WI0300476_Injection Event Record_20221123

hart '%o hickman
SMARTER ENVIRONMENTAL SOLUTIONS
Via Email
November 22, 2022
North Carolina Department of Environmental Quality
UIC Program
NC Division of Water Resources
1636 Mail Service Center
Raleigh, NC 27699-1636
Attention: Mr. Michael Rogers, P.G.
Re: Injection Event Record (Form UIC-IER)
Former Knitronics Facility
1515 West Academy Street
Cherryville, North Carolina
Deemed Permit No. WI0300476
H&H Job No. MOH-013
Dear Mr. Rogers:
On behalf of Mohican Mills, Inc., Hart & Hickman, PC (H&H) is submitting the enclosed
Injection Event Record for the SRS®-SD injection event performed on September 19, 2022
through October 24, 2022 at the above -referenced facility. Should you have any questions or
need any additional information, please feel free to contact me at [phone].
Very truly yours,
Hart & Hickman, PC
Stephen Libbey, PG
Project Managerl
Attachments
cc: Mr. Andrew Pitner, NCDEQ MRO (via email)
Mr. Edward Watson, NCDEQ MRO (via email)
Mr. Jim Baxter, Mohican (via email)
Ms. Susan Cooper, WBD (via email)
2923 South Tryon Street, Suite 100
Charlotte, NC 28203
704.586.0007 main
3921 Sunset Ridge Rd , Suite 301
Raleigh, NC 27607
919.847.4241 main
www.harthickman.com
https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Mohican Mills - MOH/MOH-013 Phase II ERD and SVE O&M/Phase II Injection/UIC
Permit/IER/UIC-IER Cover Letter.doc

North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number WI0300476
1.
2.
3.
Permit Information
Mohican Mills, Inc.
Permittee
Former Knitronics Facility
Facility Name
1515 West Academy Street, Cherryville, Gaston
County, North Carolina
Facility Address (include County)
Injection Contractor Information
Hart & Hickman,PC
Injection Contractor / Company Name
Street Address 2923 South Tryon Street, Ste 100
Charlotte North Carolina 28203
City State Zip Code
[phone]
Area code — Phone number
Well Information
Number of wells used for injection 75
Well IDs IP-C8 through C13, IP-D9 through DI 1, IP-
E8 through E16, IP-F7 through F12, IP-G1 through
G6, IP-H1 through H8, IP-I1 through I7, IP-JI
through J3, IP-K1 through K4, IP-LI through L6, IP-
M 1 through M7, IP-N 1 through N7, and IP-01
through 03
Were any new wells installed during this injection
event?
a Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection — Stainless steel extractable
_75
well screens/open ended rod in Geoprobe borehole
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled r Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
A Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells 0
Number of Injection Wells 75
Please include a copy of the GW-30 for each well
abandoned.
4. Injectant Information
1,590 gallons SRS®-SD/160 liters bioaugmentation
culture (TSI-DC)/-96 (dissolved) pounds sodium
ascorbate/-13,I001bs (dissolved) sodium
bicarbonate/-1,3501bs (dissolved) calcium carbonate
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration —10% SRS®-SD and —90% water
If the injectant is diluted please indicate the source
dilution fluid. Public Water
Total Volume Injected (gal) 17,865 of solution
includes 375 gallons of chase water)
Volume Injected per well (gal) Average of 232
(includes 5 gallons of chase water per well); double
volume injected into IP-D9 and IP-D11
5. Injection History
Injection date(s) 9/19/22-10/24/22
Injection number (e.g. 3 of 5) 1 of 1
Is this the last injection at this site?
❑ Yes /1 No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
11/22/22
SIGNATURE OF INJECTION CONTRACTOR DATE
Stephen Libbey for Hart & Hickman, PC
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 3-1-2016

