
copy ofrhis record has beets provided to the well atrner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCfIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10. Static water level below top of casing: (ft.) Division of Water Quality, Information Processing Unit,
If u-aier level is above casing, use "+" 1617 Mail Service Center, Raleigh, NC 27699-1617
IL Borehole diameter: 1'5 (in.) 24b. For Iniection Wells: fit addition to sending the form to the address in 24a
DPT.RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: - construction to the folldwiiig° - -
Ge. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Muil Service Center, Raleigh, NC 27699-1636
138. Yield (gpm) Method of test- 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of wtiil construction to the county health department of the county
where constructed.
Form C W-I North Carolina Department of EnvitonctKnt and Natural Resources — Division of Wntcr rituality Rc •iscd Jan. 2013

WELL CONSTRUCTION RECORD
This Corm can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
Z. Well Construction Permit k: W 10300295 (UIC)
list all applicable well construction permits ft.e. County. State Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
O Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
GAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑ Geothermal (Heati*Cool ing
❑MunicipallPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
Ill. Groundwdtef Remediation
❑Salinity, Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
OOther (explain under #21 1
4. Date Well(s) Completed: 08/25/16 Well ID# IW-6-15
Sa. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facilitylowner Name Facilitv IDg (ifopplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00410
Parcel Identification No. (PIN)
For Internal Use ONLY:
.14. WATER ZONES
FROM
TO
DFSCRIMON
Ct.
fL
fit_
It.
15. OUTER CASING for multi -used wells OA LINEA if a (icable)
FROM TO D1AML-I'ER
THICKNESS
AfATERLAL
. A. in.
16. INNER CASING OR
TUBING eothermat dosed -log
FROM
TO
DIAM EiF.AI
THICKNESS
MATERIAL
ft.
fL
in.
ft.
tt.
in.
17: SCREEN - - -
FROM
TO
DIAMETER
SLOTSIZE
THICKNSS
I MATERIAL
ft.
ft.
in.
It.
ft.
in.
I& GROUT
FROM
TO
MATERIAL
EMPLACFhtENrMEfliOD&.MOUNT
0.0 It.
33.0 fit'
voaaavaeFuronrrs
SLURRY
ft.
ft.
ft.
ft.
19. SANDIGRA VEL PACK if applicable)
' FROM
TO
MATERIAL I EMPLACEMENTMETHOD
ft.
ft.
I
ft.
rt..--
-
20. DRILLING
LOG fattach additional sheets if necessary)FROM
TO
DESCRIPTION rokr, hnrdgns, sniUrark rato sire, ru.
0.0 ft.
33.0 ft.
DIRECT PUSH
ft.
ft.
ft.
it.
ft,
fit
ft.
; ft.
+
ft.
I ft.
ft.
Ct
'
21. REMARKS - - - - - -
I
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certifies i n
(ifwelt Geld one lattlong is sufficient)
35 29 17.98 N 81'
15 24.76tW 09/30/16
6. Is (are) the well(s): ❑Permanent or IaTemporary
7. Is this a repair to an existing well: ❑Yes or Elio
jf'rh s is a rerair, fill out known well consintcrion infin- n ition and esplain the aaruri: oft/le
repair under 421 rentarkr section or on the back oj'this farm.
8. Number of wells constructed: 1
Fur multiple injection or non -water supply trells ONLY with the same construction, you can
submit one fort.
9. Total well depth below land surface: 33.0
For multiple wells list all depths ifdleerent (example- :.n 700' and 2©1001
10. Static water level below top of casing:
Ifu•aier lerel is above casing, use "+"
11. Borehole diameter: 1.5 (in.)
DPT RODS
Signature of Certified Well Contractor _ Date
By sighing this farm, 1 hereby certify that the ire/1(s) was (were) eonrtrucied in accordance
with I SA NCAC 02C .0100 or 154 NCAC 02C .0200 Well Corsrrucrion Standards and that a
cagy ofdtis retard has been pror kled to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to.provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft..) Division of Water Quality, Information Processing Unit,
1617 rilail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY.WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
139. Yield (gpm) Method of test 24c. For Water Suonly .& Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection e• Amount: completion of Avil construction to the county health department of the county
type: where constructed.
Form GW-I North Carolina Department ofEnvironrnani and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W 10300295 (LI IC)
List all applicable Well construction permits (i.e. Country, State, Variance, etc.)
3. Well Use (check well use):
water bupply Well:
❑Agricultural
OGeotherma! (Heating/Cooling Supply)
❑Industrial/Commercial -
7lrrigation
Non -Water Supply Weil:
OMonitoring
Injection Well:
OAruifer Recharge
OActuifer Storage and Recovery
O Aa ui fer Test
❑Experimental Technology
OGeothermal(Closed Loop)
❑Municipal/Public
OResidential Water Supply (single)
OResidential Water Supply (shared)
C
OGroundwater Remediation
OSalinity Barrier
C,Stoimwater Drainage
❑Subsidence Control
OTracer
OOther fexo)ain under 921 1
4. Date Well(s) Completed: 08/22/16 Well ID# IW-6-14
Ss. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name Facility IDti (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LiNCOLN 00410
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if wail field, one fat/long is sufficient.)
35a 29' 17.98" N 81 a 15' 24.76" W
6. is (are) the well(s): OPermanent or [ZTempurary
7. is this a repair to an existing well: ❑Yes or ElNo
If this is a repair, f ll nut knouvt irel/ construction in joraratiot and explain the nature of the
repair under a21 remarks .section or an the back of this form.
8. Number of wells constructed: 1
For andtiple it jectian or no -water suppty wells aNi_1' with the same canatraction, _tau can
ubmit ane farm.
9. Total well depth below land surface: 34.0 (ft )
l hr nndtiple wells list all depilis ifdifj ren7 (exaarplc- FizjlfiD' and 2 t(i�IOG')
For Internal Use ONLY;
14. WATER ZONES - -
FROM
To
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells)OR LINER if a Eicattle)
FROM
TO DIAMETER
THIC[iNESS MATERIAL
ft.
«. ;a
- 16. INNER CASING OR TUBING-eottserrnal cloied-loo -- -
FROM
I to 1 DIAMETER j TRICKNESS
MATERIAL
fa
ft.
fL
ft. in.
17. SCREEN .
FROM
TO
DIAMETER
SLOTSIZE
I THICKNESS
I MATERIAL
ft
ft.
in
ft.
ft.
ire.
i
is. -GROUT ; -- - - -
FROM
TO MATERIAL . EMPLACEMENT METHOD& AMOUNir
0.0 ft•
34.0 ft. a F� i SLURRY
ft.
ft,
ft.
ft.
19. SAND/GRAVEL PACK if a- licable
i FROM
TO
I MATERIAL EMPLACEMENTME HOD
ft.
ft.
I
ft.
20. DRILLING
LOG attach additional sheets if.neeessa-
FROM
To
DESCRIPTION (color, hardiim, sait/rsck typ,, rota a a, etr.t
o.0 ft.
34.0 ft.
DIRECT PUSH
ri-
ft.
ft.
ft.
ft.
ft.
«.
ft.
tt.
ft,
i
ft.
ft.
21. REMARKS -
22. Ccrti6ca A,_z
09/30I16
Signature ofCerti6ed Well Contractor Date
fly signing dhis fi)rni. 1 hereby certify that the trclf(t_j tras (were) constructed in accordance
with I5A NCAC 02C .0100 ar 15A VCAC WC . 02OU Well Contraction Stoo lan/s and drat a
cope of1his record has been prarided to the well on•ner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may aise attach additional pages if necessary.
SUBMITTAL iNSTUCTIONS
24a. For All Yells: Submit this form within 30 days of completion, of well
construction to the following:
10. Static water level below top of casing: (ft.) Division of Water Quality, Information Processing Unit,
If hater level is abore casing, use "+- 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1'S (in.) 24b. For Injection Wells: in addition to sending the form to the address in 24a
DPT RODS- above, also submit a copy of this form, within 30 days of completion of %veil
12. Welf consfrtictititi met6odc` consfnicpon to the fallowing:
(i.e- auger, rotary, cable, direct posit, etc.)
Division of Water Quality, Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpnt) Method of test: 24c. For Water Suuoly & Injection Netts: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount- completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Div:sioe, orwater Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can he used for single or multiple wells
L Well Contractor information:
KENNY SARGENT
Well Contractor Name
A — 4226
NC Well Contractor Certificntion Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit la: W10300295 (UIC)
List all applicable well caesstruuinn permits (t e. County. State, Yariance, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipaf/Public
❑Geothermal (HeatinglCooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
1
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aqui ter Test
❑Experimental Technology
❑GeothermaI(Closed Loop)
❑Geothermal (Heating/Cooling
OGroundwaler Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under k21 Remarks)
4. Date Will(s) Completed: 08/23/16 Well MY IW-6-13
Sa. Well Location:
ROBERT BOSCH TOOL NONCDO001154
FacilitylOwncr Name I Facility IDk (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
Comity
00410
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
,if well field. one tat/long is sufficient) -
35' 29' 17.98" N 81 ' 15' 24.76" W
6. is (are) the well(s): ❑Permanent or [OTemporary
7. Is this a repair to an existing well: ❑Yes or EINo
lfthis is a repair, fill out known well construction information and explain file nature of -file
repair :utter 421 renuarkv section or rvn the back r f this form.
S. Number of wells constructed: 1
For multiple h fection ar non-tratersupply wells ONLY with the .sante.cunsfruction. }sta can
submit one fnntf.
9. Total well depth below land surface: 42.0
lror multiple irel/s list all depths if dii erent (example- 3@200' aru12 rr 100')
10. Static water level below top of casing:
If +rater lerci Ls above casing, use - _ "
11. Borehole diameter: 1.5 (in.)
DPT RODS
For Internal Use ONLY;
14. WATER ZONES
FROM
To
nESCRIMON
ft.
fr.
ft.
It.
.15. OUTER CASING for mal➢-casedEwelORHSap licable
FROM
DtIMErR
T
MATERIAL
rr.
ft. I in
16.INNER CASING OR TUBING eathermal closed -loop)
FROM TO
D4411 ETER
THICKNESS
MATERIAL
f1 ft.
is
ft. ft.-
17. SCREENFROM
I
TO
DIAMETER
SLOT31ZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
it.
in.
la GROUT - - -
FROM
TO
:MATERIAL
EMPLAC£MLNTMETHOD &A:110UNr
0.0 ft.
42.0 ft.
poatWcancicr—
SLURRY
H.
ft.
ft.
ft..
19. SANDIGRA VEL PACK if a plicable - -
FROM t TO
MATERIAL
EMPLACEMEN METHOD
ft. ft.
ft. ft.
20. DRILLING
LOG atracb'addilg4l sheets if necessary) .. -
FROM
TO
p£SCR1PT10N color, hardaesr,soilfrock rains€u, ell.
0.0 ft-
42-0 ft-
It DIRECT.PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
it.
Ft.
ft.
ft.
'21. REMARKS -
22. Certification:#wry A.=—
09130/16
Signature ofCcrtified Well Contractor - Data
4y.sigaing this form, 1 hereby certify that the ivell(s) it -as (here) constructed in accordance
,,,fill 15A NCAC 02C.010 or 13A NCAC 02C.0200 Well Construction Standards and that a
cony oftltis record Iran been provided to the,,•ell awner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: lac. For Water Sunp(v & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department ofEtvironment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCT ION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Nance
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: WI0300295 (UIC)
List all applicable well construction Permits ri, e. County, state, Irariance, etc.)
3- Well Use (check well use):
Water Supply Well:
OAgricuttural
OGeothermal (Heating/Cooling Supply)
Olndustrial/Commercial
Non -Water Supply
OManitoring
OAquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
OExperimental Technology
OGeothermal (Closed Loop)
OGeothermal (Heating/Cooling
OMunicipal/Public
OResidential Water Supply (single)
OResidential Water Supply (shared)
QlGroundwaler Remediation
❑Salinity Barrier
OStormvrtter Drainage
❑Subsidence Control
(3Tmcer
OOther (explain under 921 I
4. Date Well(s) Completed: 08/23/16 Well IDN IW-6-12
Sa. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Nnmc Facility 1Dd (if applicable)
_ 129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
Counry
00410
Parcel Identification No. (PIN)
For Internal Use ONLY: II
I
14. WATER ZONES
FROM
TO
DESCRIPTION
� ft.
ft.
f
I
tt.
ft.
I
i
IS OUTER CASING for multi -cased swells OA E iNER i(a Gmbte
FROM
TO
DWIETER
THICI:IVE55
IFSATERLAL
Ft.
ft.
in.
:.� 16. INNER
CASING OR TUBING geothermal
closed -loop) -
FROM
TO
I DIAMETER I
THICIi-NESS
MATERIAL
it.
f[,
I in.
ft.
ft,
in.
17. SCREEN `
FROM I TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
ft. ft.
in
£t. ` rL
in.
18. GROUT
FROM
To
MATERIAL
EhIPLACEINEKr ME'nIOD&A1I[OUN-r
0.0 ft'
40.0 It"
eaa^,fa:aaenrowrre
SLURRY
ft.
ft.
ft.
rt.
-19 SANDIGRAVEL PACK(if a ficnbie) -
FROM
TO
MATERIAL I EMPLACEMEEN7MET1101i 1
ft.
tt.
ft.
it.
20.DRILLING -LOG attachadditionalsheetsirmcessarv-
FROM I
TO
DESCRIPTION (corer hQrdaw, wiUrock t� wale size, ens.
0.0 ft'
40.0 rr•
DIRECT PUSH
ft.
fr.
rL
i
ft.
ft.
ft.
ft.
ft.
ft.
Ft,
ft.
ft.
21. REMARKS - - -
i
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22. Certi6 t'on:
(if well field one fatllong is sufcient)
35a 29' 17.98" N 81 ° 15r 24.76" W �--
6. Is (are) the well(s): OPermanent or OTemporary
7- Is this a repair to an existing well: QYes or EiNo
(this is a repair, ftdl out knotrn ire/( consirriefienr it jorniatian and erplaiu the nature afthe
repair under #21 remarks section or on the back of dris farm.
