WM0401487_Monitoring well permit application_20231026

AECOM
May 10, 2023
Department of Transportation
1505 Mail Service Center
Raleigh, North Carolina 27699
RE: Temporary Access to Install Monitor Well(s)
566 Old Hollow Road
Winston-Salem, North Carolina 27105
Dear Sir or Madam:
AECOM
6000 Fairview Road, Suite 200
Charlotte, NC 28210
aecom.com
AECOM Project # 60690075
AECOM has been retained by Speedway, LLC (Speedway) to perform an environmental assessment of the soil and
groundwater at the referenced site. In order to complete the assessment, the installation of a groundwater monitor
well (MW) on the property located at 566 Old Hollow Road in Winston-Salem, NC is necessary. Enclosed is a
Temporary Access Agreement (TAA) for installation of a monitor well on the subject property. The monitoring well will
be installed at the edge of the pavement in the DOT ROW near the former canopy. Also, enclosed you will find
Attachment A illustrating the adjoining Speedway property and the approximate location of the proposed monitor well,
Attachment B showing the appearance of a typical monitor well, and Attachment C describing the protocol for drilling,
maintaining, and removing off -site monitor wells. Every effort will be made to schedule drilling at a time convenient to
you.
Please review and, if acceptable, please sign the Temporary Access Agreement and return all to AECOM within ten
(10) business days via email. Once executed by Speedway, the original will be returned to you.
AECOM appreciates your cooperation in this matter. If you have any questions or require additional information,
please contact Nicole Long at [phone]. Thank you very much.
Sincerely,704
AECOM
Nicole Long
Project Manager
Nicole.Lon. (a)aecom.com
Marie Treiber
Regional Senior Project Manager
marie.treiber(a)aecom.com

A=COM
Department of Transportation
1505 Mail Service Center
Raleigh, North Carolina 27699
Date: May 10 , 2023
Property Owner:
Speedway LLC (Speedway), as owner of the real property located at 566 Old Hollow Road in Winston-Salem, NC
27105, has been directed by the regulations and/or environmental agency of the State of North Carolina ("State") to
investigate possible contamination in the vicinity of your property located at 566 Old Hollow Road in Winston-Salem,
NC 27105 ("Property"). In connection with such investigation, Speedway may be required to install, operate, and
maintain wells on your Property. Such investigation will be undertaken by Speedway at Speedway's sole cost and
expense and will be commenced and completed in a workmanlike manner. Subject to any requirements of the State,
Speedway will use reasonable efforts to minimize interference with current operations on your Property. Upon
completion of the above investigation, Speedway will, at its cost and expense, restore the portion of your Property
utilized by Speedway to a condition substantially equal to its condition immediately prior to the commencement of
such investigation. Speedway may be entitled to receive reimbursement under the State reimbursement/insurance
program for any expenses incurred by it in connection with the above investigation. If such is the case, Speedway will
retain any reimbursement funds it receives.
If the foregoing is acceptable, please execute the enclosed copy of this letter and return the same in the enclosed
self-addressed stamped envelope to:
AECOM
Nicole Long
6000 Fairview Road, Suite 200
Charlotte, NC 28210
[phone]
Nicole. Long(aDaecom.com
Very truly yours,
Speedway, LLC
By: Samuel Kramer
Title: Manager Environmental Services
By execution hereof, I, NCDOT , owner of the Property, hereby acknowledge the foregoing and
agree to grant Speedway and its employees and contractors' access to such Property for such period of time as
reasonably necessary to complete the investigation described above. In addition, I agree that, if requested by,
Speedway I will cooperate with it in connection with any applications for reimbursements that it may make with the
State.
By: See Approval Attached
(Print Name)
Date:

A=COM
ATTACHMENT A
Proposed Monitor Well Location Map

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Client: Speedway #6934 WELL ID:
Project Number:
AEC0M
Site Location: 566 Old Hollow Road, Winston-Salem, NC Date Installed:
Well Location: Coords: Inspector:
Method: Auger 1 Contractor:
WELL CONSTRUCTION DETAIL
Depth from G.S. (feet) Elevation (feet)
Datum
Top of Riser Pipe
Ground Surface (G.S.)
Riser Pipe:
Length
Diameter (ID)
Type of Material
Thickness
Grout:
Type
Thickness
Top of Bentonite
Bentonite Seal Thickness
Top of Sand
Top of Screen
Bottom of Screen
Bottom of Tail Pipe:
Bottom of Borehole
Borehole Diameter
Describe Measuring Point:
20'
2"
PVC
Sch 40
Neat Cement
16'
2'
Stabilized Water Level
Screen:
Length
20'
Diameter (ID)
2"
Slot Size
10 slot
Type of Material
PVC
Thickness
Sch 40
Type/Size of Sand
#3
Sand Pack Thickness
22'
0.0
0.0
20'
18'
20'
40'
40'
40'
Signature Date

