WI0400523_Injection Event Record_20200113

WELL CONSTRUCTION RECORD GW-1
L Well Contractor Information:
For Internal Use Only:
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
36.1413649N -80.2636088
W
6. Is(are) the well(s)IDPermanent or IDTemporary
7. Is this a repair to an existing well: Yes or X�No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only J_ClW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: ** t
9. Total well depth below land surface: multiple, see attached
For multiple wells list all depths ifdifferent (example- 3@200' and 2@100') (tl
10- Static water level below top of casing:
If water level is above casing, use -+" (ft.)
11. Borehole diameter: 1.5
(in.)
12. Well construction method: direct push
(i.e. auger, rotary, cable, direct push,
Zachary Poole
Well Contractor Name
NCWC 4415-C
NC Well Contractor Certification Number
Redox Tech, LLC
Company Name
2. Well Construction Permit #: ill
List all applicable well construction permas U1C, County, St te, Variance, etc.)
3. Well Use (check well use): W 164DnTL3
•• -PPy rr ell:
(isothermal (Heating/Cooling Supply)
hidustrial/Commercial
Non -Water Supply Well-
Recharge
Storage and Recovery
Test
lxpenmental Technology
Geothermal (Closed Loop)
Geothermal (Heatinn/(', 1;,.,,. r
QMunicipaUPublic
Residential Water Supply (single)
Residential Water Supply (shared)
Groundwater Remediation
ID Salinity Barrier
IDStormwater Drainage
0Subsidence Control
Tracer
Other (explain under #21 Remarlrc
4. Date Well(s) Completed.. 1/24/2020
WeIIID#
5a. Well Location:
Facility/Owner Name Facility ID# (ifapplicable)
4015 Cherry St, Winston-Salem, NC 27106
Physical Address, City, and Zip
Forsyth
County
��. %-urnrcanon:
02/10/2020
Sid u of Certified Well Contractor
Date
By signing this form, 1 hereby certifv that the wells) was (were) constricted in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that e
COPY of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. F r All iii Submit this form within 30 days of completion of well
construction to the following: e
Division of Water Resources, Information i ro y � nit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. F r Injection Wells: In addition to sending the form -to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
FOR WATER SUPPLY WELLS ONLY: Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test:
24c. For Water Su l & Injection Wells: In addition to sending the form to
13b. Disinfection type: the address(es) above, also submit one copy of this form within 30 days of
Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

,�q

WELL ABANDONMENT RECORD
I. Well Contractor Information:
Zachary Poole
Well Contractor Name (Orwell owner personally abandoning well on his/her property)
NCWC 4415-C
NC Well Contractor Certification Number
Redox Tech L
LF;ase ONLY:NDONMENT DETAILS — — — — — — — — —
7a. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
well construction/depth, only 1 (W�
wells abandoned: f 0 is needed. Indicate TOTAL NUMBER of
-aaa,
7b. Approximate volume of water remaining in well(s):
Company Name — FOR WATER SUPPLY WELLS ONLY:
2. Well Construction Permit #: I `1 O J,tl 7c. Type of disinfectant used:
List all applicable well construction permits (i.e. UIC, County,, Str te, Variance, etc.) ifknown z
3. Well use (check well use): wZ o 40d sa,3 7d. Amount of disinfectant used:
Water SuPP1Y Well: — — — -- — — — — f
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commerc ial
Non -Water Supply Well
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatinfl/r,,,, i;. t
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
"Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
[]Subsidence Control
❑Tracer
— ❑Other (explain under 7
4. Date wells) abandoned: 1 /24/2020
5a. Well location:
Facility/Owner Name
Facility Di
4015 Cherry Point, Winston-Salem,NC2applicable)7106
Physical Address, City, and Zip — — — -- —
Forsyth_ _
County —
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
36.1413649 N-80-2636088
—W
CONSTRUCTION DETAILS OF WELL S BEING AB Attach welt construction record s i available. For multiple injection or noon-watteerrsupply wells
ONLY with the same construction abandonment, you can submit one form.
6a. Wen ID#: multiple, see attached
6b. Total well depth: multiple, see attached
6c. Borehole diameter: 1.5
6d. Water level below ground surface:
6e. Outer casing length (if known):
6f. Inner casing/tubing length (if known):
6g. Screen length (if known): —
(ft.)
7e. Seating materials used (check all that apply):
❑ Neat Cement Grout
❑ Sand Cement Grout
—0 Bentonite Chips or Pellets
❑ Concrete Grout
❑ Dry Clay
❑ Specialty Grout
❑ Drill Cuttings
❑ Bentonite Slurry
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected
­251bs per hole
above, provide amount of materials used:
7g. Provide a brief description of the abandonment procedure:
Pulled rods out of ground, backfilled with bentonite, once
filled all the, ay to the top, took a blunt tip and pushed the
bentonite down 5 ft and filled back to surface
S. Certification:
2/10/2020
g ire of Certified a ontractor or Well Owner
Date
By signing this form, I hereby certify that the wells) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTI NS
10a. For Ate. Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
lOb. For InlectiOn Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Wafer 1, & In'ection 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 countyajth department of the county where
abandoned. §
Form GW-30
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 2-22-2016

North Carolina Department of Environmental
INJECTION EVENT REC RDER Iiof Water Resources
Permit Number Wl: 04 0b 5,1'j
--
1. Permit Information
6h
Permittee
Facility Name - -
Facility Add ess (include County)
2. Injection Contractor Information
i nnection Conlractor / Company Name
Street Address_ko01
A -
Ci State Zip Code
A -1�) 1i 1E6H0
Area code - Phone number
3. Well Information
Number of wells used for injection ?
I
Well IDs�]_�-h) L. sr.,
Were any new wells installed during this injection
event?
❑ Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells —�
Number of Injection Wells q--
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled [4 Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-I orm for each
well installed
I
Were any wells abandoned during this injection
event?
VkYes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells_
Please include a copy of the 2W-30 for each well
abandoned
4. Injectant Information
"��v �
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration�(ttj
If the injectant is diluted please ind�icai� he to urce
dilution fluid.-r
Total Volume Injected (gal)A I Z. g 4:j n .A I
Volume Injected per well (gal) 5�J- �U
5. Injection History
Injection date(s)
Injection number (e.g. 3 of 5)
Is this the last injection at this site?
❑ Yes ❑ No
DO HEREBY CERTIFY THAT ALL THE
NFORMATION ON THIS FORM IS CORRECT TO
HE BEST OF MY KNOWLEDGE AND THAT THE
NJECTION WAS PERFORMED WITS THE
TANDARDS LAID OUT IN THE PERMIT.
�- oz J�rrJ�za
NATURE OF INJECTION CONTRACTOR
DATE
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 3-1-2016

A

North Carolina Department of Environmental
INJECTION EVENT Environmental
Division
DER of Water Resources
Permit NumberMLOq a23—
I I. Permit Information
nvmm— _ _ _
Permittee
Facility Name
N S1 n- m alU�
Facility Addre s (include County)
CTo�s�.��►,
2. Injection Contractor Information
Injection Cone actor / Company Name ��
Street Address &v.
a,� State Zip Code
Area code - Phone number
j 3. Well Information
I
Number of wells used for injection
I y
Well IDs-Ld-- � JTW_-- .I�3
Were any new wells installed during this injection
event?
❑ Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells_
Type of Well Installed (Check applicable type): I
❑ Bored
❑ Drilled ❑Direct -Push �
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW--1 orm for each
well installed
LE
Were any wells abandoned during this injection
event?
❑ Yes ANo
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells_ -
Please include a copy of the !GE_-30 for each well
abandoned.
4. Injectant Information
I�� 1,ruc,�-a� Co,m ru vcx�ivw,
Inje tant(s) Type (can use sep ra a additional sheets
if necessary
Concentration 1(JU N FC Sa �� ��`
9_ [ !
If the injectant is Idilut d pleas'indicate he source
dilution fluid. �� V�-
Total Volume Injected (gal)- I "
Volume Injected per well (gal) Gv S
5. Injection History
Injection date(s)
Injection number (e.g. 3 of 5)
Is this the last injection at this site?
❑ Yes ❑ No
DO HEREBY CERTIFY THAT ALL THE
NFORMATION ON THIS FORM IS CORRECT TO
'HE BEST OF MY KNOWLEDGE AND THAT THE
WECTION WAS PERFORMED WITHIN THE
TANDARDS LAID OUT IN THE PERMIT.
NATURE OF INJECTION CONTRACTOR � 2 L � 1020
DAT=
Ea�,
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attu: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 3-1-2016

