WM0401488_Monitoring well permit application, Highway Mobil_20231101

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.
FOR OFFICE USE ONLY
1. Date: 10/5/23
2. County: Davidson PERMIT NO. ISSUED DATE
3. What type of well are you applying for? (monitoring or recovery): Recovery
4. Applicant: Geological Resources, Inc. Telephone: [phone]
Applicant's Mailing Address: 3502 Hayes Road, Monroe NC 28110
Applicant's Email Address(if available): rtb(a-)geologicalresourcesinc.com
5. Contact Person (if different than Applicant): Rae Troiano Brown Telephone: [phone]
Contact Person's Mailing Address: 3502 Hayes Road, Monroe NC 28110
Contact Person's Email Address(if available): rtb(�geologicalresourcesinc.com
6. Property Owner(if different than Applicant): Rex Oil Company Telephone: [phone]
Property Owner's Mailing Address: 1000 Lexington Avenue,Thomasville, NC 27360-3411
Property Owner's Email Address(if available): alexk(a).rexoil.com
7. Property Physical Address(Including PIN Number) 170 Evans Road PIN#: 16-331-0-000-0006
City Thomasville County Davidson Zip Code 27360
8. Reason for Well(s): assessment ground water contamination
(ex: non-discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility or site for which the well(s)is(are)needed: petroleum retail facility
(ex: non-discharge facility,waste disposal site, landfill, UST, etc.)
10. Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
NCDEQ Incident Number 44664
11. Type of contaminants being monitored or recovered: petroleum
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? 29
Existing Monitoring or Recovery Well Construction Permit No(s).: WM0401081, WM0401292,WM0401363, WM0401364(attached)
13. Distance from proposed well(s)to nearest known waste or pollution source(in feet): 12'
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s):
15. Well Contractor: Geological Resources, Inc. Certification No.: 3270A
Well Contractor Address: 3502 Haves Road, Monroe NC 28110
PROPOSED WELL CONSTRUCTION INFORMATION
1. 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?
material: 1 Bolted manhole cover with locking well cap
3. Number of wells to be constructed in bedrock: 0 6. Estimated beginning construction date: Oct 2023
4. Total Number of wells to be constructed: 1 7. Estimated construction completion date: Oct 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 hereby agrees that the proposed well(s)will be constructed in accordance with approved specifications and conditions of
this Well Construction Permit as regulated under the Well Construction Standards(Title 15A of the North Carolina Administrative Code,
fJ ,,�, Subchapter 2C)and accepts full responsibility for compliance with these rules
i�/f0�7/1ei 0 ewnwJ Project Manager, P.G.
ignature of Applicant or*Agent Title of Applicant or*Agent
Rae Troiano Brown *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
wells as outlined in this Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the
well(s)conform to the Well Construction Standards(Title 15A of the North Carolina Administrative Code, Subchapter 2C).
See attached Professional Services Agreement Rex Oil Company
Signature of Property Owner(if different than Applicant) 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 Raleigh Regional Office Wilmington Regional Office
2090 U.S. Highway 70 3800 Barrett Drive 127 Cardinal Drive Extension
Swannanoa, NC 28778 Raleigh, NC 27609 Wilmington, NC 28405
Phone: [phone] Phone: [phone] Phone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
Fayetteville Regional Office Washington Regional Office Winston-Salem Regional Office
225 Green Street, Suite 714 943 Washington Square Mall 450 W. Hanes Mill Road
Fayetteville, NC 28301-5094 Washington, NC 27889 Suite 300
Phone: [phone] Phone: [phone] Winston-Salem, NC 27105
Fax: [phone] Fax: [phone] Phone: [phone]
Fax: [phone]
Mooresville Regional Office `
610 East Center Avenue s sal• r,,
Mooresville, NC 28115 �L r all
Phone: [phone] r�
Fax: [phone] a
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t Il• or I• 1
Z
F Nt�irill• C ,.-r���
I
Wil gton
GW-22MR Rev. 3-1-2016

