MO-6024_22471_CA_WR_20190917

IF AV
ff TkC
ASSOCIATES OF NORTH CAROLINA, P.G.
September 17, 2019
7606 Whitehall Executive Dr. Suite 800
Charlotte, NC 28273
Tel: [phone]
Fax: [phone]
www.atcassociates.com
N.C. Engineering License No. C-1598
Mr. Ed Leach
North Carolina Department of Environmental Quality
Mooresville Regional Office
Division of Waste Management - Underground Storage Tank Section
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Re: Well Abandonment Records
Circle K Store No. 4522 (RM No. 3029)
7225 Albemarle Road
Charlotte, Mecklenburg County, North Carolina 28227
Facility ID No. 0-014883
Incident No. 22471
Dear Mr. Leach:
ATC Associates of North Carolina, P.C. (ATC) is pleased to submit the attached well abandonment
records for groundwater monitoring and remedial wells associated with the subject site. On June
28, 2019, ATC supervised the abandonment of monitoring wells GW-01 through GW-13, air
sparge wells AS-1, AS-2, AS-3, and soil vapor extraction wells SVE-1 through SVE-6, by a
licensed well drilling subcontractor. The well abandonment records are provided as Appendix A.
Under separate cover(s) provided to the NC DEQ, ATC has completed Public Notifications and
filing of the Conditional No Further Action (CNFA) for the subject incident (Appendix B), and has
recorded the Notice of Residual Petroleum with the Mecklenburg County Registrar of Deeds. In
addition to abandoning the monitoring and recovery wells associated with this incident, ATC has
also removed the aboveground components of the AS/SVE system, including the remedial
system trailer, electric utility pole and main power disconnect, the concrete pad, and the wooden
privacy fence surrounding the remedial compound area.
ATC has completed site closure requirements as required by the CNFA. If you have questions or
require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Ja e Whittle
Project Manager

APPENDIX A
WELL ABANDONMENT RECORDS

WELL ABANDONMENT RECORD
This form can be used for single of multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contactor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, l'ariance, etc.) iiftnown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 06/12/19
5a. Well location:
RM - 3029
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35012' 16.61" N 800 43' 13.76"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: '
For multiple hyection or non -water supply wells ONLY with the same
construction/abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3.25 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
&.. W''", 06/28/19 _
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby certify that the wells) ivas (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Constniction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well consiruction records) iif'arailable. For multiple byection or non -water supply
wells ONLY with the same constructionabandotinieni, you can.subndt one form.
6a. Well ID#: GW-1
6b. Total well depth: 20.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 4.3 (ft.)
6e. Outer casing length (if known): (ft.)
6E Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
Form GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, Slate, I'ariance, etc.) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
OMonitorine ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other(explain under 7g)
4. Date well(s) abandoned: 06/12/19
5a. Well location:
RM - 3029
Facility/Owner Narne Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one ]at/long is sufficient)
35' 12' 16.80" N 800 43' 14.40"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For inuhiple injection or non -crater .supply wells ONLY ividt the same
construction abandonment, you can submit one farm.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Scaling materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
3.25 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (here) abandoned in
accordance with ISA NCAC 02C .0100 or 2C .0200 Well Constniction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
�Y abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELLIS) BEING ABANDONED
Attach well conssirucdon record(v) if available. For multiple injection or non -water supply
wells ONLY with the same consinictiott ahandonment, you can submit one forni.
6a. Well ID#: GW-2
6b. Total well depth: 20.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 4.0
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
6e. Outer casing length (if known): (ft.) 10c. For Water Sunnly & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 201.i

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Natne
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
[?] Monitorine ❑ Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
OSubsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 06/12/19
58. Well location:
RM - 3029
Facility/Owner Natne Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one ]at/long is sufficient)
350 12' 17.03" N 800 43' 13.10"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
Far multiple byection or non -water supply wells ONLY with the same
construction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
21 Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
711 For each material selected above, provide amount of materials used:
3.25 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this fonn, l hereby certh, that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Consiniction Standards
and that a copy of this record has been provided to the ivell owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifat•allable. For multiple ityection or note -water somb,
wells ONLY with the same construction abandonment you can subunit one form.
