WI0400567_Permit (Issuance)_20210316

February 17, 2021
North Carolina Department of Environmental Quality
Division of Water Resources — UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699
Subject:
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina 28208
Licensures: NC Engineering F-1253, Geology C-247
T: 704-357-8600
www.woodplc.com
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Notification of Intent (NOI) to Operate Injection Wells for Pilot Testing
CCI National Fleet Supply
2744 West Mountain Street
Kernersville, North Carolina 27284
NCDEQ IHSB ID: NONCD0001720
Wood Project 3160-20-1043
Dear UIC Program:
Wood Environment & Infrastructure Solutions, Inc. (Wood) on behalf of Illinois Tool Works, Inc. (ITW) is
pleased to submit the attached Notification of Intent (NOI) to Operate Injection Wells for a pilot test at the
above -referenced site.
We appreciate your time in the review of this data and are available at your convenience to discuss the
contents of this submittal. You may contact the undersigned below at [e-mail] or
[e-mail] to further discuss the site.
Sincerely,
Wood Environment & Infrastructure Solutions, Inc.
Nick Hotzelt, PE
Environmental Engineer
Enclosures
cc: Michael Hoffman, Wood
Andrew Dorn, ITW
Wood' is a trading name for John Wood Group PLC and its subsidiaries
Cdt
Helen P. Corley, LG, BCES
Principal Hydrogeologist
•

C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): Illinois Tool Works, Inc. I ITW) / Mr. Andrew Dorn, PE, Sr. Environmental Engineer
Mailing Address: 155 Harlem Avenue
City: Glenview State: IL Zip Code: 60026 County: Cook
Day Tele No.: 224-661-8870 Cell No.:
EMAIL Address: adorngitw.com Fax No.:
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Robert Arnold, President
Company Name Associated Posters, Inc.
Mailing Address: 2737 West Mountain Street
City: Kemersville
State: NC_ Zip Code: County: Forsyth
Day Tele No.: 336-723-1018 Cell No.:
EMAIL Address: roberassociatedposters.com Fax No.:
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Helen Corley
Company Name Wood Environment & Infrastructure Solutions, Inc. (Wood)
Mailing Address: 2801 Yorkmont Road, Ste 100
City: Charlotte State: _NC Zip Code: 28208 County: Mecklenburg
Day Tele No.: 704-236-3494 Cell No.:
EMAIL Address: helen.corley(u woodplc.com Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Former CCI National Fleet Supply Facility
2744 West Mountain Street
City: Kemersville
County: Forsyth
Zip Code: 27284
(2) Geographic Coordinates: Latitude**: 36 ° 06 ' 48.5 " or °.
Longitude**: 80 ° 09 ' 42.0 " or
°
Reference Datum: Center of site parcel Accuracy:
Method of Collection: Google Earth
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: 99.750 square feet
Land surface area of inj. well network: 2,000 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: —2% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells;
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE — Provide a brief narrative
regarding the cause of the contamination, and purpose, scope, goals of the proposed injection activity:
The site was formerly occupied by an approximately, 29.000 square foot manufacturing building constructed in
the early 1960s. The building was used as a brake manufacturing facility from initial construction until the early
2000s. A release from the petroleum underground storage tank system at the adjacent One Stop property was
discovered in the early 1990s, at which time chlorinated solvents were detected in groundwater. Subsequent
assessment activities indicated the presence of chlorinated volatile organic compounds (VOCs) and 1,4-dioxane
above their respective NC 2L Standards. Wood proposes to implement an in -situ chemical oxidation (ISCO)
pilot study in the source area (MW-2) and in the vicinity of the highest concentration detected in groundwater
(MW-6). ISCO is a proven technology capable of treating 1=4-dioxane and chlorinated solvents present at the
site including trichloroethylene (TCE). Sodium persulfate with FeEDTA activation was selected as the ISCO
injectant based on aquifer and site -specific parameters. The injection will be performed by Redox Tech out of
Caiy, NC under the supervision of Wood.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: Proposed 4 Existing (provide NC Well
Construction Record (GW-1) for each well)
Appx. injection depths (BLS): 25-40 ft below ground surface
For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
(2)
(3)
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 3

