MO-28919_48123_C_NRP_20221116

3502 Hayes Road • Monroe, North Carolina 28110
Phone [phone] • [phone] • Fax [phone]
November 16, 2022

Mr. Ron Taraban
North Carolina Department of
Environmental Quality
Mooresville Regional Office
610 East Center Avenue, Suite 600
Mooresville, North Carolina 28115

RE: No Further Action
Rushco #9
929 Jake Alexander Boulevard
Salisbury, Rowan County
Incident # 48123
GRI Project #5726

Dear Mr. Taraban:

Please find enclosed the certified copy of the Notice of Residual Petroleum, well abandonment records,
and certified mail receipts for public notice for the above referenced site.
Please do not hesitate to contact the undersigned at [phone] if you have any questions or
require additional information.

Sincerely,

Samuel L. McKay, III, P.G.
Geological Resources, Inc.

cc: Rusher Oil Co., Inc.
file

Site Name:Date:
Project Number:Personnel:
Company:
Driller:License Number:
Boring ID:Bentonite (lbs):
Diameter:Grout (lbs):
From (ft)To (ft)Length (ft)
From (ft)To (ft)Length (ft)
From (ft)To (ft)Length (ft)
PHOTOS
Depth to Water Inner Casing
Water Volume (gal)Screen
SITE INFORMATION
DRILLING INFORMATION
WELL ABANDONMENT INFORMATION
Total Depth Outer Casing
WELL ABANDONMENT RECORD
Form GW-30 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1.Well Contractor Information:
Well Contractor Name (or well owner personally abandoning well on his/her property)
NC Well Contractor Certification Number
Company Name
2.Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.) if 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)
□Irrigation
Non-Water Supply Well:
□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:
5a. Well location:
Facility/Owner Name Facility ID# (if applicable)
Physical Address, City, and Zip
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonment, you can submit one form.
6a. Well ID#:
6b. Total well depth: (ft.)
6c. Borehole diameter: (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
well construction/depth, only 1 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
7b. Approximate volume of water remaining in well(s): (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:
7g. Provide a brief description of the abandonment procedure:
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 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 Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Supply & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
For Internal Use ONLY:

May 9, 2022
Joey Rusher Rusher Oil Company Inc. 2201 Executive Drive Salisbury, NC 28147

Re: Acknowledgement of Report Receipt
Rushco Food Store #9 (Former)
929 Jake Alexander Blvd, Salisbury
Rowan County
Facility ID#: 00-0-0000032871
Incident Number: 48123
Risk Classification: Low

Dear Mr. Rusher:

The UST Section, Division of Waste Management, is in receipt of the LSA Report dated April 29,
2022. The report has been reviewed and will be maintained in the Mooresville Regional Office.
The UST Section agrees with the Conclusions and Recommendations presented in the Report.
If you have questions regarding the information contained in this letter, please contact me at
[e-mail] or at the address and telephone number listed below.

Sincerely,

Ryan A. Bond, P.G.
Hydrogeologist
Mooresville Regional Office
UST Section, Division of Waste Management, NCDEQ

cc: Sam McKay, P.G. - GRI
Mooresville Regional Office | 610 E Center Ave | Suite 301 | Mooresville, NC 28115 | [phone]
MO-28919_48123_G_C_20220509

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

Ms. Karen K. Alexander
Mayor – City of Salisbury
P. O. Box 479
Salisbury, NC 28145-0479

Re: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

Mayor Alexander;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

Mr. Aaron Church
Rowan County Manager
130 W. Innes Street
Salisbury, NC 28144

Re: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

Mr. Church;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

Ms. Alyssa Harris
Health Director
130 W. Innes Street
Salisbury, NC 28144

RE: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

Ms. Harris;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

Clark Stores, LLC
P. O. Box 469
Clinton, North Carolina 28329

RE: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

To Whom it May Concern;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

United Evangelical Lutheran Church
Synod of NC Headquarters
1988 Lutheran Synod Drive
Salisbury, North Carolina 27144

RE: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

To Whom it May Concern;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

Mid State Petroleum Realty LLC
P. O. Box 1618
Jamestown, North Carolina 27282

RE: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

To Whom it May Concern;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

Safhi, Inc.
Shuford Caddell & Farley LLP
P. O. Box 198
Salisbury, North Carolina 28145

PIN: 5659-04-91-1736 and 5659-04-81-8933

RE: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

To Whom it May Concern;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

Jindani Gibson 1, LLC
830 Jake Alexander Boulevard S.
Salisbury, North Carolina 28147

RE: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

To Whom it May Concern;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

Salisbury Boulevard Group
Belle Realty Development
P. O. Box 102
301 N Main Street
Salisbury, North Carolina 28145

PINs: 5659-04-82-6271 and 5659-04-82-8498

RE: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

To Whom it May Concern;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

Casa Grande Inc.
905 Klumac Road
Salisbury, North Carolina 28147

RE: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

To Whom it May Concern;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

N&H Investment Company
1005 Klumac Road
Salisbury, North Carolina 28147

RE: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

To Whom it May Concern;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
November 15, 2022

CERTIFIED MAIL

Waffle House Inc. #720
Attn: Tax Department – Property
P. O. Box 6450
Norcross, Georgia 30091

RE: Public Notice of No Further Action
Rushco Food Store #9
929 Jake Alexander Boulevard
Salisbury, North Carolina
Rowan County
Incident Number: 48123
GRI Number: 5726

To Whom it May Concern;

On behalf of Rusher Oil Company, Inc., per the requirements of Title 15A of the North Carolina
Administrative Code, Subchapter 2L.0115(k), please find enclosed a copy of the Notice of No Further
Action for the above referenced site located at, 929 Jake Alexander Boulevard, Salisbury, Rowan County,
North Carolina. If you have any questions concerning this notice please contact Sam McKay with
Geological Resources, Inc. at [phone] or Mr. Ron Taraban of the North Carolina Department of
Environmental Quality Mooresville regional office at [phone].

Sincerely,

Samuel L. McKay, III
Senior Project Manager