PROFESSIONAL SERVICES AGREEMENT
In Reference to Proposal#23-130
I. SERVICES. Geological Resources, Inc. ("GRI") proposes to perform the services for the
undersigned client ("CLIENT") at the fees and costs set forth in the scope of services and cost
proposal attached hereto and incorporated herein by reference (the "Services"). GRI represents and
warrants that the Services will be performed in a manner consistent with customary industry
standards. No other representation,warranty,or guaranty,expressed or implied, is intended.
II. FEES. GRI reserves the right to revise its fee schedule subject to thirty (30) days written
notice. In the event GRI revises its fee schedule, CLIENT shall have fifteen (15) days from receipt of
notice of the revision to determine whether to terminate this Agreement. Any revision to the
Services shall be pursuant to a written change order agreed to in advance by CLIENT and made a part
of this Agreement.
III. CONFIDENTIALITY. The Services are solely for the benefit of CLIENT. This Agreement shall
not be construed as creating any contractual relationship of any kind between GRI and any third
party. The information and materials provided by GRI to CLIENT in connection with the Services shall
be utilized by CLIENT only for the purposes contemplated by this Agreement, and shall not be
provided by CLIENT to third parties without the prior written consent of GRI, except that GRI agrees
that information and materials provided by GRI to CLIENT may, if required, be provided to and used
by governmental regulatory agencies, CLIENT's attorneys, and pursuant to any valid court order. GRI
agrees that all reports and other documents prepared for CLIENT pursuant to this Agreement are the
property of CLIENT. GRI also agrees that it will not disclose to any third party any documents,
reports, laboratory data or other information generated, created or produced for CLIENT pursuant to
this Agreement unless required by law, pursuant to a valid court order,or upon written instruction of
CLIENT.
IV. CLIENT DISCLOSURES. CLIENT shall notify GRI of any known or suspected hazardous
substances or conditions on the property upon which the Services are to be performed which in
anyway relate to or affect the Services and GRI shall have the right to rely on the accuracy of such
CLIENT-furnished information. Thereafter, GRI shall take all reasonably necessary and appropriate
measures to protect its employees, agents and subcontractors against such possible hazards and to
prevent adverse impacts to the environment. The cost of such measures shall constitute a revision
to the Services and shall be managed in accordance with Section II of this Agreement.
V. RIGHT OF ENTRY. GRI is to have free access to the applicable properties at the times and on
the dates Services are scheduled. Delays to GRI are subject to waiting time charges to the extent
such delays are caused by CLIENT or its employees, contractors or agents. GRI shall take reasonable
and customary precautions to prevent damage to CLIENT's property. CLIENT understands that the
discovery of certain hazardous substances and conditions and/or the taking of preventive measures
relative to these substances and conditions may result in a reduction of the value of the property
upon which the substance or condition is found to exist or on which the preventative measures are
taken. Accordingly, CLIENT waives any claim against GRI and its subcontractors and agrees to
defend, indemnify and hold GRI and its subcontractors harmless from any claim based upon the
diminished value of real property allegedly arising from the discovery of a hazardous substance or
condition or the taking of a preventive measure, unless such claim is based upon GRI's gross
negligence.
1of3