6a. Well ID#: GW-3
6b. Total well depth: 20.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 7.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water SunDly & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable we// construction permits (i.e. County, State, Variance, etc.) ifktmwn
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑ Ind ustrial/Commercial ❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
OMonitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquit'er Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heating/Cooling
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 06/12/1 9
in. Well location:
RM - 3029
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one fat/long is sufficient)
350 12' 16.65" N 800 43' 12.72"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple hyection or non -water supply wells ONLY with the .save
construction' abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
* Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3.25 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
Signature of Certified Well Contractor or Well Owner
06/28/19
Date
By signing this form, 1 hereby certify that the wells) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach we// construction record(s) if available. For multiple injection or non -water .supply
wells ONLY with the same construction abandonment, you can submit mw form.
6a. Well ID#: GW-4
6b. Total well depth: 20.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 3.2 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
Gf. Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Count),, State, Variance, etc.) ifknown
3. Well use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal(Closed Loop)
❑Geothermal (Heating/Cooling
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 06/12/19
5a. Well location:
RM - 3029
Facility/Owner Name Facility ID# (if applicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one tat/long is sufficient)
350 12' 16.67" N 800 43' 13.84"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple injection or non -water supply wells ONLY udth the .scone
construction abandonment, you con submit one fornt.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
0 Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
4.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
&"` "-.`"'"'"' 06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this fonn, l hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non -water supply
wells ONt-Y with the same construction abandonment, you call submit one form.
6a. Well ID#: GW-5
6b. Total well depth: 25.0 (ft.)
6c. Borehole diameter: 2•0 (in.)
6d. Water level below ground surface: 4•7 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Iniection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc.) ifknarrn
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑ Ind ustrial/Commercial
❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
M Monitorine
❑ Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 06/12/19
5a. Well location:
RM - 3029
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(tfwell field, one W/long is sufficient)
35012' 16.19" N 800 43' 14.48"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple itjection or non -crater supply wells ONLY with rite same
construction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
4.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
&. ` 06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, l hereby certify that the well(s) was (were) abandoned in
accordance with l SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple itjection or non -Crater supply
wells ONLY frith the .sante consiruction'abandonnnent, ),on can submit one form.
69. Well ID#: GW-6
6b. Total well depth: 25.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.0 (ft.)
SUBMITTAL INSTRUCTIONS
10.4. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
lob. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Foam GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc.) ifknmrn
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
M Monitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 7g)
4. Date well(s) abandoned:
06/12/19
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple injection or non -outer supply wells ONLY with the satire
construction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
4.0 GALLONS
7g. Provide it brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
5a. Well location:
RM - 3029
Facility/Owner Name Facility ID# (ifapplicable)
8. Certification:
7225 ALBEMARLE ROAD CHARLOTTE 28227
"`"`
Physical Address, City, and Zip
_06/28/19
Signature of Certified Well Contractor or Well Owner Date
MECKLENBURG
By signing this fonn, l hereby certify that the wells) was (were) abandoned in
County Parcel Identification No. (PIN)
accordance with 15A NCAC 02C .0100 or 2C .0200 Nrell Construction Standards
and that a copy of this record has been provided to the well owner.
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
9. Site diagram or additional well details:
350 12' 16.72" 8O0 43' 14.64"
You may use the back of this page to provide additional well site details or well
N W
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
SUBMITTAL INSTRUCTIONS
Attach urll construction records) if avattable. For multiple injection or non -crater supply
wells ONLY with the satire construction abandonment, you call submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
GW-7
abandonment to the following:
6a. Well ID#:
6b. Total well depth: 25.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 8.6 (ft.)
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10h. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f. Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Font GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable ire/1 construction permits (i.e. County, State, Variance, etc.) ifknown
3. Well use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
OMonitorinl; ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
5a. Well location:
RM - 3029
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
06/12/19
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one tat/long is sufficient)
350 12' 17.18" N 800 43' 14.56"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
ror multiple injection or non -water supply
construction abandonment, you call submit one form.
1
hells ONLY with rite same
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
O Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3.25 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
*"` %'"'y'"' 06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, l hereby certify that the wells) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Mach we// construction record(.) if arailable. Ear multiple b jection or non -crater .supply
wells ONLY with the .came construction abandonment, you can submit one farm.
6a. Well ID#: GW-8
6b. Total well depth: 20.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 6.5 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Iniection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): () where abandoned.
ft
6g. Screen length (if known): (ft.)