8. Number of wells constructed: 1
?rot multiple injection ar nun -osier supply irons ONL P with the sume construction, you can
sub:nu one form.
9. Total well depth below land surface: 40.0 (ft.)
.-or inulaple wa/1.t list all depths ;rdi�•rent ,/example- 3rry200' and 2 r�r 1001
Signature aFCertified Well Contractor
09/30/16
Date
Ny signing 11tis form, ) hereby certify that the irell fs) was (were) constructed in accordance
ii ith 15A NCAC UX . 0100 or 15A NCAC 02C.0200 We/l Comiruction Slondords and that a
cop}, nftJtis record bat been provided to the ire// owner.
23. Site diagram or additional well details:
You may use the back of this page to, provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10. Stolle water level below top of casing: (ft.) Division of Water Quality, Information Processing Unit,
f ralerlevel is obore casing, use "+" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
,.. ,
OPT RODS above, also submit a copy of this form within 30 days of completion, of well
12. Wetfcdnsfrucfiors method: construction to the following:
(i a auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY" WELLS ONLY. 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Suppiv & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of w^elf construction to the county health department of the county
where constructer..
Form GW-I - North Carolina Department of &,viroumeut and Natural Resources —Division of Water Quality Revised Ian. 2013

WELL CONSTRUCTION RECORD
This form can be used For single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Wcll Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2_ Well Construction Permit #: W10300295 (UIC)
List all applicable urll construction permits (i.e. County. State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
OAgricultufal
OGcothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
OExperimental Technology
OGeothermal (Closed Loop)
ONlunicipal/Public
OResidential Water Supply (single)
OResidcntiai Water Supply (shared)
S
OGround,mater Remediation
❑Salinity Barrier
OStormwater Drainage
OSubsidence Control
OTracer
OGther (exotain under #21 F
4. Date'IWell(s) Completed: 08/23/16 Well 1D4 IW-6-11
Sa. '*Yell Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility 1Di1(if applicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00410
County
Parcel ldentificalion No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds
or decimal degrees:
(if weft field, one fatllong is sufficient)
35' 29' 17.98"
81 a 15' 24.76"
N
W
6. Is (are) the well(s): OPermanent or 17Temporary
7. Is this a repair to an existing well: ❑Yes or EJNo
if this is a repair. Jill out known well caruirnction information mid explain the nature of the
repair under'. 21 renwrks section or air the bark of this fornt.
8. Number of wells constructed: 1
]--or withiple byection or non -tracer supply wells OAT l' with the sane construction, jwu con
slibnh one form.
9. Total well depth below land surface: 37-0
For nudople wells list all depths ifdifferent (example- 3@200' and 2©10')
10. Static water level below top of cusing:
!f water level is above casing. use " + -
I I. Borehole diameter: 1.5
DPT RODS
For Internal Use ONLY:,
14. WATER ZONES
FROM TO
DESCRIPTION
It. ft.
ft. ft.
15. OUTER CASING for multi -cased wells OR LINER ifa licable
FROM
TO
DIAMETER
TItICKNfSS
MATERIAL
it.
I ft.
in.
16. INNER CASING OR TUBING gcotherinal
closed-loop)FROM
TO DIAMETER I
T14ICKNFSS
MATERIAL
ft.
ft. j in.
ft.
ft. is
17. SCREEN .
FROM
TO
DIAMETER
SLOTSIZE
I THICKNESS
I MATERIAL
ft.
ft.
in.
A.
It.
in.
IS: GROUT
FROM
TO
MATERIAL
EMPLACEMENTMETHOD3raMOUNT
0.0 ft.
37.0 It'
SLURRY
ft,
ft.
ft.
fr.
19. SAND/G RAVEL PACK(if applicable)
FROM
TO
MATERIAL
E:MPLACEMENTMETIIOD
If-
ft.
20. DRILLING
LOC iittath
additional sheets if necessury
FROM
TO
DESCRIPTION (rotor, hzanl. ss, spill-k t rain A.,. etc.
0.0 ft-
37.0 ft-
DIRECT PUSH
ft.
Yt.
fr.
ti.
Fr.
ft.
ft,
ft.
ft.
ft.
,
ft.
ft.
21. REMARKS - - -
_1
+
22. Certification:
A"'-z 09/30/16
Signature orcenified Well Contractor Date
By signing this fain. I hereby certify that the well(s) was (here) cautrucied in accordance
with 15.4 NCAC 02C - 0100 or 15A NCAC 02C .0200 1VWI Construction Standards and that a
caps' of this record has been provided to the urll corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction detaits. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. Fur All Wells: Submit this form within 30 days of completion of'well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 tLiail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For }rater Supply & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multipte wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well ContractorCertiticmion Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit 9: W10300295 (UIC)
List a// applicable well construction perntirs (i.e. County, Stare, Variance, cte.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial!Commercial
❑ lrrieation
C
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑MunicipaUF'ublic
❑Residential Water Supply (Single)
❑Residential Water Supply (shared)
OGround>kater Remediation
OSalinity Barrier
+Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 921 F
4. Date Well(s) Completed: 08/24/16 Well ID9 IW-6-10
5a. Well Loealinn:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGiONAIRE ROAD
Physical Address. City, and Zip
LINCOLN
County
NONCDO001154
Facility IDk (ifapplicabte)
LINCOLNTON 28092
00410
Parcel Identification No: (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwetl field, one laUlong is sufficient)
35e 29' 17.98" N 81 ° 15' 24.76" W
6. Is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ®No
if this is a repair• fill oul knnten we?i construction ilrformation and explain the nature ofthe
t-ar;air under ell remarks section ar on the back of this jornr.
8. Number of wells constructed: 1
Fnr mrtlriplc ?ttiecnan nr t+ort-,rater supply ure/?s ON? -I' with dte name caartruct?act. }nu can
submit one fnrm.
9. Total welt depth below land surface: 43.0
For muhipte wells list all tleptln ?jd�ercnt (exuntplc- 3�100' and 2'rt i00�
For Internal Use ONLY-
14. WATER ZONES
FROM I TO DESCRIPTION
ft. I ft.
ft. It.
i
I5.OUTER CASING for mutts -eased wells) OR L[NER if applicable)
FROM I TO
DIAMETER
THICKNESS
MATERIAL
16aNNER CASING OR TUBING eathenaalclased-loo
i
FRONT
TO
DIAMETER
THICKNESS
MATERIAL
ft.
a
ft.
in,
ft.
ft.
in.
17. SCREEN-
-
FROM
TO
DIA3fET£R
SLOT SIZE
THICKNESS MATERIAL i
ft.
fL
in.
ft.
i
ft.
in
IS., GROU3
FROM
TO
MATERIAL I E,RIPtAG'E,M£NTMET11OD & ARIOUNT
0.0 ft.
43.0 tr.
wrnx�arx o r SLURRY
ft.
ft.
ft.
ft.
J9. SAND?GRAVEL PACK ifapplicable)- -
FROM
TO
MATERIAL I E14PLACEM ENT NIETHOD
ft.
ft.
4
ft.
ft.
20.• DRILLING
LOG attach additional sheets if riecessii ) - -
FROM
TO
DESCRIPTION color, hasdam soiVrnck t cafe: size, etr.t
0.0 ft.
43.0 fr•
DIRECT PUSH
ft
ft.
fr.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. RE;IARKS - -
22. Certification:
09130/16
Signature of Certified Wei! Contractor Date
By signing this form. I hereby certify shot the rrell(s) u•av (mere) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Mee Construction Standards and rhor a
copy arthis record has been provided to the well corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction. details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCIIONS
24a. For AD Wells: Submit this lorm within 30 days of completion of well
construction to the following:
td. Static water level below top of cosine (it,) Division of Water Quality, Information Processing Unit,
junto lorel is ahnre coring, use -+ 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1-5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well.
12. Well construction method: construction to the ibllowin `
g: _
(i.e. anger, rotary, cable, direct push, etc.)
Division of V:'ater Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
! 24c. For Water Supply & Iniection Wells: In addition to sending the form to
13a. Yield (gpm) ;Method of test:
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form G W-1 North Carolina Department of Environment and Nai-1 Resources - Division of Water Quality Rcvuscd Jan 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name -
2. Well Construction Permit 4: W10300295 (LIIC)
List all applicable yell canstructfnn permits fr.c. CounrY, State, Variance, eta)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
I:
❑Aquifer Recharge 9Groundwater Remediation
❑Aquifer Storage and Recovery, ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 F
4. Date Well(s) Completed: 08/24/16 Well ID# IW_6-9
Sa. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility ID# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip -
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwcll 8cld, one lathang is sufficient)
35" 29' 17.98" N 81 ° 15' 24.76" ay
6. Is (are) the well(s): ❑Permanent or IOTemporary
7. Is this a repair to an existing well: ❑Yes or ElNo
Ifdris is a repair, _fill nut brawn trell construction ii jirmadon and explain the nature of the
repair under #21 retuarks section or on the back of ibis form.
8. Number or wells constructed: 1
hbr multiple injection or non-trater.supplp +veils ONLY mith the same canstruction, you can
submit one firm.
9. Total well depth below land surface: 37.0 (ft.)
rarnmltiple trells list all depths ifdii Brent (example- 31Qr 2011'rr)td 2rct 100')
10. Static water level below top or easing: (ft.)
ljcraier level is above casing, use "+"
11. Borehole diameter: 1.5 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY
13a. Yield m Method of test- 24c. For Water Supply & Iniection Wells: In addition to sending the form to
(gp ) the address(es) above, also submit one copy of this form within 30 days or
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
For Internal Use ONLY...
14.1VATER ZONES
FROM
TO 1 DESCRIPTION
ft.
fL i
I'L
ft. 1
IS. OUTER CASING for rituIti- - d welts OR LINER if a IicnMe -
FROM
TO i DIAMETER
THtCtiNFSS
MATFJitAL
ft.
ft. in.
16. INNER CASING OR TU61NG eotherm.1 timed -loop)
FROM
TO nIAMETER
THICKNESS
I MATERIAL
ft.
ft. I im
ft.
ft. in.
17. SCREEN
: FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
i
ft.
in.
18. GROUT
FROM i TO
MATERIAL
EMPLACEMENT METHOD 3r AMOUNT
0.0 ft' 137.0 ft.
'°°run°arry °" `
SLURRY
iz. ft.
it. ft.
19. SANDIGRAVEL PAC fi if a lieable
FROM
TO
MATERIAL
EMPLACEMENTMETHOD
ft.
ft.
ft.
ft.
20. DRILLING
LOG nitach additional sheeb ifnecessa
FROM
TO DESCRIPT]ON (ralor. hardnm, spill-k rain sire, era)
0.0 ft-
37.0 ft- , DIRECT PUSH
ft.
ft.
ft.
rt.
I
ft.
ft.
iL
ff.
21. REMARKS
22. Certification: �'
Signature of Certified Well Contractor Date
By.signing this form, I hereby eertyy that the rvelJ(s) bras (trere) constructed in accvrdanve
Wilt 15A NC4C 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that.a
copy ofthis record has beery provided in the hell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 241
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division ofWater Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
J
Form G W-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable well consiruetiar permits rue. County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
OAgricultural
DGeothermal (Heating/Cooling Supply)
❑ 1 ndustria 1lCotn mere ial
DMunicipallPublic
0Residential Water Supply (single)
DResidential Water Supply (shared;
Non -Water Supply Well: I
❑Monitoring ❑Recovery I
❑Aquifer Recharge
❑Aquifer Storage and Recovery
DAquifer Test
DExperimental Technology
DGeothermal(Closed Loop)
DGeothermal (Heating
/Cooling
OGroundwater Rernediation
OSalinity Barrier
OS€ormwater Drainage
OSubsidence Control
OTracer
DOther (explain under #21 1
4. Date Well(s) Completed: 08/25116 NYell ID# IW-6-8
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
FncititylOwner Name Facility 1Dii (if applicable)
129 LEGIONAIRE ROAD LiNCOLNTON 28092
Physical Address, City, and Zip t rrAA
LINCOLN 00410
Comity
Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degree
(ifwelI Geld, one iaUtorg is sufficient)
35a 29' 17.98" Nr 81 a 15' 24.76"
6. Is (are) the well(s): ❑Permanent or ;o7Temporary
For Internal Use ONLY.
A4. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
rt.
IS. OUTER CASING (for multirrsed wells OR LINER ifs licnble
FROM
TO
DIAMETER 1 THICKNESS
MATERIAL
H.
ft
in. i
..T
-I6ANNER CASING ORUBING eothernta}dt➢sed-too -
FROM
TO DIAMETER i THICKNESS
MATERIAL
ft.
ft. in. I
R.
fr. in. j
1
77. BEEN
FROM
TO
DIAMETER
SLOT SIZE THICKNESS
MATERIAL
in.
ft.
rt.
in.
18. GROUT
FROM
TO
MATERIAL EhIPLACEMEN-r t IETHOD & A\COUNT
0.0 fr.
45.0 rt•
roanuaetxT SLURRY
ft.
ft.
ft.
ft.
19. SANDIGRAYEL PACK if a ticable - - -
FROM
TO
MATERIAL _ EMPiACERIE:tiTIt1ETHOD
ft.
ft.
j
i
ft.
ft.
-.2D..DRILLING
LOG attach additional sheets if necessary) -
FROhl
TO
DESCRIIrrtON (color, hardness, solUtsck t , rain sim etc.)
0.0 fr
45.0 ft•
DIRECT PUSH
ft,
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft
ft.
ft.
i
21. RE'11ARKS - - -
s' 22. Certification: Signature of Certified Well Contractor
7. Is this a repair to an existing well: OYes or DNo
lfthis is a repair, fill nut knnuvt trell cansinit-non inforitiaticir and erpfain die nnture tf the
repair under 'i 21 r markv scetion fir all the back of'dtis fiinr..
