Guilford_Well Abandonment_20221104

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WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAIL!!S'
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-L`oop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
432$-B wells abandoned:one
NC Well Contractor Certification Number 7b.Approximate volume of water rr i wining in well(s): 6 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used: r
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown • NIA
7d.Amount of disinfectant used.
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic a Neat Cement Grout 19 Bentonite Chips or Pellets
❑Geothermal(HeatinglCooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons,
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 56 pounds
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
F--
Oct(10th&11th)2022 � vk I M
4.Date well(s)abandoned: ' 4 @ 1
5a.Well location:
Piedmont Natural Gas Company.
t'roc=;:,g Ur;p
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification: 1 [;Ap1Q/B0G
1029 Winston Street, Greensboro, 27.405 1 10-12-22
Physical Address,City,and Zip Signa e o ertified ell utractor or Well Owner Date
Guilford
By signing this form, I hereby certify that the ivell(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 this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: j
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W You may use the back of this page fo provide additional well site details or well
abandonment details. You may also'attach additional pages if necessary.
i
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For multiple injection or non-waiersupply wells
ONLY with the same consiruction/abandomnent,you can submit one form.
10a. For All Wells: Submit this!form within 30 days of completion of well
6a.WellID#: MW-28M abandonment to-the following: 1
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 45.6 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
2 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 10.5 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Supply&Iniectio 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 1 health department of the county where
6E Inner casing/tubing length(if known): 35.6 (ft) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS:
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one I I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 16 (gal.)
JIG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A'
7c.Type of disinfectant used:
2.Well Construction Permit#: !
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)iflmown N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout 19 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Neat Cement 2 gallons,'
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 224 pounds;
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
h E'
4.Date well(s)abandoned: Oct(10th&11th)2022
NOV 0 4 22
5a.Well location:
Piedmont Natural Gas Company. tt>:,ca a�t�;l ..y Z• �u
Facility/Owner Name Facility ID#(if applicable) 8.Certification: D%,A/Q/BO'G
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Signatur f (Med V611 CoWractor or Well Owner Date
Guilford
By signing this form, I hereby certify that the ivell(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 this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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.
I
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Atlacha,ellconstructionrecord(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the 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#: MW-30D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 149.6 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following: il
9.5 Division of Water Resources Underground Injection Control Program,
6d.Water level below ground surface: (ft) �1636 Mail Service Ce,,nter,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) lOc.For Water Supply&Iniectio Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
139.E of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): (ft.)
abandoned. !
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS',
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:oneI
I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 1 1 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name - N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,variance,etc.)ifknown
7d.Amount of disinfectant used: N A
3.Well use(check well use):
i
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural _❑Municipal/Public S Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 102 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
�r`-r— s� y�
4.Date well Oot(10th&11th)2022
s)abandoned: 'k^^'
Sa.Well location: N
Piedmont Natural Gas Company. o-_. r
Iniorn- 4is-I . ,.�., ,.o Urt
Facility/Owner Name Facility ID#(ifapplicable) 8.Cer ideation: D1p/QJ:'0G
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Sign re of Certifie ell outractor or Well Owner Date
Guilford ,
By signing this form, I hereby certify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.01,,00 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]among is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.For multiple it jection or non-water supply wells
ONLY with the 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#• MW-33D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 73.7 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following: I'
I
6d.Water level below ground surface: 5.5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.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 where
6E Inner casing/tubing length(if known): 63.7 (ft) abandoned.
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6g.Screen length(if known): 10 (ft.)
l �
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
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f
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS::
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-LI oop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one '�
NC Well Contractor Certification Number 7b.Approximate volume of water rem in well(s): 2 (gal.)
JG Drilling, LLCi FOR WATER SUPPLY WELLS ONLY:
Company Name NSA
7c.Type of disinfectant used: I
I,
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,variance,etc.)ifknown N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public G Neat Cement Grout s Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 1 ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑bTi ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
MMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
Bentonite 16 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
FEA
nlOct(10th&11th)2022 ' 5 e�
4.Date well(s)abandoned: i Alfl\1 ' A 2022
5a.Well location:
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(if applicable) 8.Certification: D%�,1 1BOG
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Sigiiatur ftkkcd W9 Co .tor or'Well Owner Date
Guilford
By signing this form, I hereby certify that the ivell(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 this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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.
6
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction records)ifarailable. For multiple injection or non-water supply wells
ONLY with the 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#: MW-34 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition,to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this!form within 30 days of completion of well
abandonment to the following: d
6.5 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.)
1636 Mail Service Cent er,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) loc.For Water Supply&IniectioniWells: 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
6E Inner casing/tubing length(if known): 5 abandoned.
6g.Screen length(if known): 15 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loopp Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-3b is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one i 17
NC Well Contractor Certification Number 7b.Approximate volume of water remaining+r in well(s): (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 19 Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating(Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
IRMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 153 pounds
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer
7g.Provide a brief description of the abandonment procedure:
i
-• ❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
Grouted well in place.
4.Date well(s)abandoned: 0ct(10th&11th)2022 -t s 'V @_
5a.Well location: NOV 0 tt 2027
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(if applicable) 8.Certification: If1�U4� 1 PracSZOMg Un4
v�n1Q1:3GG
1029 Winston Street, Greensboro, 27405 ; 10-12-22
Physical Address,City,and Zip Sig&[ure`of'Certifi6d We Contractor or Well Owner Date
Guilford By signing this form, 1 hereby certify that the ivell(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 this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I'
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.Pormultiple injection or non-water supply wells
ONLY with the same constructionlabandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-35D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 106.8 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 4.5 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.Outer casing length(if known): (ft.) 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
6C Inner casing/tubing length(if known): 86'8 (ft.) abandoned.
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6g.Screen length(if known): 20 (ft.)
i
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016
1