Well IDs and their corresponding depths
44-70 bps.' FS-004
24-50 bgs: FS-002; FS-003
40-58 bgs: FS-032
40-70 bgs: FS-031; FS-010
50-7�0 b9s: FS-033
34-58 baj; FS-070
3012 bgs: FS-019
20-58 bRL FS-041; FS-026
20-46 bgs: FS-085; FS-039
24-40 bps: FS-092; FS-105; FS-117
24-56 bgs: FS-019
34-70 bps: FS-020; FS-001
25-55 bps: FS-023; FS-054
20-64bgs: FS-055
30-60 bps: FS-015
20-44 bas FS-075
24-50 bps: FS-098; FS-008; FS-094; FS-101; FS-109; FS-095; FS-102; FS-108; FS-096; FS-103; FS-097;
FS-099; FS-093
30-50 bes: FS-107; FS-107; FS-009; FS-115; FS-077
20-38 b- FS-028
20-62 bgs: FS-028
24-52 bgs: FS-066

Well IDs and their corresponding depths
20-6Qs: FS-071; FS-083; FS-082; FS-087; FS-091; FS-089; FS-073; FS-080; FS-079; FS-046; FS036;
FS-047; FS-035; FS-024; FS-025; FS-056; FS-029; FS-051; FS-086; FS-078; FS-006
20-5�FS-065; FS-050; FS-088; FS-007
29-57�b-rs-'s. FS-122
35-51 bps: FS-069
36-40�F-104
29-39 bgs_FS-127
26-6�FS-149
2626-8�FS-151
26-72�FS-150;FS-148
26-800 b9s.. FS-153; FS-152
4646-7�s_ FS-147
26-76 b -S FS-154; FS-146; PS-145
24-60 bj�sLFS-084
20-48 b9s: FS-076
30-44 bps: FS-114
24-42 b9 FS-120
30-4_ 6 b9s_: FS-113
19-55 bEs:-FS-131; FS-129; FS-143; FS-142; FS-141
29-55 bgs- FS-128; FS-123; FS-121; FS-124; FS-125; FS-126; FS-130
20-7sF5-048; FS-049; FS-061; FS-057; FS-074
20-54 bPs: FS-090; FS-045; FS-062; FS-063
20-52 b9s_ FS-016; FS-081; FS-040; FS-064
20-56FS-072; FS-034; FS-059; FS-058; FS-027
20-6� FS-013; FS-037; FS-017; FS-018
2424-4�s: FS-111; FS-116; FS-112
2222-6� FS-011
30-52bs_: FS-052
40-50 bps FS-014
44154 bs: FS-021
24-35 b s_: FS-100
30-6FS-005
25-45 bg—s: FS-110
25-55 b&s; FS-068; FS-060
50-60 FS-044
30-58 bps_ FS-042
30-4 FS-118; FS-119
FS-053; FS-067
44-64 b�5 FS-043; FS-022

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WELL CONSTRUCTION RECORD
Thar can he aced for single or nailtipk wells
1. Well Contractor Infurrnatfon:
NICHOLAS HAYES
K ell Contraclw Name
A - 4121
NC We l Conlraeiw CertrFicaiatn Number
GEOLOGIC EXPLORATION, INC
Company Name - - - - - -
2. Well Construction Permit 9. l.+irtanoppllrable srl/ ranvrarrlw, permlrr (Lr_, ('awr -
ry �smr, Yarimrrr. rrr)
J. Well Use (cheek well on),
1Vater Supply Well:
DAgricultural
bMunicipalipublic
OQ hitter mat mmerng/Cooling SnPP1Y) OResidential Water Supply (single)
01m2a'rrallCvmmeretal OResidential Water Supply (shared)
Dlrcrreanrai
Non -Water Supply Well:
DAquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
OExperimental Technology
OGethermal(Closed Loop)
-- _ �Rewvery
0GrOundwater Remediation
OSalmi'y Barrier
OStormwater Drainage
OSubsidence Control
❑Tracer
4. Date Wells) Compleled: 10/28/19 IW-3
Well ID#
Sa. Well Location:
CINTAS
Fac,141hvaer Name
Facairy ID tifapptltabk)
4015 NORTH CHERRY STREET WINSTON SALEM 27106
Physical address, Cay ions zip
FORSYTH
Coumv �'
' Parcel tdeairfiratlon No. (PIN)
Sb, Latitude and Long i Longitude in degrees(millOft1seeonds or decimal degrees:
(rt'well field, one lel;ttinga sufFrcieml
a r
la l f (2,2
Fur Inertial Use ONLY - -.
14 WATBR 7ni"Pc -
AFRO OUTER CASING for mulNtarel wells OR LINER if a cable
FROM TO D1AMCM
ft R, TRIC1rIYATERIAL
ia.
115. INNER CASING OR TUBINC PRO -thermal el
M TO 01AMET-t
TH[CRNE$g 0.0 2 58MATERIAL
.0 R 4.0 fu
SCH 40 PVC
ft g, is
58.0 R. 88.0 ft 4.0 MATEWA
010 SCH 40 PVC
AFL R• in
it Gil
FROM TO MATERIAL
PJNPLAC'EMENrMETNODQ AMOU
0.0 53.0 R• coanrwaartira.re SLURRY
R. fill.
ft. -
19 RAVEL PACK ills able
Fnont To MATEIiIAI
R• wrlacttMElrT ars:nrpo
56.0 R• 88.0
20.40 FINE SILICA SAND
J 0.0
� 15.0
�•
._._.. _..� awroea r
BROWN SANDY SILT
15.0
R 35.p
R'
RED CLAYEY SILT
35.0
R 50.()
R
RED SANDY SILT
50.0
tL 60.0
tL
BROWN SANDY SILT
60.0
R74.0
ft
PWR
74.0
R 86.0
fr.
WEATHERED ROCK
86.0
R 88.0
R•
ROCK
21. ROIARKS
BENTONITE SEAL FROM 53.0 TO 56.0
FEET
22. Certification: -
36 08 27.85" 80" 15' 49.40"
N
�ti
- �
6, Is (are) the Well(s): Opermanent or raTemporary
S sffiure arcenirled Well cwitiaGw 11/25/19
--
Daft
7, Is this a repair to an existing well: :Ayes Or ONO
IJ Jac ar a repo",
!ly srgtrrag rlkr farm. / lrrrehy rrrrl that Jre rell(x/ um (irrrr/ rwrstrwred rn Ja rvrnGunr
uirh 13AN( A(' oIt' 0/r1p nr !SA Mf'A(' 07('.UIOrI Weq
fJl ma "W we!! rraarrrnr rk»i mf"rmotk:" anJrsploLi N" rxrn"r afd4r
rep"ir wnk► . 21 reauirla WX tin" nron the back afdrts form.
(iurrrrunlan V
rap! M rh& mstrd hrrr hre"I-mded ret thr well arum �JaxLr sou/ that n
8. Number of writs constructed: 1
13. Site diagram or additional well details:
You may use the back of 'his Page to
1, rP rnrlfrrple inlserrhur ornan-Irater srygyy wills' ONLY wgh rhr..ra"u cwraradfcw.
ririinar Jere frtrM.Y
provide additional %ell site details or %%ell
eon ruction details. You also attach additional pages II neCe55ary
you can
9. Total We" depth below land surface: 88.0
SUBMITTAL INSTUCTIONS
_ _
14" eadrpk wells hsr all rkprhs /Ji,(jereirr (rxampdr- .i4FzlY1'atull10(!'1--(ft.)
24a. For A� N Well: Submit this form within 30 des of completion
construction
10. Static water level below top of casing: 20.0
to the following; of iixil
0 sister level is abin-v rasing, we -, - - - - - - _. (ft.)
Division of Water Quality, Information Processing Unit,
i2.0/7.$75
1 f. Borehole diameter: � iin.)
1617 Mail Service Center, Rakigb, NC 27699-1617
%yellAUGER/AIR
12, auW constructionbit,method:
II-t auger,
24D For Iniec` tiWells, n addition to sendi
) the form to the address m a
above, also submit il copy of this form witht 30 days
rotary. Wyk, direct push, etc.J �
of completion of iitill
construction to the f(dbwnrg: %e
SUPPLY WELLS ONLY:
Division of Water Quality, Underground Injection Control Pr1636
FFORWA71ER
gpm)
!►tail Service Center, Ralei �roa''
Igh. NC 27699_1636Method
of Zest:
clion type:
24c. lmiecfioo W u� ithe add ---���n addition to sending the form to
address(es) above, also submit one copy of this form
- - _ Amount:
- - - - - --
within 30 days of
completion of well construction to the county Health department of the counh
Where constructed.
Form GW_I
North Carolina Department of pA, imameiu and Nalural Resources - Division of Water (IuaIi y
RevisalJm 20I:

