Brunswick_Well Abandonment_20231113 (3)

WELL ABANDONMENT RECORD For3otcnwI Use ONIX:, f
This fobs can bi used,fod single or mulliple wells j 1
i
1.Wett Ctantractitc loforrnatian: WELL.ABAND6NRiENT DETAIL.►
Stefan Smith 7,.L Number ofrriAs being aliandoled-I
��rc7lCorliaetorN_aura(urtirJla�cc rsanall}abaiRfonirr8swtl.onlusll>irpru{icay) F r ti+rrltrplt tr!fcetia► by Imi-rr{Uer, �ivp i, -errfli ONLY Wilk tl,e swue
'� r<wisfnrcniNr:m4zntrrnrA��a',',tnncwesral4fii are/F�rrrr,,
3576A „i
NC\Nell ContractorCcitifiailiari itantacr 7b.Apprnxiinate volume tit water renlr rrtrimg in ii•ell(s)j 6
sAEDAcco FUR%Alf RSUPP14Y.I`I LTSCkNLY,
Ctin>t+uq Aantc
7c,TyPetif disintilctarrt riSclQ'None
2c WcU Consttuctlou Permit N.,
113t irlf a�ilrlttttble url!}arMitr fl.r.Cr ulrrp.Slab;3'ai lrvYc,lltjadior,.cdc l ff @+rvr q7 7d.i1ntountaf diatufcctatlt tlSCll: '
I WAl use(ehcd vYdl rest}:
Water supply.lVcth 7c.'8calirn6"t0i;ds:0scd(ehes iAI:dmC:apply):
t]Agti,trtltttal 17t44nnicpaUPlt�lic CR NcafCcuiciit.G61 !a Hmoiiitc.Cbiti;ofPellcts
mcmothcmt,•lt(licatinecooling Supply) ORCSicl:ni;tl Watcr Sarpply(5ingtc) 13 Saud Centenl Grout' ❑,Dry Clay
13htctu51dal/Camnrere)al 1:31AWdenti:d Water Supply(shared) I7Oncrete;Gtaut .13 Drill Cottin
❑hti tiou -VS
,peciallty Grout ❑,Grwcl
Nun%Vatcr Suppty}Yell: O Bentonite.5lurw C1 Otlter(explain uadcr Tg),
O11Ronitoriirg �Recat�en
Injm inn NVctl: X Por each motet lal selected abovet pit ivide'amount otmAterials used:
OAgiriferRcc[iare DGmuiuh}alerRcoteaiiatiari Neat Cem.:941b .,Wtr:7ga1. -Sand Cem.:lb ,Wtr:gal.
bAquifcr Storage uttl P.,edwery 13Saiiitits'Barrier h
Bentonite.:31b ,Wtr:gal. '
❑AiprikrTtst. ]3SlonmtatcrDn[in;rgc• _.-------
13 bNPgAIIteLIIAl'T'LvhopIoL%,
pSubsidetb-eCprNttal
Pantile a brill d6cryttion of thc'ahaddari rcut prrteitiure:
003eodigrtnal(Closcd.Leo0 17Traret
Tremie grouted recovery wells using grout pump. Used
C3GcothcmltHc:t(iner`CuoliokRetum)_ . ®bitter( _ lainuodcr.7s)
standard Portland/bentonit'e "mix. Did not record actual
4.D#tiwOt(s}:4hanildncd. 30-17-23 gallons. Returned next morning and tagged wells and grout
$a.{yell lura'ttilir: was >3.5 r below grade': - —-
a'..r:
ExxonMobil -
FaCilitjlO�v'ncrNuit+ fatilityim(inppliwbic) 8•Ccrfificsdioit: N A+0V y l 223
1 n 1,
1515 River Road SE Leland, 28479 _ 10/26/2023
PhcsicaFAd+tn ss.Citl,and Zip
` r rrcdiGed 1t'etl Corl At`riri`e!1
Brunswick . lit+s�'gifing_ihis forte, !hereby caj,dfy that Ilia tYrll(c) irm firers}irhamdanud ii:
County lattNol(PiN) ' '6&mYhrtxe with I5A M7ifc b?C,914t7 ur x.010tt fG:cdF Lurisdi ticffun Slaini&rtrls
mid ffi(d a trpirofffdti Mcard 114as beers.jir ot4j"cl fa dre.14 ell ois)oen
Sfi:I..ttihrdcandlongitutCcigcicga�ccsfiteinntcrJsacanidsordccini;lld4*grccs: .. �;• '
(if well ravel arrL utt/lnit;ic.7dti¢a tA) 9.Sito diagram or addItlonat vv`t.�il daubs:
You* ';iise the baiG'of iliis'.0&tu.proF'ide additional well site.6dils or`till
39.181463 �* 77.988743 fj} dauudotnitcttlitetails. l'otituayalsosalacb>tiSditioiwlpasiProcc�ssaty_
CONSTRl?(.-nox brrAms OV WEL11114 BLtING ABANIRMIRD, SUBXt__AT,iNSTR>M, .ONS
:lrGrtlr�rirlf c»irrtrirclierri rrcurc�fsllj aviailrari:n. '!}rrmirltipte ir�rrtioreGr'rnin•nYrtir�trpplt' _ -
inelli.l?NGYtriilir;a.avmatinstn�fivuaPigrr ha,;rrcmtr jur+cnins�idmitrvrr me OU For All Wells:. $uhmit tiu5 faun nithin 30 stays of•cdoiplction of Hell
Ga well pI •Itws abandaatiicnt to'tho folloti�dag:
Division of Water I'tesourcc+.Information Prtice.Lft Unit,
6It:Totulltcll depth: 26 ({k,} IGI714fail Smice Center,Italtd;;l.Nib27li99-IGI7
fob.Fnr Tnlcelian Wells: hi addition to denting tlrr(drill Co the ailla,s in 10a
Bat�elrolc diantcice:6 . ;dtatr;also submit Dire eiltn of this fomt within,30 days of completion of arll
t'>r.
(iu'y ubaridomiterd to thOulldwiny: j
Dh isms of water Resonmes,Underground in jution CaCUM Pccigratu,
Grl Water Fcv'cl.hclow I;rittind sttrfaeo: 7 {ft;} t631 R1ai1 Scrticc Centc`i,Ral�iglr,ltC 27699-1636
i
Vc.Far\filer•..mQuIv.0 idatfam MLs rn addition to sending the fornt-to
Ge,t}ntcr casing la rardh'(if lmrtn n): (fc.} the address(es) above. also submit©nc copy of this t'bmi within'3Q days of
ccampledan of vtril abandnnmerit to Ifiet:alunty heath dcpartntept oC ilia count}'
6L Inner easiugltubtng tcnytth-(if tmawn): (ft.)
wherc abandoned. h
6g.screen length(if knottm
Fomi G%N'40 Nonit:Camlim Depsonbol of Pnvinianrcnt:ail Naruml Rcsoummcs-Dlvldan of Plato•Roattao s Revised Augosa.o t3

I
WELL ABANDONMENT RECORD ForlrAcmall7tzONlti':,
Thts iomt can tie used:lb'rsinglz oc tuttltiptrr rF�lis
l.�Yc[t:Cnntr7ciur.ldformddqu: WpLL.ABANDONMENT DETAInt
Stefan Smith 1a,Number ofwdis-being Alii.ndo ued..l
q'c1fCFot�ractgrt�autc(oe'tr luarsr tSarislly;il�autfarii>tgyallnuliLSlhsscpruticnyj For reiilttph 'trtfetirar cw rwn-tieiter .ArpjVy taels ONLY 101dr IN .soma
. rortrmrcniivtr�,arclri,iritc�<r,trtrr cktre,mafi,nr w,c/6n,u
357 6A. ..