A=COM
ATTACHMENT B
Color Photograph of Typical Monitor Well

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NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
PLEASE TYPE OR PRINT CLEARLY
In accordance with the provisions of Article 7, Chapter 87, General Statutes of North Carolina and regulations pursuant thereto,
application is hereby made for a permit to construct monitoring or recovery wells.
Date: 5/10/2023
2. County: Forsyth
3.
4.
5.
6.
7.
8.
9.
10
11
12
13
14
FOR OFFICE USE ONLY
PERMIT NO. _ ISSUED DATE
What type of well are you applying for? (monitoring or recovery): Monitoring
Applicant: Speedway, LLC. Telephone: [phone]
Applicant's Mailing Address: 500 Speedway Drive, Enon, Ohio 45323
Applicant's Email Address (if available): Samuel. Kramer(@7-11.Com
Contact Person (if different than Applicant): Nicole Long Telephone: [phone]
Contact Person's Mailing Address: AECOM, 6000 Fairview Road, Suite 200, Charlotte, NC 28210
Contact Person's Email Address (if available): Nicole. LongCcDAECOM.com
Property Owner (if different than Applicant): Department of Transportation Telephone Unknown
Property Owner's Mailing Address: 1505 Mail Service Center, Raleigh, NC 27699
Property Owner's Email Address (if available): Unknown
Property Physical Address (Including PIN Number) 566 Old Hollow Road, PIN: 6829-92-5043
City Winston-Salem County Forsyth Zip Code 27105
Reason for Well(s): Assessment Assessment
(ex: non -discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
Type of facility or site for which the well(s) is(are) needed: UST
(ex: non -discharge facility, waste disposal site, landfill, UST, etc.)
Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
Type of contaminants being monitored or recovered: Petroleum
(ex: organics, nutrients, heavy metals, etc.)
Are there any existing wells associated with the proposed well(s)? If yes, how many? No
Existing Monitoring or Recovery Well Construction Permit No(s).: N/A
Distance from proposed well(s) to nearest known waste or pollution source (in feet): Unknown
Are there any water supply wells located less than 500 feet from the proposed well(s)? WSW-2, WSW-3, WSW-4, WSW-7,
WSW-16 & WSW-1 7. All water supply wells are non -potable.
If yes, give distance(s): All 6 wells within 500 feet (see Site Vicinity Map for exact locations)
15. Well Contractor: Geological Resources, Inc. Certification No.: 3270
Well Contractor Address: 2301 Haves Road, Monroe, NC 28110
PROPOSED WELL CONSTRUCTION INFORMATION
As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth f. Grout horizons
C. Screen intervals g. Well head completion details
d. Sand/gravel pack intervals

Continued on Reverse
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated 5. How will the well(s) be secured? Grout
material: 1
3. Number of wells to be constructed in bedrock: N/A 6. Estimated beginning construction date: May 2023
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: June 2023
(add answers from 2 and 3)
ADDITIONAL INFORMATION
1. As required by 15A NCAC 02C .0105(f)(5), attach a scaled map of the site showing the locations of the following:
a. All property boundaries, at least one of which is referenced to a minimum of two landmarks such as identified roads,
intersections, streams, or lakes within 500 feet of the proposed well or well system.
b. All existing wells, identified by type of use, within 500 feet of the proposed well or well system.
C. The proposed well or well system.
d. Any test borings within 500 feet of proposed well or well system.
e. All sources of known or potential groundwater contamination (such as septic tank systems, pesticide, chemical or fuel
storage areas, animal feedlots as defined in G.S. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant assumes total responsibility for ensuring that the well(s) will be located, constructed, maintained, and abandoned in
accordance with 15A NCAC 02C.
Signature of Applicant or *Agent
Project Manager -as limited field agent for Speedway
Title of Applicant or *Agent
Nicole Long * If signing as Agent, attach authorization
agreement stating Printed name of Applicant or *Agent that you have the authority to act as
the Agent.
If the property is owned by someone other than the Applicant, the property owner hereby consents to allow the Applicant to construct
well(s) as outlined in this Well Construction Permit application and acknowledges that it shall be the responsibility of the Applicant to
ensure that the well(s) will be located, constructed, maintained, and abandoned in accordance with 15A NCAC 02C.
See Attached Right of Way Encroachment Contract
Signature of Property Owner (if different than Applicant)
NCDOT
Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources' Regional Office:
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Phone: [phone]
Fax: [phone]
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
Phone: [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Mo