WELL CONSTRtt I N RECORD
Thu Dorm can be am for single or induple wells
I. %Veil Contractor Information:
NICHOLAS HAYES
Well C-I.. Name
A - 4121
NC Well Controaor CenrrWW,,. Nnniber
GEOLOGIC EXPLORATION, INC
Company Nmue
2. Well Construction Permit 4: _
1Jrr u/l applicable uvil mnrrnrrtianlXmrifc p.r. (igrrin: Sw1A. 140r1mn4. tit)
3. Well Use (ckeck well use):
Water Supply Well:
OAgricultural OMumclpa11Pablic
OGeothermal (HeatinglCoolrng Supply) ❑Residential Watt"
Supply (single)
Olndustrial/Commerciai ❑Residential Water Supply (shared)
Non -Water Supol ` Nell:
nWelerRec®Groundwater
sl
y
rOODE9
Remediation
er Storage and Recovery
❑Salinity Barnet
❑Agtafer Test
CStormwater Drainage
O$xperime I Technology
OSubsidence Control
Geothermal (Closed Loop)
LOGeothermal
OTracer
(Heat m uoli2 Return)
OOlher ex lam undo iY21 Remarks
4. Date WeII(S) Completed: 10125/19
Well ID# IW-4
Sa. Well Location:
CINTAS
FacilWOwaer Name
Facdrty IDN (,rappivahle)
4015 NORTH CHERRY STREET
WINSTON SALEM 27106
Physical Address, City, and Zip
FORSYTH
County �- - - -- -- - --
Parcalldeotifrcetwa Mo. (PIN)
56. Latilude and Longltude in deg '
For luterml Use ONLY
rr. ff.
rERCASIN faraiultitaaedwelh ORLIhER !fa table
TD DUMErER TxlcluvEss MATERu
ft. p,
ER CASINO OR TUBING retherinpl doaeaatoo
To DUMETER TRICKNE��111ATYMP.VLC60.0 ff• 4.0 SCH 40
60.0 ff. 90.0 4.0 la 010 SCH 40 PVC
R. fP. iaw
Ili. GROUT
FROM TO - MATERIA BMH.ACiMpvr METROD AAa1611
0.0 55.0 tL SLURRY
ff. R.
58.0
R 90.0
fl'
2040 FINE SILICA A S _
SAND
D.
n,
20. DRILLING LOC atlarA addiriaaalsheeb if Rem"YR
M
0.0
TO
tL 15.0
ff.
DE5Ca11ilQY ualpr, iaVisek 'e ala elr,
BROWN SANDY SILT
15.0
ff• 35.0
rL
RED CLAYEY SILT
35.0
ff• 50.0
ft.
RED SANDY SILT
50.0
ff' 60.0
ff•
BROWN SANDY SILT
60.0
D• 78.0
h'
PWR
78.0
rt 88.0
R
WEATHERED ROCK
88.0
�• 90.0
°'
ROCK
21. REaIARKS
BENTONITE SEAL FROM 55.0 TO 58.0 FEET
tee mil -seconds or decimal degrees:
(ifwell !'aid one lat/lon(i is sufficient)2Z.
Certification:
367 08- 27.85" 80" 15 49.40"
6. Is (are) the well(s): ®Permanent or ❑Temporary
Signmum ofCenified Well Cornmew Date
I. Is this a repair to an existing well: Oyes EINO
y). ai9A"9 lhir furaa /hereby+ crrlify dint the well(s) u'ae (uvre) eaiicwacred ra ucrurrkrnri
uerh 15A N('A(' 02(' O/OO rrr ISA N(if(- D2(',O2W Nall (-Owirlwkm UmeJgrck
or
lfrhu Ls a repo/r. Jill raa kaami well CaLrlmclida l arrrl erphixr rhr aprrrre of /h,•
rrpvir raa/er -•21 rearark. seaviar7
tux/ ihur o
arr ofihir ir(rwd hat bran nrrmklrd M dw well au tier
reran III,/iak aJ rlantn"
23. Site diagram or additional well details:
8. Number of wells constructed: 1
You may rse the back of this page to pro%ide additional Weil site delads or welI
_
1•irrnrurnpr i4 rrrian ru nun-worrrx Ywy -1/.s ONLY Ih "h nc� same canr<•rractlnu. Wh Wit
.iirMariam �`�''
construction details. You may also allach additional pages ifnecessary
SUBMITTAL IIVSTUC7lUNS
9. Total well depth below land surface: 90.0
1 ry,
Par aud1I ae& list all r6I,• 1/,l prre„r cram a-J,� Word I
� ?@
24a. For All Wells:
Wei) Submit this Ibrm within 30 days of bumpieuon of well
construction to the following:
10. Static rveterkvei below top ofeasittg: 20.0
/J'uwferMir/habarorar/irl(, use -, - (ft.)
Division of Water Quality, Information Processing Vail,
III. Borehole diameter: 12.017.875
1617 Mail Service Center. Raleigh, NC 27699-1617
(in.)
24ii hqLLajjtqt0A Wells: In addition to sending the form to the address in 24a
12. Well Construction method: AUGERIAIR
above. also submit a copy of this tbrm within 30 days of completion of nail
ti.e. auger, totary, cable, dim pusA etc.)
construction to the following:
FOR WATER SUPPLY WELLS ONLY:
Division of Water Quality. Underground Injection Control Program,
1636 Mail Barrier Cenler,'Rakigb, NC 27699-1636
13m, Yield (gpm) - Method of test:
I—
24e. For Wafer Sag v & Imi.rtian Wells Ili addition to sending the form to
13b. Dis)afection type: Amount:
the addresses) above, also submit one copy of this form within 30 days of
completion of µtill construction to the coup heath
tY department of the county
W11tre constructed
Form GW I Nardi Caralina Depanment of Encironnam and Nntuml Resources Divuian of Water Quality Reriscd Jvi. 2t11 ;

WELL CONSTRUCTION RECORD
This form cen be used for single or mdlipk wells
I. Well Contractor Information:
NICHOLAS HAYES
Well Conlraclor Nam
A - 4121
NC Well Contractor Cenrfieatum Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit P:
1.rs1 aOalWicoMe well a, a svorrianpern,yis (i_c. 1'onary. Shin, varlaxe. crcJ
3. Well Use (arch well use);
❑Agricultural
❑Geothermal (Heabog/Ccolmg Supply)
D IndustriallCommercial
Non -Water Supply Well:
❑Aquifer Rechruge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed loop)
❑MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shamd)
❑Recovery
OGroundwmer Remediation
OSelinity Barrier
❑Slormwater Drainage
❑Subsidence Control
❑Tracer
caarr awn e%a t7Vlhd' ex lam under1121 Remarks)
4. Date Well(s) Completed: 10/23/19 Well IDN 1W-5
So. Well Location:
CINTAS
. a..,nryry rncr mail= Facdnv IDH (ifapplrcabk)
4015 NORTH CHERRY STREET WINSTON SALEM 27106
Physical Address, City. and Zip
FORSYTH
County Parcel IdenlifxAM a Na (PIN)
5b. Latitude sod Longitude ire degree istiouteslsecouds or decimal de
For interrad Ust ONLY
n. i e.
R. I ft.
lS.OUTERCASING forroaltl.cr
PROM DIAM
>ti n
16. INNER CASING OR TUBING
FROM TO _I OIAM
0.0 f' 58.0 4.0
in.
Ise rial elmed hero -
Tiflmzss MA ERIAL
SCH 40 PVC
In.
58.0 t''
88.0 0'
4.0 '"
010 SGH 40 PVC
B.
R.
to
IS. GROUT
FROM
TO
MATERIAL PLAC EM'METRODa AAtOVNT
0.0 M
63.0 rL
MAn.noerWOM SLURRY
ft
ft.
R.
O.
19. SAND/GRAVEL
PACK Ha likable
FROM
TO
ATt7tiAL
eMrM[NTAIrrIrOn
56.0 D•
88.0 R
20-40
FINE SILICA SAND
In.
R
20: DRILLING
L allaeh r ddlrFanar strtey if runs:■
Far►M
TO
DESCRerr1OH rolar. la salYr"eh r rJ"r. airy
0.0 n•
15.0 R•
BROWN SANDY SILT
15.0 n•
35.0 111•
RED CLAYEY SILT
35.0 n
50.0 pL
RED SANDY SILT
50.0
60.0 fL
BROWN SANDY SILT
60.0
70.0 fL
PWR
70.0 n
86.0 n•
WEATHERED ROCK
86.0 R
88.0 R•
ROCK
21. REMARKS
BENTONITE SEAL FROM 53.0 TO 56.0 FEET
(ifweb field, one lastongis sufficiemf
grees'
21 Certifieadon:
36' 08' 27.85" 80" 15' 49.40"
//''
Ali
N
w
" 1125/19
6. Is (are) the welt(s): G]Permanent or ❑Temporary
SnitriMMpre ofCenified Well Coaimcror pate
7.1s this a repair to an existing well ❑Yes or OND
Ily sry "119 dnv fiver. I Aerebr cerlify Thar d,r nvll(.J uptr (,rvre► rrvuvmchd rn rnrrnrknr,W=
Wilk MAJ CAC 021'.0100 or ISA N('A[' 0a
2C 0200 tYe11l'nnsr,rnYin,r S'wmlprilrmodo
flxu
If dris is a repair, fill old known well nwisirwa nr n frvn,afum aid explain rlv,wnire dyaw
n py M rhta rearrrl hoc Area pmrirMd fu,lu ur/1 r,nner
repair wakr 1121 mmn ks secrian err on the Awk.y rArr fora,-
23. Site diagram or additional well details:
8. Number of wells constructed:, 1
You may use the bock of this page to provide additional well site details or .cell
I -or nndrlpie fr jeniaa err pan-uanr s+,yPlv,reOs f1N1.Y n•irh rhr some rn,fstrarririn, trw ran
coitstnlciion details. You may also attach additional pages if necessary.
rnMni,.weforar
SUBMITTAL INSTUG711710NS
9. Total well depth below land surface: 88.0
I irr nnd0ple UWIS ;or all diprhr y dire" (example- 3,@200' and 2@1 off)
(fl)
24s. For All Welts: Submit this form within 30 days of completion of well
construction to the following:
lQ Static water )reel below top of casing: 20.0
ij parer Ierel iv oMnv rauoq�, -. -
(ft.)
Division of Water Quality, Information Processing Unit,
we
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 12.017.875 (in.)
24b. For Injection Wells; in addition to sending the form 10 the address in 24a
Well construe AUGER/AIR
method: /AI
above, also submit a copy of this form within 30 days of completion 01• %sell
-e
r•e. anger. miary, cattle,
construction to the following
FOR WATER SUPPLY WELLS ONLY:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
138. Yield (gpm) Method of test:
13b. Disinfection
24e. For Water SUDDIv & Iniection W Ie Is• In addition to sending the form to
The addresses} above, also submit one copy of this form within 30 days of
type: Amount:
completion of well conslru aion to the county health department of the
- - ---
count'
where constructed
Form G W.l Nonh Carolina Depanmen, of Hnviraamem and Natural Reso wees Dim on of Water VualiM
Rer, sc i f air