NCNtrcIICOntractoi'uviric1liouNiHhCi 3U.AppcnsImatclnlmtaecifiFatcrrbmfimingiuwell(N 6
SAEDACCO FOR%VATERS!IPPLV1Vm13ON1-v.,
C4nappm trams 7c,Type of disiu&4timi med::Non
2:Well Construction Permtt Of,
ft�tirll aj��ltribla nr'fll+armfLe i7.it.Coin,k�tartr;Q'GYli,r.+ee.IlrJeC9iol;,Ci[:1 fJkertc�st7 I• '
7d.,lm6udt ofdisiafeciant ttsed:
3.�V�t_u�.(�becln'ell usr}: 1,
Waters pplyaVeth '7c Scaling_mitceials,tised(Ocidi.all,iliat 20,01y):
❑Agri�a)ittiral I]h0tinic pcvl/Piifplir Pd Nck Ceniciit.Crtoatt m e' moti tc CWIjU OfNiets
l7Crnlhcmatl(HcaSinrLCoquno Supply} ORcOctitutl Water Sltppl} L7.Sala)CcnttatGrdut ❑ Dry C ay
❑ludustrial/CcSmnicici11 ORcsidentfidW.1terSupply(5bared) 13 Coucte(e:Greut D Dtill.Clulings
❑bri •tion []specialty.Groitt b Gravel
Non AVatcc Sapplc)Yell; C7 Bett4otiite;Shtriy d Ocher(explain under 7g)
OIVldtiltodiag 161[$eccit�en• - _
injection Wclio- if.For each material scltcted abGve;'pevvide:tntount'of;tuateriats used,
❑AgttiferRccfiarQ6 l7CtOttis1it11erRctuediuripn Neat Cem..:941b ,Wtr:7gal. Sand Cem.:t.b ,Wtr:_gal.
O1�tiaeifei Strsrage uit'i_Elcri)�'eiv 17Snituily(3atrier ,' - I;
❑ApnikirTcst, 17Slonmfit[ctDictinagc• Bentonite.:31b ,wtr:gal.
OENperitmutul•Tccliiwlo pSubsJdetr Cotttml- l
. � .Pritvidc a brief ieeciiptian of tbcl.ilt:irtc&ronicnt PnicWutc:
13deol6nnat(Closed Loop) OTMON i,
.13Cn-othent a((He aGnu/Cco ingRetum3 ©U1kmtes lain_un_der.7A)
Tremie grouted-recovery wells using grout pump. Used
^� T standard.Portland/bentonite mix. Did.not record actual
d.DatcvvcU(s)•aband6fied: 10-17-23 'gallons. Returned next•morning and tagged wells and grout
U. Vefl luedilim. was >3.5' below grade.
ExxonMobil N,�t J 2 •_' 2023
Gacilitj/Otvnvv]lainc Faitit}!nN(i('applicatilc) �::Certi(Iiiai6it• U
1515 River Road SE Leland, 28479 - rt26/2023
PIu sieai Addrc�,City,and Zip' rich a�.CCdU➢tl W'clt Ciinu rrlar or t4'efli�nar w e U ue
fijl:etgnln flits fnrrtt,-f hemb} a+rhjt+ihm lfae it-fifs)rrrrs(here)abandoned in
Cotiuiy Panel idcnti("aaijh*No(PiNj' v6e vnkn c uith l i�t e4�;IC 4.'C`,C1lQt7,ur 2a^.6200 fi'elI Cuirslrttetlura Strirrfkrrrls
mrilllrrrf cic�pa aJlr,rsrcee�rdlrccsbec,a,proviirerlio7lre.uelibirhem.
Sb:latihtda and Mn�itutC�in.tfcgariccs�ituuutawlseindds oc dcciat�t degrees: .
(ifiyell_Q"a�cl;o�rza,auMu�tss,�IticictwD 9.Situ disgrttnt or addidonai�rll d�^tiits: .
34.181720 77..988428 SFOu itaa}.rise tiae.Gal:'of iltis page to.pio(tde additional tell site.detpils or viell
h �Y ab tndonuieru details:'You uws'also.utaeit aciilitioiral pct�n's if tkressacy.
C(biV5T1tU 1`M— DrTAII.S-OF`VELit.%1i1EiNC.ABAN"66NE6. SUBMTlTAI.iNSTRiITQ:TiO_N%.
;Qttuch urT1 cr,rzrrrirciiz+a trcvr�!(�t i3 ai»ihdil�+ !:m mm&tp1�iifrctiriu w•tmn.uxk�:rarppft' .
irells OVLY tr ifli t w avnR rrurstr,rt,olNvLarchn rlenf.�r,a cY1r,stiL+mut wre�Finrr. I'
• - 1p,t Nnr All t•Ve(Is: Suhraiit tliiS farm Within 30 days'of cdtuptctian of well
abandatitncnt to'thetallQwi
Eliv�b dart(if Water Resources,Information Praiocssing.Qinit,
16k7.Mail Scn ice Center !d rlc++ti,I+iC 27fi99-lfik7
Gp 'Ihtat troll dcptia: 25 (la• '...,' i,.•
Iola.For iiticyOm yelixt-ha addittaq:ia kading tlae ferny to the addcdss in 10a.