ATTACHMENT C
PROTOCOL FOR DRILLING, MAINTAINING, AND REMOVING OFF -SITE WELLS
The proposed monitor well(s) will be installed to an appropriate depth below ground level. It will be drilled
with a mobile drilling rig, direct push equipment, or a "hand -auger," depending on overhead and available
space restrictions. The monitor well(s) will be constructed with threaded, PVC pipe and installed properly
to meet all appropriate local/state water well rules and regulations. The top of the monitor well(s) will be
completed to be at, or slightly below, ground level and will be encased in a "water -tight" steel manhole
box and secured in order to protect it and not interfere with typical, everyday use of the land around it.
The length of time required for installation is approximately four (4) to six (6) hours (actual time may vary).
The area around the proposed monitor well(s) will be cleaned up after installation is completed.
Groundwater will be checked with an electronic probe and samples collected from the monitor well(s)
once per quarter, or as directed by the appropriate regulatory agency. These activities will typically be
completed by one (1) person. The length of time required for this activity is approximately one and one-
half (1 '/z) hours per quarter.
When the monitor well(s) is no longer needed or required by the regulatory agency for groundwater
monitoring, to the extent permitted to do so, the monitor well(s) will be plugged according to appropriate
State Water Well Rules and Regulations. After the monitor well(s) is plugged, the area around it will be
restored as stated in the temporary access agreement.

AW
Shoulder Work
(2'-15' From the Edge of Pavement)
a
LI
Notes:
F
3
f
Speed
Limit
35
45
55
Shoulder
Taper (#t)
70
150
185
Shoulder
Taper
1
500'
V
SHOULDER
WORK
For operations of 60 minutes or less, all signs and
channelizing devices may be eliminated if a vehicle
with an activated rotating or strobe light is used.
For low -speed (35 MPH or less) conditions, a 200-
foot sign spacing may be used. For speeds of 40
to 50 MPH a 350-foot sign spacing may be used.
"Utility Work Ahead", "Road Work Ahead", or
Worker symbol signs may be used instead of the
"Shoulder Work" sign.
For work performed on a paved shoulder at least
8 feet wide, an additional general warning sign
(e_g. "Road Work Ahead") should be used in
advance of the "Shoulder Work" sign.

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ENGLISH STANDARD DRAWING FOR
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ROLLING ROAD ROCK OPERATION
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STATE OF
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DEPT. OF TRANSPORTATION
DIVISION OF HIGHWAYS
RALEIGH, N.C.

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
ROY COOPER J. ERIC BOYETTE
GOVERNOR SECRETARY
August 29, 2023
Forsyth County: NC 8 (Germanton Road)
Subject: Right of Way Encroachment Contract — R/W 16.1A — Job Number — E092-034-23-
00429 — Installation of Groundwater Monitoring Well
Mr. Samuel J. Kramer, Manager, Environmental Services
Speedway, LLC
Dear Mr. Kramer:
Attached, for your file, is a copy of the above referenced Right of Way Encroachment Contract,
properly executed. This contract covers the following:
Installation of a Groundwater Monitoring Well on Germanton Road near Old Hollow Road, as
shown on the attached plans.
APPROVED SUBJECT TO: Attached Special Provisions
ENVIRONMENTAL ISSUES AGREEMENT
The encroaching party shall comply with all applicable state and federal environmental regulations,
and shall obtain all necessary state, federal and local environmental permits, including but not
limited to, those related to sediment control, stormwater, wetlands, streams, endangered species,
and historical sites.
Sincerely,
DocuSigned by:
E
CO{f �bvxs
707888B5D87F4AC...
Scott A. Jones, P.E.
DISTRICT ENGINEER
SARREO
cc: Kevin Neal, P.E. • Forsyth County Maintenance Engineer
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
DIVISION NINE / DISTRICT TWO
SILAS CREEK PARKWAY
WINSTON-SALEM, NC 27127
Telephone: [phone]
Fax: [phone]
Customer Service: 1-877-368-4968
Website: ncdot.gov
Location:
375 SILAS CREEK PARKWAY
WINSTON-SALEM, NC 27127