K. INJECTION SUMMARY
NOTE: Onh• injectants approved by the epidemiology section of the NC Division of Public Health, Department
of Health and Human Services can be injected. Approved injeetanfs can be found online at
http://d_sq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/groutul-water-
ctioniground-water-approved-bjectants. All other substances must be reviewed by the DIMS prior to use.
Contact the UIC Program for more info if you wish to get approval for a different additive. However, please
note it may take 3 months or longer. If no iniectants are to be used use N/A.
lnjectant: Sodium Pcrsulfate Total Amt. to be injected (gal)/event: —953 gallons
Injectant: Iron Eth► lenediaminetetraacetic Acidjj e(EI)TA )i Total Amt. to be injected (gal)/event: —8 gallons
lnjectant: Hydroxide (base) Total Amt. to be injected (gal)/event: —300 gallons
Injectant: municipal water Total Amt. to be injected (gal)/event: —2.750 gallons
Injectant: Total Amt. to be injected (gal)/event:
Total Amt. to be injected (gal/event):
No. of separate injection events:1 Total Amt. to be injected (gal): --4,000 gallons O,000 gal/well)
Source of Water (if applicable): municipal fire hydrant along West Mountain Street
L. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
Performance monitoring will be conducted to evaluate the effectiveness of the infection near the source area and
near the area of highest concentration. Closely prior to injection activities, a sampling event will be conducted
to establish baseline conditions at the site. Following injection. performance monitoring events will be conducted
approximately 1 month. 3 month. 6 months. and 12 rnonths following substrate iniection to evaluate treatment
progress at the site. Foriperformance monitoring. Wood personnel will sample monitoring wells MW-2. MW-
2D. MW-6. MW-7. MW-CBD- and MW-C11. Groundwater samples will be analyzed for volatile organic
compounds (VOCs) by EPA Method 8260. 1,4-dioxane by EPA Method 8260 SIM, nitrate and sulfate by EPA
Method 300.0. and select metals (As, Ba. Cd. Cr. Se, and Pb) plus total and dissolved iron by EPA Method 6020.
Additionally, three surface water samples will be collected during the baseline. 6-month. and 12-month
performance monitoring events. Surface water samples will be collected from three downgradient surface water
Ibcations. The surface water samples will be analyzed for VOCs by EPA. Method 8260 and 1.4-dioxane by EPA
Method 8260 SIM.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Anplicant: "7 hereby certify, under penalty of law, that 1 am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false.information, 1 a wec a onstr-uct, operate, maintain, repair, and if applicable, abandon the
injection well and cll/ related apt rrtenances it accordance with the 15A NCAC 02C 0200 Rules."
Signatiirc of Applicant
Print or Type Full Name and Title
Deemed Permitted GW Remediation NOi Rev. 2-17-2020 Page 4

Property Owner (if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A NCAC 02C .020Q)."
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the landowner, in the
absence of contrary agreement in writing.
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Please send 1 (one) hard color copy of this NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 5

