Iredell_Well Abandonment_20230118

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Numberofwellsbeingabandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) ror multiple injection or non-water supply wells ONLY with the same
C - 4421
0"L i •� 1 construction/abandonment,you can submit one form.
NC Well Contractor Certification Number �°�� � '
7b.Approximate volume of water remaining in well(s): 3.5 (gal.)
GEOLOGIC EXPLORATION JAN 1 8 2023 FOR WATER SUPPLY WELLS ONLY:
Company Name Uri
{f1f�f��3n Pf."G.3aw'°'ri 7c.Type of disinfectant used:_
2.Well Construction Permit#: DWOMOG
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown 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 ❑Neat Cement Grout ❑ 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
❑lrri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: 171 Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 8.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/16/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
201 PHOENIX STREET STATESVILLE 28677 �"` "`^� 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL 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]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.55" N 800 54' 55.83" 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 WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(v)if'ovailable. 1,or multiple injection or non-wafer supply
wel/s ONLY with the same consiriicvionlabandonmeni,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-86 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 44.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
6e.Borehole diameter: 2.0 (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: 27.5 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also subunit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
i
I
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) 1--or multiple h jection or non-u aler supply wells ONLY with the saute
r�> construction/abandonment,you can submit one form.
C - 4421 P- E 11�l D 7.5
NC Well Contractor Certification Number 7b.Approximate volume of water)remaining in well(s): (gal.)
GEOLOGIC EXPLORATION JAN 1 8 2023 FOR WATER SUPPLY WELLS ONLY:
Company Name �• t fG'u3S+31'k�
UM 7c.Type of disinfectant used:
IRfOf►'y1�+.1Di1 o
2.Well Construction Permit#: C&Ajoizoo
List all applicable well construction permits(i.e.County,State,Variance,etc)ifknown 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 ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 11.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage -
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/16/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �'"'"� 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this font, I hereby certify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with ISA NCAC 02C.0I00 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:
350 47' 20.03" 800 54' 00.40" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Allach well construction record(s)if available. 1;ior multiple injection or non-tracer supply
welle ONLY wide the sauce comslruclion/abandonnteut•you can subnuil one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-48 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 68.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: in addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
6e.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 21.5 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
Gf.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known):
Font GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells I J
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-[rater supply wells ONLY with the some
C -4421 E '"� ! cons(nrctia✓abandonment,you can submit one form.
NC Well Contractor Certification Number
�� . E 7b.Approximate volume of waterlremaining in well(s): 7'S (gal.)
GEOLOGIC EXPLORATION JAN 1 8 2023 FOR WATER SUPPLY WELLS ONLY:
Company Name
)nfofp',g' ^v7 Pmc3oQ'm rj Uri 7c.Type of disinfectant used:
2.Well Construction Permit#: DWOMOG
List all applicable well construction permits(i.e.County,State,tlariance,etc.)ifknmrn 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 ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
EMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 11.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage -
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 5/22
Sa.Well location:
KINDER MORGAN
Facility/Owner Name Facility 1D9(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"''`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this fayn, I hereby certify that the ivell(s) was (were) abandoned in
Comity Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0I00 or 2C.0200 Well Consimcdon 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]at/long is sufficient) 9.Site diagram or additional well details:
35e 47' 20.03" N 800 54' 00.30" 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 WELDS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)rj'orailable. For multiple b jection or non-[rarer supply
wells ONLY with the same consiructioniabandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-49 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 68.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2.0 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: 23.0 (ft,) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
611 Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form OW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) ror nudtiple h jec[ion or nor-ii ler supply wells ONLY with the same
C - 4421 cotstruction/abandonnient,you can submit one form.
NC Well Contractor Certification Number
® f 7b.Approximate volume of waterremaining in well(s): 5.75 .(gal-)
GEOLOGIC EXPLORATION 14N 1 9 7071 FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: )f fF11o,?�I Pf" )i- •3 Un l
List all applicable hell construction permits(I.e.County,Stare,Larrance,etc.)ifknoum
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 ❑Neat Cement Grout ❑ 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
❑lrri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: El Bentonite Slurry ❑Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 10.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage -
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 ' "�"°"^ 100122
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the well(s)ivas (ivere) 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]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.46" N 800 54' 59.14" 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
Atiach well construction record(y)if available. For multiple ityection or non-water supply
wells ONLY with the same consiructiodabandomnew,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 Quality,Information Processing Unit,
6b.Total well depth: 62.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in l0a
2 0 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: 26.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple h jeclion or non-i0aler supply wells ONLY with the same
constructiou/abandonment,you can submit one form.