SPECIAL PROVISIONS — Page 1
R/W 16.1A — Speedway
E092-034-23-00429
1. Approval may be rescinded upon failure to follow any of the provisions in this permit and
may be considered a violation of the encroachment agreement.
2. The Encroaching party or their contractor shall provide the following notices prior to
construction activity within the NCDOT Right of Way:
a. Three (3) business days advance phone call at telephone [phone] to the
Division 9 Traffic Engineer.
Failure to provide these notifications prior to beginning construction is subject to the
Division Engineer's discretion to cease construction activity for this encroachment. NCDOT
reserves the right to cease any construction or maintenance work associated with this
installation by the encroaching party until the construction or maintenance meets the
satisfaction of the Division Engineer or their representative.
3. Prior to beginning work, it is the requirement of the Encroaching Party to contact the
appropriate Utility Companies involved and make arrangements to adjust or relocate any
utilities that conflict with the proposed work.
4. It shall be the responsibility of the encroaching party to determine the location of utilities
within the encroachment area. NCGS § 87-115 through § 87-130 of the Underground
Utility Safety and Damage Prevention Act requires underground utilities to be located by
calling 811 prior to construction. The encroaching party shall be responsible for notifying
other utility owners and providing protection and safeguards to prevent damage or
interruption to existing facilities and maintain access to them.
5. The encroaching party shall notify the appropriate municipal office prior to beginning any
work within the municipality's limits of jurisdiction.
6. This approval and associated plans and supporting documents shall not be interpreted to
allow any design change or change in the intent of the design by the Owner, Design
Engineer, or any of their representatives. Any revisions or changes to these approved plans
or intent for construction must be obtained in writing from the Division Engineer's office or
their representative prior to construction or during construction, if an issue arises during
construction to warrant changes.
7. NCDOT does not guarantee the right of way on this road, nor will it be responsible for any
claim for damages brought about by any property owner by reason of this installation. It is
the responsibility of the encroaching party to verify the right of way.
8. Encroaching party shall be responsible for obtaining all necessary permanent and/or
temporary construction, drainage, utility and/or sight distance easements.
9. All Right of Way and easements necessary for construction and maintenance shall be
dedicated to NCDOT with proof of dedication furnished to the District Engineer prior to
beginning work.
10. Traffic control shall be coordinated with the Forsyth County Maintenance Office at
telephone [phone], prior to construction.
11. WORK ZONE TRAFFIC CONTROL QUALIFICATIONS AND TRAINING PROGRAM

SPECIAL PROVISIONS — Page 2
R/W 16.1A — Speedway
E092-034-23-00429
All personnel performing any activity inside the highway right of way are required to be
familiar with the NCDOT Maintenance / Utility Traffic Control Guidelines (MUTCG). No
specific training course or test is required for qualification in the Maintenance /Utility
Traffic Control Guidelines (MUTCG).
All flagging, spotting, or operating Automated Flagger Assist Devices (AFAD) inside the
highway right of way requires qualified and trained Work Zone Flaggers. Training for this
certification is provided by NCDOT approved training resources and by private entities that
have been pre -approved to train themselves.
All personnel involved with the installation of Work Zone Traffic Control devices inside the
highway right of way are required to be qualified and trained Work Zone Installers. Training
for this certification is provided by NCDOT approved training resources and by private
entities that have been pre -approved to train themselves.
All personnel in charge of overseeing work zone Temporary Traffic Control operations and
installations inside the highway right of way are required to be qualified and trained Work
Zone Supervisors. Training for this certification is provided by NCDOT approved training
resources and by private entities that have been pre -approved to train themselves.
For questions and/or additional information regarding this training program please refer to
htips:Hconnect.ncdot.gov/projects/WZTC/Pages/Training_asox or call the NCDOT Work
Zone Traffic Control Section [phone].
12. The party of the second part shall employ traffic control measures that are in accordance
with the prevailing federal, state, local, and NCDOT policies, standards, and procedures.
These policies, standards, and procedures include, but are not limited to the following:
a. Manual on Uniform Traffic Control Devices (MUTCD) — North Carolina has
adopted the MUTCD to provide basic principles and guidelines for traffic control
device design, application, installation, and maintenance. North Carolina uses the
MUTCD as a minimum requirement where higher supplemental standards specific to
North Carolina are not established. Use fundamental principles and best practices of
MUTCD (Part 6, Temporary Traffic Control).
b. NCDOT Maintenance / Utility Traffic Control Guidelines — This document enhances
the fundamental principles and best practices established in MUTCD Part 6,
Temporary Traffic Control, incorporating NCDOT-specific standards and details.
It also covers important safety knowledge for a wide range of work zone job
responsibilities.
13. If the Traffic Control Supervisor determines that portable concrete barrier (PCB) is required
to shield a hazard within the clear zone, then PCB shall be designed and sealed by a licensed
North Carolina Professional Engineer. PCB plans and design calculations shall be submitted
to the District Engineer for review and approval prior to installation.
14. Ingress and egress shall be maintained to all businesses and dwellings affected by the project.
Special attention shall be paid to police, EMS and fire stations, fire hydrants, secondary
schools, and hospitals.
15. Traffic shall be maintained at all times. All lanes of traffic are to be open during the hours of
7:00 A.M. to 9:00 A.M. and from 4:00 P.M. to 6:00 P.M. Monday through Friday, during
any time of inclement weather, or as directed by the County Maintenance Engineer. Any
violation of these hours will result in ceasing any further construction by the Encroaching
Party or their contractor.