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WELL CONSTRUCTION RECORD I GW-11
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 #:
List all applicable well construction permits (Le. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ IndustriaUCommercial
❑ Irrigation
❑ Municipal/Public
❑ Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells> 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
DAquifer Recharge
DAquifer Storage and Recovery
❑Aquifer Test
DExperimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
OGroundwater Remediation
❑ Salinity Barrier
❑Stormwater Drainage
0 Subsidence Control
❑Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 12/14/20 Well ID#
5a. Well Location:
CCI FLEET SUPPLY
IW-1-1
Facility/Owner Name Facility ID# (if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address, City, and Zip
FO RSYTH
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
36° 06' 48.33" N 80° 09' 43.32"
6. Is(are) the well(s): IJPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or I!!No
If this is 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. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 40.0 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 25'0 (ft.)
If water level is above casing. use "+"
11. Borehole diameter: 6.0
12. Well construction method:
(in.)
SONIC
(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
DESCRH'TION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop}
FROM
TO
DIAMETER
THICKNESS MATERIAL
0.0 ft'
25.0 ft•
2.0 in.
SCH 40 PVC
ft.
ft.
in.
17. SCREEN
FROM
TO I DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
25.0 ft,
40.0 ft. 1
2.0 in'
.010
SCH 40
PVC
ft.
ft. I
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft.
18.0 ft.
PORTLANDBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL
PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
23.0 ft-
40.0 ft'
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DF.SC RI I.1 ION Iso lur, hardness. soil/rock type. grain size, etc.)
0.0 ft'
1.0 ft'
CONCRETE/GRAVEL
1.0 ft•
29.0 ft'
BROWN SILTY SANDY CLAY
29.0 ft'
40.0 It'
BROWN SANDY SILT
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL - 18.0 - 23.0 FEET
22. Certification:
Signature of Certified Well Contractor
12/29/2020
Date
By signing this form, I hereby certift that the well(s) was (were) constructed in accordance with
1SA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction 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 construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Suppl, and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100.000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-11
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 #:
List all applicable well construction permits (i. e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ lndustriaVCommercial
['Irrigation
❑Municipal/Public
['Residential Water Supply (single)
❑Residential Water Supply (shared)
[Wells > 100,000 GPD
Non -Water Supply Well:
[Monitoring
['Recovery
Injection Well:
[Aquifer Recharge
❑Aquifer Storage and Recovery
[Aquifer Test
['Experimental Technology
❑Geothermal (Closed Loop)
['Geothermal (Heating/Cooling Return)
OGroundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed:
5a. Well Location:
CCI FLEET SUPPLY
12/14/20
Well ID#
IW-1-2
Facility/Owner Name Facility ID# (if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address, City, and Zip
FORSYTH
County Parcel Identification No. (PIN)
5h. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
36° 06' 48.33" N 80° 09' 43.32°
6. Is(are) the well(s): ©Permanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑ Yes or IENo
If this is a repair, fill out (mown well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 40'0 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100)
10. Static water level below top of casing: 25.0 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 6•0 (in.)
SONIC
12. Well construction method:
(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.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
I TO
DIAMETER
THICKNESS 1 MATERIAL
ft.
1 ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft.
25.0 ft.
2.0 in.
SCH 40
PVC
ft
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
25.0 ft'
40.0 ft•
2.0 in'
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft.
18.0 it.
PORTLANDBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK Of applicable)
FROM
TO
MATERIAL ! EMPLACEMENT METHOD
23.0 ft.
40.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
nEsC• II t10' (color, hardness, soil/rock tn5e, grain size, etc.)
0.0 ft.
1.0 ft.
CONCRETE/GRAVEL
1.0 ft.
29.0 ft.
BROWN SILTY SANDY CLAY
29.0 ft
40.0 ft'
BROWN SANDY SILT
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL - 18.0 - 23.0 FEET
22. Certification:
Signature of Certified Well Contractor
12/29/2020
Date
By signing this form, I hereby certift that the well(s) was (were) constructed in accordance with
15A NCAC 02C .0100 or I SA NCAC 02C .0200 Well Construction 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 construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supplv and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
JACOB MESSICK
Well Contractor Name
A - 4252
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (Le. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ IndustriaUCommercial
❑Irritation
❑MunicipaliPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
El Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
ClGroundwater Remediation
❑Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 01 /14/21 Wen ID#
5a. Well Location:
CCI FLEET SUPPLY
Facility/Owner Name
IW-2-1
Facility ID# (if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address, City, and Zip
FORSYTH
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
36° 06' 48.33" N 80° 09' 43.32"
6. Is(are) the well(s): !Permanent or ❑Temporary
w
7. Is this a repair to an existing well: ❑Yes or No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #2I remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 41.0 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100)
10. Static water level below top of casing: 30•0 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8•0 (in.)
AUGER
12. Well construction method:
(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.
ft.
ft.
15. OUTER CASING ffor multi -cased wells} OR LINER (if applicableI
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASINGOR TUBING (geothermal closed -loop)
FROM _
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft•
26.0 ft•
2.0 in'
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO J DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
26.0 ft'
41.0 h•
2.0 in'
.010
SCH 40
PVC
ft.
IL
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft.
200 ft.
PORTLANDBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
23.0 ft•
41.0 ft'
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (aHat h additional sheets if necessary)
FROM
TO
DIi NC It I1,11i1t {color, har,incya, snillrecli tyke, grain size, etc.)
0.0 ft•
5.0 h•
RED/BROWN SILTY CLAY
5.0 ft'
20.0 ft'
TAN SILT
20.0 ft'
41.0 ft"
BROWN SILT
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL - 20.0 - 23.0 FEET
22. Certification:
elitisoWit
Signature of Certified Well Contractor
1/15/2021
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance with
15A NCAC 02C.0100or ISA NCAC 02C.0200 Well Construction 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 construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100.000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
JACOB MESSICK
Well Contractor Name
A - 4252
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (Le. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑ Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
Other (explain under #21 Remarks)
4. Date Well(s) Completed: 01 /14/21 Well ID#
5a. Well Location:
CCI FLEET SUPPLY
IW-2-2
Facility/Owner Name Facility ID# (if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address, City, and Zip
FORSYTH
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one let/long is sufficient)
36° 06' 48.33" N 80° 09' 43.32"
6. Is(are) the well(s): HIPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or IaJNo
If this is 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. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 41'0 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100)
10. Static water level below top of casing: 30'0 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8'0
(in.)
12. Well construction method: AUGER
(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.
-
ft.
L
ft.
15. OUTER CASING !for multi -cased wells[ OR LINER (if ap licable)
FROM
TO DLAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER THICKNESS
MATERIAL
0.0 ft'
26.0 ft.
2.0 in'
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
26.0 ft.
41.0 ft•
2.0 r"'
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft.
20.0 ft.
PORTLANDBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
23.0 ft.
41.0 ft'
20-40
FINE SILICA SAND
ft. ft.
20. DRILLING LOG (attach additional sheets if necessary)
F ROM
TO
tl F:ti CIt1PI ION t.ilor, harffneaa, sutUree4 type, rain size, etc.)
0.0 ft'
5.0 ft'
RED/BROWN SILTY CLAY
5.0 ft'
20.0 ft'
TAN SILT
20.0 ft'
41.0 ft'
BROWN SILT
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL - 20.0 - 23.0 FEET
22. Certification:
Signature of Certified Well Contractor
1/15/2021
Date
By signing this form, I hereby certih• that the well(s) was (were) constructed in accordance with
ISA NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction 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 construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 6-6-2018