S. Number of wells constructed 1
For radtiple injection or molt-u•oter s-uaply wells ONLY trill, the same car:structior., you care
submit atte form.
9. Total well depth below land surface: 45.0
For multiple irellt list all depth., tf'd�cretri (example- 3@200' and 2@ 109)
10. Static water level below top of casing:
If irate, /Orel is above casing, use "
11. Borehole diameter: (in.)
(ft.)
09/301/6
By signing this farm, I lterebY eertfi that the trell(v) nay (it•ere) constructed in accordance
with 13A NCAC 02C .0100 ar 15A NCAC 02C -0200 Fttelt Coutnrctioa Standards atrrl that a
copy afdris record has been provided to tlee well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional vvell site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSFUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For iniection Wells: In addition to sending the form to the address in 24a
DPT-RODS above, also submit a- copy of this form within 30 days of completion of well.
12. Well construction method: consttuctionlo the Ib`lowing:
(i.e. auger, rotary, cable, direct push, etc) ,
Division ofWater Quality, Underground Injection Control Program,
FOR WATER SUPPLY" WELLS ONLY: 1636 14fail Service Center, Raleigh, NC 27699-1636
13u, Yield (gpnt) Me (hod of test 24c. For Witter Supply & Injection Wells: In addition to sending the form tv
the address(es) above; also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of w'ell construction to the county health department of the county
where constructed.
Form GW-t North Carolina Department of Environment and Natural Resomccs—Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit 4: W103Q0295 (UIC)
List all applicable well con unction permits fi-e. County State. Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
OGeothermal (Healing/Cooling Supply)
O 1 ndustrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
OAquifer Storage and Recovery
❑Aquifer Test
OExperimental Technology
DGeothermal (Closed Loop)
CGeothermai (HeatingiCooling
OMunicipal/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
OGroundwater Remediation
OSalinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
DOther (explain under #21 1
4. Date Well(s) Completed: 08/25716 Well ID# IW-6-7
5a. Well Location:
ROBERT BOSCH"TOOL NONCDO001154
Facility!Owner Namc Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28M
Physical Address, City, and Zip
LINCOLN
county
00410
Parcel Identification No. (PIN)
5b. Latitude and Longitude in "degrees/minutes/seconds or decimal degree
(if well Geld one latliong is sufficient)
35a 29' 17.98" N 81 n 15' 24.76"
6. Is (are) the well(s): OPermanent or ©Temporary
For Internal Use ONLY:
14. WATER ZONES
FROM
TO DFSCRIPTION
ft.
ft.
h.
ft.
15. OUTER CASING (for multi -cased we)ls) OR LINER if n Iicable .
FROM
TO DIAMETER
THICKNFSS
MATERIAL
" ft.
fL in.
16. INNER CASING OR
TUBING eotk7nl rimed -too
FROM TO
DIAMETER
THICKNESS
MATERIAL
ft. I.
ft. ft.
in.
17_ SCREEN
"
FROM
TO
DIAAl LITER
SLOTSIZE
THICKNESS MATERIAL
in.
ft.
ft.
. I& GROUT
FROM
TO
MATERIAL EM PLACEMENT METHOD& AMOUNT
0 0 ft.
4ti U n•
PQRi 03E"Tc`nfi SLURRY
ft.
ft.
c
ft.
19. SANDIGRAVEL PACK if applicable)
FROM
TO
MATERIAL
E:MPLACEMENTMET1IOD
ft.
ft.
fL
ft:
20..DRILLING LOG nuach additional sheets ifnecessary)
FROM
TO
! DESCRIPTION solar, hardnem, scilhoek tv ruin
0,0 ft.
:46 Q fr.
! DIRECT PUSH --
fe.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
I It.
ft.
ft.
21.REAIARKS. -
s' 22. Certification:All—::t-
W 09/30/16
Signature of Certified Well Contractor Date
7. Is this a repair to an existing well: ❑Yes or EiNo
lfthis is a repair, fill ant knoirn reell construction information and esp)ahr the nature grdw
repair trader 921 remarks section or an the back afiltis form.
S. Number of wells constructed. 1
hat multiple injection or molt -crater supply srells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 46.0
For multiple welds list all depths if liflirem (example- 3@200' and 2Q100')
10. Static water level below top ofcasing:
Ifsraterkrel is above casing, use
11. Borehole diameter: 1.5 (in.)
DDT RODS
By signing this form. I hereby comfy that the well(s) was fivere) constructed in accordance
with 15.4 NCAC 02C.0101) or IjA NCAC 02C:0200 Well Construction Standards and that a
copy ofihis record has been provided to dw well otrner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL iNSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the Form to the address in 24a
above, also submit a copy of this form within 30 days of completion of Well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, elc.)
Division of Water Quality, Underground lnjection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13s. Yield (gpm) Method of test: 24c. For Water Suoa►v & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Ion.. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Far Internal Use ONLY:
14.WATER ZONES
. - -
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
ft.
ft,
ft.
ft.
IS. OUTER CASING (far tnutti-eaeed wells
FROMft
To
DIAMETER
fL
tti
Company Name
w10300295 tUIc
2. Well Construction Permit #: t
List all applicable n-ell cott.vimctintt permits Ct.e. County, State, Variance, etc.)
3. Well Use (check well use): -
16. INNER
CASING OR TUBING "eotherr
FROM
TO
DIAMETER
ft.
rt.
in
ft.
ft.
in,
17. SCREEN
Water Supply Well:
OAgricultural ❑MunicipaUPublic
OGeothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
Olndustrial/Commercial DResidential Water Supply (shared)
OIrri • tion
FROM TO
DIAriIETER
I SL(
tt• ft.
is
ft. ft.
irl
18. GROUT '
FROM
TO
MATERIAL
0.0 fY.
46'G ft.
eonnx oaevr wrr
Non -Water Supply Well:
❑Monitoring ❑Recovery
ft.
ft.
Iniection Well:
ft, I
- ft.
❑Aquifer Recharge OGroundwater Remediation
❑Aquifer Storage and Recovery !]Salinity Barrier
❑Aquifer Test QStormwater Drainage
OExperimental Technology OSubsidence Control
❑Geothermal (Closed Loop) OTracer
OGeothermal (Heating/Cooling Return) OOther (explain under 921 Remarks) i
19. SANDIGRA VEL PA(
FROM
TOft.
It.
ft.
ft,
20. DRILLING LOG at1
FROM
To
0.0 fL
46.0 ft-
Ibis-6-6
4: Date Well(s) Completed: Well IDp
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facilitrtowner Namc Facility 1D9 (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
rt.
ft,
ft.
ft.
ft.
ft.
It.
rt.
fr.
ft,
ft.
ft.
ft.
Physical Address, City, and Zip
LINCOLN 00410
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latilong is sufficient)
350 29' 17.98" N 81 a 15' 24.76" W
6. Is (are) the well(s): OPermanrnt or 12-Temporary
7. Is this a repair to an existing well: OYes or QNo
/f thi.t is a repair, fill our knoirn treil construction information and erploin the nature of the
repair under y 21 remarks .section or on the back of this form.
8. Number of wells constructed: 1
Far ninhiple injection or non-a-ater supply irelis O:W:.Y with the same construction, you can
submii one fomi.
22. Certi lion:
SLURRY
DIRECT PUSH
09/10/i f
Signature of Cenified Well Contractor Date
Hysigning ihit form. 1 hereby cerlify that the trell,rt) eras then.) constrrcied in accordance
frith 15A NC4C 02C .0100 or 15.4 NC4C (12C .0200 Well Construction Standards and that a
copy ofdtls record has been prorided w the well owner.
23. Site diagram or additionul well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary_
SUB14ITTAL INSTUCTIONS
9. Total well 0 depth below land surface: 46.
p (it.) 24a. For All Wells: Submit this form within 30 days of completion of well
For inultyile welks lisr all depths ifdii j*renr (example- 3,@a 2019'and 2 rt 100') construction to the following: .
10. Static water level below top of casing: (ft,) Division of !Water Quality, Information Processing unit,
l' iroter lore/ is alun•e casing, use "}" 16t 7 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: to addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction tnIethod. - construction to the following: '
(i_e. auger, rotary, cable, direct push, etc-)
Division or Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Wit ter Supply & Iniection Wells: in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of evil construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Em•itonmen: and Natural Resources - Division of Water Quality Revised Jan. 201--

WELL CONSTRUCTION RECORD
This form cm be used for single or multiple wells
I. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2.Well Construction Permit '4: WI0300295(UiC)
List all applicable weft construction permllr r.e. CounO: Stare, Variance. etc.)
3. Well Use (check well use):
OAgriculturel ❑Municipal/Public
©Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial OResidential Water Supply (shared)
ro
n-Water Supply Well:
Moniitorng ❑Recoveryitorng ❑Recovery
OAquifer Recharge
OGroundwater Remediation
OAquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainaee
❑Experimental Technology
❑Subsidence Control
OGeothermal(Closed Loop)
©Tracer
OGeothermal (Heatini:/Coolinit Return)
00ther (exolain under 411 f
4. Date Well(s) Completed: 08/25/16 Well IDN IW-6-5
5a- Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Nome
. Facility IDN (ifapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LiNCOLN
00410
Countv
Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minuteslseconds or decimal degrees:
(if well field, one [at/long is sufficient)
35e 29' 17.98"
810 15' 24,76"
N
W
6. Is (are) the well(s): ❑Permanent or 12Temporary
7. Is this it repair to an existing well: Oyes or E]No
lfthis is a mpoin fill our knotcn we// carsrructian infatntrtion and explain the nature oj'tfre
repair under "21 remorks section or an the back of thistarot.
8. Number of wells constructed: 1
Por nnrltiple injection ar non -crater supply iredds 0NL1` ivith the same construction. )eau can
submit are form.
For Internal Use ONLY,
14, WATER ZONES
FROM I TO
DESCRiFric
R- ft
it. ft.
15. OUTER CASING Cor multi -cased wells) OR LINER if a lieable
FROM
TO DIAMETER
THICI:PiFSS
161ATERLIL
ti.
ft is
- 16..INNER -CASING :OR TUBING fecothermal closed -too
FROM
To
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in
ft.
ft.
in.
'17.SCREEN`
- - - -
FROM
TO
DLIMETER
SLOTSIZE
T.11XNESS
MATERIAL
ft.
ft.
in.
.18: GROUT
FROM
TO MATERLL
EMPLACEMENT AIL -MOD & AdtOU?4r
0.0 tt._
43-0 R• POFTt WagENToraiE
SLURRY
ft.
ft
fr.
ir. 1
19. SAND/GRAVEL PACK if a Iicable
FROM
TO
MATERIAL
EMPLACEMEhTalMOD
ft.
ft.
ft.
fs.
.20. DRILLING -LOG- attach additional sheets if necessary -
FROM
TO
DESCRIPTION color hardness, saiVrack rain sin, eta
0.0 ft-
43.0 It-
DIRECT PUSH
ft.
It—
ft.
ft.
ft.
ft.
rt-
ft.
ft.
Ct,
it.
21. REMARKS
22. Certification:
r 09J30/16
Signature orCertified Well Contractor L Date
!Yv signing this Tarn, f hereby certify that the we/lft) tray (mere) constructed in accorrlmtee
rrith 15A NCAC 02C.0100 or lSA NCAC 02C.0200 {yell Construction Standards and that a
cvpj, rfthie retard has been provided to the irel/ owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL It\STUCTIONS
9. Total well depth below land surface: 43.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
Far nadtiple wells list all depths dfdieren (example- 3 a_200' and 2Q100') construction to the following:
10. Static water level below top of casing: M.) Division of Water Quality, Information Processing Unit,
Iftralerlevel irabove casing, use -+•" 1617 Mail Service Center, Raleigh, NC 27699-1617
I1. Borehole diameter: 1.5 (in.) 24b. For Inieetion Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc,)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method oftest: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources- Division of Water Quality
Revised lan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wets
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable well conciruclion pemuls (I.e. Comup. State, Yariarre, etc.J
3. Well Use (check well use):
❑Agricultural ❑MunicipatlPublic
❑Geothermal (HeatingiCooling Supply) ❑Residential Water Supply (single)
❑lndustiiallCommercial ❑Residential Water Supply (shared)
Supply Welf.
❑Aquifer Recharge
0Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
4. Date Well(s) Completed: 08/26 16
Sa. Well Location:
ROBERT BOSCH TOOL
FacilitylGwnc. Name Facil:ty lD9 (ifappticable)
129 LEGiONAIRE ROAD LINCOLNTON 28092
OGroundl ater Remediation
❑Salinity Barrier
❑Stormvtiater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
WelliD# IW-6-4
Physical Address, City, and Zip
LINCOLN
County
NONCDO001154
NE
Parcel identification No. (PIN)
5b. Latitude and Longitude in degreesiminutesfseconds or decimal degrees:
(ifwell field one tatflong is sufficient)
350 29' 17.98" N 81 a 15' 24.76" W
6. Is (are) the well(s): ❑Permanent or GlTemporary
7. Is this a repair to an existing well: OYes or ONo
If this it a repair, ftlt oni known well eonstrectdon iafornration and eiplain the nature ,rrhe
repair under �,21 remarks section or on the back- oftais form.
8. Number of welts constructed: 1
For nmliiple bia yectn or non-u'aler.ruppl3g cre)/s OIVL I' with the sane construction, 1 it call
.submit rite farm. -
9. Total well depth below land surface: 43.0
Far nndtiple ire/ls lira all depths f d rent (example- 3 00' and : @1011
10. Static water level below top ofeasing: (ft.)
If water lerei is ahom casing, u.se "* •'
11. Borehole diameter: 1.5 (in.)
DPT RODS
For Internal Use ONLY:
14, WATER ZONES
FROM TO I DESCRIPTION
ft. ft.
rt. ft. )
15.-OUTER CASING" for multi -cased -Its OR LINER if a 8cabk
FROM TO DFAM EfEA THICKNESS MATERIAL
ft
. ft. in.