SPECIAL PROVISIONS — Page 3
R/W 16.1A — Speedway
E092-034-23-00429
16. Nighttime and weekend operations will NOT be allowed unless written approval is received
from the District Engineer. If nighttime or weekend work is allowed or required, all signs
must be retro-reflective, and a work zone lighting plan must be submitted for approval prior
to construction.
17. Two-way traffic shall be maintained at all times unless designated by the County
Maintenance Engineer. Traffic shall not be rerouted or detoured without the prior written
approval from the County Maintenance Engineer. No utility work will be allowed on state
holidays from 7:00 PM the night before through 9:00 AM the day prior to, following or
during local events without prior approval from the County Maintenance Engineer. If the
construction is within 1000 feet of a school location or on a designated bus route, the
construction shall be coordinated with the school start and end times to avoid traffic delays.
18. Work requiring lane or shoulder closures shall not be performed on both sides of the road
simultaneously within the same area.
19. Any work requiring equipment or personnel within 5 feet of the edge of any travel lane of an
undivided facility and within 10 feet of the edge of any travel lane of a divided facility shall
require a lane closure with appropriate tapers per current NCDOT Roadway Standard
Drawings or MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES.
20. At the discretion of the District Engineer, a traffic control plan shall be developed and
submitted under the seal and signature of a Licensed North Carolina Professional Engineer
prior to construction. The plan shall be specific to the site and adequately detailed. Issues
such as the close proximity to intersections shall be addressed.
21. Any pavement markings that are damaged or obliterated shall be restored by the encroaching
party at no expense to NCDOT.
22. Sidewalk closures shall be installed as necessary. Pedestrian traffic shall be detoured around
these closures and shall be signed appropriately and in accordance with The American with
Disabilities Act Accessibility Guidelines. The encroaching party must adhere to the
guidelines for accommodating pedestrians in encroachment work zones as described in the
NCDOT Pedestrian Work Zone Accommodations Training found at
htips://www.youtube.com/watch?v--AOuYa5lW3dg&feature=youtu.be
23. The encroaching party shall comply with all applicable Federal, State and local
environmental regulations and shall obtain all necessary Federal, State and local
environmental permits, including but not limited to, those related to sediment control,
stormwater, wetland, streams, endangered species and historical sites. Additional information
can be obtained by contacting the NCDOT Roadside Environmental Engineer regarding the
North Carolina Natural Heritage Program or the United States Fish and Wildlife Services.
Contact the Division Roadside Environmental Engineer's Office at 336-896-2380.
24. All erosion control devices and measures shall be constructed, installed, maintained, and
removed by the Encroacher in accordance with all applicable Federal, State, and Local laws,
regulations, ordinances, and policies. Permanent vegetation shall be established on all
disturbed areas in accordance with the recommendations of the Division Roadside
Environmental Engineer. All areas disturbed (shoulders, ditches, removed accesses, etc.)
shall be graded and seeded in accordance with the latest NCDOT Standards Specifications
for Roads and Structures and within 15 calendar days with an approved NCDOT seed
mixture (all lawn type areas shall be maintained and reseeded as such). Seeding rates per

SPECIAL PROVISIONS — Page 4
R/W 16.1A — Speedway
E092-034-23-00429
acre shall be applied according to the Division Roadside Environmental Engineer. Any plant
or vegetation in the NCDOT planted sites that is destroyed or damaged as a result of this
encroachment shall be replaced with plants of like kind or similar shape.
25. The contractor shall not begin the construction until after the traffic control and erosion
control devices have been installed to the satisfaction of the County Maintenance Engineer
or their agent.
26. An executed copy of the encroachment agreement, provisions and approved plans shall be
present at the construction site at all times. If safety or traffic conditions warrant such an
action, NCDOT reserves the right to further limit, restrict or suspend operations within the
right of way.
27. The Encroaching Party and/or their Contractor shall comply with all OSHA requirements. If
OSHA visits the work area associated with this encroachment, the District Office shall be
notified by the encroaching party immediately if any violations are cited.
28. All disturbed areas are to be fully restored to current NCDOT minimum roadway standards
or as directed by the Division Engineer or their representative. Disturbed areas within
NCDOT Right -of -Way include, but not limited to, any excavation areas, pavement removal,
drainage or other features.
29. The encroaching party shall notify the County Maintenance Engineer or their representative
immediately in the event any drainage structure is blocked, disturbed or damaged. All
drainage structures disturbed, damaged or blocked shall be restored to its original condition
as directed by the Division Engineer or their representative.
30. Unless specified otherwise, during non -working hours, equipment shall be located away from
the job site or parked as close to the right of way line as possible and be properly barricaded
in order not to have any equipment obstruction within the Clear Recovery Area. Also, during
non -working hours, no parking or material storage shall be allowed along the shoulders of
any state -maintained roadway.
31. Right of Way monuments disturbed during construction shall be referenced by a registered
Land Surveyor and reset after construction.
32. All Traffic signs moved during construction shall be reinstalled as soon as possible to the
satisfaction of the Division Traffic Engineer or their representative.
33. All driveways disturbed during construction shall be returned to a state comparable with the
condition of the driveways prior to construction.
34. If the approved method of construction is unsuccessful and other means are required, prior
approval must be obtained through the District Engineer before construction may continue.
35. All traffic control, asphalt mixes, structures, construction, workmanship and construction
methods, and materials shall be in compliance with the most -recent versions of the following
resources: ASTM Standards, Manual on Uniform Traffic Control Devices, NCDOT Utilities
Accommodations Manual, NCDOT Standard Specifications for Roads and Structures,
NCDOT Roadway Standard Drawings, NCDOT Asphalt Quality Management System
manual, and the approved plans.
36. Excavation material shall not be placed on pavement.