VI. INDEMNIFICATION. GRI will defend, indemnify and hold harmless CLIENT and its
representatives, agents, employees and successors and assigns from and against any and all claims,
suits, actions, losses, penalties, fines and damages of any nature whatsoever, including reasonable
attorney's fees, expert witness fees, consultant fees and court costs (collectively "Legal Claims and
Costs") arising or resulting from (1) GRI's breach of this Agreement; and/or (2) GRI's negligence or
intentional misconduct. In addition to the specific provisions set forth above, CLIENT will defend,
indemnify and hold harmless GRI and its representatives, agents, employees and successors and
assigns from and against any and all Legal Claims and Costs arising or resulting from (1) CLIENT's
breach of this Agreement; and/or (2) CLIENT's negligence or intentional misconduct, and (3) the
existence of any hazardous substance or condition at any site(s) where Services are performed,
unless the negligent conduct of GRI exacerbates and causes the spread of such hazardous
substance(s) or the development of such hazardous condition.
VII. PAYMENT TERMS CLIENT agrees to be responsible for all charges as set forth in the GRI
Proposal # 23-130. The work outlined in Proposal #23-130 will be payable by the CLIENT in the
following manner:
A. In the Commercial State Trust Fund Eligibility Application letter dated June 13, 2016
regarding the application for this site, the North Carolina Leaking Underground Storage Tank
Trust Fund (Trust Fund) applied a 37% apportionment for approved costs for cleanup
regarding this site. Therefore, all tasks approved will be paid by the Trust Fund at 63%,
making the client responsible to pay for the 37% apportionment of cost. Therefore, all costs
associated with tasks pursuant to GRI Proposal # 23-130 and approved on the Trust Fund
Task Authorization form will be invoiced in full and 37% will be paid directly by the CLIENT
and due within 30 days of invoice. Any non-reimbursable, non-authorized costs will also be
due from the client within 30 days of invoice.
B. To receive payment for the other 63%of costs for Trust Fund approved tasks, GRI will submit
a co-pay reimbursement package to the Trust Fund with the invoice detailing 100% of costs
pursuant to GRI Proposal # 23-130 and as approved in the NCLUSTTF's associated task
authorization. With the exception of the 37% apportioned costs, GRI will wait for payment
from client until the North Carolina State Trust Fund Program has reimbursed client the 63%
of costs. Therefore, upon receipt of the Trust Fund reimbursement check, client will endorse
the check and send it to GRI within 1 (one) business day of receiving the reimbursement.
Additionally, as GRI completes the reimbursement package, client is required to sign the
appropriate documents as requested.
C. Payments not received within 30 days are subject to a finance charge of 1.5% per month
(18% annually).
Vill. COMPLETE AGREEMENT. This Agreement, along with its attachments, including the GRI
Proposal # 23-130 incorporates all of the provisions and contemporaneous discussions,
representations, understandings, and agreements between the parties with respect to the subject
matter of this Agreement. The terms and conditions expressed in this Agreement shall not be
altered except in writing,signed by both parties.
2 of 3

IX. APPLICABLE LAW. This Agreement is governed by, and will be construed in accordance with
the laws of the state where such property is located.
Executed as of the latest date set forth below.
GRI: CLIENT:
GEOLOGICAL RESOURCES,INC. REX OIL COMPANY
By: By:
Date: 3/7/23 Date: 3 I I a 3
3 of 3

LEGEND
—••—••—••— SUB✓ECT PROPERTY
BOUNDARY LINE
AD✓ACENT PROPERTY \
BOUNDARY LINE \
TREE/WOODS LINE \ \
UAL/TY/ELECTRIC POLE
—•— •—•—•—OVERHEAD ELECTRIC LINE
p FUEL DISPENSER \,
UNDERGROUND STORAGE \
TANK
PRODUCT LINE I —..—..—..—..—..—..—..—.._..—..—..—..—..—..—..—..—..—..—. — —•--..—..—..—..—..—.. \\
l� CONCRETE SURFACE MW-24 •—`..—_ _ — —
:�•�,�•\• arm MW-14 - - `�� �•� ,i
TYPE /l MONITORING WELL �j ST-1 MW-11 J(3.87 J) MW-26
UST-3._.-`-'f41.3 J) \
TYPE /// MONITORING WELL -` r—Former
Form MW--6 O UST 2 O(N) (40 VF) �• ' \.
----------------- APPROXIMATE EXCAVAT/ON s I AST-4 - - - - FP _
AREA BOUNDARY I Form
S"'-5 a MW�2 (50.1) O�) S TW 5 MW-15
_ � di (3,oiv/• ;.V
igh way
(FP; FREE PRODUCT I 1 MW=2 SKY) y°oisore 920,} .�. 0 MW6 MW16 180) \
�J �. 7W FP
(NF, NOT FOUND i j \ \ `rr MW-4..�' (51.6) (163)
S vMW (NF) `( MW-
•.� S •i• TW-4
I - __: ��•• (FP)
I /.• (103)
MW--12 _A670) MW9
MW-27
MW--19 I i MW--18
�p FF
T I j O (FP)O 13 S ROAD MW-21 ( /
(1.770) j (1'S) AN� '� ' EV Mw-n S Sp�TM To l
j5 ce�sboro
- BUSINE �.
•�` (FP 1�85 TH
MW-022 SINESS NOR (<0.180)
�j MW- I�gS 8U MW-23
MW-28
N
/ Proposed4" recovery
well location RW-1
BENZENE CONCENTRA TONS & FREE PRODUCT MAP (0 911 212 0 2 2)
0 30 60 120 High way Mobil 170 Evons Rood
Incident No. 44664 Thomasville, North Corolino
IN FEET) G1?1 Project No. 3935 DGvidson County
Geological Resources, Inc. 1 inch = 60 ft Dote: 0912712022 Drown by. SLL Figure: 3