' 16. INNER CASING OR -TUBING ieothermal closed -too
FRO117 TO DIAMETER THICEChtFSS MATERIAL
ft. ft. in
ft, ft. in.
i
17. SCREEN
FROM TO DtAME7'ER 5lAT5[ZE 7Ii1CKNESS MATF.R(AL
ft. ft. in.
ft. ft. in.
13. GROUT
FROM TO MATERIAL I EMPSACEM&W METHOD & AMOUNT
Q.0 it. 43.0 ft. mn-DnENTIX TE SLURRY
-
ft. ft.
19. SANDIGRAVEL PACK ira licabte
FROM TO MATERIAL EMPLACEMENTMETHOD
ft. tr.
ft. I rt.
20. DRILLING LOG "(attach additional sheets if necessary
FROM TO DESCRIPTION(rotor, hmrdnm soiVmck rain sim etc)
0.0 ft. 43.0 ft DIRECT PUSH
ft. ft.
ft. ft.
€t. D.
ft. ft.
ft. ft.
ft. fe.
21. REMARKS
22. Certification:
-�' 09I30116
Signaturc urCertified Well Contractor Date
By signing dais form, 1 hereby ceritf' liar the irell(s) was (were) constructed in accordance
irate 15A NCRC 02C.0100 or 15A %JCAC 02C.0200 Well Coastructian Siatdarris and dear a
copy arthis record has been provided to the irell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary. .
SUBM=AL INSTUCt'IONS
24a, For All Wells: Submit this form within 30 days of completion of well
construction: to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Sel-vice Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12.. Well -construction method: construction to the following:-
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13.4. Yield (gpm) lvlethod of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed. .
Form GW-I Nonh Carolina Deparrmcat of Encironrnent and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information_:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295 (UIC)
I.irt ail aPPlicable well construction permits (,e. Count),, State, I'arianee, etc,)
3. Well Use (check well use):
❑Agricultural ❑ Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
t! ❑Ivionitonng ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquiler Test
!=Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeatineiCoolinQ I
❑Groundwater Remedial ion
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other(cxDiainunder #21 F
4. Date Weil(s) Completed: 08/26/16 Wen IDO IW-6-3
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility ID9 (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00410
Coumv Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latilong is sufficient)
35* 29' 17.98" N 81 ° 15' 24.76"
6. Is (are) thewell(s): ❑Permanent or IOTemporary
7. Is this a repair to an existing well: Oyes or FINo
Ij'this is a repair, fill ant known ire// construction it fornmtion and e_tplain the nature of the
repair under If2l rentarkssection or an the hack afthis farm.
8. Number of wells constructed: 1
Far audliple injection or nmt-:rater suPPly melts ONLY With the same construction, you can
submit one fornr.
9. Total well depth below land surface: 46.0
Far multi, le ulel/s list all depthr if different (example- 3 a 700' and 7 tt 100')
10. Static water level below tap of casing:
jtrater lerel is abm•e casing, use
11. Borehole diameter: 1.5 (in.)
DPT RODS
For Internal Use ONLl'-,
14.. WATER ZONES
FROM
TO
DESCR1P IO-N
;t.
ft.
rt.
ft.
15. OUTER CASING I for multi -cased wells 'OR LINER if a licable)
FROM
TO DIAMETER THICKNESS MATERIAL
ft,
ft in
16.INNER
CASING OW BINC ircothermal closed-►oo )
FROM
TO
DIAMETER
THICKNESS-
MATERIAL
ft.
f,-
in.
ft.
ft.
in
17.SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
ft.
ft_
in.
ft.
- ft.
in
18. GROUT ..
FROM
TO
MATERIAL
ERIPLICEMENTAIECIIOD&A:%IOUKr
0.0 .IL
46.0 B'
pnanAVoa&v on re
SLURRY
ft.
ft.
ft.
ft.
19.SANDIGRAVELPACK ifv licable - --
FROMTrIll-TO
MATERIAL EMPL4CEMENTMETHOD
It. I
20. DRILLING'LOC
attach ddfiitional sheNs if necessa - -
FROM
7'O
OESCRtPIION color, hardaess, saiVrwk type, train size, etc.t
0.0 rr•
46.0 rL
DIRECT PUSH
ft.
fL
:
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
2I. REMARKS
22. Certification:
09/30/16
Signature ofCenifiedWell Contractor - Date
By .signing this furor, 1 hereby certify that the irell(i) was (mere) constructed in aceardance
frith ISA NC 4C 02C.0100 or 15.4 NCAC 02C .0201) !Yell Construction 57andardr and that a
copy ofilris record /un been provided to the trell on•ner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSFUCTIONS
24a. Fur All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
16I7 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc,) "
Division of Waler Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount' completion of well construction to the county health department of the county
where constructed.
Form G W-1 North Carolina Department of Environment and Natural Resources - Division or Water Quality Revised Jan. 2013

[/v103002-'75
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable ❑rll construction permits rlx. County. State, Variance; etc.)
3. Well Use (check well use):
Water Supply Well:
[]Agricultural
❑Geothermal (Hearing/Cooling Supply)
O Industrial/Commercial
Non -Water Supply Well:
❑ Monitoring
OMunicipaUpublic
OResidential Water Supply (single)
OResidential Water Supply (shared)
[]Aquifer Recharge
OGroundcsater Remediation
OAquifcr Storage and Recovery
[]Salinity Barrier
OAquiferTest
❑Stormwnter Drainage
0Experimental Technology
❑Subsidence Control
t OGeothermal (Closed Loop)
OTracer
OGeothermal (Heating/Cooling Return)
[]Other (explain under # 1 F
4. Dntc Well(s) Completed: 08/26/16
Well ID# IW-6-2
So. Well Location:
ROBERT BOSCH TOOL
FacilirylOwner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LINCOLN
Count.
NONCDO001154
FacilitvlD:(ifapplicabte)
LINCOLNTON 28092
00410
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: -
(if well field, one lat/long is sufficient)
35o 29' 17.98" N 81 a 15' 24.76" W
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: []Yes or QNo
fjtbis is a repair, fill out known well conrinrction hformarion and explain the nature ofthe
repair under h21 remarks seciion or oo tire back of iltis firm.
S. Number of wells constructed: 1
For multiple b jection or non -,rater supply wells 01VI,Y with the some construction. yap car:
submit one farm.
9. Total well depth below land surface: 46.0 (ft.)
Fur multiple it -ells list all depilu' irdWerent (example- 3@200' and 2©100)
10. Static water level below top of casing:
fjuwier level is abore cming, use "-"
11. Borehole diameter: 1.5 (in.)
DPT
For Intermt Use ONLY:
I4: WATERZONES
FROM TO DESCRII i ION
ft. fG
fl. It,
15: OUTER CASING for multirased welts) OR LINER tf Tirsble
FROM Td DIAMETER I THICKNESS MATERIAL
ft. I in.
-16 INNER CASING OR TUBING - eothermal clmed-loo) -
FROM � TO DIAMETER THICKNESS MATERIAL
£f. I ft. in.
in.
17.:SCREEN - -
FROM - TO DIAMETER SLOTSIZE I THICKNESS I MATERIAL
ft. ft. in.
I ft. ft. in,
:. IS. GROUT
FROM TO MATERIAL -ENIPLACEME14ThtEIHOD,&A510UN-r
0.0 $ 46.0 ft' vnnwre seoc*a E SLURRY
ft. ft.
It. it.
l 9. SANDIGRAVEL PACK ru usable FROM TO MATERLL I F-MPLACEM ENT ItErIIOn
ft.
ft. ft.
20: DRILLING LOG attach additional sheets if necessary
FROM TO DESCRIPTION {color, hardness, so0lmck type. Fruin size, slc.l
d o fl• 46.0 rt• {DIRECT PUSH
1 ft. It. I
ft. f4
ft. ft.
tt. ft.
I ft. ft
ft. It.
21. REMARKS
i
22. Certification:
Q9130/16
Signature ofCertifted well Contractor Dale
By signing this fora, I hereby certify that the „'ell(s) was (ts,erei conrtrucled ill accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C .0200 Nell Comiraction Standards and that a
capt• ofthis record has been provided in tip- well utrner.
23. Site diagram or additional well details:
You may use the tack of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL ItYSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Waiter Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
RODS above, also submit a copy of this form within 30 days of completion of well
f2. Well construction method: construction to the following:
(i e. auger, rotary, cable, direct push, etc.)
Division or Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Methud of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 (lays of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
(ft.)
Form C W-I North Carolina Department ofEnvitonmcm and Natural Resources — Division orwater Qualnv Revised jars. 20'3

For Internal Use ONLY-
14. WATER ZONES
FROM TO DESCRIPTION
ft. ft.
:15.OUTER CASING ifor multi -cased wells} OR LINER if a Eieabte '
FROM TO=D.1AE.R T1fiCliN£SS M1fATERIAL
ft, in.
16.INNER CASING OR TUBING geothermal closed4oa
FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. im t
ft. ft. in j
17. SCREEN - I
FROM To DIAMETER SLOT SIZE THICKNESS tFiATERLiL
£t. ft. in 1
3
ft. ft. in '
18. GROUT -
FROM To MATERIAL EMPLACEMENT METHOD &AMOtiRT
O,O 1- 15.0 ft' PORM-DOFITOWE SLURRY
ft. IL
rt. ft.
- 19.SAND/GRAVEL PACK ifs ticable
FROM TO MATERIAL E-MPLACEMENTMET11OD
ft. ft.
ft. ft.
ZQ. DRILLING LOG hunch ndditionht sheets if necessary)
FROM TO DESCRIPTION solvr, li-dnos, svill.vk type, =rain slur ctcl
0.0 ft. 15.0 ft- DIRECT PUSH
ft. rt.
ft. ft.
ft. ft.
It. ft.
ft. ft.
ft. rt.
. Z1. REMARKS
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22. Certification: _ ,
it f t �f/ r """'-s-'
os/sotl s
Signature ofCcrtified Well Contractor Dale
By signing this fame. / herehv certify dim, the trell(s) was (were) conwrucied it; accordance
with 15A NC'AC 03C .W ofl ar 15A NC AC 02C . r12Dt1 t1'eli Con tructiwr Standanls and 1har a
cnpy of this record has been prarided io Me. well corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or avell
S. Number or was constructed: construction details. You may also attach additional pages if necessary.
For ntuhiple injection or non -crater supply "ells ONl-Y rnidt the .same construction, J uu can
submitoneform. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 15.0
For ntuhiple Irclls list a// depths ffdoe rein leromple- 3 a 0' and =@1 W,
10. Static water level below top of casing:
IJ'warer level is above casing, use "i
11. Borehole diameter: 1.5 (in.)'
DPT RODS
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2.Well Construction Permit#: WI0300295(UIC)
List all applicable it -ell constructian permits (F.e. County, State, lrariance, etc.)
3. Well Use (check well use):
Water Supply Well:
OAgricultural
OGeothermal (Heating/Cooling Supply)
❑industrial/Commercial -
Non -Water Supply Well:
OMunicipai/Public
LResidential Water Supply (single)
OResidential Water Supply (shared)
injection sveu:
OAquifer Recharge
DGroundwater Remediation
OAquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
LStormwater Drainage
❑Experimental Technology
OSubsidence Control
❑Geothermal (Closed Loop)
OTracer
OGeothermal (Heat in Coul ing Return)
DOther (explain under 421 Remarks)
4. date Weil(s) Completed: 08/24i16 Wetl ID# DPMW-11
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name - Facility ID9 (itapplicable)
129 LEGiONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zcp
LINCOLN 00631
County Parcel Identification No- (PIN)
5b. Latitude and Longitude in degrees?minutes/seconds or decimal degrees:
(ifwell field, one tat/long is sufficient)
35o 29' 17.98" N 810 15' 24.76" W
6. Is (are) the well(s): OPermanent or OTemporary
7. is this a repair to an existing well: 11Yes or EJNo
If this is a repair. jilt out ktrnrrn well rnn.Nrucrinn it fitrmaria: and cxpinir. an notr;re rJThe
repair under 221 remorks section or on the hack r f this jarnt-
1
(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 M1lail Service Center, Raleigh, NC 27699-1617
24b. For tniection Wells: In addition to sending the form to the address in 24a
above, also submil a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.) -
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) fvtethod of test 24c. For Water Supply & Injection Wells: 1n addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount. completion of well construction to the county health department of, the county
where constructed.
Form GW-t North Carolina Drpanmcnt of E,wirooment and Natural Resources- Division of Water Quality Revised lac: 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wills
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Comractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2- Well Construction Permit #: W10300295 (UIC)
List all applicable well construction permits ri e. Counry. State, Variance, etc.)
3. Well Use (check well use):
WaterSimply Well:
©Agricultural
OGeothermal (Heating/Cooling Supply)
O industrial/Commercial
Non -Water SunalY Well:
GAquifer Recharge
GAquifer Storage and Recovery
GAquifer Test ,
OExperimental Technology
OGeothermal (Closed Loop)
OGeothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
OGroundwater Remediation
OSallnity Barrier
OStormwater Drainage
OSubsidence Control
OTracer
GOther (explain under 921 F
4. Date Well(s) Completed: 08/24/16 Well ID# DPMW_10
5a. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
FaeilityiOwrierName '
Facility ID.4 (dapplicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, utid Zip
LINCOLN
00631
County
Parel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
of well field, one latilong is sufficient)
350 29' 17.98"
81 a 15' 24.76"
. N
W
For Internal Use ONLY,
14. WATER ZONES
FROM
TO I DESCRIPTION
ft.
ft.
ft.
15. OUTER CASING for multi - it welts OR LINER if a ticable
FROM
TO DIAMETERT THICKNESS
MATERIAL
ft.
I ft. I in
16; INNER CASING OR TUBING limotherial dosed -too
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
In.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICIGVESS
MATERIAL
It.
ft.
in. -
ft,
ft.
in.
is. GROUT:
FROM
TO
MATERIAL
F-MPLACF-MEYr MZnIOD & AAIOL+NT
0.0 ft.