Am.utsa submit one aopr of this form iAthiit 30 days,of ctrmptelion of well
4.Boreltole diirntchc.6 (iu.} I•
:abutaiounteW to dit fallrsa in;:
7 Ditisloia of«uicr Resumes,Underground injectlou Cot but Ftxigram
QL Water(ad.bclow gmutfd cttt•Faeo: (ft:) 1
CG3d RiailSetiicc Ccntcr"Ralcigir,IiC 23C99-IG3G
Ge.flnteecaWnglct h'(iElmnriu); (ft.� lfic.Fna•tViter.unn[ .�cr rn finn�demv; 'in addition to sending'the form to
the address(es) (abot`e. nlso submit one;copy of this.faint within 30 aayi of
r:ratttptetioti.of it�c11 a-Widannxnt to the:coif y hcatilt department of tine county
GL Inn&easinpJtuhfng length(if 1,'uart•u): (ft.)
tvlat ro ah alxiotsed
6g.Ser6en length(if knoisn): M.)
Fam<G%1-30.. vis{anofWhtcrRcsowtes i [;citcdAugus 2011

WEELABANU.UNMENT RECORD
Fotatncen5l l)Q ONLY;. I i •
this fomrt�itba ttseil:lbe sine&.oe tnuitipte ills
1.1Vcll. citttracfur:Infotmution: W ZMARANI1fANI N+t'nmtut
Stefan Smith 7a,Numherofteens being Abandoned.- l
�VelfCat�rietarhaaic(ors�ello��acrperXoiiall}:ulr5�toriiibtioEloalrfsllrittifupcu9) �� n+ulnph -mfppp' ifes ONLY wifiJ sruue
- cavagtrrrattor'ttm'rrar�lruiAi�Rt),tYirrcyursafv�li wtcfrrrwr;
3576A
71►.Approximate gfiluineat ti:aiL-tvtttainiugua lleli(s)
NC 1Vd1 ConlractarCsrtifiuiUon Nimtcr µ i.
SAEDACCo FOR.�VATF,RS4)PPt�Y%� LJ3ONLY:.
Co'n utg Naine, 7c.Type of tltidfceWntt.arct0:None
2:1V�t construction Permit N:,
I W 0 rrii1illr0f ;rollIcrtvhs(i.r,Coora.) Sate,l'oriarx-4ligedtui,,atc,f t(kirubrtr
7d.Amount of disinfectant ttsd:
3.Wdl asr(�hcdat'etl usep
�Vater.Suppl�?�R'etl: �c:Sealinbinatcoi:tis�d�t(c4ccl:all'bnt.anply):
❑4g'riciiih4 B: t)149anicipallPitblic FAN�ttCenicttt., root 0 Hattigtiifc.Cbi(tstirPcllcts
)aGrntltemt tt'(Hca4inr.JCoolina Sttppty) Mcsidrntial\Nate;$pppls(Singly) t7 Spud Cetiient Gitint D'I)ty Clay .
OlnduSitiaUCbmntcrciul 171tesidenth.dWater Supply"(slxlmd), 0&C'.1 te�brintt -13 Drill4lttliiiy
❑left tiou a7 Specalty.GrouC 17,Grivel -
Non-water S4'PP!yWet@; --- -- 7 l99ento11ite'$ItrttY CIOther(esplainunder7,g)•
I3Matiltoring ®l�ccoc'en'
Injec'tionWCU 7f For oaclrtmetiil selected-above',piiocidaantouttYaf:tttutedalsused:
❑AquiferRecfrarge - OCrotindnnlerReniediatipn Neat Cem.:941b ,Wtr;7ga1. Sand Cem.:lb ,wtr:gal:
�rtiquii'er S(otirge atrl t2ecat'rni OSaltnity 13a►ricr � -
.❑Aquifer Test-, l7Slonmt'nter l)ntinage
Bentonite.:31b ,Wtr:gal.
_ r .