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-LI of Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one I
11
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 2 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7e.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown IV/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
El Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Bentonite 6 pounds 1,
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
4.Date well(s)abandoned: Oct(10th&11th)2022 s
5a.Well location: NOV V h 2022
Piedmont Natural Gas Company.
i
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification: )F1vytlii$;29t1 Pr.^.=„tri{j Unit
1029 Winston Street, Greensboro, 27405 ' '�
10-12-22
Physical Address,City,and Zip SignattgofKlffificd Vell CVhttactor or Well Owner Date
Guilford
By signing this form, I hereby certify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance ivith 15A NCAC 02C.0100,or 2C.0200 Well Construction Standards
and that a copy of this retard has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ;,
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailab(e.For multiple injection or non-water supply wells
ONLY with the same construction/abandontnem,you can submit one form. 1
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-37 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 14.6 (ft) 1617 Mail.Service Center,Raleigh,NC 27699-1617
i
10b.For Iniection'Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy of this;form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 1 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Supply&IniectionlW1ells: 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
6E Inner casing/tubing length(if known): 4.6 (ft.) abandoned.
10 i
6g.Screen length(if known): (ft.)
I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
i
� i

I
i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAIL'S,
i '
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-36 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:onef
NC Well Contractor Certification Number 7b.Approximate volume of water ri miaining in well(s): 1 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,Comity,Stare,Variance,etc.)ifknowta N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 19 Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
MMonitoring El Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons,
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 6 pounds
❑Experimental Technology El Subsidence Control I
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) []Tracer Grouted well in place.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) n -
4.Date well(s)abandoned: Oct(10th&11th)2022
NOV 0 4 2022
5a.Well location:
urkt
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Signah of PdKficd Il CGfitractor or Well Owner Date
Guilford By signing this form, I hereby certify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) 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 well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 l
Anach well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the 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#: MW-38 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 14.6 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in,) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
b
6d.Water level below ground surface: 7.5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.Outer casing length(if known): (ft.) lOc.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 completion
of well abandonment to the county health department of the county where
6E Inner casing/tubiag length(if known): 4.6 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources i Revised 2-22-2016

I,
G
WELL ABANDONMENT RECORD For Internal Use ONLY:
i '
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JeffreyGrant
7a.For Geoprobe/DPT or Closed-�oop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW f its needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:o^a I
NC Well Contractor Certification Number 7b.Approximate volume of water i e wining in well(s): 1 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction perntits(i.e.UIC,County,State,variance,etc.)iflmown N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
®Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
[]Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage
Bentonite 14 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) []Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted WeII In place.
Oct(10th&11 th)2022
4.Date well(s)abandoned: r, Z X: 'LZ 5 V 5Z,Ll
5a.Well location: NOV 0 �- 2022
Piedmont Natural Gas Company. {�
Facility/Owner Name Facility ID#(ifapplicable) S.Certification: {flivG"o-tit3<+�D ! r�v f�M' Urih
1029 Winston Street, Greensboro, 27405 DI,D,fQfB()G10-12-22
Physical Address,City,and Zip Sigibture VftertifiMWeVCoutractor or Well Owner Date
Guilford '
By signing this form, I hereby certify that the ivell(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 this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: II
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable. For multiple h?ection or non-water supply wells
ONLY with rite same constructionlabandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-39 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 19.4 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
2 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
I '
I
6d.Water level below ground surface: 7.5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 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 deparhnent of the county where
6E Inner casing/tubing length(if known): 9.4 (ft.) abandoned.
i
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
I
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-LI op Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 iS needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:One
NC Well Contractor Certification Number 7b.Approximate volume of water retraining in well(s): 1 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction pennits(i.e.UIC,County,State, Variance,etc.)!£known N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
®Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons,
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 6 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place. `d j
4iV E
4.Date well(s)abandoned: Oct(10th&11th)2022
NOV 0 4 2022
5a.Well location:
Piedmont Natural Gas Company. � g; tP ar=�irtr,Urtil
Facility/Owner Name Facility ID#(if applicable) S.Certification:
1029 Winston Street, Greensboro, 27405 9i� 10-12-22
Physical Address,City,and Zip Signa6de o riifie ell Vontractor or Well Owner Date
Guilford
By signing this form, I hereby certify that the ivell(s) ivas (were) abandoned in
County Parcel Identification No.(PIN) 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 well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one]at/long is sufficient) 9.Site diagram or additional well details:
N W You may use the back of this page Yo 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
Attachweliconsinictiarrecord(s)ifavoilable.For inultiplehjectionornon-watersupplywells
ONLY with the same construction/abandonment,you can submit one fonn.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-41 abandonment to the following: j
I
Division of water Resources,Information Processing Unit,
6b.Total well depth: 13.7 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6e.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following: I
6d.Water level below ground surface: 8.6 (ft.) Division of Water Resources,UInderground Injection Control Program,
1636 Mail Service Ce'nter,Raleigh,NC 27699-1636
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 where
6C Inner casing/tubing length(if known): 3.7 (ft,) abandoned.
I
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016