C - 4421 ,.,, S.75
e 7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number r 4 E�7 f V D
GEOLOGIC EXPLORATION � ��� FOR WATER SUPPLY WELLS ONLY:
Company Name {! 7c.Type of disinfectant used:_
2.Well Construction Permit#: Infornia tun Rfi?CS}a'Ssing Un!i
Lisl all applicable we//construction permits(i.e.County,Stale, din ,E7. known 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 ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: O Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 10.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
5a.Well location: -
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 '"""` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the well(s)was (Were) abandoned ill
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 tvell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 9.Site diagram or additional well details:
35° 47' 20.01" 800 54' 00.66" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(y)if available. ror mtlliple in jeclion or non-water supply
wells ONLY with the sane consa,uctiodabandonnteni,you can submit one firm. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
MW-46 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 63.0 (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 0 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 24•0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply& Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Fonn GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
1

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAM ES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abanc{onin swell erVperty) For multiple it jection or non4ater supply ire//s ONLY with the same
C - 4421 {yae �o i � � construction/abandonment,you can subtltit one form.
f 7b.Approximate volume of water remaining in well(s): S.75 gal.)
NC Well Contractor Certification Number JA N 1 S 2023
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name lntorma on ProcwQg rg Ur-gl 7c.Type of disinfectant used:_
CV/QI'30
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown 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 ❑ Neat Cement Grout ❑ 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: 0 Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 10.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 5/22
58.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 " ""°^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this fornt, 1 hereby certify that the well(s) ivas (lucre) 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:
35e 47' 19.88" N 80e 54' S9.56" 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)if available. For multiple it jection or non-crater supply
wells ONLY with the same construction/abanclatanent,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDN:
MW-55 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 64.0 (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 0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
Gd.Water level below ground surface 22.0 (ft,) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Suuuly&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ft) where abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For mu/liple itjeelion or non-u[�aler supply wells ONLY with die same
constructiontabandonmew,you can subolit one form.
C - 4421
y `+ 7b.Approximate volume of water'remaining in well(s): 4'25
NC Well Contractor Certification Number (gal.)`, j
GEOLOGIC EXPLORATION ^ FOR WATER SUPPLY WELLS ONLY:
Company Name U
7c.Type of disinfectant used:_
2.Well Construction Permit#: lr4ofw,3:iz?n Pf.^.G3 g' rr3 Urci
List all applicable well construction perttdts(i.e.CounlyDXWQ% o'113G,etc)ifknown 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 ❑Neat Cement Grout ❑ 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
❑lrri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: 21 Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 9.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of.the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMII= PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 5/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
201 PHOENIX STREET STATESVILLE 28677 °^' 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this farm, I hereby certify that the well(s)ivas (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and drat a copy of this retard has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one tat/long is sufficient) 9.Site diagram or additional well details:
350 47' 20.08" N 800 54' 58.70" 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
Allach well construction record(s)if arailable. Far multiple ityeclion or non-wafer supply
wells ONLY with the same consiructiou/abanrlontnent,you can subtnit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-62 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 56.5 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Irriection Wells: In addition to sending the form to the address in 10a
2.0 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: 30.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Suaoly& Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
Gf.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Font GW-30 North Carolina Department of Enviromnent and Natural Resources-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple h jection or non-uiater supply weAs ONLY with the same
constructionlabandonmeni,you can subnliil ate form.
C - 4421 , IV
NC Well Contractor Certification Number "'�E"' ED 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION JAN 1 8 ?V3 FOR WATER SUPPLY WELLS ONLY:
Company Name
Infiara;a.t
�]t.;,-n AI•,^:.4iw,A.g Urt;�S 7e.Type of disinfectant used:_
2.Well Construction Permit#: C AIWI I•
List all applicable well construction permits(i.e.Comity,State,Variance,etc.)ifknomtt
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 ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
o Monitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 5.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility 1D4(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"" '"`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.83" N 800 54' 55.02" 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(v)if available. Par multiple injection or non-crater supply
wells ONLY wilh the same consOvction/abandonmettt,you can submit one form. 1 Oa. For All Wells: Submit this form Within 30 days of completion of well
6a.Well ID#: MW-68 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 30.0 (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: 2.0 (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: (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
Ge.Outer casing length(if known): (ft.) 10c. For Water Suonly&Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
611 Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) ror multiple b jection or non-heater supply we/Is ONLY with the scone
C - 4421 construction/abattdotmtettt,you can subnl7 one form.