ACCESS AGREEMENT
Illinois Tool Works Inc. ("ITW") is conducting an environmental investigation pursuant to NCDEQ
IHSB Guidelines for Assessment and Cleanup of Contaminated Sites, dated January 2020 at its
Former ITW/CCI Fleet Supply facility ("Facility") at 2744 West Mountain Street in Kernersville, North
Carolina.
More Than Billboards, Inc. ("Owner") owns the property at 2737 West Mountain Street,
Kernersville, North Carolina ("Property"). In order to investigate an environmental condition at the
Facility ITW must install groundwater monitoring wells and collect groundwater samples at the Property
to delineate downgradient contamination detected at the Facility ("Sampling").
ITW requires access to the Property and assistance from the Owner to complete Sampling. ITW
will bear all costs of the Sampling and provide the results of the Sampling to the Owner promptly upon
receipt from the analytical laboratory. ITW will take care not to damage the Property in conjunction with
the Sampling, and in the unlikely event of damage to the Property, ITW will restore the Property to
substantially the same condition it was in prior to the commencement of the Sampling.
In consideration of the mutual promises set forth in this agreement, Owner agrees to allow ITW or
its environmental consultant access to the Property to complete the Sampling and to assist ITW or its
environmental consultant in locating suitable sampling locations.
This document embodies the entire agreement between ITW and the Owner and may be modified
only in writing, signed by both parties.
AGREED:
ILLINOIS TOO KS INC,
By:
Title: /)�'i'r'� c
Date: 6I #I °a Z2
CONTACT INFORMATION:
ILLINOIS TOOL WORKS INC.
Ken Brown, CHMM
Director of Safety
and Environment
155 Harlem Avenue
Glenview, IL 60025
P: 847-657-4843
E:
AGREED:
MORE THAN BILLBOARDS, INC.
By: Robert Amold
Title: President
Date: 5/27/2020
MORE THAN BILLBOARDS, INC.
Robert Arnold
President
2737 W Mountain St.
Kemersville, NC 27284
P: 336-723-1018
E: [e-mail]

February 17, 2021
North Carolina Department of Environmental Quality
Division of Water Resources — UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699
wood.
Wood Environment & Infrastructure Solutions, Inc.
2801 Yorkmont Road, Suite 100
Charlotte, North Carolina 28208
Licensures: NC Engineering F-1253, Geology C-247
T: 704-357-8600
www.woodplc.com
Subject: Notification of Intent (NOI) to Operate Injection Wells for Pilot Testing
CCI National Fleet Supply
2744 West Mountain Street
Kernersville, North Carolina 27284
NCDEQ IHSB ID: NONCD0001720
Wood Project 3160-20-1043
Dear UIC Program:
Wood Environment & Infrastructure Solutions, Inc. (Wood) on behalf of Illinois Tool Works, Inc. (ITW) is
pleased to submit the attached Notification of Intent (NOI) to Operate Injection Wells for a pilot test at the
above -referenced site.
We appreciate your time in the review of this data and are available at your convenience to discuss the
contents of this submittal. You may contact the undersigned below at [e-mail] or
[e-mail] to further discuss the site.
Sincerely,
Wood Environment & Infrastructure Solutions, Inc.
*6, C(sdeij
Nick Hotzelt, PE Helen P. Corley, LG, BCES
Environmental Engineer Principal Hydrogeologist
Enclosures
cc: Michael Hoffman, Wood
Andrew Dorn, ITW
Wood' is a trading name for John Wood Group PLC and its subsidiaries
•