i
WELL ABANDONMENT RECORD' For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT oi\Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-bol is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): '7 (gal,)
I ,
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used: i•
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaVPublic a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
CMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Bentonite 6 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description oft Gte abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑other(explain under 7g) Grouted well in place. :
4.Date well(s)abandoned: Oct(10th&11th)2022 NOV0 << 2022
-
5a.Well location: r Unit
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Sign c oY'(_"ertifieMVcIMontractor or Well Owner Date
GUIIfOfd By signing this form, I hereby certi)5)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 this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the 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#• M W-42 abandonment to the following:
i
Division of Water Resources,Information Processing Unit,
14.2 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
i
i
6d.Water level below ground surface: 10.45 (ft) Division of Water Resources,Underground Injection Control Program,
11
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) loc.For Water Sunoly&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 i health department of the county where
611 Inner casing/tubing length(if known): 4.2 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Enviromnenial Quality-Division of Water Resources Revised 2-22-2016
i

WELL ABANDONMENT RECORD For Internal Use ONLY: f
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-LI op Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one
NC Well Contractor Certification Number 7b.Approximate volume of water remaining i in well(s): 1'S (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ijknown
7d.Amount of disinfectant used: N/t4
3.Well use(check well use):
Water Supply Well: 7e.Scaling materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout N Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Bentonite 7 pounds
❑Experimental Technology []Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
—e ref 4 m.
4.Date well Oct(10th&11 th)2022
s)abandoned: NOV 0 4 2022
5a.Well location:
i
!' r^ zcl31 Prx?iaus,9`'1 Ural
Piedmont Natural Gas Company. rf�;t
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip :Sign a 6TtCertifieVWelttoutractor or Well Owner Date
Guilford
By signing this form, 1 hereby certify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.01.00 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell oivner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one laUlong is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.For multiple injection ornon-waer supply wells I'
ONLY with the 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#: MW-44 abandonment to the following:
I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 14.4 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 5.85 (ft.) Division of Water Resources,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 form within 30 days of completion
of well abandonment to the county:health department of the county where
6E Inner casing/tubing length(if known): 4.4 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016.
ll

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-36 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:One I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 1 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used: I
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,Stare,Variance,etc.)ljknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural• ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
ImMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons'
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Bentonite 7 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer '
[]Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place. rm
4.Date well(s)abandoned: Oct(10th&11th)2022 NOV '0 A 20Z2
5a.Well location: InS y. .0 nro� �J Unh
Piedmont Natural Gas Company.
Facility/Owner Name Facility lD9(ifapplicable) S.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Signatur f Crai red W9 CotWractor or Well Owner Date
Guilford By signing this form, I hereby certify that the ivell(s)was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.01 00 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 lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction records)ifavailabte.For multiple injection or non-water supply welts
ONLY with the 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#• MW-45 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 13.9 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 7 (ft.) Division of Water Resources,Uind'erground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Supply&Iniectio I 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
6E Inner casing/tubing length(if known): 4.4 (ft) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources` Revised 2-22-2016
i