131►xp iuwulal TLciutoiogc' OSasidelw CoiyrdI 7g.Fritvidc a brief.d�criptipti of flee'tit iudannicnt pnuccdan:.
19Ggo1hetrtta1(Closed Loop) Mrrce[
Tremie grouted recovery wells using grout pump. Used
Meothenoat(Iicatina�Coolipxlietum)• Mdter.(e."lain upder.7R)
standard.Portland/bentonite mix: Did not record actual ,
.d 10-17-23.°t)atc�'cltia}.ahnnilrinetR, gallons. Returned next morning and tagged wells and grout
S L Well fucailim: was >3:5' below grade.
ExxonNobil NOV 1 2023
FaoflitjiOnrNaiti: FacilitSiD�Arupplirablc> 8:Oettifieisiiait•
i•-r?,�.e;'Y,!7{ +
1515 River Road SE Leland, 28479 :� _ itli +:,•'r •� 011026/2023
Pimsical-Addms,CitpraW Zip S. ..'Inri Cettit3ed Weft tiriunaot or t4ell Qti ''� `'°� Uttc.
i
Brunswick . �}r,eigulr{z/�>ls.fvrrrr,,I hentiby cerd;6-•dent the trctlfs)-was prere)afirtridoned:in
COMM), Panel ldcn1ii60*No:(PIN) riccunhrt:c'%.n'tthISA CWb2C,0tt?O,ur,6200(Veili7o s'!ri'tettanSlrirriktrr(s
and iffo a,ivp.;,ajthis rrevrd leas bvcrt,pr»v t+'ar1lo flte.yr ell ort�►er.
5h.Lhtifudoand.Igngifella;n ds o ccstRt€nutcs/sceotitis ar dccitit i9;dcgtccs:
(iru it Eifel,one iatf Mig iss�ritkieur) #.S(to diagram or addltiorat well dGgatls:
Yoft alay.tbe tltc back of Afis pagb t li,'ib tde;'additiotud;tell site-'.&Oils or i8ill.
34.181576 �* 77._988402 �V. �aitdoitutcntJeutils l'otitua5',tlso,llt�cltaslditiotttlpages'ifitecsati~'_
COtCS'L'RIx-rim bETAILS OF WFLI,fSI'titijN[ ARAND[DNEIi - SLIR111F@ rAT.-MTRUCTIONS.
rittuch 11r11 twrsti':}cilun rrCWM(aO lj pi•n WIC. !'ar i #Jple iAjeaiui:,or rvin;u•utir supph'
urll ONLY vlilr tJ�r evrn� iuntr�ctioanvf+anrhi+ricrtP.rr�n eun s�iCuru'i cure Ginq. IO,t:"Far Alt Wdl.. Subttiit dii.` fptnt 30 da}V,of edmpietian of It
4n.\Nell m .t;w6 abatimonuicnt to'thb rallotving:
�.
Divfiaion of WaterResourc�;,Information PrucessinvEnic,
61t:`Thtal troll depth: 27 I6t7 Mail"ice Ccatcr",'Rale'Pa .,NC. 2769946t7
lob.For Itt10414n Neils: In Wdittbtt;co,settdiog Air fbtut to the addte,,s fa Wa
fie.Bo hol;tliamctet:6 (u y :mote.also subudi one bopy of this faun withiii 30 days 6C completion,of well
abatidontitcut to Chi.,follEkying:
4.tI.`Voter @cFcCbcton g putid atcfucy 7 Sft.} Ilitision of\�mter Reseal cos,Uiidrruund tit jt'ctiun Catidtvl l'c96tt~am,
i63tr lliail Sciiicc Center;Itulcigh,NC 27649-1636
6e.Outer ea4ing Icngrth'(ifflmown): (ft} Inc,rnr� ict.. t nt�'. •in)cetbaro-McBs': In addition to-sending the Corot to
the.address{es1 above. also subatit bnc copy of this'.fbrnt within 30 day of
completion of%hell abavi onmcnf to(60�1ufly health department of the cou*,
6f.Inner CaAn);jtuhin.tentKl (it hha' n): (ft.) tvhrty abandoned,
4g:Ser6en.length(if known)::
I
FannGW-3U Nonh•CatutiraMpgnarrn afEnvirountent and NatwutResotmes-Divfstonof14atcr12'ooft=s kovicdAasus 200 "