6.0 ft-
voa,vu aaw « re
SLURRY
R.
ft.
ft.
ft.
- -
19 SAND/GRAVEL PACE if applicable)
FROM
TO
I MATERIAL
EMPLACEMENTME HOD
ft.
ft.
ft.
ft-
20. DRILLING
LOG- nttaeadditional sheeft if necessi
FROM
TO
DESCRIPTION Icalar, hardn will-k type, rainsirt. ctc.
0.0 ft-
6.0 fL
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
It.
ft.
ft.
21. REMA•RKS
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22. Certification:
09/30/16
Signature of Certified Well Contractor Date
6. Is (are) the weH(s): OPermanent or [OTemporary
By signing drir form, i hrrihv certify that the +rel1(s) max (u•er¢J cnristnrrted in accordance
wilt 15A NCAC 02C .0100 or 13A NCAC 02C .0200 Well Construction Standards and that a
7. is this a repair to an existing well: OYes or E1No
copy of this record has been provided to the i ell ou•rmr.
xjdris fs a repair. Jill out knamtr tree coil tnrctiati it fornration and explaitr the mourn ojtht
repair under> 21 remarks section or or the back of Ibis form.
23. Site diagram or additional well details:
1
You may use the back of this page to provide additional well site details or well
8. Number ofwens constructed:
construction details. You may also attach additional pages ifnecessary.
For nathiple injection or non-iramr supply wells ONLY mirk the same construction,.volt can
SUBi•'IITTAL INSTUCTIONS
.suhndr onejorat
9. Total well depth below land surface: 6.0 (ft.)
24a. For All Wells: Submit this form within 30 days of completion of well
For muhdple irells list all depths ii different (example- 3[rd,-700' and 2@1001
construction to the following:
" 10. Static water level below top of casing- (ft.)
Division of Water Quality, Information Processing Unit,
ljtraterlevel is above casing, use "• "
1611 eNlail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter-` ' 1-5 (in.)
24b. For lniection Wells: In addition to sending the form to the address in 24a
DPT RODS
above, also submit a copy of this form within 30 days of completion of Nvell
12. Well construction method:
construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Control Program,
"
FOR WATER SUPPLY WELLS ONLY:
1636 :titan Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
-
l3a. Yield (gpm) filethod of test
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
=
736. Disinfection tye Amount
p '
where constructed.
=Foim G W-I North Carolina Department orEnvironmenl and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable well construction permits (t.e.: Coun(s. State. Variance, etc.)
3. Well Use (check well use):
❑Agricultural ❑MunicipaYPublic
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supplv (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
lion -Water Supply Well:
❑Recovery
_10Monitoring
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal(Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under #21 Remarks)
4. Date Wells)Completed: 08/24/16 well ID#
5a. Well Location:
ROBERT BOSCH TOOL' NONCDO001154
Facility1Dwner Name Facility 1D# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel tdentificalion No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lattlong is sufficient)
35a 29' 17.98" N 81 a 15' 24.76" W
6. Is (are) the well(s): ❑Permanent or Q-Temporary
7. Is this a repair to an existing well: ❑Yes or 91No
feld., is a repair, fill orrr known yell corsintoian inforatation and explain the nature ofthe
repair under i'21 remarks section or nit the back of this form.
S. Number of wells constructed: 1
Igor multiple itryection or nun -water .supply wells ONLY with thesome construction. you can
submit one form.
For (mental Use ONLY;
14. WATER
ZONES
FRORt
I TO
DESCRIFrION l
Ct.
ft.
«.
ft.
15. OUTER CASING for multi -cased wells OR LINER if liwble
FROM
TO
DIAMETER
TRICI:NESS MATERIAL
Ct.
ft.
in.
I
16 INNER
CASING OR TUSING geothermal
closed -Too
FROM
TO
DIAMETER
THICKNFSS
MATERIAL
ft.
It.
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
TMCKNESS
MATERIAL
ft.
ft.
in.
t
ft.
IS. GROUT: !
FROM
TO
MATERIAL
EMPLAC€MENT MET110tI& AAIOUN17 l
0.0 ' it
3.0 ft
eoanauaseu a,E .
SLURRY i
ft.
It.
I
ft.
ft.
19iSANDIGRAVELPACk fifamilicablel,
FROM
TO
MATERIAL
EMPLACEMENTMET110D
ft.
ft.
i I
ft.
«.
20. DRILLING LOG attach additional shtets if ntcessaiv -
FROM
TO
DESCRIPTION (color, hardness, sei4§oek t ruin sins, etel
0.0 rt.
3.0 ft.
DIRECT PUSH '
ft.
ft.
I
3
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
I
22. Certification:
� 09!30#16
Signature ofCcrtified Well Contractor Dale
By .signing this forar. 1 hereby certify that the well(s) was (were) constructed in accordance
with 15A NC'AC 02C .0100 or 15A AICAC 02C .0200 Ifell Catalructian Standards and that a
copy of this retard Gas been prawded to tire well corner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details •ar well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 3.0 (ft) 24a. For All Welts: Submit this toms within 30 days of completion of well
l-vr nraltiptrtrells list all depths ifdrent (example- J rt 700' and 2 rCr31PA'; construction to the following:
10. Static water level below top of casing: (ft.) Division ufWutcr Quality, Information Processing Unit;
Ifu•arer lerel is abor•rcasinrg. nse -" 1617 NMI Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Iniection Wells: In addition to sending the form to the address in 24a
©PT RODS., above, also submit a copy of this form within 30 days of completion of well
12: Welf construction method: construction to the following: - - -
(i.e. auger, rotary, cable, direct push, etc.)
Division ofWater Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (grim) Method of test: 24c. For Water Suortly & Injection Wells: In addition to sending the farm to
the address(es) above, also submit one copy of this form within 30 days of
tab. Disinfection type: Amount: completionof well construction to the county health department of the county
where constructed.
Form GW-t Noah Carolina Department of Environment and Nalrval Resources - Division or Water duality Revised Jau. 2013
R

WELL CONSTRUCTION RECORD
This form can be used for single or multiple welts
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit 4: W10300295 (UiC)
List all applicable irelf construction permits (i. C. Caonty, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑!Agricultura)
❑Geothermal (HeatinglCeoling Supply)
❑ Industrial/Com mere ial
Non -Water Supply
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heatin¢/Coalin¢
❑ Mun icipal/Publ is
❑Residential Water Supply (single)
❑Residential Water Supply(shwed)
❑Groundwater Remediation
❑Salinity Barrier
❑Stortnwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 921 F
4. Date Well(s) Completed: 08/24/16 Well IDk DPMW-8
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facility/Owner Name - Facility ID# (if -applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PtN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwe0 field one Iattlong is sufficient)
35a 29' 17.98" N 81 a 15' 24.76" W
6. is (are) the well(s): ❑Permanenl or 13Temporary
7. 1s this a repair to an existing well: ❑Yes or IDNo
lithis is a repair, fill nor knout, well c mxunrction infarn:arina and explain the nature ofthe
repair antler 921 remarks section or on the back afri ix form.
S. Number of wells constructed:
Pot multiple ii fecrian nr umi-v ntrr s+rpply wells ONLY wiNi. the samr canstrnctfnn, aeon
submitaucform.
9. Total well depth below land surface: 23.0 00
Par m+ddple u•cAT fist all depdn ifdjffirent (example- 3�6@200' mid 2rt�r IG )
10. Static water level below top of casing: 15.0 (ft.)
f irater level is above casing, ase "+ "
11. Borehole diameter: 1.5 (in.)
DDT RODS
For Internal Use ONLYr
14. WATER ZONES
rROM
To
D.CRtrriciX
ft_
ft.
- 15. OUTER CASING for multi -cased wells OR LINER if a Itcabk} -
FROM TO
DIAMETER
TFIICIJVFSSAIATERIAL
ft. ft_
I is
16. INNER CASING OR TUBING eothermal closed -loom)
FROM
TO
DIAMETER
Tn1Ci<'NEss
MATERIAL
fL
ft.
in.
ft,
ft_
in
17. SCREEN
- -
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
Ct,
rt.
in.
ft.
ft.
to.
18..GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD &AAIOUIVr
0.0 R,
23.0
SLURRY
It.
f4
ft.
ft.
19. SANDIT VEL PACK if a licable
FROM
To
MATERIAL I
EMPLACEhIENTMETHOn
ft.
It.
`20. DRILLING LOG attach additional sheets if necessary)..
FROM
TO
DESCRIPTION color. hmrdneu, soiVrock t io aiu, efc.
.-
0.0 ft.
23.0 ft.
i DIRECT PUSH
ft.
I ft.
'
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21.REMARKS -- - -
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22 Certification:{�t r
� 09/34/16
Signature ofCcttited Well Contractor Date
By signing this farm, 1 hereby certifi, that the irell(s) Bras (were) constructed in accardmrce
",hh MA NCAC 02C.0100 ar 15A NCAC 02C.0200 Irell Construction Srandardx and that a
copy of this record hav been provided to the tie/1 owner.
23, Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of -well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc)
Division of Water Quality, Underground Injection Contrul Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water SuDnly & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount completion of well construction to the county health department of the county
where constructed.
=.-Form G W-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor CeniGcation Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295(UIC)
List all applicable well construction permits (i.e. County, State, ;Iariance, etc.)
3. Well Use (check well use):
Well:
OAgricultural
OGeothermal (Heating/Cooling Supply)
O Ind ustrial/Com mere is I
Olrrigation
:Von -Water Supply Well:
❑Aquifer Recharge
OAquifer Storage and Recovery
OAquifer. Test .
QExperimental Technology
OGeothermal(Closed Loop)
❑Municipal/Public
OResidential grater Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
OSalinity Barrier
OSlormwater Drainage
❑Subsidence Control
❑Tracer
00ther (explain under #21 F
4. Date Well(s) Completed: 08124/16 Well ID# DPMW-7
So. Well Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner-Namt Facility IDtI (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN . 00631
Cougty Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well Geld, one Jai/long is sufficient)
35a 29' 17.98" N 81 a 15' 24.76" W
6. is (are) the weli(s): ❑Permanent or fr7Temporary
7. Is this a repair to an existing well: ❑Yes or E1No
!f this is a repair, fill out know? well cortsrruction information and explain tire nature of the
repair wider 921 rernar i section or on the back gfthis fitrnt.
S. Number of wells constructed: 1
lrnr n!zdtiple hyecvion or not: -tracer supply treBs olvLY mirlt tire same cnrstrtictinr. )r�u can
submit one foror.
9. Total well depth below land surface: 29.0 (ft.)
For attelliple wells fist all depths ifdiereut (example- 3@200' otul 2@100')
10. Static water level below top of casing: 15.0
ffwaterlevel is abom casing, use -+ -
11. Borehole diameter: 1.5 (in.)
DDT RODS
For Internal Use ONLY,
14. '*VATER ZONES '
FROM TO DESCRIPTION
Ft. ft.
ft. ft.
15. OUTER CASING(for matti-cascdwefts OE LINER ifs livable
FROAt TO DIAM LTER T THICKNESS MATERIAL
16.INNER CASING OR TUBING eothermal closed-Itio
FROM TO I DIAMETER THICKNESS MATERIAL
ft. ft. in
ft. ft, in
17.SCREEN " - -
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
ft. ft. im
ft. ft. in.
I
13. GROUT
FROM TO MATERIAL I EMPLACF.M ENT bIMIOD & AMOUNT
0.0 ft• 29.0 fL roa waea r e;e SLURRY
ft. ft. i
ft.
19.SANDiGRAVELPACK ifu livable
FROM TO MATERIAL EMPLACEMENTMECHO➢
ft, Ft.
20. DRILLING LOG attach -additional sheets irnecessa
FROM TO DESCRIIri'ION rolnr, hardness, saiUrvcR tr rain sirs, etc.l
0.0 It- 29.0 f - DIRECT PUSH
R. fr.
ft., ft.
j ft. ft.
ft. ft.
ft. ft.
ft. ft.
I
21. REMARKS,
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22. Certification:
�- 09/30f16
Signature ot"Cenified Well Contractor Date
By signing this fornr, 1 herehr certif}r drat the irefl(t) rras (:rere) consrnrcted in accordance
with 15A ACAC 02C.0100 or 15A NCAC 02C.0201) Well Comiraeetian Storufords and that a
cart, ofthis record has been provided in tire well oetwer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTL'CTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.) -
Division of Water Quality, Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test. 24c. For Water Sul & Iniection Wells: to addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-t North Carolina Department of Envimument and Natural Resources - Division, of Water Quality Revised San. 2013

WELL -CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable well consimcitau permits (r e. C'annry, Stale, variance, etc..)
3. Well Use (check well use):
Avatcr supply well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
O industrial/Commercial
❑irrigation
Non -Water Supply Well:
lahlonitoring
❑Aquilar Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/Public
!]Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other (explain under 421 F
4. Date Well(s) Completed: 08/24/16 Well ID# DPMW-6
Sa. Welt Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD
L►NCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
County _
Parcel ldcnti&cation No. (PIN)
fib. Latitude and Longitude in degrees/minutes/seconds or decimal degrees,
( if well field, one Iat/long is sufficient)
35" 29' 17.98"
81 a 15' 24.76"
N
W
6. Is (are) the well(s): ❑Permanent or ®Temporary
7. Is this a repair to an existing well: ❑Yes or EINo
!f this is a repair, fill am known ire// construction informatian and explain the nature of the
repair under fi 21 remarks section or rat the back of this form.
8. Number of wells constructed: 1
1-or mnlnple ity'ection or nan-irarer supply wells ONLI' with the same construcrian, you can
submit one font.
9. Total well depth below land surface: 35.0 (ft.)
lrornuilriple wells list all depths ifdiMVerent (example- 3 a )00' and 2@100'.)