Foam GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/Iter property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable i e// construction permits (i e. County, State, Variance, etc.) ii known
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
[?]Monitorine ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aqui ter Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heating/Cooling Return
4. Date well(s) abandoned:
5a. Well location:
RM - 3029
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
06/12/19
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
350 12' 17.54" N 800 43' 13.76"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
Far multiple itjection or non-a-ater .supply wells ONLY with the same
construction abandonment, you can submit one fitrnt.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7e. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
91 Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3.25 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form. 1 hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Constniction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For nnr/tiple itjection or non -water supply
wells ONLY twith the same construction abandonment. you can submit ore,(brut.
6a. Well ID#: GW-9
6b. Total well depth: 20.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 7.4 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County. State, Variance, etc.) ifknown
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Ind ustrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other(explain under 7g)
06/12/19
Sa. Well location:
RM - 3029
Facility/Owner Name Facility ID# (if applicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
350 12' 15.75" N 800 43' 14.18"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple injection or non -water supply hells ONLY wrath the same
construction abandonment, you can submit one fornn.
7b. Approximate volume of water remaining in well(s): 1.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
711 For each material selected above, provide amount of materials used:
2.5 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
4. TM"""`"` 06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, l hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 01C .0100 or 1C .0100 lVell Constnuction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non -Crater supply
wells ONLY with the .same construction abandonment, you can submit one form.
6a. Well ID#: GW-10
6b. Total well depth: 15.0 (ft.)
6c. Borehole diameter: 2•0 (in.)
6d. Water level below ground surface: 7.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Summly & Iniection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
Foram GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit 0:
List all applicable well construction permits (1. e. County. State, Variance, etc.) ii known
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑ Ind ustrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return
4. Date well(s) abandoned:
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
06/12/19
5a. Well location:
RM - 3029
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
350 12' 16.69" N 800 43' 14.32"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple injection or non -crater supply wells ONLY with the same
construction abandonment, you can submit one fornt.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
O Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
4.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
'" 14.. "` 06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, / hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ijawailable. For multiple injection or non -Crater supply
hells ONI Y with the same construction abandonment, you can submit one form.
6a. Well ID#: GW-11
6b. Total well depth: 25.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 3.5
6e. Outer casing length (if known): (ft.)
6E Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
Form OW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Countv, State, Mariance, etc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
ElMonitoring ❑ Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
5a. Well location:
RM - 3029
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
06/12/19
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one linking is sufficient)
350 12' 16.10" N 800 43' 13.96" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. ror multiple injection or non -water supply
wells ONLY with lire same construction abandonment, you can submit one form.
6a. Well IDth GW-12
6b. Total well depth: 20.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 3.6 (ft.)
6e. Outer casing length (if known): (ft.)
611 Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
!or multiple injection or non -crater supply wells ONLY frith the .same
construction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
I?l Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
3.25 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
" W`'� 06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby certify that the wells) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
Form OW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc.) ifknorrn
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 06/12/19
58. Well location:
RM - 3029
Facility/Owner Name Facility ID# (if applicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifsvell field one lat/long is sufficient)
350 12' 16.13" N 800 43' 13.68"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple it jectinn or non -crater supply wells ONLY will; the saws
construction abandonment, you can submit one forty.
7b. Approximate volume of water remaining in well(s): 2.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
O Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7t: For each material selected above, provide amount of materials used:
3.25 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
8. Certification:
&." vw'"`"` 06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach uvell construction record(s) if available. For nmlliple injection or non-rraler supply
wells ONLY ividt the .same construction abandonment, you can submit one form.
6a. Well ID#: GW-13
6b. Total well depth: 20.0 (ft.)
6c. Borehole diameter: 2.0
6d. Water level below ground surface: 3.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Iniection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, I'ariance, etc.) ifknown
3. Well use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑ Ind ustrial/Commercial ❑Residential Water Supply (shared)
❑lrri ation
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Geothermal (Heating/Cooling
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
DOther (explain under 7g)
4. Date well(s) abandoned: 06/13/19
5a. Well location:
RM - 3029
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
350 12' 17.02" N 800 43' 13.90"
For Intemal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple byection or non -crater supply wells ONLY frith the .same
constnuction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 3.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
4.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
***AIR-SPARGE***
8. Certification: 4. &. TM`'"`"' 06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
accordance frith 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non -water supply
wells ONLY wilt lte .same construction abandonment, you can submit one form.