RECOVERY WELL
TYPICAL CONSTRUCTION DETAILS
CONCRETE PA MANHOL E E CO VR
Traffic bearing;flush mounted;domestic steel
LOCKING WELL CAP
GROUND SURFACE
0' 0'
°
a
a
° °a 2 INCH DIAMETER
GROUT CEMENT SCHEDULE 40 PVC CASING
(PROPOSED CASING LENGTH
OF 2 FEET
a.
TOP OF SENTON/TE 26' BGS
SENTONITE SEAL
TOP OF SAND PACK 28' BGS
0.010 INCH SLOTTED
2 INCH DIAMETER
SCHEDULE 40 PVC SCREEN
(PROPOSED SCREEN LENGTH
OF 30 FEET
SAND F/L TER PACK
PROPOSED WELL DEPTH 50' BGS END CAP
Highway Nbbil
GRI 3935 Note:
6 1. This diagram is not to scale.
Geological Resources, Inc.

3�35
' f NEE OCT 2 6 201?
ROY COOPER
Governor
MIC.HAEL S'.REGAN.. . _
5'ecrewry
Wt�tel IZ.esal�t'ces S.JAY ZIMMERMAN
Environmentali')utility C)irectvr
October 19, 2017
Mr. Harold Kennedy
Rex Oil Company
1000 Lexington Avenue
Thomasville, North Carolina 27360
SUBJECT: MONITORING WELL CONSTRUCTION
PERMIT NO. WM0401081
COUNTY: Davidson
FILE NAME: Highway Mobil
Dear Mr. Kennedy:
In accordance with your application received on October 16, 2017, we are forwarding herewith:
1. Monitoring Well Construction Permit No. WM0401081 for the construction of three (3)
monitoring wells at 170 Evans Road in Thomasville in Davidson County.
Henceforth, correspondence and data relating to this well shall be designated as specified in the
subject heading above. This Permit will be effective from the date of issuance and shall be
d subject to the conditions and limitations as specified therein. If you have any questions
regarding this permit, please contact me or Jim Gonsiewski at [phone].
Sincerely,
#"""'�-'
Sherri V. Knight, PE
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ -WSRO
cc: WQROS—Groundwater Protection Unit, 1636 Mail Service Center, Raleigh, NC 27699
Chris Corriher— NCDOT— Division 9
Joanna Alley—Geological Resources, Inc.
WSRO Files
thi ar e�
State of'North Carolina I Environmental Quality
450 W.Hanes Mill Rd.,Suite:3001 Winston Salem.,North Carolina 27105-7400
:336-776-9800