NC Department of Environmental Quality — Division of Water Resources (DWR)
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are `permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C.0200 (NOTE: This form must be received at least 14 DAYS prior to injection)
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells is located within an area that does not exceed five percent of the land surface
above the known extent of groundwater contamination. An individual permit shall be required to conduct more
than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
5) In -Situ Thermal Wells (IST) — Used to `heat' contaminated groundwater to enhance remediation.
Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.
DATE: February 17, 2021
PERMIT NO.
(to be filled in by DWR)
NOTE- If this NOI is being submitted as notification of a modification of a previously issued NOI for this site (e.g.,
different injection wells, plume, additives, etc.) and still meets the deemed permitted by rule criteria, provide the
previously assigned permit tracking number and any needed relevant information to assess and approve injection:
A.
B.
Permit No. WI
Issued Date:
WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well Complete sections B through F, J, M
(2) Aquifer Test Well . Complete sections B through F, J, M
(3) Passive Injection System .. Complete sections B through F, H-M
(4) Small -Scale Injection Operation Complete sections B through M
(5) X Pilot Test Complete sections B through M
(6) Tracer Injection Well Complete sections B through M
(7) In -Situ Thermal (IST) Well Complete sections B through M
STATUS OF WELL OWNER: Business/Organization
Deemed Permitted GW Remediation NOI Rev. 2-17-2020
Page 1

C. WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): Illinois Tool Works, Inc. (ITW) / Mr. Andrew Dorn, PE, Sr. Environmental Engineer
Mailing Address: 155 Harlem Avenue
City: Glenview State: _IL Zip Code: 60026 County: Cook
Day Tele No.: 224-661-8870 Cell No.:
EMAIL Address: [e-mail] Fax No.:
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Robert Arnold, President
Company Name Associated Posters, Inc.
Mailing Address: 2737 West Mountain Street
City: Kernersville
State: NC Zip Code: County: Forsyth
Day Tele No.: 336-723-1018 Cell No.:
EMAIL Address: [e-mail]
Fax No.:
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Helen Corley
Company Name Wood Environment & Infrastructure Solutions, Inc. (Wood)
Mailing Address: 2801 Yorkmont Road, Ste 100
City: Charlotte State: NC Zip Code: 28208 County: Mecklenburg
Day Tele No.: 704-236-3494 Cell No.:
EMAIL Address: [e-mail] Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Former CCI National Fleet Supply Facility
2744 West Mountain Street
City: Kernersville
County: Forsyth
Zip Code: 27284
(2) Geographic Coordinates: Latitude**: 36 ° 06 ' 48.5 " or °.
Longitude**: 80 ° 09 ' 42.0 " or °.
Reference Datum: Center of site parcel Accuracy:
Method of Collection: Google Earth
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: 99,750 square feet
Land surface area of inj. well network: 2,000 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: —2% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells;
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE — Provide a brief narrative
regarding the cause of the contamination, and purpose, scope, goals of the proposed injection activity:
The site was formerly occupied by an approximately 29,000 square foot manufacturing building constructed in
the early 1960s. The building was used as a brake manufacturing facility from initial construction until the early
2000s. A release from the petroleum underground storage tank system at the adjacent One Stop property was
discovered in the early 1990s, at which time chlorinated solvents were detected in groundwater. Subsequent
assessment activities indicated the presence of chlorinated volatile organic compounds (VOCs) and 1,4-dioxane
above their respective NC 2L Standards. Wood proposes to implement an in -situ chemical oxidation (ISCO)
pilot study in the source area (MW-2) and in the vicinity of the highest concentration detected in groundwater
(MW-6). ISCO is a proven technology capable of treating 1,4-dioxane and chlorinated solvents present at the
site including trichloroethylene (TCE). Sodium persulfate with FeEDTA activation was selected as the ISCO
injectant based on aquifer and site -specific parameters. The injection will be performed by Redox Tech out of
Cary, NC under the supervision of Wood.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: Proposed 4 Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): 25-40 ft below ground surface
(3) For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 3