6a. Well ID#: AS-1
6b. Total well depth: 25.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 3.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Suonly & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6E Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C-4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, hariance, etc.) ifknown
3. Well use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
i) DOther (explain under 7g)
4. Date well(s) abandoned: 06/13/19
5a. Well location:
RM - 3029
Facility/Owner Name Facility ID# (if applicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one hu/long is sufficient)
350 12' 16.59" N 800 43' 13.88"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple itjection or non -water supply irells ONLY with the saute
construction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 3.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
4.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
***AIR-SPARGE***
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the ivell(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction records) if available. For multiple itjection or non -water supply
wells ONLY with the same construction abandonment, you can submit one form.
6a. Well ID#: AS-2
6b. Total well depth: 25.0 (ft.)
6c. Borehole diameter: 2.0
6d. Water level below ground surface: 3.0
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): () where abandoned.
ft
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
I. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc) ljknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑ Ind ustrial/Commercial ❑Residential Water Supply (shared)
❑Irri ation
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
Other (explain under 7g)
4. Date well(s) abandoned: 06/13/19
5a. Well location:
RM - 3029
Facility/Owner Name Facility ID4 (if applicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35e 12' 16.33" N 80e 43' 13.74"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For muhiple injection or non -Crater .supply irells ONLY with the sunte
construction abandonment, you can .submit one form.
7b. Approximate volume of water remaining in well(s): 3.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
IZI Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
4.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
***AIR-SPARGE***
8. Certification:
06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this fonn, 1 hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well consintction record(s) ifavailable. For multiple bjeetion or non -crater supply
ire/Is ONLY with the sante construction abandonment, you can submit one form.
6a. Well ID#: AS-3
6b. Total well depth: 25.0 (ft.)
6c. Borehole diameter: 2.0 (in.)
6d. Water level below ground surface: 3.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-I617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Suonly & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Cenification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Cmat05 State, Variance, etc) ifknotrn
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitorine ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
DOther(explain under 7g)
4. Date well(s) abandoned: 06/13/19
58. Well location:
RM - 3029
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one hit/king is sufficient)
350 12' 16.65" N 80e 43' 14.18"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple itjection or non -realer supply wells ONLY with the .came
construction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 3.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
5.5 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
***SOIL VAPOR EXTRACTION'`''
8. Certification:
06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby certify that the we/l(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Constriction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction recortift) ifarailable. For multiple itjection or non -crater .supply
wells ONLY with the same constriction abandonment, you can submit one forms.
6a. Well ID#: SVE-1
6b. Total well depth: 8.5
6c. Borehole diameter: 4•0 (in.)
6d. Water level below ground surface: 3.0 (ft.)
6e. Outer casing length (if known): (ft.)
611 Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
Form GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction perntics (i.e. County, Slate, flariance, etc.) ifknou•n
3. Well use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑ Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
4. Date well(s) abandoned:
5a. Well location:
RM - 3029
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
ElOther (explain under 7g)
06/13/19
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
35e 12' 16.63" N 80e 43' 13.90"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple injection or non -crater supply hells ONLY with the saute
construction abandonment, you can .submit one farm.
7b. Approximate volume of water remaining in well(s): 3.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
5.75 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
***SOIL VAPOR EXTRACTION`
8. Certification:
&"" -'"`"` 06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby certify that the well(s) teas (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(v) if available. For mtdtiple it jection or non -scaler supply
wells ONLY with the same construction abandonment, you can .submit one fftrm.
6a. Well ID#: SVE-2
6b. Total well depth: 9.0 (ft.)
6c. Borehole diameter: 4.0 (in.)
6d. Water level below ground surface: 3.0 (ft.)
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water Supply & Iniection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources — Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction perntils (i.e. County, State, Variance, etc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Injection well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
00ther (explain under 7g)
4. Date well(s) abandoned:
5a. Well location:
RM - 3029
06/13/19
Facility/Owner Name Facility ID# (if applicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
35e 12' 16.70" N 800 43' 13.84" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) ifavailable. For multiple injection or non -water supply
wells ONLY wilh the sane convruction abandonment, you can submit one form.
6a. Well ID#: SVE-3
6b. Total well depth: 9.0
6c. Borehole diameter: 4.0 (in.)
6d. Water level below ground surface: 4.0 (ft.)
6e. Outer casing length (if known):
611 Inner casing/tubing length (if known):
6g. Screen length (if known): (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple injection or non -water supply hells ONLY with the .same
construction/abandonnient, you can submit one form.