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES —WATER QUALITY REGIONAL OPERATIONS
SECTION
PERMIT FOR THE CONSTRUCTION OF A MONITORING WELL
In accordance with the provisions of Article 7, Chapter 87, North Carolina General Statutes, and
other applicable Laws, Rules and Regulations.
PERMISSION IS HEREBY GRANTED TO
Rex Oil Company
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM consisting of three monitoring
wells owned by the Rex Oil Company. The wells will be located at 170 Evans Road in
Thomasville, North Carolina, in Davidson County. This Permit is issued in accordance with the
application received on October 16, 2017 in conformity with specifications and supporting data,
all of which are filed with the Department of Environment and Natural Resources and are
considered integral parts of this Permit.
This Permit is for well construction only, and does not waive any provision or requirement of
any other applicable law or regulation. Construction of any well under this Permit shall be in
strict compliance with the North Carolina Well Construction Regulations and Standards (15A
NCAC 02C .0100), and other State and Local Laws and regulations pertaining to well
construction.
If any requirements or limitations specified in this Permit are unacceptable, you have a right to
an adjudicatory hearing upon written request within 30 days of receipt of this Permit. The
request must be in the form of a written petition conforming to Chapter 150B of the North
Carolina General Statutes and filed with the Office of Administrative Hearings, 6714 Mail
Service Center, Raleigh, North Carolina 27699-6714. Unless such a demand is made, this
Permit is final and binding.
This Permit will be effective for one year from the date of its issuance and shall be subject to
other specified conditions, limitations, or exceptions as follows:
I

i
1. Issuance of this Permit does not obligate reimbursement from State trust funds, if these
wells are being installed as part of an investigation for contamination from an
underground storage tank or dry cleaner incident.
2. Issuance of this Permit does not supersede any other agreement, permit, or requirement
issued by another agency.
3. The well(s) shall be located and constructed as shown on the attachments submitted as
part of the Permit application.
4. Each well shall have a Well Contractor Identification Plate in accordance with 15A NCAC
02C .0108(o).
5. Well construction records (GW-1)for each well shall be submitted to the Division of
Water Resources' Information Processing Unit within 30 days of the well completion.
6. When the well is discontinued or abandoned, it shall be abandoned in accordance with
15A NCAC 02C .0113 and a well abandonment record (GW-30) shall be submitted to
the Division of Water Resources' Information Processing Unit within 30 days of the well
abandonment.
' 7. The County Health Department may require a county monitoring well construction
permit, Please contact the health department for their requirements.
Permit issued the 19th day of October, 2017
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Sherri V. Knight,(Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ -WSRO
By Authority of the Environmental Management Commission
Permit No.#WM0401081

ATE�"V
ROY COOPER
Governor
DIONNE DELLI-GATTI
Secretary
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
April 27, 2021
Mr. Harold Kennedy
Rex Oil Company
1000 Lexington Avenue
Thomasville,North Carolina 27360
SUBJECT: MONITORING WELL CONSTRUCTION
PERMIT NO. WM0401292
COUNTY: Davidson
FILE NAME: Highway Mobil
Dear Mr. Kennedy:
In accordance with your application received on April 22, 2021, we are forwarding herewith:
1. Monitoring Well Construction Permit No. WM0401292 for the construction of three (3)
monitoring wells. The wells will be installed on the North Carolina Department of
Transportation (NCDOT) Right-of-Way at 170 Evans Road in Thomasville in Davidson
County.
Henceforth, correspondence and data relating to this well shall be designated as specified in the
subject heading above. This Permit will be effective from the date of issuance and shall be subject
to the conditions and limitations as specified therein. If you have any questions regarding this
permit, please contact me or Jim Gonsiewski at(336) 776-9800.
Sincerely,
EDocuSigned by:
L-0n, T. 5 ,ilcr
145B49E225C94EA...
Lon T. Snider
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources,NCDEQ—WSRO
cc: Josh McMahan-NCDOT (Electronic Copy)
Rae Troiano Brown—Geologic Resources, Inc. (Electronic Copy)
WSRO Electronic Files
Laserfiche Files
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road,Suite 300 1 Winston-Salem,North Carolina 27105
NORTH OAROLINA _
nw ^�& ^a^W a.•Inv 336.776.9800