i
WELL ABANDONMENT RECORD For Internal Use ONLY: +
1.Well Contractor Information: WELL ABANDONMENT DETAILS 1
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-LI op Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-3b is needed. Indicate TOTAL NUMBER of
wells abandoned:one
4328-B 17
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name NSA
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery []Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Bentonite 153 pounds,-
0 Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer a:� --
Grouted well in place. p`� '' 3 k. I
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) X. ��
4.Date well(s)abandoned: Oct(10th&11th)2022
t .•
5a.Well location: IFlifii,,t 3 1 i'r.
rjqyfQ���
Piedmont Natural Gas Company.
i
Facility/Owner Name Facility lD#(ifapplicable) S.Certification:
1029 Winston Street, Greensboro, 27405gt8� -
10-12-22
Physical Address,City,and Zip Signature offfertitrRKVell antrMor or Well Owner Date
Guilford By signing this form, I hereby certify that the well(s)teas(were)abandoned in
County Parcel Identification No.(PIN) 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 well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 j
Attach well construction record(s)ifavailable.For multiple injection or non-water supply wells SUBMITTAL INSTRUCTIONS
ONLY with the 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#: MW-46D abandonment to the following: i
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 112 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in IOa
6c.Borehole diameter: 2 (in.) above,also submit one copy of this forth within 30 days of completion of well
abandonment to the following: 1
I
6d.Water level below ground surface: (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.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 where
6f.Inner casing/tubing length(if known): 102 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
i
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
t
1.Well Contractor Information: WELL ABANDONMENT DETAILS'
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-LI op Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water rem Iaining in well(s): 25 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)i/knoum N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery ,
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Bentonite 243 pounds
❑Experimental Technology ❑Subsidence Control 7g,provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted Well in place.
4.Date well(s)abandoned: Oct(10th&11th)2022 NOV 20
72
5a.Well location:
Piedmont Natural Gas Company. Irtr�e�er:=^' nr^^ raUni�
J1P1�'2,1�0�
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Si re ertifi We ontmctor or Well Owner Date
Guilford
By signing this form, I hereby certify that the ivell(s) ivas (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 this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one hit/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the same construction/abandonmem,you can submit one form.
10a. For All Wells: Submit this'form within 30 days of completion of well
6a.Well ID#: MW-47D abandonment to the following:
i
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 162.1 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
1
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface:
8.5 (ft.) Division of Water Resources,UInderground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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 where
1
6f.Inner casing/tubing length(if known): 152. (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For InternalUse'ONLY: }
1 ,
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:-On-
NC Well Contractor Certification Number 7b.Approximate volume of water>•e dining in well(s): 17 (gal.)
JG Drilling, LLC FOR WATER7SUPPLY WELLS ONLY:
Company Name N/A,
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.VIC,County,State,[variance,etc.)ifknown N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check a I ll that apply):
❑Agricultural ❑Municipal/Public 19 Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry i ❑ Other(explain under 7g)
®Monitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 163 pounds;
❑Experimental Technology OSubsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Grouted well in place.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: Oct(10th&11th)2022
5a.Well location: Nov
Piedmont Natural Gas Company. Ur;;;
�7^1 7alc� a• t`J
Facility/Owner Name Facility IDff(ifapplicable) 8.Cer•lcation: t f CSiv f R,t�r
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Signa re oTCertifiedWell tontractor or Well Owner Date
Guilford By signing this form, I hereby certify that the ivell(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 this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the 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#• MW-47M abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 111.8 (,ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 8.5 (ft.) Division of Water Resources,Underground rground Injection Control Program,
1636 Mail Service Centi r,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Suanly&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
6E Inner casing/tubing length(if known): 101.8 (ft) abandoned.
6g.Screen length(if known): 10 (ft.)
I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS,
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Lo I op Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) wel I construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one
NC Well Contractor Certification Number 7b.Approximate volume of water remaining 38
maining in well(s): (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)tfknown
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public N Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
IMMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons'
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 368 pounds'
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Grouted well in place.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: Oct(10th&11th)2022 2�22
NOV 0
5a.Well location: Uritl
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Signature Ce++ ed WeIPConMactor or Well Owner Date
Guilford
By signing this form, I hereby certify that the ivell(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 this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwelI field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the 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#: MW-48D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 240 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Infection Wells: In addition to sending the form to the address in 10a
6e.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 5.5 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) loc.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
6E Inner casing/tubing length(if known): 220 (ft.) abandoned. f
6g.Screen length(if known): 20 (ft.)
1
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-L loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-3b is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 135 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: N
2.Well Construction Permit#:
List all applicable well construction permits(i.e.VIC,Comity,State,Variance,eta.)ifknown N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) -❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring RRecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 23 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage
Bentonite 1200 pounds
❑Experimental Technology ❑Subsidence Control 1
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Grouted well in place.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) ^m _
4 s v F_lam'
4.Date well(s)abandoned: Oct(10th&11th)2022 NOV 0 2022
Sa.Well location: Pm,::. rg urtg
Piedmont Natural Gas Company. r�tip;
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 � 10-12-22
Physical Address,City,and Zip Signa of red ll C61uractor or Well Owner Date
i
Guilford By signing this form, I hereby certify that the well(s)was(were) abandoned in
County Parcel Identification No.(PIN) 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 well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 '
Anach well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the same constructioniabandonment,you can submit one form.
10a. For All Wells: Submit this ;form within 30 days of completion of well
6a.Well ID#• RH-21 D abandonment to the following:
I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 100 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter 6 (in) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
I
6d.Water level below ground surface: 7.5 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) l0c.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 where
6E Inner casing/tubing length(if known): 90 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources 1 Revised 2-22-2016
V
i