WELL CONS1'RUCTIOI�i RECORD
This form can be used for smgk or multiple wells
1- Well Contractor Information.
NICHOLAS HAYES
Well Coacraetor Name
A - 4121
NC Well Contractor Ceinfieauwt Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit N:
liar all rrWAvhle well cOM1rfWdWr1x7arl1s r,e. f'narny Scare. Yarkwerc etc.J
3. Well Use (check well use):
Water Supply Well:
DAgncuhural
OMunicipal/Public
OGeothermal (Heaung/Cooltng Supply)
❑Residential Water Supply (single)
Olndusiriatf/Commercini
DResidential Water Supply (shared)
Olrri anon
_
Noa.Wafer Supply \yell:
OManitoring
ORecovery
Injection Well: -
—
OAquifer Recharge
®Groundwater Rernedtation
OAquifer Storage and Recovery
OSalinity Harrier
OAquifer lest
OSformwater Drainage
ExExpertmentatTechnology
OSubsidenceCo_ntrol
OGeothermal (Closed Loop)
OTra cer
OGeolhermaJ(Heafin Dolt Keeton}
❑Wier{ lam underN21 Remar&s)
4. Date Well(s) Completed: 10/22/19 Well IDN IW-6
Sa Well Location:
CINTAS
Facility Uxtxr Name Faciliev ID# (if applrcabfe)
4015 NORTH CHERRY STREET WINSTON SALEM 27106
Physical Address. City, and Zip
FORSY_ TH
ceuaty
Parcel Idenliftciiion No. (PIN)
Sb. Latitude sad Longitude in degreeslmiaules/seconds or decimal degrees:
(irwen field one latlkiiet is sut6cient}
36e 08! 27.85" N 80e 15' 49.40"
- w
6. Is (are) the wtll(s): 0Permanent or OTemporary
7. Is this a repair to an existing well: GYes or ONO
!Jana rt a relwir. Jill Ord krx)u a'el! cwrsrrwrYAxt injnrntmiwr and eaploia the narure r7! the
repair —ter 21 remarks -seeven or wr Ilse back rtf'dtifevnr•
& Number of wells consiracted: 1
/•}rr inn/riple fajernm er near -tenter supply ur!!s gN1.Y uhh tAe carat CWlshrtMlnlr, pm can
xnhiwl art: Jrrrm, -
9. Total well depth below land surface: 88.0
I'kw nrrdriple irellt hsr o11 tkpnhs iJ'dOrrut ([iawp%- IQ200' wa12Q100-i
10. Sfatie water level below top of casing: _ 20.0
!J muter level a ahnre t aving. ute " "
11. Borehole diameter: 12.0/7.875 in,
12. Well construction method:
(r.e anger rotary. Cable, tl7roct push etc.)
AUGER/AIR
Far Imemal Use UNLY•
22. Certification:
11/25/19
Stgrnmre ofCenified Well Contmclor Deft
111' srlpnaX dal Jarm. I hereby eerrijy tAw rAe WrOM -at (were) twnunuved rn ursunkm,,
a•ltlt 15A N(;t(' 02(' J1R70 w• 1S4 Nr -At - 02(' .02W well r irtarraet&rn.Vmdurdt wril den a
cagy of ebxs Fetwd has beta provdrd at rAe arll wmer.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or wel I
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NS"fUCTIONS
(ft.) 24m. For All Wells: Submit this form within .30 days of completion ol- well
construction to the folzowing:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh. NC 27699,1617
24b. For Injection Wells:
above, also submit a ropy [n addition to sending the form to the address in 24a
of this form within 30 days of completion of writ
construction to the following
Division of Water Quality. Underground Injection Control Program.
FUR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center. Raleigh, NC 27699-1636
l3a. 1 idd (gpm) Method of test.• _ 24e. For Water Stlnoly & Injection Wells: In addition to sending the form to
It,
address(es) above, also submit one topy of this form within 30 days of
tab. Disinfection type: Amount: eanpletion of well consitwtion to the county health department of the couniti•
where constructed.
Form GW-1 Non' Caroline D eptvtmem ofEnviromnent and Natural Reaoarces -Division of Winer ()uality Re+°iipi tan hq =