0'S
NC Well Contractor Certification Number f �t 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION 16-- IV ` FOR WATER SUPPLY WELLS ONLY:
Company Name JA N 1 b 2023 7e.Type of disinfectant used:
2.Well Construction Permit#:
roi n Lirt all applicable well construction permits(i.e.Cot , t 'e-1
������ 7d.Amount of disinfectant used:,
3.Well use(check well use):
Water Supply Well: 7e.Scaling materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: 21 Bentonite Slurry ❑ Other(explain under 7g)
Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 5.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage -
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 °�''"^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivel/(s) ivas (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:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
3 5 o 47' 19.81" N 800 54' 57.42" 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 WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach hell construction record(s)if arailable. Tor multiple injection or non-water supply
we/Is 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-70 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth:
29.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in l0a
2,0 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: 28.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply& Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6C Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
I
i
I

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON � 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For niukiple injection or non-}eater supply wells ONLY with the same
construction/abandonment,you can submit one form.
C - 4421 IC EIV
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 0'S-(gal.)
GEOLOGIC EXPLORATION JAN 1 S 2023 FOR WATER SUPPLY WELLS ONLY:
Company Name
N,s �-3 Um7c.Type of disinfectant used:
Ifl0fgi�� til fz..K�34r:.a
2.Well Construction Permit#: rtr.�"tOG
i}jr�
List all applicable well construction permits(i.e.County,State,Variance,etc);fknown 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 ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑lrri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: 0 Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 5.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage -
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 5/22
5a.Well location: _ --_--. _- -- _ -- -
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �" �'"'"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 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 Consn-ttction 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:
(ifwelI field,one hat/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.65" N 800 54' 57.16" 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 consirumon record(s);f available. For nudliple it jection or non-water supply
we/ls ONLY with the same consiraciimdabmidorimeiii,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-74 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 27.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 26.5 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
loc.For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
Gf.Inner casing/tubing length(if known): (ft.)
where abandoned.
6g.Screen length(if known): (ft.)
i
i
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply hells ONLY with the some
constructioniabandonment,you can submit one form.
C - 4421 9 '
1\ 7b.Approximate volume of water remaining in well(s): 4'0 (gal.)
NC Well Contractor Certification Number B i `•
GEOLOGIC EXPLORATION I A b19 FOR WATER SUPPLY WELLS ONLY:
Company Name 7e.Type of disinfectant used:_
2.Well Construction Permit 9: ► ufRiail�l nf` 3 Unit
List all applicable well construction permits(i.e.County,State,I aq ,��2 ~known 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 ❑Neat Cement Grout ❑ 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: 21 Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 8.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stonnwater Drainage -
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 S/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL 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 ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.51" N 800 54' 56.34" 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
Auach well construction record(,)if available. For multiple it jection or non-water supply
wells ONLY with the satue construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well[DO: MW-82 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 51.0 (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: 27.0 (ft,) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6C Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Fonn GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
1

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandol ed: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-crater supply wells ONLY with 1he .enure
construction✓abandonment,you call submil are form.
C - 4421
NC Well Contractor Certification Number !�t _p / 7b.Approximate volume of water remaining in well(s): 4.0 (gal)
GEOLOGIC EXPLORATION "'�"', FOR WATER SUPPLY WELLS ONLY:
Company Name JAN 1 8 2023 7c.Type of disinfectant used:_
2.Well Construction Permit#: 1 1MW
List all applicable well construction permits(i.e.Co)Llfy{i'ik?`%dl•alrci.;'%i"� ro rn
G�eo(�. 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 ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: 0 Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 8.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Coolin Return ❑Other(explain under 7
( � g ) ( P g)
4.Date well(s)abandoned: 1 1/15/22
ia.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
201 PHOENIX STREET STATESVILLE 28677 '"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.6100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
ib.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one tat/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.51" N 800 54' 56.20" 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
Allach well consiruclion recor (y)if available. For nudliple u jeclion or non-wafer supply
wells ONLY with the sane carstrrtciiotr/abandonment,you can submil one form. 1 Oa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-83 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb."Total well depth:
52.0 (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: 2'0 (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: 28.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Infection Wells: in addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
611 Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON l 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For nudtip/c injection or non-haler supply wells ONLY will; the .same
consiruciion/abamloirnrent,you call submit one forrn.