WELL ABANDONMENT RECORD For Internal Use ONLY:
l �
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-P`o p Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one iI
NC Well Contractor Certification Number 7b.Approximate volume of water remaining aining in well(s): 128 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.VIC,County,State,Variance,etc.)ifknoun N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring XRecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Neat Cement 23 gallons.
❑Aquifer Storage and Recovery []Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 1085 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Grouted well in place.
❑Geothermal(Heating/Cooling Return) El Other(explain under 7g)
4.Date well(s)abandoned: Oct(10th&11th)2022 i NOV 0 6 ZLQC
5a.Well location: UpjC
lrl`iiiSil u�±3 i1 Y i 0
Piedmont Natural Gas Company. QC-
Facility/Owner Name -Facility ID#(if applicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 �� 10-12-22
Physical Address,City,and Zip Si at �'
gn of erttfied Vell 06,itractor or Well Owner Date
Guilford ''
By signing this form, I hereby certify 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 this record has been provided to the well owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 j
Atlach well construction records)ifavailable.For multiple injection or non-water supply wells
ONLY with the same consiruction/abandonmem,you can submit one form.
10a. For All Wells: Submit this Ifoi n within 30 days of completion of well
6a.Well ID#: RH-22D abandonment to the following:
I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 92 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 6 (in) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 5 (ft.) Division of Water Resources,Uindierground Injection Control Program,
1636 Mail Service Ceuter,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Supply&Iniectio i 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
6f.Inner casing/tubing length(if known): 82 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

,I
WELL.ABANDONMENT RECORD For Internal Use ONLY:
f
1.Well Contractor Information: WELL ABANDONMENT DETAILS'
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-P.o I p Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one
1 '
122
NC Well Contractor Certification Number 7b.Approximate volume of water'remaining in well(s):
JIG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)ifknown N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 19 Neat Cement Grout s Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring IlRecovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 23 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 1000 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place. p
4.Date well(s)abandoned:
Oct(10th&11th)2022
5a.Well location: NOV 0
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(ifapplicable) S.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Si tm Certi d WI Contractor or;Well Owner Date
Guilford
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) 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 well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well&tails:
N W 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 well construction records)ifavailable.For multiple ityectionornon-water supply wells
ONLY with the sane construction/abandonment,you can submit one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: RH-23D abandonment to the following:
I
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 86 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Iniection Wells: In addition to sending the form to the address'in 10a
6c.Borehole diameter: 6 (in) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface:
i
3 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.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 where
6E Inner casing/tubing length(if known): 76 (ft.) abandoned. i
6g.Screen length(if known): 10 (ft.)
I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resourcesl Revised 2-22-2016

i
I
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Connector Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW j30,is needed. Indicate TOTAL NUMBER of
wells abandoned: I
43Z8-B
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 116 (gal.)
JG Drilling, LLCi FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: NIA
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown NIA
7d.Amount of disinfectant used: •
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 1'Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring RRecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 23 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 1000 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place., a ; ° �fe xe
4.Date well(s)abandoned:
Oct(10th&11th)2022 Nov % A. 2022
Unit
5a.Well location:
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 gt �� 10-12-22
Physical Address,City,and Zip Si re 11frertifieYWelWontractor or Well Owner Date
Guilford
By signing this form, I hereby certify that the ivell(s) was(were)abandoned in
County Parcel Identification No.(PIN) 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 ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: ,
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.1%or multiple injection or non-water supply wells
ONLY with the 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#: RH-29D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 86 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6e.Borehole diameter: 6 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 7 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
1 I
6e.Outer casing length(if known): (ft.) 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 whe're
6E Inner casing/tubing length(if known): 76 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS!
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-LI op Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:one
4328-B 11
NC Well Contractor Certification Number 7b.Approximate volume of water rf niaining in well(s): (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U1C,County,State,Variance,etc.)ijknowtt N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public S Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
IMMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 7 gallons'
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
Bentonite 95 pounds !
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Grouted well in place. . o
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
Oct(10th&11 th)2022 «
4.Date well(s)abandoned: -
2022
5a.Well location: In'Gi71 Pr.rc*GbS', Urt"
r'}i�ttllc?nd:
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(ifapplicable) S.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Signa o0'Wafied&VeII 66titractor or Well Owner Date
Guilford
By signing this form, I hereby certify that the ivell(s)was (were)abandoned in
County Parcel Identification No.(PIN) accordance ivith 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I'
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable. For multiple injection or non-water supply wells
ONLY with the 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#: MW-5 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth 25 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 4 (in) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following: I.
6d.Water level below ground surface: 7•9 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Suaaly&Iniectio.,Wells: In addition to sending the form to the
address(es)above,also submit one cbpy of this form within 30 days of completion
of well abandonment to the county;health department of the county where
611 Inner casing/tubing length(if known): 15 abandoned.(ft.) # �
I
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016
I