7b. Approximate volume of water remaining in well(s): 3.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
O Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
5.75 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
***SOIL VAPOR EXTRACTION"*i'
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, I hereby certify that the well(s) was (were) abandoned in
accordance with 1 SA NCAC 02C .0100 or 2C .0200 Well Consiniction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of we] I
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunoly & Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
Form GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc.) ifknorn
3. Well use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑ Ind ustrial/Commercial ❑Residential Water Supply (shared)
❑lrri ation
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
00ther (explain under 7g)
4. Date well(s) abandoned: 06/13/19
5a. Well location:
RM - 3029
Facility/Owner Name Facility ID# (if applicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
350 12' 16.81" N 800 43' 13.30"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
ror multiple injection or non -water supply wells ONLY frith the same
construction' abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 3.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
TI Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
5.75 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
***SOIL VAPOR EXTRACTION*'`*
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple byection or non -crater supply
hells ONLY with the same construction abandonment, you can .submit are fora.
6a. Well ID#: SVE-4
6b. Total well depth: 9.0 (ft.)
6c. Borehole diameter: 4.0
6d. Water level below ground surface: 4.0
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f. Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Fort GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Mariance, etc.) ifknown
3. Well use (check well use):
ter
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
DOther (explain under 7g)
4. Date well(s) abandoned:
5n. Well location:
RM - 3029
06/13/19
Facility/Owner Name Facility ID# (ifapplicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one hullong is sufficient)
35012' 16.33" N 800 43' 13.48" W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(v) iforailable. For multiple injection or non -water supply
wells ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#: SVE-5
6b. Total well depth: 9.0 (ft.)
6c. Borehole diameter: 4.0 (in.)
6d. Water level below ground surface: 4.0 (ft.)
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple injection or non -water .supply wells ONLY will; the same
construction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 3.5 (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
5.75 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
""'`SOIL VAPOR EXTRACTION**'
8. Certification:
Signature of Certified Well Contractor or Well Owner Date
By signing this form. 1 hereby certify that the well(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10.4. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Iniection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f. Inner casing/tubing length (if known): (ft) where abandoned.
6g. Screen length (if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
JAMES MORRISON
Well Contractor Name (or well owner personally abandoning well on his/her property)
C - 4421
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. County, State, Variance, etc.) ifknorn
3. Well use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑ Ind ustrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
210ther (explain under 7g)
4. Date well(s) abandoned: 06/13/19
5a. Well location:
RM - 3029
Facility/Owner Name Facility ID# (if applicable)
7225 ALBEMARLE ROAD CHARLOTTE 28227
Physical Address, City, and Zip
MECKLENBURG
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
35e 12' 16.25" N 800 43' 13.70"
For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7.9. Number of wells being abandoned: 1
For multiple injection or non -water supply wells ONLY with the same
construction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): 3.5 gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
El Neat Cement Grout
❑ Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Dry Clay
❑ Concrete Grout
❑ Drill Cuttings
❑ Specialty Grout
❑ Gravel
❑ Bentonite Slurry
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
5.75 GALLONS
7g. Provide a brief description of the abandonment procedure:
WELL ABANDONED VIA TREMIE PIPE WITH
PORTLAND BENTONITE SLURRY
""`SOIL VAPOR EXTRACTION'`''
8. Certification:
x'" W''""' 06/28/19
Signature of Certified Well Contractor or Well Owner Date
By signing this form, / hereby certify that the well(s) was (here) abandoned in
accordance with 15A NCAC 02C .0/00 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For inuhiple injection or non -Crater supply
hells ONL I' wide the .same construction abandonment, you can subndt one faro.
6a. Well ID#: SVE-6
6b. Total well depth: 9.0 (ft.)
6c. Borehole diameter: 4.0 (in.)
6d. Water level below ground surface: 4.0 (ft.)
SUBMITTAL INSTRUCTIONS
109. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Infection Wells: In addition to sending the form to
6e. Outer casing length (if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f. Inner casing/tubing length (if known): (ft.) where abandoned.