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES —WATER QUALITY REGIONAL OPERATIONS
SECTION
PERMIT FOR THE CONSTRUCTION OF A MONITORING WELL
In accordance with the provisions of Article 7, Chapter 87,North Carolina General Statutes, and
other applicable Laws, Rules and Regulations.
PERMISSION IS HEREBY GRANTED TO
Rex Oil Company
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM consisting of three (3)
monitoring wells owned by Rex Oil Company. The wells will be located on the NCDOT Right-
of-Way at 170 Evans Road in Thomasville, North Carolina, in Davidson County. This Permit is
issued in accordance with the application received on April 22, 2021 in conformity with
specifications and supporting data, all of which are filed with the Department of Environmental
Quality and are considered integral parts of this Permit.
This Permit is for well construction only, and does not waive any provision or requirement of any
other applicable law or regulation. Construction of any well under this Permit shall be in strict
compliance with the North Carolina Well Construction Regulations and Standards (15A NCAC
02C .0100), and other State and Local Laws and regulations pertaining to well construction.
If any requirements or limitations specified in this Permit are unacceptable, you have a right to an
adjudicatory hearing upon written request within 30 days of receipt of this Permit. The request
must be in the form of a written petition conforming to Chapter 150B of the North Carolina General
Statutes and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh,
North Carolina 27699-6714. Unless such a demand is made, this Permit is final and binding.
This Permit will be effective for one year from the date of its issuance and shall be subject to other
specified conditions, limitations, or exceptions as follows:
D E QJ� North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road,Suite 300 1 Winston-Salem,North Carolina 27105
o pan i e.;o�mam�osu\ r 336.776.9800

1. Issuance of this Permit does not obligate reimbursement from State trust funds, if these
wells are being installed as part of an investigation for contamination from an underground
storage tank or dry cleaner incident.
2. Issuance of this Permit does not supersede any other agreement, permit, or requirement
issued by another agency.
3. The well(s) shall be located and constructed as shown on the attachments submitted as part
of the Permit application.
4. Each well shall have a Well Contractor Identification Plate in accordance with 15A NCAC
02C .0108(o).
5. Well construction records(GW-1)for each well shall be submitted to the Division of Water
Resources' Information Processing Unit within 30 days of the well completion.
6. When the well is discontinued or abandoned,it shall be abandoned in accordance with 15A
NCAC 02C .0113 and a well abandonment record (GW-30) shall be submitted to the
Division of Water Resources' Information Processing Unit within 30 days of the well
abandonment.
7. The County Health Department may require a county monitoring well construction permit.
Please contact the health department for their requirements.
Permit issued the 27th day of April, 2021
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
EDocuSigned by:
Loti T. 5,41cr
-,'B49EMC94EA...
Lon T Snider, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources,NCDEQ -WSRO
By Authority of the Environmental Management Commission
Permit No. # WM0401292
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road,Suite 300 1 Winston-Salem,North Carolina 27105
magi oui� /`� 336.776.9800

f,Mt STAfE°j'�
ROY COOPER _
Governor d C
ELIZABETH S.BISER '
Secretary •E Q .
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
May 5, 2022
Mr. Harold Kennedy
Rex Oil Company
1000 Lexington Avenue
Thomasville,North Carolina 27360
SUBJECT: MONITORING WELL CONSTRUCTION
PERMIT NO. WM0401363
COUNTY: Davidson
FILE NAME: Highway Mobil
Dear Mr. Kennedy:
In accordance with your application received on May 3, 2022, we are forwarding herewith:
1. Monitoring Well Construction Permit No. WM0401363 for the construction of one (1)
monitoring well. The well will be installed at 218 Evans Road in Thomasville in Davidson
County.
Henceforth, correspondence and data relating to this well shall be designated as specified in the
subject heading above. This Permit will be effective from the date of issuance and shall be subject
to the conditions and limitations as specified therein. If you have any questions regarding this
permit, please contact me or Jim Gonsiewski at(336) 776-9800.
Sincerely,
EL
D-ocuSiTgned by:
MJfr
145B49 22�C 4EA...
Lon T. m er
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources,NCDEQ—WSRO
cc: John and Shirly Dingus
Rae Troiano Brown—Geologic Resources, Inc. (Electronic Copy)
WSRO Electronic Files
Laserfiche Files
D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
v Winston-Salem Regional Office 1 450 W.Hanes Mill Rd,Suite 300 I Winston-Salem,North Carolina 27105
LINA
oep.u..n at uw
NoarH cnaoVF�nrsi 336.776.9800
o„i�

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES —WATER QUALITY REGIONAL OPERATIONS
SECTION
PERMIT FOR THE CONSTRUCTION OF A MONITORING WELL
In accordance with the provisions of Article 7, Chapter 87,North Carolina General Statutes, and
other applicable Laws, Rules and Regulations.
PERMISSION IS HEREBY GRANTED TO
Rex Oil Company
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM consisting of one (1)
monitoring well owned by Rex Oil Company. The well will be located at 218 Evans Road in
Thomasville, North Carolina, in Davidson County. This Permit is issued in accordance with the
application received on May 3, 2022 in conformity with specifications and supporting data, all of
which are filed with the Department of Environmental Quality and are considered integral parts of
this Permit.
This Permit is for well construction only, and does not waive any provision or requirement of any
other applicable law or regulation. Construction of any well under this Permit shall be in strict
compliance with the North Carolina Well Construction Regulations and Standards (15A NCAC
02C .0100), and other State and Local Laws and regulations pertaining to well construction.
If any requirements or limitations specified in this Permit are unacceptable, you have a right to an
adjudicatory hearing upon written request within 30 days of receipt of this Permit. The request
must be in the form of a written petition conforming to Chapter 150B of the North Carolina General
Statutes and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh,
North Carolina 27699-6714. Unless such a demand is made, this Permit is final and binding.
This Permit will be effective for one year from the date of its issuance and shall be subject to other
specified conditions, limitations, or exceptions as follows:
D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 W.Hanes Mill Rd,Suite 300 1 Raleigh,North Carolina 27105
NORTH CAROUNA _
Depwbnwd
ofEW—m vla.. �/ 336.776.9800

1. Issuance of this Permit does not obligate reimbursement from State trust funds, if these
wells are being installed as part of an investigation for contamination from an underground
storage tank or dry cleaner incident.
2. Issuance of this Permit does not supersede any other agreement, permit, or requirement
issued by another agency.
3. The well(s) shall be located and constructed as shown on the attachments submitted as part
of the Permit application.
4. Each well shall have a Well Contractor Identification Plate in accordance with 15A NCAC
02C .0108(o).
5. Well construction records(GW-1)for each well shall be submitted to the Division of Water
Resources' Information Processing Unit within 30 days of the well completion.
6. When the well is discontinued or abandoned,it shall be abandoned in accordance with 15A
NCAC 02C .0113 and a well abandonment record (GW-30) shall be submitted to the
Division of Water Resources' Information Processing Unit within 30 days of the well
abandonment.
7. The County Health Department may require a county monitoring well construction permit.
Please contact the health department for their requirements.
Permit issued the 5th day of May, 2022
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
DocuSigned by:
945B49E225C94EA...
Lon T Snider, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources,NCDEQ -WSRO
By Authority of the Environmental Management Commission
Permit No. #WM0401363
D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 W.Hanes Mill Rd,Suite 300 1 Raleigh,North Carolina 27105
NORTH CAROUNA _
Depwbnwd
ofEW—m via.,\ �/ 336.776.9800