WELL ABANDONMENT RECORD For Internal Use ONLY: I
I �
1.Well Contractor Information: WELL ABANDONMENT DETAILS
� t
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-k is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:-One
NC Well Contractor Certification Number 7b.Approximate volume of water e}wining in well(s): 2 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
r
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,Comity,State,Variance,etc.)rfknown N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public N Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑hri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: 11 Bentonite Slurry ❑ Other(explain under 7g)
aMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 16 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
4.Date well(s)abandoned:
Oct(10th-&11th)2022 F p
Sa.Well location:
Piedmont Natural Gas Company. n,ofnnM71 t r..•.,-7=7.719 MR
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification: ,rJt31:Q/1630'G
1029 Winston Street, Greensboro, 27405 9 �yt 10-12-22
Physical Address,City,and Zip Signatm f ed W#CoVactor or Well Owner Date
Guilford
By signing this form, I hereby certify 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 this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this iform within 30 days of completion of well
6a.Well ID#: MW-12 abandonment to the following: j
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20.3 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
i
6d.Water level below ground surface: 7.4 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.Outer casing length(if known): (ft.) 10c.For Water Sunaly&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
611 Inner casing/tubing length(if known): 10.3 (ft.) abandoned.
I
6g.Screen length(if known): 10 (ft.)
' � I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources ' Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
t ;
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-1Soop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:one
4328-B
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 7 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout IN Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial El Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Bentonite 72 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Grouted WeII In place.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: Oct(10th&11th)2022
5a.Well location:
Piedmont Natural Gas Company. aee;9@iRg Ung
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 9 10-12-22
Physical Address,City,and Zip Signature o ertikTkWell 06aitrMor or Well Owner Date
Guilford
By signing this form, I hereby certify that the wells) 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 this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 j
Attach well construction record(s)ifavoilable.For multiple injection or non-water supply wells
ONLY with the sane construction/abandonment,you can submit one form.
10a. For All Wells: Submit this!form within 30 days of completion of well
6a.WeII ID#: MW-14D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 55 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in,) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 9.5 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.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 where
6E Inner casing/tubing length(if known): 50 (ft) abandoned.
I
6g.Screen length(if known): 5 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS,
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(orwell owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned: 1
NC Well Contractor Certification Number 7b.Approximate volume of water r'Iaining in well(s): 1 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used: 1
2.Well Construction Permit#:
List all applicable well construction permits(i.e.U/C,County,State,Variance,etc.)ifknown NIA
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 19 Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) El Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 1.5 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 8 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
El Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
4.Date well(s)abandoned: Oct(10th&11th)2022
5a.Well location:
Piedmont Natural Gas Company. l��L��,;�;;��- = ^T6'r+i'
Facility/Owner Name Facility ID#(if applicable) 8.Certification: J�a3Ol
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Signal o fled ell ntractor or Well Owner Date
Guilford
By signing this form, 1 hereby certify that the wells) was (were) abandoned in
County Parcel Identification No.(PIN) accordance ivith 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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
Attache,ellconsiructionrecord(s)ijavailable. For multiple injection or non-water supply wells
ONLY with the same constructionlabandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-15 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 12.9 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 5.5 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i
6e.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 i health department of the county where
6f.Inner casing/tubing length(if known): 2'9 (ft.). abandoned.
6g.Screen length(if known): 10 (ft.)
1
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one
NC Well Contractor Certification Number 7b.Approximate volume of water le I aining in well(s): 7'5 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial - ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring 9Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 7 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 25 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Grouted well in place.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) ,
4.Date well(s)abandoned:
Oct(10th&11th)2022 NOV 2022
5a.Well location:
Piedmont Natural Gas Company.
t kt!QWG
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Signatur fC t ied W611 Col6actor or Well Owner Date
Guilford \�
By signing this form, I hereby certify that the the//(s) was (were)abandoned in
Comity Parcel Identification No.(PIN) accordance ivith 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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
Atlacli trell construction records)ifavoilable.For multiple injection or non-water supply wells
ONLY with the 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#: MW-16 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 14.2 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 4 (in) above, also submit one copy of thi form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface:
2.7 (ft.) Division of Water Resources,U1ntierground Injection Control Program,
i i
1636 Mail Service Cen� ter,Raleigh,NC 27699-1636
i
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 where
6E Inner casing/tubing length(if known): 4.2 (ft.) abandoned. I
I
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