C - 4421
a as
NC Well Contractor Certification Number C" 3.0
` E�� �,; 7b.Approximate volume of water remaining in well(s): (gal.)
s �
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name V
7c.Type of disinfectant used:
2-Well Construction Permit#: c -^"'^•��ft7 3stT URa
List all applicable well construction perinits(i.e. ouniy,SlolC-4 bD, 16?)ifknorrn 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7c.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ 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: 21 Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 7.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage -
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE: PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 5/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) S.Certification:
201 PHOENIX STREET STATESVILLE 28677 °'`^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, /hereby certify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15.4 NCAC 02C.0.100 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 tat/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.51" N 800 54' 56.12" 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 wolf construction record(s)if available: For multiple ityeclion or non-haler supply
we/Is ONLYwithdresameconstrucciotr/abandonment,youcansubiniionefonn. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-84 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 45•0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: in addition to sending the form to the address in 10a
2.0 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 27.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Fonn GW-30 North Carolina Deparlment of Environment and Natural Resources—Division of Water Quality Revised March 2013

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
.JAM ES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name or well owner personally abandolti `s6f n hts m For multiple h jection or non-haler supply wells ONLY with the .came
( P Y t l
� �.o.. • cwrstruction/abandanmen(,you can svbnut are form.
C - 4421 i 3.75
NC Well Contractor Certification Number JA N 1 8 2023 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION inf tsar«a„1 "I•.^ m. L-,,� I� FOR WATER SUPPLY WELLS ONLY:
Company Name W110iBaG 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,Slate,Variance,etc)ifknown
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 ❑Neat Cement Grout ❑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: 21 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 10.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/16/22
Sa.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 '`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)was (here) 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]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 18.83" N 800 54' 58.86" 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)if available. For multiple h jeclion or nor-wafer supply
wells ONLY with the same cons(ruction/abandoanew,you can submit one forty!. 1 Oa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: AS-28 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth:
64.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
41.0 Division of Water Quality,Underground Injection Control Program,
Gd.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
i

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON i 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple hyectiwn or non-neater supply wells ONLY with the sane
C - 4421
construction/abandonment,you can submit one form.
NC Well Contractor Certification Number ��—
j ""� ��I 7b.Approximate volume of water remaining in well(s): 3.75 gal.)
GEOLOGIC EXPLORATION JAN 1 S 2023 FOR WATER SUPPLY WELLS ONLY:
Company Name 7 .�,. .,�,.:r.
i�CfF;�OD p i,.,�s,,++•,-3 UR:' 7e.Type of disinfectant used:_
2.Well Construction Permit#:
C+aaiC�i u0ii
List all applicable welt construction permits(i.e.County,State,Irariance,etc.)ifknown 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7c.Sealing materials used(check sill that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ 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: RI Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 10.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/16/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"'`"� 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, /hereby certify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0/00 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:
350 47' 18.70" N 800 54' 59.42" 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 WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. 1%or multiple hyection or non-neater 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#: AS-27 abandonment to the following:
Division of Water Quality,information Processing Unit,
Gb.Total well depth:
62.0 (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 0 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: 40'0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply& Infection Wells: In addition to sending the forms to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For mulliple it ieclion or non-water supply u•e/ls ONL1' with the sane
.�� � `'*� construction/abandonment,you can submit are form.
C -4421 ��„vo����"� 3.75
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION JAN 1 S 2023 FOR WATER SUPPLY WELLS ONLY:
Company Name 1 i�fi::r•SrF- Lru(
If1�CfFlewd- 3 7c.Type of disinfectant used:_
V 1�i\dJ f�JJV
2.Well Construction Permit#:
List all applicable well construclion perntils(i.e.County,State,Variance,etc.)ifknown
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 ❑Neat Cement Grout ❑ 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: 0 Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRetmediation 10.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage —
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
[]Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/18/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID4(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the well(s)teas (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 tat/long is sufficient) 9.Site diagram or additional well details:
35 0 47' 18.21" 800 t 54' 58.76' You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(,)if available. For multiple byection or non-crater supply
welts ONLY with the saute co»struction/abandonnteni,you can submit ate form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
AS-29 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 65.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 2'0 (in.) abandonment to the following:
6d.Water level below ground surface: 39.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known):
i
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her�rro a For multiple injection or non-}rater supply wells ONLY with the same
C - 4421 0 construction/abandonment,you can submit one form.