10. Static water level below top of casing: 15.0 (ft.)
lfirater level is above casing, use "r -
11. Borehole diameter: 1.5 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use ONLYc
Id: WATER ZONES
Fao:1t ToI
DESCRIPTION
ft. ft.
ft. ft-
15. OUTER CASING (for multi -cased welh) OR LINER if ap licable
FROM
TO I DIAMETER I
THICKNESS
MATERIAL
n.
ft. I in.
'16.'INNER
CASING OR TUBING fewthermal closed -loon)
FROM
TO
DIAMETER
THICI(NESS
MATERIAL
ft.
I rt.
L in.
ft.
I ft.
I in
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
TIIIMNESS
MATERIAL
ft.
ft.
in.
'
ft.
ft.
in
18 GROUT ,
FROM
TO
MATERIAL
EMPLAC&b ENT METtrOD.& A:A1oljrfr
0.0 ft'
35.0 rr.
"'atxciawrcwre
SLURRY
fL
ft.
ft.
ft.
19.SANDIGRAVEL PACK Jif applicable)
FROM
TO
MATERIAL.
EMPLACEMENTMETHOD
ft..
fr.
ft.
ft.
20. DRILLING LOG_(attach additional sheets itnecessary)-- -
FROM
TO
I DESCRIPTION color, hardness, soi0rock type, Criti. sin, eir.l
0.0 rt.
35.0 rt•
DIRECT PUSH
ft.
fI
ft.
ft.
ft.
ft.
ft.
rL
it.
ft.
ft.
ft.
21: REMARKS ,
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22. Certif catioi
A"r 09130/16
Signature ol'Certifted Well Contractor Date
By signing this farm, 1 hereby certify that the it ell(s) was (were) cotmtristed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
capy ofthis record has been provided to the ire11 nu,ner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
utiere constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised tan: 2013

WELL CONSTRUCTION RECORD
This form can be used fat single or multiple wells
I. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #: WI0300295(UIC)
List all applicable u•cll cansintclton pernflts A e, County, State, Irariance, etc.)
3. Well Use (check well use):
Water Supply Well:
OAgricultural
❑Geothermal (Heating/Cooling Supply)
❑IndustriallCommerc ial
Non -Water Supply Well:
®Monitorinp
❑Aquifer Recharge
❑Acjuifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal(Closed Loop)
[]Geothermal I HeatinrJCooline
OMunicipal/Public
❑Residential Water Supply (single)
DResidential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormt+ater Drainage
OSubsidence Control
❑Tracer
OOther (explain under n I I
4. Date Well(s) Completed: 08/24/16 WeI ID# DPMW-5
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
Facilitylowner Name Facility IDg (ifapplicable)
129-LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
Countv
Parent lden[fication No_ (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latllong is sufficient) -
35a 29' 17.98" N 81 a 15' 24.76n W
6. Is (are) the well(s): ❑Permanent or FATemporary
7. is this a repair to an existing well: Oyes or ®No
If this is a repair, fill oar known a ell construction in forrttalinn and explain the nature rffire
repair under "21 rewarkT section nr on the hack oft/tisfornf.
S. Number or wells constructed: 1
1$nr nn,ltiple hyeciion or nfjwlrurerstrpply nrells OW I' witlt fire sane crtrfstruetian, ynu can
submit one forut.
9. Total well depth below land surface: 43.0
Tor multiple belle list all depths fills rent (example- 3@200' and 2 tt 10tr)
10. Static water level below top of casing: 30.0
!f water lerel is ahoye casing, use •'+•'
11. Borehole diameter: 1.5 (in.)
DDT RODS
For Internal Use ONLY
14. WATER ZONES
FROM TO DESCRIPTION
ft. ft.
R. R.
IS. OUTER CASING for ruulti-cased welts OR Li1VER (if a icahh"
FROM TO DIAMETER T._..- ESS MATERIAL
ft. Pt. iu
16. INNER CASING OR TUBING eothermat closed -loon)
FROM TO DIAMETER TRICIENESS MATERIAL
tt fr. in.
ft. in,
17. SCREEN'
FROM , To DIAMETER SLDTSIZE TIRCKNESS MATERIAL
ft. ' rt. in.
I
ft. It. in.
sa.GROUT.
FROM TO MATERIAL I EMPLACEMENT METHOD&AMOUNT
0.0 ft- 43.0 rt. PaR, DEWDMTE SLURRY
ft. ft.
ft, ft.
19.SANDIGRAVEL`PAC K(ifa tieable
FROM TO MATERIAL EAIPLACEMENTRIETROD
ft. ft. t
ft. ft.
20. DRILLINGLOG(attach additional sheets irnecessa
FRONT I TO DESCRIPTION dealer, hardness, soitlrock tv rsin sizr, ctr.}
0.0 fit• 43.0 fl• DIRECT PUSH
ft. ft.
ft. ft,
ft. ft.
ft. ft.
ft. ft.
ft. ft.
_2t RENIARKS..:. - -
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22. Cert%f atio
-a- 09,`30i1 s
Signature of Certified Well Contractor Date
By signing this form. I hereby certify that, the trell fs) x av j n ere) constructed it; accordance
rrith /SA NCAC 02C.0100 ar 1SA NCAC 02C.0200 Well Construction Stmklards and filar a
copy ofthis record has been prarided to the ire/l Owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional' pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction: to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method::- construction to the following:
(i.e. auger, rotary, cable, direct push etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection typt: Amount- completion of well construction to the county health department of the county
where constructed.
(ft.)
Form GW-I North Carolina Department ufEnvironment and Natural Resources- Division of Wilier Quality Revised Jan 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit 9: W10300295 (UIC)
List all applicable ,cell carrstntclion permits (t. e, County, State, Yammer, etc.)
3. Well Use (check well use):
❑Agricultural
OGeothermal (Heating/Cooling Supply)
O I nd ust r is l /Com m e rc i a i
OMunicipaliPublic
❑Residential Water Supply (single)
OResidential Water Supply (shared)
Non -Water Supply Well:
OMonitoring ORecovery
OAquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
OEeperimental Technology
OGeothermal (Closed Loop)
OGeothermal (Heating/Coohng
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
OTracer
OOther (explain under #21 F
4- Date Well(s) Completed: 08/24/16 Well 1DN DPMW4
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001 154
Facility/Owner Name Facility ID9 (if applicable)
129 LEGiONAiRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
Countv
Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds
or decimal degrees:
(if well field, oae fat/long is sufficient)
35e 29' 17.98"
81 a 15' 24.76"
N
W
6. Is (are) the well(s): ❑Permanent or OTemporary
7. Is this a repair to on existing well: OYes or . ONo
Ifthis is a repair, fill out known well construction information and explain the nature afthe
repair under'21 remarks section or on the back t f'rhit- itrnr.
S. Number of wells constructed: 1
For multiple injection or non -water supply irelfs ONLY irirh the saute construction, ),oil can
submit one farm.
For Internal Use ONLY;
I
f4. }VATER ZONES
FROM
TO
➢ESCRIPTSoN
It.
fL
fL
A.
15. OUTER CASING for multi -eased wells) OR LINER if licable)
FROM
TO DIAMETER
MATERIAL
ft.
ft. in.
I
16. INNER CASING OR TUBING eothermal closed -loop)
FROM
I TO
r DIAMETER I
THIMNESS
MATERIAL
ft.
CL
is
ft.
fL
�n
17.SCREEN
FROM
TO
OLIMETER
SLOTSIZE i THICKNESS
I MATERIAL
fL
ft,
in.
I I
fL
fL
in.
i i
13. GROUT -
FROM
TO
MATERIAL
EMPLICEM1f EN7METHOD&AMOtIhT
0.0 ft-
46.0 ft'
co rwvaearawte
SLURRY
ft.
ft.
ft.
it.
19. SANDIGRAVEL PACK if at- licahie
FROM
TO
MATERIAL EM1IPLACEMEI'rT'METHOD
ft,
f4
It.
CL
20. DRILLING LOG attach additional sheets if necessary) -
FROM
TO
DESCRIPTION { (color, hardness, will ck type, grain size, etc.)
0.0 ft-
46.0 ft-
DIRECT PUSH
ft.
It.
ft.
Ft.
fL
ft.
ft.
it-
ft.
fL
ft.
ft.
21. REMARKS.
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22. Cel
er Ycatjon:
mzttl j
- 09/30/16
Signature of Certified Well Contractor Date
By signing this form. I hereby certify that the irell(s) was (mere) constructed ill accordance
frith 15A NCAC 02C.0100 or 15ANCAC 02C.0200 Well Carutruction Standards and that a
cony of this record has been provided to the irell a,raer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSfUMONS
9. Total well depth below land surface• 46.0 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of Weil
For multiple wells list all depths tj dgerenr (-sample- 3Q200' and 2 tr,1QO') construction to the following:
10. Static water level below top of casing' 30,0 (ft.) Division of Water Quality, Information Processing Unit,
tf,raterle,•-1 is abuse co.+i,tg, usr 'v " 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
DPT RODS above, also submit a copy of this form within 30 days of completion of well
12- Well construction method; construction to the following:
(i.e. auger, rotary, cable, direct push, etc )
Division ofWater Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raje'tgh, NC 27699-1636
13a. Yield (gpm) Method of test' 24c. For Water Suooly & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-t North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Nome
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit?: W10300295 (UIC)
List all applicable teell consirnciion permits (I.e. County, State, Variance. etc.)
3, Well Use (check well use):
Wafer Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Ind ust ria (/Commerc ial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heatinp/Coolinp
4. Date Well(s) Completed:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 921 1
08/24/16 Well1D9 DPMW-3
5s. Nl'ell Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE. ROAD
Physical Address, City, and Zip
LINCOLN
NONCDO001154
Facility ID# (if npplicable)
LiNCOLNTON 28092
00631
County - Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one la rlong is sufficient)
35' 29' 17.98" N 81 a 15' 24.76" W
6. Is (are) the well(s): ❑Permanent or QTemporary
7. Is this a repuir to an existing well: ❑Yes or ®No
Ifthis is a repair, fill our knoirn well construction infornrnrlan and explain the nature ofthe
repair under r 21 renrorkt section ar at; the back of this jbrat.
8. Number of wells constructed: 1
For multiple h jection or non-rratersupply nvelis ONL I' frith the same construction. you can
submit one jbrai.
9. Total well depth below land surface: 50.0 (ft.)
For malnple iwelir list all depilrs ifdifferenf (example- 3@200' and 2Lr^g100')
10. Static water level below top of casing: 30.0 (ft.)
lfiiater level is above casing, use "+"
11. Borehole diameter: 1.5 (in.)
DDT RODS
For lntemal Use ONLY.
14. WATER ZONES
FROM I To DFscluFrloN
ft. fe:
ft. rt.
15. OUTER CASING (for multi -used wells) OR LINER ifa linable
FROM TO DIAMETER THIC7:NFS5 MATERIAL
ft. I t. I is
16. INNER CASING OR TUBING fecothermal closed -loon)
FROM TO I DIAMETER I THICKNESS I MATERIAL
ft, ft. in.
ft. ft. In.
J7: SCREEN- FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
ft. ft. in.
I
ft. ft. in.
IS. GROAT
FROM TO MATERIAL EMPLACEMENTMEJ'IIOD&AMOUNT
0.0 ft- 50.0 ft- POR LJta8E4tao rE SLURRY
ft. ft.
ft. ft.
19. SAND/GRAVEL PACK ifa lieable
FROM TO I EMPLACEIWEIR'TMErHOD
fL ft.
rt. rt.
20. DRILLING LOG nttacb additional sheets if necessary)
FROM I TO DESCRIPTION frolor, hardarss, soilf t k typ,. g.i. sire. rtr.)
0.0 ft. 50.0 ft. DIRECT PUSH
fr. ft.
ft. tt.
ft. ft.
ft. ft.
e. ft.
2L REMARKS -
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22. Certification: A'�-JYL09/30/16
Signature ofCenified Well Contractor Date
Hj, signing this jhrrtr, 1 hereby eertifv Oar tic irell(s) it -as 6rerv) constructed in accordance
tritb 15A NCAC 02C .0100 or 15.4 NCAC 02C.0200 Ii ell Construction Siondardr gild thaw a
copy ofthis record has been prorided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion: of well
constriction to the following:
Division of Water Quality, Information Processing Unit,
1617 Muil Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of %,vll
12: Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.) -
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) \lethud or test: 24c. For Witter Supply & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of wetl construction to the county health department of the county
where constructed.
Fonn GW-1 North Carolina Depannteta of Environment and Natural Resources - Division of Water Quaio, Revised Jan. 2013

SELL CONSTRUCTION RECORD
This farm can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2- Well Construction Permit #: WI0300295 (UIC)
Litt ail applicable ?rell coralmetion permits (t,e Corrtuy, State, lrariance, etc)
3. Well Use (check well use):
Water Supply Well:
OAgricultural ❑Municipal/Public
OGeothermal (HeatinglCooling Supply) OResidential Water Supply (single)
Olndustrial/Commercial OResidential Water Supply (shared)
Supply Well:
01NIonitori
OAquifer Recharge OGroundwater Remediation
OAquifer Storage and Recovery OSaiinity Barrier
OAquifer Test OStormwater Drainage
OExperimental Technology OSubsidence Control
OGeothermal(Closed Loop) OTracer
)lain under k21 Remarks
4. Date Weil(s) Completed: 08/24/16 Well ID# DPMW-2
5a, NVeil-Location:
ROBERT BOSCH TOOL
NONCDO001154
Facility/Owner Name
Facility ID# (if applicable)
129 LEGIONAIRE ROAD
LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
00631
County
Parcel identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(it -well field one latilong is sufficient)
350 29' 17.98"
81 ° 15' 24.76"
N
W
6. Is (are) the well(s): ❑Permanent or 10Temporary
7. Is this a repair to an existing well: Oyes or 91No
1101tir is a repair, fill our known well constnrction it formation and explain the nature afthe
repair under #21 remarks section or on the back of thus fans.
8. Number of wells constructed: 1
For nndri'ole it jectian or lion -outer supply urlhs ONLY wish the same construction. you can
submit our farts.