4
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 its needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:One lI I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 10 5 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used: I
2.Well Construction Permit#: 1
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown N/A
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public C Neat Cement Grout S Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single), ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water-Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
eMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 100 pounds,
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Grouted well in place.
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) F
Oct(10th&11th)2022 NOV �n —
4.Date well(s)abandoned: I
5a.Well location:
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(if applicable) S.Certification:
1029 Winston Street, Greensboro, 27405gt��4
10-12-22
Physical Address,City,and Zip SignatwofCYLWied V441 Cdefiractor or Well Owner Date
Guilford By signing this form, I hereby certify that the tvell(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 this record has been provided to the well owner.
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W You may use the back of this page to provide additional well site details or well
abandonment details. You may alsol6ttach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the sane construction/abandonment,you can submit one form.
10a. For All Wells: Submit this Iform within 30 days of completion of well
6a.Well ID#: MW-17D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 73.5 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following: jp
6d.Water level below ground surface: 8.3 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
s I
6e.Outer casing length(if known): (ft.) 10c.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 completion
of well abandonment to the county'health department of the county where
6E Inner casing/tubing length(if known): 68.5 (ft) abandoned.
I
6g.Screen length(if known): 5 (ft.) J
J
I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
i

l
WELL ABANDONMENT RECORD For Internal Use ONLY:
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW 30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one
NC Well Contractor Certification Number 7b.Approximate volume of water+e aining in well(s): '5 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,Stale,Variance,etc.)ifknowlt
7d.Amount of disinfectant used: NSA
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public a Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
XMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge []Groundwater Remediation Neat Cement 2 gallons
[]Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage
Bentonite 3 pounds
❑Experimental Technology El Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
4.Date well(s)abandoned: Oct(10th&11th)2022 NOV 0 4 2022
I
5a.Well location:
Urt�l
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Signat66 o6lWafied Well ntractor or Well Owner Date
Guilford
By signing this form, I hereby certify that the wells) 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 this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the same constructio labandonnent,you can subunit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
MW-19 abandonment to the following: 1.
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 12.5 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface' 9.3 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.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 where
6f.Inner casing/tubing length(if known): 2.5 (ft.) abandoned.
i
I
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016
I

f
WELL ABANDONMENT RECORD For Internal Use ONLY:
II
1.Well Contractor Information: WELL ABANDONMENT DETAILS
i
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:One II I
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 15 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name N/A'
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)lfknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MunicipaUPublic a Neat Cement Grout a Bentonite Chips or Pellets
❑Gedthermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
XMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test El Stormwater Drainage
Bentonite 144 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
4.Date well(s)abandoned:
Oct(10th-11 th)2022
v :a 2A22
5a.Well location:
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
D�. Ol�CYG
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Sig re GfVrtifiVWeaontractor or Well Owner Date
Guilford
By signing this form, I hereby certify that the well(s) was (tivere) abandoned in
County 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 ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 wellconstructionrecord(s)ifavailable.For multiple injection ornon-watersupply wells
ONLY with the sane construction/abandonment,you can submit one form.
10a. For All Wells: Submit this'form within 30 days of completion of well
6a.Well ID#: MW-20D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 101.5 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
106.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
8.5 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 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
6f.Inner casing/tubing length(if known): 91.5 (ft) abandoned.
6g.Screen length(if known): 10 (ft.)
I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
I

I �
WELL ABANDONMENT RECORD For Internal Use ONLY:
I
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:0^e
NC Well Contractor Certification Number 7b.Approximate volume of water 1 e i aining in well(s): 14 (gal.)
JG Drilling, LLCM FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction pennits(i.e.UIC,County,State,Variance,etc.)ifknoam
7d.Amount of disinfectant used: ,N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 1'Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay -
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
IlMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 128 pounds
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
Grouted well in place. _
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: Oct(10th&11th)2022
5a.Well location:
Piedmont Natural Gas Company. ��. �� Un:►
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
C; sOia- �
1029 Winston Street, Greensboro, 27405 9� 10-12-22
Physical Address,City,and Zip SignatiVe of Itified Well gntractor or Well Owner Date
Guilford
By signing this form,.I hereby certify that the ivell(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 this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 well construction record(s)ifavailable.Forundtiple injection or non-watersupply wells
ONLY with the same constructionlabandonntent,you can submit one form.
10a. For All Wells: Submit this,form within 30 days of completion of well
6a.Well ID#: MW-24D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 92.1 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following: i
6d.Water level below ground surface: 8 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.Outer casing length(if known): (ft.) 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
6E Inner casing/tubing length(if known): 72.1 (ft.) abandoned.
6g.Screen length(if known): 20 (ft.) 1
f �
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
I
I
I I