WELL CONSTRUCTION RECORD
This farm can be used for iingk or aruftiple wells
1. Well Contractor Information:
NICHOLAS HAYES
Nell Comraetor Name .____
A - 4121
NC Well Contractor Ceniftctaron Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit Il:
l.1sr o1l rgrprkroblr nrd rronutvcrtmr prrmhs (I.e. ('onaty, StaJr, Varra"re Ole)
3. Well Use (check well use):
Water Supply Well:
OAgricultural OMun(cipal/Public
OGeothemtal (Heating/Cooling Supply) 13Residential Water Supply (single)
DlndusirialfCommercial OResidential Water Supply (shared)
Non -Water Supply Well:
OMonetaring
ORecovery,
Injection Well:
❑Aquifer Recharge
OGroundwater Remediation
❑Aquifer Storage and Recovery
OSalimty Barrier
❑Aquifer Test
OStormwater Drainage
]Experimental Technology
DSubsidence Control
7Geothermal (Closed loop)
OTmcer
uA,eotliermat ( rleatinwL ows xetum) OOtlter i exLlam under 021 Remarks
4. Date Well(s) Completed: 10/21/19 Well IDq IW-7
5a, Well Location:
CINTAS
Fecililytowner Nance recilily IDa (if applicable)
4015 NORTH CHERRY STREET WINSTON SALEM 27106
Physical Address, City, and Zip
FORSYTH
county Parcel ddemrfrca icut No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwcll field, one lattbng is suRicieat)
36° 08' 27.85" N 80" 15' 49.40" W
6. Is (are) the well(s): OPermanent or OTemporary
7. Is this a repair to an existing well: DYes or EINo
Y 11M 1% o repair. Jd1 ran k wwn well cnarrrarlkw n fimmaram and eWizin the mrrare tl the
repair rnxler • 21 rrmarb ser7hm aran the hack ry'1h1s farm,
8. Number of wells constructed: 1
Pier anwhiple Jnjecdnx or xna-,mter.supply "tills ONLY will, the smut ea0mffdkw,.i1 v rare
.submit one farm.
9. Total well depth below land surface: 90.0 (R,)
P- nodaple ",ills hsr all depiM eJ,heemnr Atianrp ,r..i@2W a o,wl2 ,&10
10. Static water level below top of Busing: 20.0 (R,)
1J crater level is abate casino, we - -
1 I. Borehole diameter: 12.0/7.875 (in.)
IZ Well construction method: AUGERIAIR
(i.e auger. rotary. Able, direct paste, etc )
FOR WATER SUPPLY WELLS ONLY:
i 13a. Yield (gpm) _ Method of test:
13b. Disinfection type:
Amount:
Far Internal Use ONLY.
JA WATER ZONES
FROM TO I DRSCRUTION
rt. ff.
ft. ff.
Is• OUTER CASING for aratti-cased wells OR L,NER Ira able
iROM TO OIAMEM THICKNESS A TERIAL
ff. ff. iu.
16. INNER
CASING OR TUBING r+iie-1
elaaed-too
FRoM
TO DIAMETER
THICKNESS
MATERIAL
0.0 R
60.0 R• 4.0 in'
SCH 40
PVC
1Z.
ft. in.
60.0 R' 90.0 r' 4.0 '" 1 .010 SCH 40 PVC
0.0 R• 55.0 R '°"aAXOr�^*� SLURRY
n �
ff. fL
58.0 f' 90.0 ft1 20-40 FINE SILICA SAND
R. R.
FROM
TOnf5(�a1PTtJ]M1
(e VW vii WxA f ro,n sear, err 1
0.0
f'
15.0
R•
BROWN SANDY SILT
15.0
35.0
IL
RED CLAYEY SILT
35.0
R
50.0
H'
RED SANDY SILT
4-1
60.0
ff
BROWN SILT
60.0
R•
88.0
R
PWR
150.0
88.0
R
90.0
R
ROCK
ff.
ff.
BENTONITE SEAL FROM 55.0 TO 58.0 FEET
ZZ. Certification;
11/25l19
Signature ofCMified Well Contractor pate
he sigiting tins Jarnt. I herehr reri# drat ilm urllf) unr 6rere) amrnuerrd to rxtivmrhxre-r
with 15A Nr AC 02C.d1110 or l.i t NCA • 02C 02W Well ( irasrria dim titwrdarilr mni rltar u
tali, ry that rernrd has been provided in ibe well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or uclI
construction details. You may also attach additional pages if necessary.
SUBMITTAL INS'TUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of welt
construction to the following.
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Wells: In addition to sending the form to the address in 24.1
above, also submit a copy of this form within 30 days of complexion of well
construction to the tb.rowmg
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. Ear Water Suonly tit injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form volhin 30 days of
completion of well construction to the county health department of the counly
where constructed
ForMOW-1 NorttiCantfuntDe nwinol'F.m•vonnxniwWNaiwalItesoureas-DisyyhulofWaterQualiry Revised Jan 114.

WELL CONSTRUCTION RECORD
This form can be used for single or nwluple wells
1. Well Contractor Information:
NICHOLAS HAYES
Well Contractor Name -
A - 4121
NC Well Conuactor CeniGearion Number
GEOLOGIC EXPLORATION, INC
Company Nome
2. Well Construction Permit S: _
"s' ad olfirlieable ur1/ mrulrKL[Yiinr /rermrts Ae. Connor, .Prate. I'arianee• erc)
3. well Use (cheek well use):
11'ater Supply Wen:
OAgncultural OMunicipallPubhc
❑Geothermal (Heating/Cooling Supply) 0,Rcsidenlial Water Supply (single)
❑Industnal/Commercial JResidential Water Supply (shared)
Olrm-,tion
Non-IVater Supply Well:
on Wetl:
c
- -
=lajec6
rw Recharge
0(imundwater Rtmedtation
OAgwte r Storage and Recovery
OSalinity Barrier
OAgwfer Test
OStormwatef Drainage
❑Experimental Technology
OSubsidence Control
❑Geothermal (Closed Loop)
OTiacer
OGeothermal (Heat_ _'oulm; Rectum)
O(kher;� lain us er N21 Remarks)
4. Date Well(s) Completed: 10/30/19
Well IDN 1W-8
5a. Well Location:
CINTAS
FaeililylOwxer Name
Facility IDr (if applicable)
4015 NORTH CHERRY STREET WINSTON SALEM 27106
Physical Address, City, and Zip
FORSYTH
Coltl1F
Parcel Identification No. (PIN) -
5b. I atltttde and Longitude in d reeshnioules/ d d: 1 d
Far Inner Use ONLY
14. WA11ll,R
ZONES
RROMt
TO
t DESCRIPTION
It.
fl.
I ft. I fL I Ia I i ____1
0.0 fl• 61.0 fl• 2.0 I" SCH 40 PVC
fl. n. im i
61.0 91.0 fL 2.0 "L .010 SCH 40 Pvc
in
0.0
fl•
56.0
R
P0"aANDeF„'°'°rr
SLURRY
R.
R.
19.SANWGRAVELPACK
ban inra e
FROM
WVFFRIAL
EMFLACSM9TAIETJFoP
59.0
fl•
91.0
f
20-40
FINE SILICA SAND
R.
R
20. DIt1LLINC
LOG arlaeb
additional sperm if e
FROM
'M
DESCIUMON a rack r>�,rn
0.0
fl•
20.0
ft.
RED CLAY
20.0
n
60.0
fl•
BROWN CLAYEY SILT
60.0
fL
72.0
fl•
BROWN SILT
72.0
°
91.0
fl.
PWR
ft.
tfL-
I BENTONITE SEAL FROM 56.0 TO 59.0 FEET
eg se an s or rani egrees,
td'weld meld one :etrlogi is s4flicientl
36" 08' 27.85"
22. Certification:
N 80" 15' 49.40" w
11125/19
G. Is (are) the wcll(a): mPermanenf or ❑Temporary
Signamrc ofCend'ied Well Contractor Dote
By signing thrs/omi, I herebi, cellify rhar the meq(•s) ans (mere) cvnrsrracred in oeximAn cr
7. Is this a repair to an existing well: Oyes or ONo
nvrh 15A N(W ' O2r' 0100 or 1 SA AK'A • 02C 02M Well r •nastracrinr landards am/ dart fi
cal,} rfthrs rrcard has been pmrided to the cell owner.
if drir -is 0 Mmrr, )ill ow kmin» well consiruc&m itybr inwinu and erplahi the immix r f the
,choir iaaler i 21 rrenark< ewimi or on rim• Amick •frlds foram
23. Site diagram or additional well details:
1
You may use the back of this page to provide additional well site details or well
8. Number of welts constructed:
constriction details You may also attach additional pages if necessary
l�ar rniJNplc Uyectlan ar rwn-iraiorr stry�ply nvl(s UNI.Y With the same cvmu►ardaa. )not can
submit a'a't+•
SUBMITTAL INSTUCTIONS
9.Total well depth below land surface: _ _91.0 --(ft.)
24a, For All Wells: Submit this form within 30 days of completion of %%vil
1•ar mid Ide wells list Oil deltAs fdorem (exam)ale_ )®200' and 2@10n
construction to the following.
10. Static water level below top of casing: 20.0 (ft.)
Division of Water Quality, Information Processing Unit,
fte-eirrbillisobaircotriig,air- ..
1617Mail Service Center. Raleigh. NC27699-1617
11. Borehole diameter: 8.0 (in.)
24b. For laieetjon Netts: in addition to sending the form to the address in 24a
AUGER
above, also submit a copy of this form within 30 days of completion of uvll
12. Well construction method:
construction to the fallowing:
cot ile,
f r.e anger. roiay, cable, direct push, ac )
_
FOR WATER SUPPLY WELLS ONLY:
Division of Water Quality. Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC: 27699-1636
13a. Yield (gpm) Method of test:
24c. For Water SuoDly & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
I3b. Disinfection type: _ Amount: f
completion of Nell construction to the county health department of the count%
- 4 J
where constructed
Form GW-I Nosh Carolina Depaanxnt of Entironment and Natural Resources r Division of Winer r2uality Revised tar. 20 F