K. INJECTION SUMMARY
NOTE; Only injectants approved by the epidemiology section of the NC Division of Public Health. ❑ partment
of Health and Human Services canbe injected. Approved injectants can be found online at
http://deq.n c. gov/about/di vi sion s/water-resources/water-resources-permits/wastewater-branch/ground-water-
prote ct i oii'rou n d atcr-approved-injectants. All other substances must be reviewed by the DHHS prior to use.
Contact the UIC Program for more info if you wish to get approval for a different additive. However, please
note it mav take 3 months or longer. if no injectants are to be used use N/A.
Injectant: Sodium Persulfate Total Amt. to be injected (gal)/event: —953 gallons
Injectant: Iron Eth? lencdiaminctetraacetic Acid [Fe(EDTA)] Total Amt. to be injected (gal)/event: —8 gallons
Injectant: Hydroxide (base) Total Amt. to be injected (gal)/event: —300 gallons
Injectant: municipal water Total Amt. to be injected (gal)/event: —2,750 gallons
Injectant: Total Amt. to be injected (gal)/event:
Total Amt. to be injected (gal/event):
No. of separate injection events:1 Total Amt. to be injected (gal): —4,000 gallons (1,000 gal/well)
Source of Water (if applicable): municipal fire hydrant along West Mountain Street
L. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
Performance monitoring will be conducted to evaluate the effectiveness of the infection near the source area and
pear the area of highest concentration. Closely prior to iniection activities, a sampling event will be conducted
to establish baseline conditions at the site. Following injection. performance monitoring events will be conducted
approximately 1 month, 3 month, 6 months, and 12 months following substrate injection to evaluate treatment
progress at the site. For performance monitoring. Wood personnel will sample monitoring wells MW-2, MW-
2D, MW-6, MW-7, MW-C8D, and MW-C11. Groundwater samples will be analyzed for volatile organic
compounds (VOCs1by EPA Method 8260. 1,4-dioxane by EPA Method 8260 SIM, nitrate and sulfate by EPA
Method 300.0. and select metals (As, Ba, Cd, Cr, Se, and Pb)plus total and dissolved iron by EPA Method 6020.
Additionally, three surface water samples will be collected during the baseline. 6-month. and 12-month
performance monitoring events. Surface water samples will be collected from three downgradient surface water
locations. The surface water samples will be analyzed for VOCs by EPA Method 8260 and 1.4-dioxane by EPA
Method 8260 SIM.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: "I hereby certify, under penalty of law, that I am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submittingfalse information. I a ee to construct, operate, maintain, repair, and if applicable, abandon the
injection well and c f l related ap t tenances r accordance with the 15A NCAC 02C 0200 Rules."
Signafl re of Applicant Print or Type Full Name and Title , -LT
Deemed Permitted GW Remediation NOI Rev. 2-17-2020
Page 4

Property Owner (if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A NCAC 02C . 0200). "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the landowner, in the
absence of contrary agreement in writing.
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Please send 1 (one) hard color copy of this NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 5

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APPROXIMATE TRANSECT LOCATION
Document Path: F:WMEC_Projects\2018\3160-08-0075 Fleet Supply\MXD\CorrectMXDs\Transects.mxd
MONITORING WELL
$ LOCATIONS (FLEET SUPPLY)
• MONITORING WELL
LOCATIONS (ONE STOP)
• ESTIMATED SOIL BORING
LOCATION
wood.
PREPARED BY: LMM
Date: 7/24/2020
CHECKED BY: AJF
Date: 7/24/2020
CROSS-SECTION TRANSECTS
ITW/CCI FLEET SUPPLY COMPANY
2744 WEST MOUNTAIN STREET
KERNERSVILLE, NORTH CAROLINA
PROJECT NUMBER: 3160201043
FIGURE NUMBER:
2

12:53pm nick.hotzelt
P:\6228 Environmental\jobs\not 6228\3160-20-1043 CCI Kernersville\2018 to present\AutoCAD\2020_09_17_Cross Sections.dwg
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wood.
C'I'SS-SECTIO VIEW A - A'
CCI NATIONAL FLEET SUPPLY
2744 WEST VOUNTAIN STREET, <ER\ERSVILLE, NC
PREPARED DATE CHECKED DATE
BY MDF 7/9/20 HPC 7/21/20
JOB N O.
3160201043
FIGURE
3a

ELEVATION
930
920
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CROSS-SECTIO V"IEW
CCI NATIONAL FLEET SUPPLY
2744 WEST VOUNTAIN STREET, 'KER\ERSVILLE, \C
PREPARED MDF
DATE
9/17/20
JOB N O.
3160201043
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FIGURE
DATE
HPC
9/17/20
3
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P:\6228 Environmental\jobs\not 6228\3160-20-1043 CCI Kernersville\2018 to present\AutoCAD\2020_09_17_Cross Sections.dwg
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CCI NATIONAL FLEET SUPPLY
2744 WEST VOUNTAIN STREET, <ER\ERSVILLE, NC
PREPARED MDF
3160201043
CHECKED
FIGURE

12:57pm nick.hotzelt
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wood.
CROSS-SECTIO VIEW D
CCI NATIONAL FLEET SUPPLY
2744 WEST VOUNTAIN STREET, <ER\ERSVILLE, NC
BYEPARED MDF DATE
7/9/20
JOB N O.
3160201043
CHECKED HPC DATE?/21 /20
FIGURE
3d

PARCELS
SITE BOUNDARY
2ft CONTOUR
ASSOCIATED POSTERS, INC.
PROPERTY BOUNDARY
O ONE STOP PROPERTY BOUNDARY
Legend
MONITORING WELL (886.54) GROUNDWATER ELEVATION (FEET)
LOCATIONS (FLEET SUPPLY) GROUNDWATER CONTOURS (FEET)
MONITORING WELL —0. APPROXIMATE GROUNDWATER FLOW DIRECTION
LOCATIONS (ONE STOP)
Document Path: F:WMEC_Projects\2018\3160-08-0075 Fleet Supply\MXD\CorrectMXDs\2021\Figure4.mxd
wood.
PREPARED BY: LMM
Date: 2/5/2021
CHECKED BY: NAH
Date: 2/5/2021
WATER TABLE MAP (NOVEMBER 9, 2020)
ITW/CCI FLEET SUPPLY COMPANY
2744 WEST MOUNTAIN STREET
KERNERSVILLE, NORTH CAROLINA
PROJECT NUMBER: 3160201043
FIGURE NUMBER:
4