SPECIAL PROVISIONS — Page 5
R/W 16.1A — Speedway
E092-034-23-00429
37. It is the responsibility of the encroaching party or their contractor to prevent any mud/dirt
from tracking onto the roadway. Any dirt which may collect on the roadway pavement from
equipment and/or truck traffic on site shall be immediately removed to avoid any unsafe
traffic conditions.
38. Any pavement damaged because of settlement of the pavement or damaged by equipment
used to perform encroachment work, shall be re -surfaced to the satisfaction of the District
Engineer. This may include the removal of pavement and a 50' mechanical overlay. All
pavement work and pavement markings (temporary and final) are the responsibility of the
Encroaching Party.
39. The Encroaching party shall notify the Division Traffic Engineer's office within 2 business
days after construction is complete. The County Maintenance Engineer may perform a
construction inspection. Any deficiencies may be noted and reported to the encroaching
party to make immediate repairs or resolve any issues to restore the right-of-way to a similar
condition prior to construction, including pavement, signage, traffic signals, pavement
markings, drainage, structures/pipes, or other highway design features.
40. If the actual construction differs from the approved plans associated with this encroachment,
a copy of "as -built" plans shall be submitted to the District Engineer's office in a PDF format
and in a current ESRI GIS format within 4 weeks of construction.

STATE OF NORTH CAROLINA
ROUTE -NC-e4r NC 8 PROJECT 60690075 COUNTY OF Forsyth
DEPARTMENT OF TRANSPORTATION
-AND-
Speedway, LLC
RIGHT OF WAY ENCROACHMENT AGREEMENT
FOR NON -UTILITY ENCROACHMENTS ON
PRIMARY AND SECONDARY HIGHWAYS
THIS AGREEMENT, made and entered into this the 1 day of May , 20 23 by and between the Department
of Transportation, party of the first part; and Speedway, LLC
party of the second part,
WITNESSETH
THAT WHEREAS, the party of the second part desires to encroach on the right of way of the public road designated as
Route(s) NC66 / 566 Old Hollow Road, Winston-Salem, NC 27105located at the corner of Old Hollow Road and Germanton Road.
with the construction and/or erection of: _ groundwater monitoring well
WHEREAS, it is to the material advantage of the party of the second part to effect this encroachment, and the
party of the first part in the exercise of authority conferred upon it by statute, is willing to permit the encroachment
within the limits of the right of way as indicated, subject to the conditions of this agreement;
NOW, THEREFORE, IT IS AGREED that the party of the first part hereby grants to the party of the second
part the right and privilege to make this encroachment as shown on attached plan sheet(s), specifications and
special provisions which are made a part hereof upon the following conditions, to wit:
That the said party of the second part binds and obligates himself to install and maintain the encroaching facility in such safe
and proper condition that it will not interfere with or endanger travel upon said highway, nor obstruct nor interfere with the proper
maintenance thereof, to reimburse the party of the first part for the cost incurred for any repairs or maintenance to its roadways
and structures necessary due to the installation and existence of the facilities of the party of the second part, and if at any time the
party of the first part shall require the removal of or changes in the location of the said facilities, that the said party of the second
part binds himself, his successors and assigns, to promptly remove or alter the said facilities, in order to conform to the said
requirement, without any cost to the party of the first part.
That the party of the second part agrees to provide during construction and any subsequent maintenance proper signs, signal
lights, flagmen and other warning devices for the protection of traffic in conformance with the latest Manual on Uniform Traffic
Control Devices for Streets and Highways and Amendments or Supplements thereto. Information as to the above rules and
regulations may be obtained from the Division Engineer of the party of the first part.
That the party of the second part hereby agrees to indemnify and save harmless the party of the first part from all damages
and claims for damage that may arise by reason of the installation and maintenance of this encroachment.
It is clearly understood by the party of the second part that the party of the first part will assume no responsibility for any
damage that may be caused to such facilities, within the highway rights of way limits, in carrying out its construction and
maintenance operations.
That the party of the second part agrees to restore all areas disturbed during installation and maintenance to the satisfaction of
the Division Engineer of the party of the first part. The party of the second part agrees to exercise every reasonable precaution
during construction and maintenance to prevent eroding of soil; silting or pollution of rivers, streams, lakes, reservoirs, other water
impoundments, ground surfaces or other property; or pollution of the air. There shall be compliance with applicable rules and
regulations of the North Carolina Division of Environmental Management, North Carolina Sedimentation Control Commission, and
with ordinances and regulations of various counties, municipalities and other official agencies relating to pollution prevention and
control. When any installation or maintenance operation disturbs the ground surface and existing ground cover, the party of the
second part agrees to remove and replace the sod or otherwise reestablish the grass cover to meet the satisfaction of the Division
Engineer of the party of the first part.
That the party of the second part agrees to assume the actual cost of any inspection of the work considered to be necessary
by the Division Engineer of the party of the first part.
That the parry of the second part agrees to have available at the encroaching site, at all times during construction, a copy of
this agreement showing evidence of approval by the party of the first part. The party of the first part reserves the right to stop all
work unless evidence of approval can be shown.
Provided the work contained in this agreement is being performed on a completed highway open to traffic; the party of the
second part agrees to give written notice to the Division Engineer of the party of the first part when all work contained herein has
been completed. Unless specifically requested by the party of the first part, written notice of completion of work on highway
projects under construction will not be required.
That in the case of noncompliance with the terms of this agreement by the parry of the second part, the party of the first part
reserves the right to stop all work until the facility has been brought into compliance or removed from the right of way at no cost to
the party of the first part.
That it is agreed by both parties that this agreement shall become void if actual construction of the work contemplated herein
is not begun within one (1) year from the date of authorization by the party of the first part unless written waiver is secured by the
party of the second part from the party of the first part.
FORM R/W 16.1A (Revised February 2021)

