Mecklenburg_Well Abandonment_ (18)

WELL ABANDONMENT RECORD Fmlmn llm ONLY
This font can be uwd fm sirgtle or nudtipk wells
1.Well Contractor Information: WELL ABANDONMENT DETAR_S
Brian Ewing 'A.\umber of wellx being abandomed: 1
WellCountiMa Name for cell uwar prxnuil.ahcd..nnt_... rvn.. oomph- uyv,ion .v w.+-.<urr n"A taus ONLY wall, 1Ar sarw
.�•mrc ran„haw(.nwrnr nv„er rvMn,.x 6xm
4240-B
NC Well COageiO,fcoifolnw NnMrcr 7h.App nix imate aidnmr of warn remaining in well(%I: I gal.)
SAEDACCO Inc FOR W ATF.R SI PPI-Y W FL1 SONLY:
COWWMo Nase 7G I\pe of Jr4nfKNn1 fixed:
2.Well Coagm-torn Permk M;70003075, ,
I.adl,q,rru eAA .,o;,—,I ,, I,w,m.Mar.Iamaar /grrM,n n, ulAman
'd. \mnnnt ul Jia ntca ani uvJ:
J.W'dl uw Ichrvk%e1J uwel:
Water Supph Well: 7e.Sealing material%uwd tcbcek all that apphl:
❑AgrcnOural flMaaclpal:Ptblrc ® Not Cement Gann I I Berronnc Chips Pelleti
O(tnehemul("emmc('oohlrc Arpvh I ❑Rc dna3l Water Supph IarE1C) O Sued Cement(unfit ❑ On('has
❑Indusmabfonmteroal DRcademal Water Slipph ImhrrdI O COYctcse(Limn ❑ D011 Cullmgs
❑Inn•-tmo ❑ SP&I31h Gtuul ❑ Gael
New-W ate'r Supph (loll: ❑ Wi4anac Slum I l fhbeiicspl;on mdo 'ui
3Alonrloum OReemm
loin-lion Well: 7f.Fol'eaeb nuh'nAl WICard ahw C.poodle Antonio of matfrtah nwd:
❑Agal<r ReclurhT DGmudumer Rarieibarcwr Rest Cem. :47lb ,Wtr:3gal. Sand Cem. :lb ,Wtr:gal.
❑Aquifer Storage and Reco,ax ❑Sabah Danner
❑Agmfer feat ❑Smmmater Uratnige
❑Evperamental lechnolop ❑Slbsidctce C'olllml 'L Prtn irk s hrfN deacripinu f Me abandonment pnwdnre:
liGeotber al(Closed I,00pl t]Tr r
tremi from the bottom to surface
uGeorhemtallNeaun ,Cooli Rneenrl UOdiertes in adcr' e
4.Date welllsl Aomdnned: 11-1-22 f'� el,,,./V " i u f,_
_ FRi=
4.Well location: NOV 9. A 2022
Norfolk Southern Intermodal Yard
Facilm(N,rcr Name Fadla,Ron of aml,,ohlr N 1 rrtdicninn; .,..1 �(,.;-Wvv-;j Uhl
1f1lGfA�%4�t-
E °`
333 Packwood Ave, Charlotte, wing 11/
, NC 28206 11/11/2022
PM seat Addce.Cm.and Zip lq, arc,d('and'rad R.11 rnmc.a ..::I(Macr Dar
Mecklenburg 08301126 111 sayruge th(s term, l h mht .. r.rr that the wefffn wm (were, abond,ned fit
('".a, 1`.naallJtmisalxin No 111%, mmnlnni'e tool,151VC-1(7(IY",0100 or]f' ONNI Ifi'll Cimrtm,rv,n.\(,.ndvde
,md ofus a«,pie of lh,,rMir'dfar beat prvno<hyf In the well own.,
ah.Latitude and bnlpmdr in dcVvr%s minutnrw'anrnds or dr omal dt-grrev
(il Dell field +uw hit.anrx 1,wna.em 9.Site diagram or Additional well drtsrs:
)"nun we Ilse back of 0Rs page to prm i&:ukbboiul well site detads or well
N \\ abaalunneta dnaib. M ou ncn also umch:aWitwtul pages if Ilacmmix
CONSTRUCTION DF.TAms OF W EI_I iSi BEING AB ASDO\I.If S_CBMfTTAL INSTRUCTIONS
truth wall ny7•G
.rd,ovf.r. .. 10a For All WeW: Slbrat thcs form ithin ;(1 dos of cangrklwo of well
6a.W ell I Ua:
TMW-5 abadonmeta to the folinst Ing
Motion of%strr Resources.Information Proevxing('fill,
6b.Total ocll drptic 15 lfLl 1617 Mail Senice Tenter,Raleigh.SI'276"AW
glib. Fur Intedlon W dls: n addutou to sadmg 11w form to the address tl Ina
rw,&rreMdc dianwh'r'1 flu.) :bola also sai,nio enc :ups of die, tone uoln l wi dais or c,mpinion of well
ibadoir"WIM to IIIC hflluw ule
Box Won of W o Ater Ruurom,I ndurgriwnd Injection Coetrl Prargram.
hA.N An'r k's'el helnw grounA wrfarr: Ih.l 16JIi Nail Smice frmer.RAkigh.NC 27699-I6.I6
111c. For Wader Sumrh& InkYtlon Wells: To addition to sending Ihr fort to
rw.Outer caring length l if knoo ne IfLI
J, aJdrcemcsr uixot e. alto xbror axe cups of dro (ono within in d;ns of
compicann of icll abandonment to the cotmh hcalih dcp:rnern of the enter,
5 u lure Au lord
6f.Inarr cArinytobmg kmtnh rig'Inns n c Ihl
(it.Sea"length(if Mon n c 10 (ILI
I.., ens.- 1,'-tl 1.u' i a..,aµawclr ufEto Ito wMard NaimIResoruees Dhownuf WawrRwuacs No e,d \nws NI!