For imerml Use ONLY;
14. WATER ZONES - - - -
FROM
TO DESCRH'TION
fe.
ft.
it-
IL
IS. OUTER CASING for multi -cased wells) OR LINER if a cabte
li
FROM
TO
DIAMETER
THICKNESS
hIATERIAL
rt.
ft.
in
16. INNER CASING OR TUBING eothermal closed -loop)
FROM
TO t DIAMETER I
THICKYESS
MATERIAL
ft.
ft. in.
ft.
IL in.
17. SCREEN
- - -
FROM
TO
DIAMETER
SLOTSIZE
THiCK.NES,S
MATERIAL
ft.
ft.
im
ft.
ft.
in.
18. GROUT
FROM
TO
I MATERIAL
EMPL10EhfENTAfETIiOD&AitiouNT
0.0 rL
48.0 rt,
vowru DOEt-ITE
SLURRY
It.
ft.
It.
ft.
19. SANDIGRAVEL PACK: if a 6coble
FROM
TO
MATERIAL I
EMPLACEME:NTMETHOD
ft.
ft.
ft.
ft.
20. DRILLING,LOG
attach additional sheets irnecessary -'
FROM
TO
DFSCRIPI'ION color, harainess, saiLrnek t rain aiu, etc.
0.0 fL
48.0 ft.
DIRECT PUSH
ft.
ft,
ft.
ft.
ft.
ft.
ft.
ft.,
ft.
It.
ft.
ft.
11. REDIARKS
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22. Certification:4"--,
08130116
Signature ofCertifred Well Contractor Date
B)r signing this farm. 1 hereby certify that the it-ell(s) teas (were) constructed in accordance
with 15AVCAC 01C.0100 or 15A,VCAC 02C.0200 Well Construction Standards and Aral a
copy ofthis record /tos been prarided to tire well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
9. Total well depth below land surface: 48.0
(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths lfdii ferent (example- 3 rt 200' and 1Q1001)
construction to the following:
10. Static water level below top of casing: 30.0
(ft.) Division of Water Quality, Information Processing Unit,
1(=rarer level Ls above caring, use "+-
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1.5 (in.)
24b. For Iniection Welts: In addition to sending the form to the address in 24a
DPT RODS
above, also submit a copy of this form within 30 days of completion of well
12- Well construction method:
construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
-
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 lElail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Alethod of test.
24c. For Water Supply do Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount,
completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of E nvironment
and Natural Resources - Division of Water Quality Revised Jan 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: W10300295 (UIC)
List all applicable well construction permits (i.c. Culm(v, State, 1'arionce, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimentnl Technology
❑Geathermal(Closed Loop)
❑Geothermal (Heatin&Coblina
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Grounds ater Remediation
❑Salinity Barrier
❑Slorm,kater Drainage.
❑Subsidence Control
❑Tracer
❑Other (explain under 921 F
4. Date Well(s) Completed: 08/24/16 Well ID# DPMW-1
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
FacilityfOwner Name Facility ID# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
'LINCOLN 00631
County Parcel ldcati(lcation No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one fat/long is sufficient)
35' 29' 17.98" N 810 15' 24.76" IV
6. Is (are) tht well(s): ❑Permanent or IOTemporary
7. Is this a repair to an existing well: ❑Yes or ®No
Ifrhis it a repair. fill alit know T-ell construction information and explain the nature of the
repair under 921 remarks section or on the back ofdnis farm.
9. Number of wells constructed: 1
Far nwhiple h jeeiion ar non -water sr np/r• trel/s ONLY u•iih the• .same cansrruciioa. you can
submit one fiirm.
9. Total well depth below land surface: 45.0
For multiple wells list all depilis ifdrirent (example- 3@200' and 2@ l Ur1,)
10. Static water level below top of casing: 30.0
Ifwater level is above casing, Use •'+
11. Borehole diameter: 1.5 (in.)
DDT RODS
For Internal Use ONLY•
14. WATER ZONES
FROM TO DESCRIPTION
ft. ft.
ft. ft.
15. OUTER CASING for multi -cased wells OR LINER if a licable
FROM 70 DIAMETER THECf:NFS5 MATERIAL
ft. ft. I in
16. INNER CASING OR TUBING f2eothermnl closed -loon)
FROM TO DIAMETER THICKNESS I SIAT£RIAL
ft. ft. in
fL ft. in-
17.SCREEN
FROM TO DIAMETER SLOTSIZE THICKNESS MATERIAL
ft. ft. in
fL rt. in
18. GROITC
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
0.0 ft. 45.0 It' PDxtt woasnTcrmE SLURRY
ft. ft.
ft. ft.
19. SAND/GRAVEL PACK if a licable
FROM TO MATERIAL I E.MPLACEM ENT METHOD
ft. ft.
ft. ft.
20. DRILLING LOG attach additional sheets if necessary)
FROM TO DESCRIPTION (color, hardness, soilfmck t -in siu, rts.)
0.0 rr• 45.0 ft- DIRECT PUSH
ft. n. -
ft. fr.
ft. ft.
fr. ft.
fa ft.
ft. rr.
21. RUNIARKS -
TEMPORARY DIRECT PUSH GROUNDWATER SAMPLE
22. Certification:
09/30/1 s
SignanueofCertified Well Contractor Date
Hr signing tha faun, l hereby cerr J• that flee nr/f(s) was (were) constructed in accardancc
frith 15A NCAC 02C .0/00 or 1 SA NCAC 02C, 0200 Well Cmuiniction Srondards and that a
cop), afthis record has becit provided to tire well of ner.
23. Site diagram or additional ivell details:
You may use the back of this page to provide additional «yell site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24n. Fur All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection \Veils: In addition to sending the form to the address in 24.1
above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: - construction to the following: - -
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13n. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount- completion of well construction to the county health department of the county
where constructed.
(ft.)
Form Gw-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised fan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Weli Construction Permit#: WI0300295 (UIC)
List all applicable well construction perndts fl.e. County. Stare, Varimice, etc.)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Pubtic
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercin] ❑Residential Water Supply (shared)
Well:
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage. and Recovery ❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑ Experimental Technology
❑Subsidence Control
❑Geothermal(Closed Loop)
❑Tracer
❑Geothermal (Hen Ling/Cooling Return)
❑Other (explain under #21 F
4. Date Well(s) Completed: 09/08/16
Well 1D# MW-44S
Sa. Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name Facility ID# (ifapplicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN
County
00631
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/fong is sufficient)
35e 29' 08.72" N 810 15' 21.20"
6. Is (are) the welt(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or MNo
1J'tliix is a repair, fill out known sell construction bybrmation and explain the nature q/'the
repair under 4"11 remarks section or e m the back of this form.
S. Number of wells constructed: 1
Far multiple huccrion or tton-i atersapply wells ONLY millr the same construction, yotd can
submit one form.
9. Total well depth below land surface: 60.0 (ft.)
For multiple hells list all depths ifdifferent (example- 3Q200' and 1 rr 1001
10. Static water level below top of casing: 25.0 (ft.)
lfmarer level is abore casing, use "+" .
11. Borehole diameter: 8•0 (in.)
12. Well construction -method: AUGER
NONCD0001154
For Internal Use ONLY.,
14. AVATER ZONES
FROM TO I DESCRIPTION
ft. fL
ft. tt.
15. OUTER CASING far multi-ensed wells OR LINER if a licabte
FROM To DIAMETER THICKNESS hATERIAL
ft. I ft, in.
16. INNER CASING OR TUBING (geothermal closed -too
FROM TO DIAMETER THICKNESS MATERIAL
0.0 It. 40.0 fL 2.0 i" SCH 40 PVC
ft. ft. is
17. SCREEN
FROM TO DlAtIfETER St.OTSiZE THICKNESS MATERIAL
40.0 It' 60.0 IL 2.0 .010 SCH 40 PVC
1
ft. ft. in.
1 19, GROUT
FROM TO MATERIAL EMPLACEMENTMETHOD&AMOUNT
0.0 ft' 30.0 ft' vonnuwartaomre SLURRY
ft, ft.
ft. M
19. SANDICRAVEL PACK if a " lieable
FROM I TO MATERIAL EMPLACEMENTAIETIIOD
36.0 It. 60.0 ft. 2040 FINE SILICA SAND
ft. tt.
20. DRILLING LOG attach additional sheets if Fte-c"n
FROM TO DESCRIPTION color, hardness soilfroch t , ruin siu, ett.
0.0 ft. 1.0 ft. BACKFILL
1.0 It. 14.0 It. RED SILTY CLAY
14.0 IL 22.0 It- BROWN SILTY CLAY
22.0 It• 36.0 ft. BROWN SILT
36.0 ft. 55.0 ft BROWN SILTY SAND
55.0 It• 60.0 fL BROWN SANDY PWR
ft. ft.
21. REMARKS `
BENTONITE SEAL FROM 30.0 TO 36.0 FEET
22. Certification:
-�-- 09/30/16
Signature ofCortif,ed Well Contractor Date
By signing this farm. I hereby certify char, III ell(s) was (mere) camxirdcled in accardatcce
with 1JA NCAC OIC .OlW or 1JA NCAC 02C .0200 lVell Carartruction Slatrdar I and that o
copy of this record has berm pravlded rn the ,ve/1 mvenr,
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For Ail Welts: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699.1617
24b. For Infection Wells: -In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
(r.c. auger, rotary, cable, Gucci push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yidd (gpm) Method of test: 24c. Fir r Wuter Suoaly & tniection Wells: In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount, completion of %veil construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jar. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or malGple welts
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit#: WI0300295 (UIC)
I.isr all applicable well conxtruction perMAT 0 e. Caunq,, State, Variance, etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothermat (HeatinglCooling Supply)
❑ tndustrial/Commerc ial
Non -Water Supply Well:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Aquifer Recharge ❑Groundwater Remediation
_
❑Aquifer Storage and Recovery ❑Salinity Barrier
OAquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other (explain under #21 P
4. Date Well(s) Completed: 09/09/16 Well ID#_ MW-44D
5a. Well Location:
ROBERT BOSCH TOOL
Facility/Owner Name
129 LEGIONAIRE ROAD
Physical Address, City, and Zip
LiNCOLN
County
NONCD0001154
Facility IDO (ifapplicable)
LINCOLNTON 28092
00631
Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one fattlong is sufficient)
35e 29' 08.79" N 810 15' 21.20" W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: , ❑Yes or ONO
If Ibis is a repair, fill out knourn well co nstrucrion information and explain dre nature ofthe
repair 'older #21 remarks section or an the back of this forin.
8. Number of wells constructed: 1
For arriitipte iryection or non,water supply wells ON1-I' with the some constracdnn, you can
submit one fomr.
9. Total well depth below land surface: 83.0 (n;)
For multiple wells list all depths ifdierent (example- 3 a300' will IQ/00'i
10. Static water level below top of easing: 25•0
lf'water lerel is above casing, use -+-
11. Borehole diameter. 12.015.87517.875 (in.)
A
For Internal Use ONLY:
14. WATER ZONES
FROM TO DESCRIPTTION
ft. ft.
15.OUTER CASING for multi a ned welts OR LINER if a Ileable
FROM TO D1MiETER TH1C7:NE55 MATERIAL
Q.0 rr. 67.0 ft. 6.0 in SCH 40 PVC
16. INNER CASING OR TUBING deenthennot closed4wril
FROM -I TO DIAMETER THICKNESS MATERIAL
0.0 R. 78.0 it. 2.0 in. SCH 40 PVC
ft. fi. in.
17.SCREEN
FROM TO DIAMETER I SLOT SIZE 711ICKNESS MATERIAL
78.0 ft' 83.0 it. 2.0 In' .010 SCH 40 PVC
D. D. in.
]& GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
0.0. 1- 65.0 f`• voanumewra.tra SLURRY
0.0 ft. 67.0 ft. Pawn WaaTNTaraTa SLURRY
ft. tt.
'19. SANDIGRAVEL PACK if a licable
FROM TO MATERIAL EMPLACEMENTMEI•HOD
75.0 . fL 83.0 ft• 20-40 ._ ' FINE SILICA SAND
ft. ft.
20. DRILLING LOG attoeh additional sheets ifnecesa
FROM TO - DESCRIPTION totor, hardness, suillmit type, criia sin etc.
0.0 ft 1.0 ft. BACKFILL
1.0 f` 13.0 f`• RED SILTY CLAY
13.0 R' 29.0 f`• BROWN SILTY CLAY
29.0 ft. 40.0 it' BROWN SILT
40.0 ft• 55.0 IL BROWN SILTY SAND
55.0 ft. 83.0 ft- BROWN SANDY PWR
ft. te.
21. REMARKS "
BENTONiTE SEAL FROM 65.0 TO 75.0 FEET
22. Certification: '
09/30/16
Signature of Certified Well Contractor Date
By signing this fornn. I hereby curt((}, that tlrc uell(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 0IC .0200 lVell Cotisiruction Standard.T and Iltar a
copy ofihis record has been provided to the well ounce:
23. Site diagram or additional well details:
You may use the back of this page to provide additional;well site details or well,
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For Ali Wells: Submit this form within 30 days of completion of well
construction to tht: following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Welig in addition to sending the form to the address in 24a
UGERlMUD ROTARY/AIR above' also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e.'augm, r Mary, cable, direct push, etc.)
Division of Water Quality, Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Nlethud of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-i North Carolina Department of Emtironment and Naturai Resources - Division of Water Quality
Revised Jan, 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, ING
Company Name
2. Well Construction Permit #: W10300295 (UIC)
List all applicable trell construction permits (i.e. County, State, Parlance, eta)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commerc ial
Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
4. Date Well(s) Completed: 09/13/16 Well ID# PMW-27-E
5a. Well Location:
ROBERT BOSCH TOOL NONCD0001154
FacilitylOwner Name Facility ID# (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City. and Zip
LiNCOLN
County
00631
Parcel Identification No (PIN)
5b. Lutitude and Longitude in degrees/minutes/seconds or decimal degrees
(if well field• one fatllong is sufficient)
350 29' 15.64" N 810 15' 27.16"
6. Is (are) the well(s): 7Permanent or. ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or EiNo
Ifthis Is a repair, fell out known well construction bt oratation and explain the nature ofilre
repair ender #11 remarks section or on the back of this fora:.