PARCELS
SITE BOUNDARY
2ft CONTOUR
Legend
MONITORING WELL
ASSOCIATED POSTERS, INC. 10 LOCATIONS (FLEET SUPPLY) (885.50) GROUNDWATER ELEVATION (FEET)
PROPERTY BOUNDARY GROUNDWATER CONTOURS (FEET)
O ONE STOP PROPERTY BOUNDARY 0 MONITORING WELL —* APPROXIMATE GROUNDWATER FLOW DIRECTION
LOCATIONS (ONE STOP)
Document Path: F:\AMEC_Projects\2018\3160-08-0075 Fleet Supply\MXD\CorrectMXDs\2021\Figure5.mxd
wood.
PREPARED BY: LMM
Date: 2/5/2021
CHECKED BY: NAH
Date: 2/5/2021
DEEP WELLS POTENTIOMETRIC SURFACE (NOVEMBER 9, 2020)
ITW/CCI FLEET SUPPLY COMPANY
2744 WEST MOUNTAIN STREET
KERNERSVILLE, NORTH CAROLINA
PROJECT NUMBER: 3160201043
FIGURE NUMBER:
5

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WELL CONSTRUCTION RECORD (GW-1)
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 #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
❑ Wells > 100,000 GPD
Non -Water Supply Well:
❑ Monitoring ❑Recovery
Injection Well:
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
❑ Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Retum)
MGroundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 1 2/14/20 Well ID#
5a. Well Location:
CCI FLEET SUPPLY
Facility/Owner Name
IW-1-1
Facility ID# (if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address, City, and Zip
FORSYTH
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
36° 06' 48.33" N 80° 09' 43.32°
6. Is(are) the well(s): Permanent or ❑Temporary
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 It'
25.0 ft•
2.0 'n•
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
25.0 ft•
40.0 ft•
2.0 in'
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft'
18.0 ft•
PORTLANDBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
23.0 ft•
40.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.0 ft.
1.0 ft•
CONCRETE/GRAVEL
1.0 ft.
29.0 ft.
BROWN SILTY SANDY CLAY
29.0 ft'
40.0 ft•
BROWN SANDY SILT
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL ' 18.0 - 23.0 FEET
22. Certification:
W
7. Is this a repair to an existing well: ❑Yes or ONo
If this is 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. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 40'0 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 25.0 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 6•0 (in.)
SONIC
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
12/29/2020
Signature of Certified Well Contractor Date
By signing this form, I hereby certify that the well(s) was (were) constructed 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 well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
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 #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
❑ Wells > 100,000 GPD
Non -Water Supply Well:
❑ Monitoring ❑Recovery
Injection Well:
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
❑ Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Retum)
MGroundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 1 2/14/20 Well ID#
5a. Well Location:
CCI FLEET SUPPLY
Facility/Owner Name
IW-1-2
Facility ID# (if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address, City, and Zip
FORSYTH
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
36° 06' 48.33" N 80° 09' 43.32°
6. Is(are) the well(s): Permanent or ❑Temporary
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 It'
25.0 ft•
2.0 'n•
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
25.0 ft•
40.0 ft•
2.0 in'
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft'
18.0 ft•
PORTLANDBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
23.0 ft•
40.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.0 ft.
1.0 ft•
CONCRETE/GRAVEL
1.0 ft.
29.0 ft.
BROWN SILTY SANDY CLAY
29.0 ft'
40.0 ft•
BROWN SANDY SILT
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL ' 18.0 - 23.0 FEET
22. Certification:
W
7. Is this a repair to an existing well: ❑Yes or ONo
If this is 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. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 40'0 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 25.0 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 6•0 (in.)
SONIC
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
12/29/2020
Signature of Certified Well Contractor Date
By signing this form, I hereby certify that the well(s) was (were) constructed 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 well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
JACOB MESSICK
Well Contractor Name
A - 4252
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
❑ Wells > 100,000 GPD
Non -Water Supply Well:
❑ Monitoring
❑ Recovery
Injection Well:
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
❑ Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Retum)
MGroundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 01 /14/21
5a. Well Location:
CCI FLEET SUPPLY
Facility/Owner Name
Well ID#
IW-2-1
Facility ID# (if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address, City, and Zip
FORSYTH
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
36° 06' 48.33" N 80° 09' 43.32"
6. Is(are) the well(s): Permanent or ❑Temporary
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft•
26.0 ft•
2.0 'n'
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
26.0 ft'
41.0 ft'
2.0 in'
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft•
20.0 ft•
PORTLANDBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
23.0 ft•
41.0 ft'
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.0 ft•
5.0 ft•
RED/BROWN SILTY CLAY
5.0 ft.
20.0 ft'
TAN SILT
20.0 ft•
41.0 ft•
BROWN SILT
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL - 20.0 - 23.0 FEET
22. Certification:
W
7. Is this a repair to an existing well: ❑Yes or ONo
If this is 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. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 41 .0 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 30'0 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8•0 (in.)
AUGER
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
1/15/2021
Signature of Certified Well Contractor Date
By signing this form, I hereby certify that the well(s) was (were) constructed 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 well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
JACOB MESSICK
Well Contractor Name
A - 4252
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑ Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
❑ Wells > 100,000 GPD
Non -Water Supply Well:
❑ Monitoring
❑ Recovery
Injection Well:
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
❑ Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Retum)
MGroundwater Remediation
❑ Salinity Barrier
❑ Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑ Other (explain under #21 Remarks)
4. Date Well(s) Completed: 01 /14/21
5a. Well Location:
CCI FLEET SUPPLY
Facility/Owner Name
Well ID#
IW-2-2
Facility ID# (if applicable)
2744 WEST MOUNTAIN ROAD KERNERSVILLE 27284
Physical Address, City, and Zip
FORSYTH
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one lat/long is sufficient)
36° 06' 48.33" N 80° 09' 43.32"
6. Is(are) the well(s): Permanent or ❑Temporary
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 ft•
26.0 ft•
2.0 'n'
SCH 40
PVC
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
26.0 ft'
41.0 ft'
2.0 in'
.010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0.0 ft•
20.0 ft•
PORTLANDBENTONITE
SLURRY
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
23.0 ft•
41.0 ft'
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0.0 ft•
5.0 ft•
RED/BROWN SILTY CLAY
5.0 ft.
20.0 ft'
TAN SILT
20.0 ft•
41.0 ft•
BROWN SILT
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
BENTONITE SEAL - 20.0 - 23.0 FEET
22. Certification:
W
7. Is this a repair to an existing well: ❑Yes or ONo
If this is 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. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 41 .0 (ft.)
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 30'0 (ft.)
If water level is above casing, use "+"
11. Borehole diameter: 8•0 (in.)
AUGER
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
1/15/2021
Signature of Certified Well Contractor Date
By signing this form, I hereby certify that the well(s) was (were) constructed 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 well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 6-6-2018