6g. Screen length (if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

APPENDIX B
CONDITIONAL NO FURTHER ACTION NOTICE

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
MICHAELSCOTT
Director
Mr. Ed Kuhn
Contract Program Manager
For Phillips 66 Company
222 S. Church Street, Suite 400
Charlotte, NC 28227
Dear Mr. Kuhn:
NORTH CAROLINA
Environmentall QaaRty-
February 18, 2019
Re: Conditional Notice of No Further Action
15A NCAC 2L .0407(d)
Risk -based Assessment and Corrective Action
for Petroleum Underground Storage Tanks
Circle K# 4522
7225 Albemarle Road, Charlotte
Mecklenburg County
Incident Number: 22471
Risk Classification: Low
Ranking: 130D
The Plume Stability Analysis Report received by the UST Section, Division of Waste
Management, Mooresville Regional Office on August 8, 2018, and the Notice of Residual Petroleum
received on February 5, 2019, have been reviewed. The review indicates that soil contamination exceeds
the residential maximum soil contaminant concentrations (MSCCs) established in Title 15A NCAC 2L
.0411 and groundwater contamination meets the cleanup requirements for a low -risk site but exceeds the
groundwater quality standards established in Title 15A NCAC 21, .0202.
The UST Section determines the subject incident to be eligible conditionally for no further action
status. However, final approval of no further action status is contingent on the filing of the approved
NRP (sent to Cardno) with the Register of Deeds in the county in which the release is located, verified by
the receipt of a certified copy of the filed NRP by this, office; and on receipt of confirmation that public
notice requirements have been completed, as described in the following paragraphs.
Be advised that as groundwater contamination exceeds the groundwater quality standards
established in Title 15A NCAC 2L .0202, groundwater within the area of contamination or within the area
where groundwater contamination is expected to migrate is not suitable for use as a water supply. Be
advised that as soil contamination exceeds the residential MSCCs, the property containing the
contamination is suitable only for industrial/ commercial use or restricted residential use (The term
"residential is inclusive of, but not limited to, private houses, apartment complexes; schools, nursing
homes, parks, recreation areas and day care centers), as stipulated in the Notice of Residual Petroleum.
aEQP4: VPI-0IJ �
oerymnemo- mntiiqumb
North Carolina Department of Environmental Quality I Division of Waste Management
Mooresville Regional Office 1 610 East Center Avenue, Suite 301 1 Mooresville, North Carolina 28115
704.663,1699

Circle K# 4522 — Conditional NFA
February 18; 2019
Page Two
As groundwater contamination exceeds the groundwater quality standards established in Title
15A NCAC 2L .0202 and soil contamination exceeds the residential MSCCs; pursuant to NCGS '143B-
279.9 and 143B-279.11, you must file the approved Notice of Residual Petroleum with the Register of
Deeds in the county in which the release is located and submit a certified copy to theUSTSection within
30 days of receipt of this letter.
As groundwater contamination exceeds the groundwater quality standards established in Title
15A NCAC 2L .0202 and soil contamination exceeds the lower of the soil -to -groundwater or residential
MSCCs; public notice in accordance with 15A NCAC 2L .0409(b) also is required. Thus, within30 days
of receipt of this letter, a copy of the letter must be provided by certified mail, or by posting in a
prominent place; if certified mail is; impractical, to the local health director, the chief administrative
officer of each political jurisdiction in which the contamination occurs, all property owners and occupants
within or contiguous to the area containing contamination, and all property owners and occupants within
or contiguous to the area where the contamination is expected to migrate. Within 60 days of receiving ,
this letter, this office must be provided with proof of receipt of the copy of the letter or of refusal by the
addressee to accept delivery of the copy of the letter or with a description of the manner in which the
letter was posted. Interested parties may examine the incident file by contacting this regional office and
may submit comments on the site to the regional office at the address or telephone number listed below.
This conditional No Further Action determination will not become valid until the UST
Section receives a certified copy of the Notice of Residual Petroleum which is fled with the Register
of Deeds and until public notice requirements are completed.
If you have any questions regarding this notice; please contact me at [phone] or at the
address for the MRO listed below.
Sincerely,
-�
Edward G. Leach, III, L.G.
Hydrogeologist
Mooresville Regional Office
UST Section, Division of Waste Management, NCDEQ
Attachments: Notice of Residual Petroleum (sent to Frans Lowman ATC)
cc: Frans Lowman, L.G.; Cardno 7606 Whitehall Executive Drive, Suite 800 Charlotte, NC 28273
(w/NRP)
Brett Morris, L.G., Mecklenburg County Groundwater & Wastewater Services (via email)
North Carolina Department of Environmental Quality i Division of Waste Management
Mooresville Regional Office 1 610 East Center Avenue, Suite 301 1 Mooresville, North. Carolina 28115
704.6b3.1699