8. Number of wells constructed: 1
Aor undtiple iglection or note -crater supply wells ONL I' with the same congructian, you can
submit ane firm.
9. Total well depth below land surface: 42.0
1'or atnitiple wells list all depths if different (sample- 3 «200' and 2@100')
10. Static water level below top of casing: i25.0 it
Ifirater lestl is above casing, nse
11. Borehole diameter: 8•0 (in.)
12. Well construction method: AUGER
(i.e. auger, rotary; cable, direct push, etc.)
For Internal Use ONLY:
14. WATER ZONES
FROM ToI DESCRIPTION
fL f6
ft. ft.
1S. OUTER CASING for multi -eased wells OR LINER tf a Gcabk
FROM TO DIAMETER THICKNESS MATERIAL
ft. it. I in.
16. INNER CASING OR TUBING eothermat closed-looril
FROM I TO I DIAMETER I THICKNESS I MATERIAL
0.0' rr• 32.0 ft- 2.0 "a SCH 40 PVC
tt. tt. in.
17, SCREEN
FROM I TO DIAMETER SLOTSIZE I TIJICKNtSS MATERIAL
32.0 1" 42.0 f° 2.0 I"• .OTO SCH 40 PVC
ft. R, in.
18. GROUT
FROM TO MATERIAL EMPLACEMENTMETROD&AMOUNT
0.0 it" 27.0 R• rann,wae-To-c SLURRY
D. ft.
ft. ft.
19. SANDIGRAVEL PACT{ if q licable
FROM TO I MATERIAL I EMPLACEMENTMErHOD
30.0 ft- 42.0 rt 20-40 FINE SILICA SAND
ft. ft.
20. DRILLING LOG factsch additional sheets if necessa
FROM TO DESCRIPTION (color, hardness, soillmli IyM grain size etc.
0.0 R' 1.0 ft. BACKFILL
1.0 R• 9.0 ft. RED SILTY CLAY
9.0 rL 27.0 rt• BROWN SILTY CLAY
27.0 rt, 42.0 fL BROWN SILTY SAND
ft. ft.
ft. ft.
ft. ft.
21. REMARKS
BENTONITE SEAL FROM 27.0 TO 30.0 FEET
22. Certi c tion:
k'z-
09/30/16
Signature ofCertified Well Contractor Date
By signing this form. I hereby certify that the 111e11(s) was (were) constructed in accordance
iritlr IBANCAC 02C.0100 or 15A NCAC 02C.0200 {Yell Construction Standants and thin a
copy of this record haw been provided to the irell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional %veil site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL iNSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells: In addition to sending the form to the address in 24.1
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jai. 2013

Wf a 30v z 95
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
KENNY SARGENT
Well Contractor Name
A - 4226
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit (l: W10300295 (UIC)
List all applicable well construction permits P.e. County, Stale, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
OGeothermal (Heating/Cooling Supply)
Olndustrial/Commercial
Non -Water
OAquifer Recharge
OAquifer Storage and Recovery
OAquifer Test
❑Experimental Technology
OGecthennat (Closed Loop)
OGeathermal (Heatine/COOIinR 1
❑ivlunicipal/Public
OResidential Water Supply (single)
OResidential Water Supply (shared)
OGroundwater Remediation
❑Salinity' Barrier
OStormwater Drainage
❑Subsidence Control
OTracer
C1Other (exolain under 921 F
4. Date Well(s) Completed: 09/13/16 Well 1D# PMW-27-W
5a. Well Location:
ROBERT BOSCH TOOL NONCDO001154
Facility/Owner Name Facility ID0 (if applicable)
129 LEGIONAIRE ROAD LINCOLNTON 28092
Physical Address, City, and Zip
LINCOLN 00631
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one IaUtong is sufficient)
350 29' 16.06' N 810
15' 28.16" W
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or . MNo
If this is a repair, fill out known well constriction itrfarnianan and esplain the nature aftlre
repair tender #21 remarks sectias or our ilia back ofthis farar.
8. Number of wells constructed: 1
For nmtriple injection at- nan-stater supply wells ONLY is -hilt the same construction• pill can
submit one form.
9. Total well depth below land surface: 28'0 (ft.)
for ntuhipie wells list all depots ij'difjercut (esasi0e- 3 st 300' and 2 t>;)i 160')
For Internal Use ONLY:
14. WATER
ZONES
FROM
TO
I DESCRIPTION
fr.
it.
ft
It.
15. OUTER CASING for
rnutti-cased wells ORTSa
licable
FROM
MATERIAL
ft.
ft
in.
16 INNER
CASING OR TUBING(geothermal
clostd-loo"
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0.0 fL
18:0 rr,
2.0 in.
SCH 40
PVC
IL
fL
in.
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
28.0 ft•
2.0 in'
.010
SCH 40
PVC
nNTo
ft.
in.'TO
IATERIAL
EMPLACEMLWMrrIIOD&AMOUNT
0.0 it'
13.0 it'
ooRI-Der7 am"
SLURRY
ft.
ft.
ft.
R.
19SAND/GRAVEL
PAC [i ifa icable
FROM
TO
MATERIAL
FAIPLACEAI NTMETHOD
16.0 fr•
28 0 R-
20-40
FINE SILICA SAND
ft.
fr.
20. DRILLING
LOG tattncb
additional sheets if necessa
FROM
TO
DESCRIPTION color, hardness, stsWrock typt, timin size, etc.
0.0 ft.
1.0 ft
BACKFILL
10 it.
9.0 ft•
RED SILTY -CLAY
9.0 it'
22.0 R
BROWN SILTY CLAY
22.0 R
28.0 ft•
BROWN SILTY SAND
R.
ft.
ft,
ft.
21 REtiIARKS
-`
BENTONITE SEAL FROM 13.0 TO 16.0 FEET
22. Certification: j
�.lots- 09/30/16
Signature of Certified WellContiacctorr Date
By signing dris form I hereby certify that the irell(s) was (is -ere) cotrstructed in accordance
with l SA NC AC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and dial a
copy of this record lute been prarlAd to the n'ell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMI7TALINSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10. Static water level below top of cusing: 18.0 (fLj Division of Water Quality, Information Processing Unit,
Ifuwier lerel is above caring, use "+- 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 8.0 (in.) 24b. For Infection Wells: In addition to sending the form to the address in 24a
AUGER above, also submit a copy of this form within 30 days of completion of well
12,1Ve11 construction method: construction to the following:
(i:e. auger, rotary, sable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test; 24c. For Water Supply & Iniection Wells: jn addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised lass. 2013

Shrestha, Shristi R
From: Wise, Gary W <[e-mail]>
Sent: Thursday, October 20, 2016 5:00 PM
To: Shrestha, Shristi R; Rogers, Michael
Subject: UIC reporting WI0300295 - Temporary Well Abandonment Records
Attachments: GW30 Forms_DPMW.pdf; GW30 Forms_Temp_IW.pdf; GW30 Residential
2016-03-14.pdf
Ms. Shrestha,
I have attached digital copies of GW30 Well Abandonment Records for temporary injection wells and direct -push
profiling borings (DPMW) for the 2016 groundwater remediation under UIC permit W1030029S.
GW30 Forms Temp_IW.pdf contains well abandonment records for 44 new temporary injection wells in
the IW6,
IW20, IW25, and IW27 arrays which were not converted to permanent
wells
GW30 Forms Temp_DPMW.pdf contains GW30 records for 11 direct -push temporary profiling borings
(DPMW-1 to -11)
GW30 Residential 2016-03-14.pdf contains the abandonment record for the residential well at 120
Legionaire, which had
to be abandoned prior to performing injections in the IW20 array.
As before, the variation in boring or well depth caused us to resort to one form per well.
Gary Wise
Senior Environmental Engineer, Environment & Infrastructure, Amec FosterWheeler
37 Villa Road, Suite 201, Greenville, SC 29615, USA
T [phone] D [phone] M [phone]
gary.wiseCcDamecfw.com amecfw.com
amec
foster
wheeler
This message is the property of Amec Foster Wheeler plc and/or its subsidiaries and/or affiliates and is intended only for the named
recipient(s). Its contents (including any attachments) may be confidential, legally privileged or otherwise protected from disclosure
by law. Unauthorised use, copying, distribution or disclosure of any of it may be unlawful and is strictly prohibited. We assume no
responsibility to persons other than the intended named recipient(s) and do not accept liability for any errors or omissions which are
a result of email transmission. If you have received this message in error, please notify us immediately by reply email to the sender
and confirm that the original message and any attachments and copies have been destroyed and deleted from your system. This
disclaimer applies to any and all messages originating from us and set out above. If you do not wish to receive future unsolicited
commercial electronic messages from us, please forward this email to: unsubscribe(i-amecfw.com and include
"Unsubscribe" in the subject line. If applicable, you will continue to receive invoices, project communications and similar factual,
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Please click http://amecfw.com/email-disclaimer for notices and company information in relation to emails originating in the UK,
Italy or France.

Shrestha, Shristi R
From: Wise, Gary W <[e-mail]>
Sent: Thursday, October 20, 2016 4:14 PM
To: Shrestha, Shristi R; Rogers, Michael
Subject: UIC reporting WI0300295 - Temporary Well Construction Records
Attachments: GW1T Forms Temp_DPMW.pdf, GWiT Forms Temp_IW.pdf
Ms, Shrestha,
I have attached digital copies of GW-1 Well Construction Records for temporary injection wells and direct -push
profiling borings (DPMW)
for the 2016 groundwater remediation under UIC permit W10300295.
GW1T Forms Temp_IW.pdf contains well construction records for 90 new temporary injection wells in
the IW6,
IW20, IW25
GW1T Forms Temp_DPMW.pdf contains GW-1 records for 11 direct -push temporary profiling
borings (DPMW-1 to -11)
As discussed, we had attempted to combine multiple wells on a single GW-1 form; however, the prevalence of shallow
refusal and variation in boring or well depth caused us to resort to one form per well.
Due to the file sizes, the GW30 Well Abandonment Records will be transmitted separately.
Gary Wise
Senior Environmental Engineer, Environment & Infrastructure, Amec FosterWheeler
37 Villa Road, Suite 201, Greenville, SC 29615, USA
T [phone] D [phone] M [phone]
gary.wise(a)amecfw.com amecfw.com
a m c+..� 9r
,
foster
wher' .
This message is the property of Amec Foster Wheeler plc and/or its subsidiaries and/or affiliates and is intended only for the named
recipient(s). Its `contents (including any attachments) may be confidential, legally privileged or otherwise protected from disclosure
by law. Unauthorised use, copying, distribution or disclosure of any of it may be unlawful and is strictly prohibited. We assume no
responsibility to persons other than the intended named recipient(s) and do not accept liability for any errors or omissions which are
a result of email transmission. If you have received this message in error, please notify us immediately by reply email to the sender
and confirm that the original message and any attachments and copies have been destroyed and deleted from your system. This
disclaimer applies to any and all messages originating from us and set out above. If you do not wish to receive future unsolicited
commercial electronic messages from us, please forward this email to: [e-mail] and include
"Unsubscribe" in the subject line. If applicable, you will continue to receive invoices, project communications and similar factual,
non-commercial electronic communications.
Please click http://amecfw.com/email-disclaimer for notices and company information in relation to emails originating in the UK,
Italy or France. i

wso3oazg5
Shrestha, Shristi R
From: Wise, Gary W < [e-mail] >
Sent: Thursday, October 20, 2016 5:00 PM
To: Shrestha, Shristi R; Rogers, Michael
Subject: UIC reporting WI0300295 - Temporary Well Abandonment Records
Attachments: GW30 Forms_DPMW.pdf; GW30 Forms _Temp _IW.pdf; GW30 Residential
2016-03-14.pdf
Ms. Shrestha,
I have attached digital copies of GW30 Well Abandonment Records for temporary injection Wells and direct -push
profiling borings (DPMW) for the 2016 groundwater remediation under UIC permit W10300295.
GW30 Forms Temp_IW.pdf contains well abandonment records for 44 new temporary injection wells in
the IW6,
IW20, IW25, and IW27 arrays which were not converted to permanent
wells
GW30 Forms Temp_DPMW.pdf contains GW30 records for 11 direct -push temporary profiling borings
(DPMW-1 to -11)
GW30 Residential 2016-03-14.pdf contains the abandonment record for the residential well at 120
Legionaire, which had
to be abandoned prior to performing injections in the IW20 array.
As before, the variation in boring or well depth caused us to resort to one form per well.
'Gary Wise
Senior Environmental Engineer, Environment & Infrastructure, Amec FosterWheeler
37 Villa Road, Suite 201, Greenville, SC 29615, USA
T [phone] D [phone] M [phone]
parv.wise(ZDamecfw.com amecfw.com
foster.
I-
W11
This message is the property of Amec Foster Wheeler plc and/or its subsidiaries and/or affiliates and is intended only for the named
recipient(s). Its contents (including any attachments) may be confidential, legally privileged or otherwise protected from disclosure
by law. Unauthorised use, copying, distribution or disclosure of any of it may be unlawful and is strictly prohibited. We assume no
responsibility to persons other than the intended named recipient(s) and do not accept liability for any errors or omissions which are
a result of email transmission. If you have received this message in error, please notify us immediately by reply email to the sender
and confirm that the original message and any attachments and copies have been destroyed and deleted from your system. This
disclaimer applies to any and all messages originating from us and set out above. If you do not wish to receive future unsolicited
commercial electronic messages from us, please forward this email to: [e-mail] and include
"Unsubscribe" in the subject line. If applicable, you will continue to receive invoices, project communications and similar factual,
non-commercial electronic communications.
Please click http://amecfw.com/email-disclaimer for notices and company information in relation to emails originating in the UK,
Italy or France.