ACCESS AGREEMENT
Illinois Tool Works Inc. ("ITW') is conducting an environmental investigation pursuant to NCDEQ
IHSB Guidelines for Assessment and Cleanup of Contaminated Sites, dated January 2020 at its
Former ITW/CCI Fleet Supply facility ("Facility") at 2744 West Mountain Street in Kernersville, North
Carolina.
More Than Billboards, Inc. ("Owner") owns the property at 2737 West Mountain Street,
Kernersville, North Carolina ("Property"). In order to investigate an environmental condition at the
Facility ITW must install groundwater monitoring wells and collect groundwater samples at the Property
to delineate downgradient contamination detected at the Facility ("Sampling").
ITW requires access to the Property and assistance from the Owner to complete Sampling. ITW
will bear all costs of the Sampling and provide the results of the Sampling to the Owner promptly upon
receipt from the analytical laboratory. ITW will take care not to damage the Property in conjunction with
the Sampling, and in the unlikely event of damage to the Property, ITW will restore the Property to
substantially the same condition it was in prior to the commencement of the Sampling.
In consideration of the mutual promises set forth in this agreement, Owner agrees to allow ITW or
its environmental consultant access to the Property to complete the Sampling and to assist ITW or its
environmental consultant in locating suitable sampling locations.
This document embodies the entire agreement between ITW and the Owner and may be modified
only in writing, signed by both parties.
AGREED:
ILLINOIS TOO KS INC,
By:
Title:
Date: G'/1> Z7Zd
L 215.
CONTACT INFORMATION:
ILLINOIS TOOL WORKS INC.
Ken Brown, CHMM
Director of Safety
and Environment
155 Harlem Avenue
Glenview, IL 60025
P: 847-657-4843
E:
AGREED:
MORE THAN BILLBOARDS, INC.
By: Robert Arnold
Title: President
Date: 5/27/2020
MORE THAN BILLBOARDS, INC.
Robert Arnold
President
2737 W Mountain St.
Kernersville, NC 27284
P: 336-723-1018
E: [e-mail]