R/W (161A) : Party of the Second Part certifies that this agreement is true and accurate copy of the form
R/W (161A) incorporating all revisions to date.
IN WITNESS WHEREOF, each of the parties to this agreement has caused the same to be executed the day and
year first above written.
ATTEST OR WITNESS::
DEPljjMghT,OF TRANSPORTATIONY.
CAM04pGINEER
(R ,�6w_s DISTRICT,, I NGINEER
e�
Y
1;
Speedway LLC
Il t '
Samuel J. Kramer, Manager, Environmental Services
Second Party
INSTRUCTIONS
When the applicant is a corporation or a municipality, this agreement must have the corporate seal and
be attested by the corporation secretary or by the empowered city official, unless a waiver of corporate
seal and attestation by the secretary or by the empowered City official is on file in the Raleigh office of the
State Utilities Manager. In the space provided in this agreement for execution, the name of the
corporation or municipality shall be typed above the name, and title of all persons signing the agreement
should be typed directly below their signature.
When the applicant is not a corporation, then his signature must be witnessed by one person. The
address should be included in this agreement and the names of all persons signing the agreement
should be typed directly below their signature.
This agreement must be accompanied, in the form of an attachment, by plans or drawings showing the
following applicable information:
1. All roadways and ramps.
2. Right of way lines and where applicable, the control of access lines.
3. Location of the proposed encroachment.
4. Length and type of encroachment.
5. Location by highway survey station number. If station number cannot be obtained, location
should be shown by distance from some identifiable point, such as a bridge, road,
intersection, etc. (To assist in preparation of the encroachment plan, the Department's
roadway plans may be seen at the various Highway Division Offices, or at the Raleigh
office.)
6. Drainage structures or bridges if affected by encroachment.
7. Typical section indicating the pavement design and width, and the slopes, widths and
details for either a curb and gutter or a shoulder and ditch section, whichever is applicable.
8. Horizontal alignment indicating general curve data, where applicable.
9. Vertical alignment indicated by percent grade, P.I. station and vertical curve length, where
applicable.
10. Amount of material to be removed and/or placed on NCDOT right of way, if applicable.
11. Cross -sections of all grading operations, indicating slope ratio and reference by station
where applicable.
12. All pertinent drainage structures proposed. Include all hydraulic data, pipe sizes, structure
details and other related information.
13. Erosion and sediment control.
14. Any special provisions or specifications as to the performance of the work or the method of
construction that may be required by the Department must be shown on a separate sheet
attached to encroachment agreement provided that such information cannot be shown on
plans or drawings.
15. The Department's Division Engineer should be given notice by the applicant prior to actual
starting of installation included in this agreement.
16. Method of handling traffic during construction where applicable.
17. Scale of plans, north arrow, etc.