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
L Well Contractor Information:
NICHOLAS HAYES
Well Contractor Name
A - 4121
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC_
Company Name
2. Well Construction Permit 9:
L'sl all opplirab/r w'elJ aruerrracrinn permits (t e. (ouuy: State, Variam•r, eu•.)
3. Well Use (check well use):
Water Supply Well:
OAgricultural
❑Municipamblic
E7Geothermal (Heating/Coolmg Supply)
❑Residential Water Supply (single)
01ndustrhd/Commercial
❑Residential Water Supply (shared)
❑lm: - lion
Non -Water Supply Well:
OMonito_nng
ORecovery
Injection Well:
OAquMr Recharge
OGNRmdwaler Rernediation
OAquifer Storage and Recovery
OSalinity Barrier
OAquifer "rest
❑Stormwater Drainage
DExperimental Technology
OSubsidence Control
OGeothermal (Closed Loop)
OTracer
OGcothermal (Heati;.,p oolm , Return)
❑tither[ - lain under f121 Remarks)
4.Date ►lell(s)Completed; 10/30/19 WeillDN IW-9
So. Well Location:
CINTAS
FacdiWOwnerName Fwil yIDII(ifapplicable)
4015 NORTH CHERRY STREET WINSTON SALEM 27106
Physical Address• City, and Zip
FORSYTH
County -- - Parcel Identification No- (PIN)
Sb. Latitude and Longitude in ditgrees/rrdautes/seconds or decimal de
For Internal Use ONLY
DESCRIPTIONnfGNG
NWATERZONES
for mukkned wells
D1AMUrER
n. in.
OR LINER ifs able
TRIC•kNLSSMATERIAL
J& INNER CASING OR TUBING
earbrrmol close
n,.--$R THICKNESS MATERIAL
FROM I To I
0.0 n 66.0 fL
2.0 1q SCH 40
PVC
R. h.
in,
66.0 R• 96.0 fi2.0 In.
h. fC in.
Ig. GROUT
FFTO MAT R L
0.0 h 61.0 R n,atr„ o.s rovers
h. 1L
64.0 h 96.0 n 20-40
h. n.
0.0 n.
20.0 %
60.0 h
72.0 n
R.
fr.
tr.
20.0 n
60.0 R
72.0 n
96.0 n.
R
ft.
n.
.010 1 SCH 40 f PVC
SLURRY
FINE SILICA SAND
RED CLAY
BROWN CLAYEY SILT
BROWN SILT
PWR
BENTONITE SEAL FROM 61.0 TO 64.0 FEET
is -es:
{iFwell field, one ivatlonR a sufficient)
360 08' 27.85" 80° 15' 49.40"
22. Certifa:ation:
N
11/25/19
_ w
Sigrluiur'e Conlraclm
of&emIfW'dell Dpk
6. Is (are) the well(s): OPermaeegt or OTemporory
By 49fting this Juan. ► herebp dYrtgi, drat the welt(s) was (w•rrel dnasrnxred in and Imk lm
7. Is this a repair to an existing well: OYes or aN0
w Uh 15A Nr rr' 0X'.0/00 or 15A N(itf' 02(• ,0200 !veil r'atsk7avrpur .Udr/wkrrylY and drat u
rape of rlus redYtnllias beer? provided m the well onvner
I thn lr a repa&. fil/ M4 known wYll c(mrnpYlan JI fit w widnl ot&J arpkra Il/r rraalre q the
rs putt under -N reauakr sertieat rtr tar the howl ey'rhis Jiam.
23. Site diagram or additional well details;
S. Number of constructed:
You may use the back of this page to provide additional well site details or weit
lawwello
15tr arulnplc uyecrum r ma>_u'ahr sa/�n/J• well.. ONLY will. rlre taste aausrracrirai, Jrtu rao
construction details. You may also attach additional pages Ifnecessary
a,vbnar duie/arat•
SUBM ITTAL INSTUCTIONS
9. Total well depth below land surface: 96.0 (ft)
1-:rr multiple veM, lire all depths if'diff irew (esaarl*- 3 r@20W 24�.110M
24a. For All Wells; Submit this form within 30 days of completion of «ell
mud
construction to the following.
10. Static wafer hunt below fop of casing:. 20.0 (ry•)
Division of Water Quality, Information Processing Unit,
JI tratrrJerrLr mMnr casrrrp, use -
1617 Mail Service Center, Raleigh, NC 27699-1617
1 1. Borehole diameter: 8 0 (in.)
24b. For Injection Wells: In addition to sending the form to the address in 24a
12. Well construction method: AUGER
above• also submd a copy of this form within 30 days of completion of wZll
Ir.e. anger, rotary, cable, direct piisl4 aeJ - -
cable,
construction to the following:
FOR WATER SUPPLY WELIA ONLY:
Division of Water Quality, Underground Injection Control Program,
163E Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) _ Method of test:
24c. For Water Saygy & Injee¢oD Welk• in addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b Disinfection type: _ Amount:
completion of uro11 twnstruetiost to the county health department of rite count%
- - - - - _-
Micre constructed
Form GW-1 North Carolina DgMnatent of Environment and Neural Resources - Division of Water Qualit
y Revised Jars 20 i

WELL CONSTRUCTION RECORD
This form can be used for singie or rwluple wells
1. Well Contractor Information:
NICHOLAS HAYES
Well ColKractor Name
A-4121
NC Well Contractor Certificatwn Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit H:
Lill all apphs'ableis-ell eamtruchunpermissp.a,('m*,.L'ah,4nrrorx etetrj
3. Well Use (check well use):
Water Supply well: --- ---
❑Agricultural 0municipal.4sublic
❑Geothermal (Healing/Cooling Supply) ❑Residential Water Supply (single)
OindustriallCommercial ❑Residential Water Supply (shared)
Dim: !iion
Non Water Supply Well:
ORecover.
OAquifer Recharge
®Groundwater Remedlation
❑Aquifer Storage and Recovery
OSaliniy Barrier
17Aquiler Test
OStormwater Drainage
06sperimenlal Technology
OSubsidence Control
OGeothermal (Closed loop)
DTracer
OGeahermal (Heatinc E'oolin RetM
OOthe-
-r lain under ilZl R
4. Date Well(s)Completed: 10/29/19
Well110 1W-10
So. Well Location:
CINTAS
Faciliry/Uwwr Name --- Facility Mai lifapplicable)
4015 NORTH CHERRY STREET WINSTON SALEM 27106
Physical Address, City, and Zip
FORSYTH
County -- - parcel lde tilicauon No. IPIN)
Sb, Latitude and Longitude in degreeslminates/seeonds or decimal d
For Internal Use ONLY
R.I R.
in.
0.0 R 70,0 2.0 "" SCH 40 -_ PVC
70.o R
100.01
12.0 is o14
seH ao Pvc
I& GROUT
FR M
0.0 fL
To MATERIAL
65•0 fL
ItMPLACWLmrr MErlt Din AatDUNT
SLURRY
n.
ti
R. R.
19.SANVICRAYBLPACi.lfa Iiealik
FROM
68.0 fL
TO MAT$RIAL
100.0 R• 2044
ItMPLACEMExTmr MOD
FINE SILICA SAND
R.
R
0,4
R
20.0
R
RED CLAY
20,0
R
60A
fL
BROWN CLAYEY SILT
80.0
R
72.0
BROWN SILT
72.0
100.o
R•
1�1A1R
R.
R.
R.
R.
R.
rL
BENTONITE SEAL FROM 65.0 TO 68.0 FEET
egrets. 22, Certification:
field, one Wong is sut3'rcieml
(if well
36e 08' 27.85" N 800 15' 49.40" --- -�11, */!/ p% 11/25119
Signalure ofCertified Wdl Coraaastor pate
6.1s (are) the well(s): OPermanent or OTemporary
BY signing 119s farar. I hereby rer(ify' that 0tr u eN(s1 was mere/ "'Porm•red nr a—mlante
"A 15A N( A(• 02(', 0100 ar !SA N( it (• 02(' 0200 $y ii (.,w,,a Iron 3rruxlar b ant/ darn o
T. is this a repair to as ar fisting well: OYes or ONo chi., recrirdhar been
I 'dnG Lr a n rnl9' o f lararrdet/ to lhr ue11 arrrrer.
I pall, J10 enH erraint uel! rarrsrrucrian h jwatorhra wxl explain die xatwr eifrhe
repair unrkr -21 reararkrxTlian wan fhe back erfthu jwnr. 23, Site diagram or additional well details:
S.1 You tray use the back of this page to provide additional well site delads or wcll
14 Number of wells constructed: construction details. You my also attach additional pages if necessary
!•ire nnrltilsfr nrp.•ninn ire txm-nrrtrr.serpph• ueltr 1)N/.Y u•ielr elm same arnarraerirxr. )an can
,uhnuiovef"rar. SUBMITTAL INSTUCTIONs
9, Total well depth below bad surface: 100,0 ft) 24a. For All WeNa; Submit this form within 30 days of completion of %%.cl I
:•w aul ft* wells list all ekptlss y'di great (esoarple- 3 rr 2U0' and 2a-2,1007) construction to the following.
10. Static water level below top Of casing: 20,0 (ff•) Division of Witter Quality, Information processing Unit,
((worer lad xs above rosins use •• - Division
1617 Mail Service Crater, Raleigh, NC 27699-1617
11. Borehole diameter 8 0 Jim.) 24b. For Infection Wells, In addition to sending the form to the address in 24a
AUGER above, also submit a copy of this form within 30 days of completion of well
1.. Well construction method: Push. construction to the following
(i.e. anger. roinry, cable. dacci lash. etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: _ 24c. For Water. namly & lnlectga Wells• In addition to sending the form to
the addresses) above, also submit one copy of this form within 3o days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the count}
where constructed.
Form OW-1 North Catolhm Depaement offincrronnknt and Natural Resources -Division of water Quality Revised tan 2013