f,Mt STAfE°j'�
ROY COOPER _
Governor d C
ELIZABETH S.BISER '
Secretary •E Q .
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
May 5, 2022
Mr. Harold Kennedy
Rex Oil Company
1000 Lexington Avenue
Thomasville,North Carolina 27360
SUBJECT: MONITORING WELL CONSTRUCTION
PERMIT NO. WM0401364
COUNTY: Davidson
FILE NAME: Highway Mobil
Dear Mr. Kennedy:
In accordance with your application received on May 3, 2022, we are forwarding herewith:
1. Monitoring Well Construction Permit No. WM0401364 for the construction of three (3)
monitoring wells. The wells will be installed on the NCDOT I-85 Business Right-of-Way
in Thomasville in Davidson County.
Henceforth, correspondence and data relating to this well shall be designated as specified in the
subject heading above. This Permit will be effective from the date of issuance and shall be subject
to the conditions and limitations as specified therein. If you have any questions regarding this
permit, please contact me or Jim Gonsiewski at(336) 776-9800.
Sincerely,
DocuSigned by:
-T. 15mltr
945B49E225C94EA...
Lon T. Snider
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources,NCDEQ—WSRO
cc: Larry Sanders—NCDOT (Electronic Copy)
Rae Troiano Brown—Geologic Resources, Inc. (Electronic Copy)
WSRO Electronic Files
Laserfiche Files
D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
v Winston-Salem Regional Office 1 450 W.Hanes Mill Rd,Suite 300 I Winston-Salem,North Carolina 27105
LINA
oq.u..n at uw
NoarH cnaovF�.rsi 336.776.9800
o..i�

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES —WATER QUALITY REGIONAL OPERATIONS
SECTION
PERMIT FOR THE CONSTRUCTION OF A MONITORING WELL
In accordance with the provisions of Article 7, Chapter 87,North Carolina General Statutes, and
other applicable Laws, Rules and Regulations.
PERMISSION IS HEREBY GRANTED TO
Rex Oil Company
FOR THE CONSTRUCTION OF A MONITOR WELL SYSTEM consisting of three (3)
monitoring wells owned by Rex Oil Company. The wells will be located on the NCDOT I-85
Business Right-of-Way in Thomasville, North Carolina, in Davidson County. This Permit is
issued in accordance with the application received on May 3, 2022 in conformity with
specifications and supporting data, all of which are filed with the Department of Environmental
Quality and are considered integral parts of this Permit.
This Permit is for well construction only, and does not waive any provision or requirement of any
other applicable law or regulation. Construction of any well under this Permit shall be in strict
compliance with the North Carolina Well Construction Regulations and Standards (15A NCAC
02C .0100), and other State and Local Laws and regulations pertaining to well construction.
If any requirements or limitations specified in this Permit are unacceptable, you have a right to an
adjudicatory hearing upon written request within 30 days of receipt of this Permit. The request
must be in the form of a written petition conforming to Chapter 150B of the North Carolina General
Statutes and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh,
North Carolina 27699-6714. Unless such a demand is made, this Permit is final and binding.
This Permit will be effective for one year from the date of its issuance and shall be subject to other
specified conditions, limitations, or exceptions as follows:
D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 W.Hanes Mill Rd,Suite 300 1 Raleigh,North Carolina 27105
NORTH CAROUNA _
Depwbnwd
ofEW—m vla.. �/ 336.776.9800

1. Issuance of this Permit does not obligate reimbursement from State trust funds, if these
wells are being installed as part of an investigation for contamination from an underground
storage tank or dry cleaner incident.
2. Issuance of this Permit does not supersede any other agreement, permit, or requirement
issued by another agency.
3. The well(s) shall be located and constructed as shown on the attachments submitted as part
of the Permit application.
4. Each well shall have a Well Contractor Identification Plate in accordance with 15A NCAC
02C .0108(o).
5. Well construction records(GW-1)for each well shall be submitted to the Division of Water
Resources' Information Processing Unit within 30 days of the well completion.
6. When the well is discontinued or abandoned,it shall be abandoned in accordance with 15A
NCAC 02C .0113 and a well abandonment record (GW-30) shall be submitted to the
Division of Water Resources' Information Processing Unit within 30 days of the well
abandonment.
7. The County Health Department may require a county monitoring well construction permit.
Please contact the health department for their requirements.
Permit issued the 5th day of May, 2022
FOR THE NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
EDocuSigned by:
LOw -T, JMdCf
945B49E225C94EA...
Lon T Snider, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources,NCDEQ -WSRO
By Authority of the Environmental Management Commission
Permit No. # WM0401364
D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 W.Hanes Mill Rd,Suite 300 1 Raleigh,North Carolina 27105
NORTH CAROUNA _
Depwbnwd
ofEW—m vla.. �/ 336.776.9800