EXHIBIT D-2
LIMITED AUTHORIZATION
KNOW ALL MEN BY THESE PRESENTS:
That Speedway LLC, Western Refining Retail, LLC; TRMC Retail LLC, Tesoro Sierra
Properties, LLC; Giant Stop-N-Go of New Mexico, LLC; Giant Four Corners, LLC; Tesoro South
Coast Company, LLC, Northern Tier Retail, LLC, 2Go Tesoro, LLC, Tesoro West Coast
Company, LLC, and Tesoro Northstore, LLC (collectively "Affiliated Entities") limited liability
companies and subsidiaries of 7-Eleven, Inc., a Texas corporation, acting by and through Kristen
W. Cook, do hereby nominate, constitute and appoint AECOM Technical Services, Inc., a
California corporation, as Limited Agent ("Agent") of Affiliated Entities, for purposes of executing
and delivering instruments and documents as more particularly described below, and does hereby
grant, delegate and invest said Agent with power and authority to execute and deliver for, in the
name of, and on behalf of Affiliated Entities, and in connection with that certain Second Amended
and Restated Agreement by and between Affiliated Entities and Agent dated as of January 1, 2014,
as amended (as heretofore or hereafter amended, the "Agreement"), the instruments and documents
listed in Attachment I hereto.
Agent may exercise the power and authority herein granted, delegated and invested, in any
particular and appropriate transaction or matter, as an agent of Affiliated Entities. Any instruments
and documents executed and delivered by Agent under this Limited Authorization shall be acts of
the Affiliated Entity and may be relied upon by third parties dealing with the Affiliated Entities,
such acts being hereby ratified and confirmed by virtue hereof. Agent shall deliver all instruments
and documents executed and delivered by Agent under this Limited Authorization to Affiliated
Entities promptly following such execution and delivery.
Any and all acts of Agent hereunder shall comply with all applicable federal, state and local
laws, regulations, rules and ordinances and with all applicable orders of any courts of competent
jurisdiction.
This Limited Authorization shall expire December 31, 2024 or upon earlier termination of
the Agreement, or may be terminated at any time for any reason by Affiliated Entities.
[SIGNATURES BEGIN ON THE FOLLOWING PAGE. REMAINDER OF THIS
PAGE INTENTIONALLY BLANK.]
EXHIBIT D-2 — LIMITED AUTHORIZATION — Page I of 3
F7668\B94417\264978368.v I

APPROVED AND EXECUTED this 1�day of , 2022, to be effective
as of April 1, 2022.
SPEEDWAY LLC
WESTERN REFINING RETAIL, LLC
TRMC RETAIL LLC
TESORO SIERRA PROPERTIES, LLC
GIANT STOP-N-GO OF NEW MEXICO, LLC
GIANT FOUR CORNERS, LLC
TESORO SOUTH COAST COMPANY, LLC
NORTHERN TIER RETAIL LLC
TESORO NORTHSTORE, LLC
2GO TESORO, LLC
TESORO WEST COAST COMPANY, LLC
By:'
60k..,
Kris en W. Cook
Vice President
STATE OF TEXAS §
COUNTY OF DQ 1�
BEFORE ME, the undersigned, a Notary Public in and for the County and State aforesaid,
on this day personally appeared Kristen W. Cook, Vice President of the Affiliated Entities, known
to me to be the persons whose names are subscribed to the foregoing instrument, and
acknowledged to me that the same was the act of the said company and that they executed the
same as the act of such company for the purposes and consideration therein expressed and in the
capacities therein stated. �y
GIVEN UNDER MY HAND AND SEAL OF OFFICE this 1hay of M CA,
20
I,
NOTARY PUBLIC
My Commission Expires: �,.....,�.
.Ay HALL
* *= Whry Pub1k, StRW of TL
• My Cortun Expires 12.8.24
Notary ID 130920l11
EXHIBIT D-2 — LIMITED AUTHORIZATION — Page 2 of 3
F7668\B94417\264978368.v 1

ATTACHMENT I
AFFILIATED ENTITIES MAY REVISE THIS ATTACHMENT I IN ITS SOLE DISCRETION,
INCLUDING, WITHOUT LIMITATION, TO ADD OR DELETE DOCUMENTATION
SUBJECT TO THIS LIMITED AUTHORIZATION.
Such permits, reports, applications and other documentation issued by any federal, state or
local governmental authority and such other standard form documentation provided by Affiliated
Entities or third parties to be completed in connection with Agent's performance of environmental
consulting services pursuant to the Agreement, including, without limitation, the following:
a. Waste Manifests;
b. Waste Characterization Forms;
c. Bills of Lading;
d. Waste Disposal Agreements;
e. Registration and Notification Forms for underground storage tanks;
f. Incident Reports;
g. Discharge Notification Forms;
h. Tank Closure Reports;
i. Permit Applications, Notices and other documents relating to the investigation,
monitoring or remediation work performed under the Agreement;
j. Reports to state environmental agencies regarding investigation, monitoring or
remediation work performed under the Agreement; and
k. Applications to any state underground storage tank insurance or reimbursement
fund;
Provided, however, that in each case, the foregoing authorization shall not extend to any permits,
reports, applications or other documentation that contain: (i) any language, the effect of which is
to require Affiliated Entities to indemnify, defend and/or hold harmless any third parry for any act
or omission of any kind; or (ii) any statement of any kind, including, without limitation, any
representation or warranty, which Agent does not personally know to be true and correct,
including, without limitation, any representation concerning the legal existence or financial
condition of Affiliated Entities.
EXHIBIT D-2 — LIMITED AUTHORIZATION — Page 3 of 3
F7668\B94417\264978368.v 1