L .+ g�" rt 5.5
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION JAN 1 S 2023 FOR WATER SUPPLY WELLS ONLY:
Company Name In iR 1 PI;-:',: 3 ur' 7c.Type of disinfectant used:_
2.Well Construction Permit#: 3�iael�ruDls
List all applicable well construction permits(i.e.County,State,Variance,etc)ifknmrn
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Scaling materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustriaVCommercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑Other(explain under 7g)
E M onitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 14.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 11/18/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
201 PHOENIX STREET STATESVILLE 28677 �"�'"' 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing ibis font,, 1 hereby certify that the ivell(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with ISA 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:
350 47' 17.44" 800 55' 00.02" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(,)if available. For multiple h jectimn or non-staler supply
wells ONLY with the sate consirtiction/abandonnneunt,yam can submit one forma. 1 Oa. For All Wells: Submit this form within 30 days of completion of well
6a.Well iD#: MW-1 6I abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 87.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For infection Wells: in addition to sending the form to the address in 10a
20 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: 53.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
loc. For Water Suonly&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6E Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
I.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) 1%or multiple It jeclion or non-waler supply wens ONLY with the .came
constructionlabanda»nuent,you can submit one form.
t v° a-- 7b.Approximate volume of water remaining in wcll(s): 3'S gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION JAN 1 S 2023 FOR WATER SUPPLY WELLS ONLY:
Company Name
(O q� - r 3 Uni! 7e.Type of disinfectant used:
inu2.Well Construction Permit#: [ANIOMOG
List all applicable well construction permits(i.e.County,Stale,Variance,etc.)if known
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 ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: Rl Bentonite Slurry ❑ Other(explain under 7g)
El Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 8.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 8/22
5a.Well location: -
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
201 PHOENIX STREET STATESVILLE 28677 �""`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 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:
(if well field,one tat/long is sufficient) 9.Site diagram or additional well details:
35�47' 17.44" 80e 55' 00.02" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Allach well construction record(v)if available. 1,or umlliple it jeclion or non-iraler supply
wells ONLY with lbe same construction,abandotnnen4 you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
MW-16S abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 50.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2O above,also submit one copy of this form within 30 days of completion of well
.
6c.Borehole diameter: (in.) abandonment to the following:
29.0 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636 .
10c. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f,Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division or Water Quality Revised March 2013

WELL ABA
NDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandon 11 on hisllter propen ) For multiple injection or non-water supply wells ONLY with the .same
11%. a"^t / ( 1 construction/abandonment,you can submit one form. 3.5
C - 4421 555 ttt��� ►E 4 •i IL,
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION JAN 1 S 2Q23 FOR WATER SUPPLY WELLS ONLY:
Company Name a i� ?r:J'r•+'r:v Un;'
Ii1tl3{p;oa:.>'1 3 7c.Type of disinfectant used:
✓�1Q.uJL=
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknotrn 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 ❑Neat Cement Grout ❑ 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
❑lrri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: 0 Bentonite Slurry ❑ Other(explain under 7g)
EMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage —
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/18/22
—5a:Well location: -
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 °'°' 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, /hereby cerlify that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0/00 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:
35° 47' 17.22" 800 54' 57.40" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach wefl consirucann records)if available. For multiple n jecrion at,non-tracer supply
wells ONLY with rho 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#: AS-25 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth:
58.0 1617 Mail Service Center,Raleigh,NC 27699-1617
(ft.)
10b. For Infection Wells: In addition to sending the form to the address in IOa
above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: 2'0 (in.) abandonment to the following:
37.0 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
IOc. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6L Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known):
i
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply wells ONLY with fire .ranee
C - 4421
construction/abandonment,you can subm I it one form.
_ _ ��''��
NC Well Contractor Certification Number ;tom 'I�, 1✓ 7b.Approximate volume of water remaining in well(s): 5.5 (gal.)
GEOLOGIC EXPLORATION t^n11y .�T ctLcd FOR WATER SUPPLY WELLSONLY:
Company Name t'c 7e.Type of disinfectant used:
t a YP -
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,Stale,Vridt kz. .tf fknown 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 ❑ Neat Cement Grout ❑ 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: 21 Bentonite Slurry ❑ Other(explain under 7g)
EMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 10.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stonmwater Drainage -
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/18/22
-- - -5a.-Well location: ------- -- _
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
„1a6u..�..�
201 PHOENIX STREET STATESVILLE 28677 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL 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.0)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[at/long is sufficient) 9.Site diagram or additional well details:
350 47' 15.42" N 800 54' 58.32" 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 ere/l construction record(s)if available. For multiple itliection or non-uraler supply
wells ON1.Y with the same construction/abandonment,your can submil one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID9: AS-31 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth:
65.0 (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:
32.0 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Supply& Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f.Inner casing/tubing length(if known):
6g.Screen length(if known):
Form G W-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013