WELL CONSTRUCTION RECORD
This form can he aseA for single or rnulhple welts
I. Well Contractor Information:
NICHOLAS HAYES
Well Cantm tw Name
A - 4121
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Cornpany Name
2. Well Construction Permit q:
f tr,oil [ygrbroNe nr// centuriaiinn permits Ae. rmany Ynrir- Yartance, err.)
3. Well Use (check well ttse):
Water Supply Well: -
OAgrrculturat OMunicipal/Public
❑Geothermal (HeabnglCooling Supply) DResidential Water Supply (single)
❑lrxiuslrial/Commercial OResidenual Water Supply (shared)
nbriaat.....
Non -Water
❑Aquifer Recharge
00roundwater Remediation
OAquiler Storage and Recovery
OSaltnily Barrier
OAquiter?est
OSturmwater Drainage
OExperimental Technology
❑Subsidence Control
OGeothermal(Closed Loop)
OTracer
OGcothermal (Neatin Cook Rctumi
OUthet (explain under #21 R
4. Date Well(s) Completed: 11/01/19
Well IDa IW-11
S% 1WI1 Location:
CINTAS
Ficdny/Owner Name Facility loq (dapplicable)
4015 NORTH CHERRY STREET WINSTON SALEM 27106
Physual Address, City, acid tip
FORSYTH
Coaiih' Parcel Identification No. (PIN)
-
5b. Latitude and Longitude in degrees)riiinutes/sec d
1 a,
For Internal Use ONLY:
i h- I n. I in. I
0.0 n 70.0 n 2.0 bi SCH 40 PVC
It. n. is
70.0 n 100.0 h 2.0 "`
ft n. in.
0.0 n 65.0 h voanr+weoraxire
n. n.
68.0 h 100.0 r`
IL fL
0.0 h 20.0 n
20.0 n 60.0 n
60.0 n 65.0 h
65.0 n 100.0
h. R
rt. IL
ft- h.
2040
.010 1 SCH 40 I PVC
e nACs IRM e 00 & -rou
SLURRY
I MPIAC�NfJyt alETil
FINE SILICA SAND
RED CLAY
BROWN CLAYEY SILT
BROWN SILT
PWR
BENTONITE SEAL FROM 65.0 TO 68.0 FEET
Certification:
dec
(d'wrll field. one tatllonsufficient)rr sucientf on s or ma egrers. 22. r�
36° 08' 27.85" N 80° 15' 49.40" w -/' 1112519
S ignmire of Certified Well Coafractor Date
6. Is (arc) the wetl(s): ®Permanent or OTemparat�• ng this HJ gn • signing farm / hereby cerr6 that the irell(s) Deus (nrre} conrrnrcred fir areorlancv
irlrh 15A Nr Nr• 02C 0/00 or J5A Ak-Ar• 02(' 0200 Well (w.1n rrirni SimrrlW, aarl Thal ri
7. Is this a repair to an existing well: OYes or ®No [xyiyafrh[+ recrird has been pwrnkd to the uen oriier-
O'dirs is o repair. Jill nut knouvr irell comtrucami iriforoioilon and explain da: ratios• dy die
cxpow muter r21 rennirks xectiim ar n ihv bock aJ thisJarm. 23, Site diagram or additional well details:
1 You may use the back of this page to provide additional well site details air ++e81
r Number of wells enastwatersu construction details. You may also attach additional pages if necessary,
Yor ni;dtiplr in)cunin nrmxi_irnirrxerppfp r•rldr /1Nl,t'rrflh rIM some rnnxrlaC:fnn• y;xicwa
cnbwaonefvin. SUBMITTAL 1NSTUCTIONS
9. Total well 0 depth below land surface: 100.
P (ft.) 24a. For All Welts: Submit this form +athin 30 days of completion of well
Pw Nvulnple liWis hit oil depiks ifd60ereni eexanil*- 3@2W' and 2ti�1 an') construction to the following
10. Static water level below top of rasing: 20.0 (ft.) Division of Water Quality, Information Processing Unit,
iy uorrr levells above caskig. rise -• � •• 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole din meter: 8.0 (in.) 24b. For Infection Wells: In addition to sending the form to the address in 24a
t2.Well construction method:
AUGER above, also submit a copy of this form within 30 days of completion or t+ela
construction to the following:
t i.e auger, nary, cable, direct posh, etc )
_ Division of Water Quality, Underground Injection Control Program,
[FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
n. 1 ield (gpm) Method of test: 24c. For Water Su�Iy & In���on Wells• In addition to sending the form to
the addresses) above, also submit one copy of this form within 30 days ofb. Disinfection type: Amount: completion of well construction 10 the county health department of the eoun(v
-- - - - -- -- - - .-- - _ where constructed.
Font GW-t North Carolina Dtlimt enu of Eavironment and Nrawat Rewarces - Divaion of Water Quabry Revvsed Jaii 2,01

WELL CONSTRUCTION RECORD
This form can be used for singla or nmhlple wells
1. Weil Contractor Information:
NICHOLAS HAYES
Well Contractor Name
A - 4121
NC Well ComracrorCenificarion Number
GEOLOGIC EXPLORATION, INC
Conp mw Name
2. Well Construction Permit #:
l.lsr all applicable evil cmistnin-thm permits (i.e. t ounn): Ytate, t'ar a n e, etc)
3. Well Use (check well use):
11'ater Supply Well:
or ci
OAgricultural
❑MtrnicipaUPublic
OGeoihermal (HcatingCooling Supply)
DResidential Water Supply (single)
❑lndustrtal/Commercial
❑Residential Water Supply (shared)
O(rrhmlion
Non -Water Supply Well: Y
OMonitoring
❑Recove ••
Injection Well:
-- - -
OAquifer Recharge
OGroundwater Remedtation
OAquifer Storage and Recovery
CISahnily Barrier
OAquifer Test
❑Sturmwater Drainage
❑Expcnmental Technology
OSubsxlence Control
❑Geothermal (Closeil Loop)
OTracer
❑Gcothermal(Heatin Ctwlin 2--1
1()lller ex lamunder#21 Remarks
4. Date Well(s)Completed. 11/05/19
Well ]DO IW-1.2
Sa. Well Location:
CINTAS
Facililyfowner Name
Facility JD# (if applicable)
4015 NORTH CHERRY STREET WINSTON SALEM 27106
Physical Address, City, and Zip
FORSYTH
County
Parcel ldeetiFicaiipu No. (PIN)
5b. Latitude nod Longitude in degreesirminutes/seeonds de 'a
ma degrres.
(ifnell field, one latlbiuf, Is sutficimll
36° 08' 27.85" N 800 15' 49.40" 11
6. Is (are) the well(a): OPermanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or EINo
If rhis it a repwr, fAmn known "•ell aurrtracawi hyii mmhm and explain the future q lite
repair under `21 remorks section or in, doe hork 4rhis form.
8. Number of wells constructed: 1
For mahlpk J"IMhnt or arnt-wafer supply we115 ONLY u•rib the mine conso,"cdon. }sni can
subnni tine famr.
9. Total well depth below land surface: 100.0 (ft.)
14,r mahtpk wells list all depths if (10- (erantple- 3@200' wed 2@1001
10. Static water level below top of casing: _ - 15'0 - (ft.)
!%Kuar leer! h a/an•r cucinu. use -
11. Borehole diameter. 10-016•0 (dn.)
12. Well construction method: AUGER/AIR
(i.e. auger, tomry, cable, direct push, do )
FOR WATER SUPPLY WELLS ONLY:
13a. field (gpm) Method of test:
136. Disinfection type: Amount:.___ _ _
For Internal Use UNLY.
14. WATER ZONES
FROM
I TO
AESCa1PTION
n.
I rL
IL
I ft
I n• I ft. I I& I I ------- I
0.0 tt' 70.0 (L 2.0 1- SCH 40 PVC.
17.SCREEN
PROM TD nIAMETER SLOT THICKNESS MATER t.
70.0 n 100.0 t` 2.0 In 010 SCH 40 PVC
ft I n, I in
0.0 n 65,0 to loarwmaoiroerrr
n. B,
SLURRY
68.0 tt 100.0 R• 20-40 FINE SILICA SAND
n. I R.
20. DRILLING LOG rattarh addirin".l eh..re rr........-,.t
0.0
to
20.0
n•
RED CLAY
20.0
tr.
60.0
n•
_
BROWN CLAYEY SILT
60.0
n
65.0
It.
BROWN SILT
65.0
R
100.0
n
PWR
n.
ft
n.
n
BENTONITE SEAL FROM 65.0 TO 68.0 FEET I
22, Certification:
Signature ofCerti6al Well Contractor Date
IV .swil"19 Ars flea!, I hereby eerio dwt me a+r11(a) "err (wen) constructed is Ini•1Mlwiri•
with 15A Ak AC 02r' .0100 or 15A AY•Ar' oft • _0200 Well witl then a
rr*tyrlf this remand leas been pmrirkd h, the nxll owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or vieiJ
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
249. For .III Wells: Submit this form within 30 days of completion of wLll
construction to the fellowmg:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
tab. For ln•Aetion Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of we11 construction to the county health department of the county
where constructed.
Form GW-1 Nonh Carohna Department of Environment and Natural Resources -Division of Water Quality Kc6scd Jan 2011