WELL ABANDONMENT RECORD For Internal Use ONLY:
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JeffreyGrant
7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW-301 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:cna I
NC Well Contractor Certification Number 7b.Approximate volume of water r e;dining in well(s): 1'6 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: N/A
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown , 'N/A
7d.Amount of disinfectant used.
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public S Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial El Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 5 pounds
❑Experimental Technology ❑Subsidence Control
❑Geothermal(Closed Loop) ❑Tracer 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Heating/Cooling Return) well in place.
) ❑Other(explain under 7g) �^•� 7 a�a as
4.Date well(s)abandoned: Oct(10th&11th)2022
5a.Well location: Uri'
Piedmont Natural Gas Company. t„.•;�r:>
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 10-12-22
Physical Address,City,and Zip Sigr re&fWrtific6t`WeILContractor or Well Owner Date
Guilford
By signing this farm, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 a•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 lat/long is sufficient) 9.Site diagram or additional well details:
N W 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
Attachu,ellconsinictioitrecord(s),ifavailable. For multiple injection or non-water supply wells
ONLY with the some construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-25 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 13.5 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:
2 above,also submit one copy of this;form within 30 days of completion of well
(in.) �
abandonment to the following:
I ,
6d.Water level below ground surface: 3.3 (ft) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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 where
6f.Inner casing/tubing length(if known): 3.5 (ft.) abandoned.
6g.Screen length(if known): 10 (ft.)
I
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

i
WELL ABANDONMENT RECORD For Internal Use ONLY: 4
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-- oop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW=30ts needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one l�
NC Well Contractor Certification Number 7b.Approximate volume of water lrei aining in well(s): 15 (gal.)
JG Drilling, LLC FOR WATER SUPPLY WELLSIONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used::N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public s Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring 9Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Bentonite 145 pounds'
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer s . r,+ �y,r_�t
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place. , C � tm t
Oct(10th&11th)2022 N011 ����
4.Date well(s)abandoned:
Sa.Well location: v D1kIt7j YOG
Piedmont Natural Gas Company.
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
1029 Winston Street, Greensboro, 27405 �yi!!�-- 10-12-22
Physical Address,City,and Zip SidXture-otrertifka W&I Contractor or Well Owner' Date
Guilford
By signing this form, I hereby certify that the ivell(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 this retard has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W You may use the back of this page to provide additional well site details or well
abandonment details. You may also I attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the saute construction/abandonment,you can submit oneform. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: RH-26D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 101 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
I
10b.For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter:
2 (in.) above,also submit one copy of this,form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 8 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Supply&IniectionWells: 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
6E Inner casing/tubing length(if known): 91 (ft.) abandoned.
' I
6g.Screen length(if known): 10 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources I Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
f
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Jeffrey Grant 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
4328-B wells abandoned:one I
NC Well Contractor Certification Number 7b.Approximate volume of water i e i aining in well(s): 33 (gal.)
JG Drilling, LLCi FOR WATER SUPPLY WELLS ONLY:
Company Name N/A
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,variance,etc.)ijknown
7d.Amount of disinfectant used: N/A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 19 Neat Cement Grout a Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial El Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry I ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge' ❑Groundwater Remediation Neat Cement 2 gallons
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑StormwaterDrainage Bentonite 320 pounds,_
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Grouted well in place.
4.Date well(s)abandoned: 0ct(10th&11th)2022
5a.Well location:
Piedmont Natural Gas Company.
�L 1�i3:Yv
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
1029 Winston Street, Greensboro, 274059&f��
10-12-22
Physical Address,City,and Zip Signa of eMtfied Vell ffoutractor or Well Owner Date
Guilford By signing this form, I hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with I5A NCAC 02C.0I00 or 2C.0200 Well Construction Standards
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: and that a copy of this record has been provided to the well owner.
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
N W 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 wellconslructionrecord(s)ifavailable.For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit one fornn.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-27D abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 209.8 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following: j
6d.Water level below ground surface: 7 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i
6e.Outer casing length(if known): (ft.) 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
611 Inner casing/tubing length(if known): 199.8 (ft.) abandoned.
l
6g.Screen length(if known): 10 (ft.)
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Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016