WELL CONSTRUCTION RECORD
This form can be turd for single or Maluple wells
1. Well Contractor Information:
NICHOLAS HAYES
Well Contractor Name
A - 4121
NC Well ComnKlor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit p: List oil appli,abli ur11 construenon pem its (Le ('_
owwy. S4are, Fmio,we. k)e
3. Well Use (check well use):
Water Supply Well:
OAgncultural ❑Municipal/Public
OGrothermal (Heatingicoolmg Supply) ❑Residential Water Supply (smgle)
Dlndustrial/Commental ❑Residential Water Supply (shared)
13 14119RI 1011
Non -Water Supply \Yell:
❑Aquifer Recharge
®Groundwater Remediation
❑Aquifer Storage and Recovery
OSahnity Banter
❑Aquifer Tesi
❑Stormwater Drainage
OF-Mvrimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
OTracer
❑Geothermal (fleatingfCoolng Return)
❑Other (ex i lam under 021 R
4. Date Well(s) Completed: 11/04/19
Well IDN IW-13
sa. Well Location:
CINTAS
riis.m,yvaraer metro: Facility IDa 01'applicable)
4015 NORTH CHERRY STREET WINSTON SALEM 27106
Physical Address, City, anti Zip
FORSYTH
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degreedmiautes/sece"ds or decimal degrees:
(ifweu field. one lauloag is sufficient)
36e 08' 27.85" N 80e 15' 49.40" W
6. Is (are) the well(s): OPermanent or ❑Temporary'
7. Is this a repair to an existing well: ❑Yes or ElNo
fl this is a repair fill out kiwnix ireft ewutracutm hyiunmimi aml explain the iramte of iht
repair inwkr =21 rratarks section or an the hark af'thix farm.
& Number of wells constructed: 1
Fier multiple injecikm fief mar -water supple' wells r)NI, y with the ame conaraerko' you can
swhmtt one farm.
9. Total well depth below land surface: 97.0 (fL)
Aur n"dltple'tells list all depths ifd6gerem (example- 3@14W'w"I2@ftl(r1
10. Static water level below top of casing: 15.0 (ft.)
level is ah"re casing axe •. .. -
11. Borehole diameter: _ 10.0/6.0
12. Well construction method: AUGER/AIR
(i.e. auger, rotary, cable, direct push, etc)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) _ Method of teat:
13b. Disinfection type: _ Amount:
For Internal Use ONLY
14. WATER
ZONES
FROMI
TO
- ---
I DFSCHIL Pr10H
E
fl,
:
fl
I OUTER CASING formulrt-casedweW
ORLINER ira Ifeable
IiROM TO
DIAMETER THICKNESS MATERIAL
r. n.
I in.
16. INNER,
CASING OR TURING
ih-i
closed•
FROM
TO i
ViAmwm
F THICKNESS
I MATERIAL
0.0 ft•
67.0 fL
2.0 i"
SCH 40
PVC
fl,
fl.
in.
67.0 tt 197.0 fl-' 2.0 ta,
ft. It. 'r im
0.0 ft. 62.0 ft' roan w osrraerae
fl. fl.
.010 I SCH 40 J PVC
SLURRY
65.0 ft• 97.0 fL 1 20-40 FINE 51LICA SAND
0.0
rL
20.0
ft•
RED CLAY
20.0
ft•
60.0
tt
BROWN CLAYEY SILT
60.0
fl,
75.0
h
BROWN SILT
72.0
fl.
97.0
ft•
PWR
fl.
fir.
ir.
rL
BENTONITE SEAL FROM 62.0 TO 65.0 FEET 1
22. Certification:
_ 11/25/19
sigtmtore- ofCertifiedWellContra�tor pwe -
rJy .sigiiirtg this jar"i 1 herehy cerjj6, Neat 11re xell(s) was ("VM) conxrruc+ed tw acxitrdene,
With IjA NCA(' ON' 0100 or ISA N( A(' ON' 42W Well a iinrrnrrirtn 5tomkmis anal dwd ,i
copp of 10 recard leas het"pro irkd ro the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or sell
construction details. You may also attach additional pages if accessary
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of sell
constriction to the following.
Division of Water Quality, Information Processing Unit,
1617 Mail Service Ceoter, Raleigh, NC 27699-1617
24b For Injection Wells: In addition to sending the form to the address in 24,1
above, also submit a copy of this form %vithin 30 days of completion of %%ell
construction to the following;
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Roleigb, NC 27699-1636
24c. For Wafer S"poly & Injection Wells,• In addition to sending the form to
the address(es) above, also submit one copy of this form %vithin 3o days 01,
completion of well construction to the county health department of the couniv
%%-here constructed
Fomi G W-I North Carolina Department of Environmein and Natural Resources- Division of Water Quality Recned Jai 201

REDOX TECH, LLC
'Providing Innovative In Situ Soil and Groundwater Treatment',
Field Summary Report for Winston Salem, NC
Prepared by Zachary Poole on February 7, 2020
Field Contractor
Redox Tech, LLC
Client AECOM
Field Lead
Zacha Poole
Field Lead A.C. Whichard
Phone Number
919-920-3641
Phone Number 919 638-2061
Email Address
[e-mail]
Email Address Ashbourne.whichard@aecom.
Start Date
11/11/2019
com
End Date 01/26/2020
Chemical
Source Area 1- ABC EVO: 102,150 lbs; 002,1501bs ZVI; Magnesium
Hydroxide: 10,215 lbs; RTB-1: 408.6 Liters concentrated to 102.15 Liters
PRB area - 10,800lbs ABC Ole; 10,800 ZVI; 1,080 lbs Magnesium Hydroxide
Downgradient Plume: 12,000lbs High Fructose Corn Syrup;
3,240 lbs Sodium
Bicarbonate
Injection Points
Source Area: 120 locations
PRB area: 9 Locations
Downgradient Plume: 12 wells
Brief Narrative
Redox Tech, LLC injected ABC Ole+ plus a pH buffer and RTB-1 into 120 planned locations in the source area.
While the original scope included 120 locations, an additional 14 locations were injected due to the inability to reach
the total depth at some of the DPT locations. Some of the volume was banked until all of the remaining points were
completed in order to distribute the remaining banked volume. In the source area, a total of 90,250 gallons were
injected in the original marked locations and 10,450 gallons in the extra points for a total of 100,700 gallons. An
extra 1,450 gallons was saved for the PRB area. Injection details are presented in Tables i - 3. Each interval
injected in the source area received 50 lbs ABC Ole, 50 lbs ZVI, 5 lbs magnesium hydroxide, and 0.2 liters of RTB-
1 into 50 gallons of solution. Due to the density of the subsurface there was some tooling loss due to DPT rod
failures at the joints.
In the PRB area, ABC Ole+ with a pH buffer (no RTB-1) was injected in the originally 9 planned locations and 1
extra location located along McCanless St. Each interval received 50 lbs of ABC Ole, 50 lbs of ZVI, and 5 lbs of
magnesium hydroxide into 50 gallons of solution. On the map in Figure 1, you will notice it has the points listed as
121-129, they have been changed to reflect the additional points we did in the source area, the new numbers are 145-
154. In total Redox injected 12,250 gallons into the PRB Area.
In addition to injecting ABC Ole+ in the source area, HFCS was injected downgradient of the source area through
12 wells that were installed by others. These injections provided treatment barriers in both the shallower saprolite
and the partially weathered rock along McCanless St. Each well received 1,000 lbs of HFCS and 2701bs of sodium
bicarbonate in 650 gallons of solution.
Redox Tech's crew consisted of Zachary Poole, Blair Mitchell, Ivan Blackman, Bradford Bailiff, Kyle Baseley, Wes
Rivett, Mike Podany, Mike Clark, and Phil Simonton with oversight functions provided by AECOM's A.C.

REDO.X TECH, LLC .
"Providing Innovative In Situ Soil and Groundwater Treatment"
Whichard. Each injection point was abandoned according to NC well drilling regulations. Injection locations are
shown on Figures 1-3.
;.,d
0
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