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit N:
List all applicable well construction permits (i.e. U1C', Cimino,. Stale. Variance. etc+
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ lndustrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Resldential Water Supply (shared)
❑Wells > 100,000 GPD
For Internal Use Only:
14. WAT'F;I1 ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
IS. OUTER CASING (for multi -cased wells) OR LINER (if ap 1ieabte)
FROM THICKNESS g MATERIA L
TO
ft.
DIAMETER
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAM ErER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
TH ICKNESS
MATERIAL
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL.
EM PLACEMENT M ETHOD & AMOUNT
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:
5a.lVell Location:
KNITRONICS
©Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
0Subsidence Control
❑Tracer
❑Other (explain under #2 1 Remarks)
09/19/22 - 10/21/22
we111Da SEE REMARKS
Facility/Owner Name Facility ID8 (it -applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County Parcel identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well Geld, one tatllong is sufficient)
35° 22' 10.10' N 81° 24' 02.60n
6. !stare) the well(s): ❑Permanent or 19Temporary
W
7. Is this a repair to an existing well: ❑Yes or No
lj'this rs o repair. fill out known well construction infornration and explain the nature oldie
repair under .21 remarks section or on the back of this fora,.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction. only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 3
9. Total well depth below land surface: 36•0 (ft.)
bar nwlliple wells list all depths if different (exanrplc- 3t00' and 4)100')
10. Static water level below top of casing: (ft.)
ifu'nrer letvl is above casting use "
11. Borehole diameter: 2.25 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
ft.
ft.
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
0.0 ft.
TO
36.0 ft•
DESCRIPTION (color, hardness, roil/roek type. grain sire. etc.}
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft,
ft.
ft.
ft.
ft.
ft.
21. REMARKS
iP-14, iP-J1, IP-L5
22. Certification:
Signature of Certified Well Contractor
11/21/22
Date
Hy signing this yarn,. 1 herehycertify that the hell(.) was (were) constructed in accordance with
15.4 N('A(' 02C 0100 or i5A N('AC- 02(' .0200 Well Construction Standard,' and that a coil
of this record ha., been pruritic,' to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add' See Over' in Remarks Box) You may also attach additional pages if necessar)
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Divisio.-. of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Fonn GW-I
North Carolina Department of Environmental Quality - Division of Water Resources
Re. iced 6-6-20I8

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. WC. ('ounry, Blare, Variance etch
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑ Residential Water Supply (shared)
❑Wells > 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
°Aquifer Test
❑Experimental Technology
❑Geothennal(Closed Loop)
❑Geothermal (Heating/Cooling Return)
°Groundwater Remediation
❑ Salinity Barrier
°Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
09/19/22 -- 10/21/22 SEE REMARKS
4. Date Well(s) Completed: Well ID#
5a. Well Location:
KNITRONICS
Facility/Owner Name Facility ID4 (ifapplicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35° 22' 10.10n N 81° 24' 02.60" ►v
6. Is(are) the well(s): °Permanent or 1JTemporary
7. Is this a repair to an existing well: ❑Yes or 19No
if this is a repair. fill our known well construction information and explain the nature of the
repair under :21 remarks section or an the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: 1
9. Total well depth below land surface: 37.0 (ft.)
bar multiple wells list all depths if different (example- 3@200' and 2®100)
10. Static water level below lop of casing:
Hater level is ahore casing, use ". "
I1. Borehole diameter: 2-25 (in.)
12. Well construction method: DPT RODS
(ft.)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
For Internal Use Only:
14, WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
n.
ft.
I5. OUTER
CASING (for
multi -cased wells) OR LINER (if ap ieable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
n.
n.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
n.
ft.
In.
rt.
n.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
n,
in,
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD &AMOUNT
n.
ft.
ft.
ft.
n.
n.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
n.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (calor, hardness, sail/reek type, Brain silt, etc.)
0.0 ft'
37.0 n.
DIRECT PUSH
ft.
ft.
n.
ft.
ft.
n.
n.
n.
n.
ft.
rt.
ft.
21. REMARKS
IP-M7
22. Certification:
Signature of Certified Well Contractor
11/21/22
Date
By signing this farm. 1 hereby certify that the well(s) was (were) constructed in accordance with
15A NCAC 02C .0100 or ISA NCAC 02C .0200 Well Construction Standards and that a copy
of this record has been provukd to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessan
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
246. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100 000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW- I North Carolina Department of Environmental Quality - Division of Water Resources
Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
Lb. all applicable well construction permits. (i.e. 1.11C, County. Stare, Variance. etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑lndustrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed:
5a. Well Location:
KNITRONICS
▪ Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under (i21 Remarks)
09/19/22 - 10/21/22
Well ID# SEE REMARKS
Facility/Owner Name Facility ID/1 (ifapplicabte)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City. and Zip
GASTON
County Parcel Identification No. r PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Of well field. 1.�c lat.Ions is sufficient)
35° 22' 10.10" N 81° 24' 02.60"
6. Is(are) the well(s): ❑Permanent or i9Temporary
7. is this a repair to an existing well: ❑Yes or l9No
f rips is a repair. fill oat kurrn iwdl construction information and expla. n the nawre of the
✓ eparr toiler = 2I remarks section or on the back of this form
8. For Ceoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-I is needed. Indicate TOTAL NUMBER of wells
drilled 2
9. Total well depth below land surface:
tor multiple wells list all depths if different reraniple- 3 oil 00 and i00'.
39.0
(ft.)
10. Static water level below top of casing: (ft.)
?J water ferel es above casing,
11. Borehole diameter: 2.25
(in.)
12. Well construction method: DPT RODS
(i.e auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
h.
ft.
ft.
ft.
15. OUTER CASING (for multi -rased wells) OR LINER Of ap licable)
FROM THICKNESS MATERIAL
TO
R.
R.
DIAMETER
in.
16. INNER CASING OR TUBING (geothermal closed -loop}
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
Ft.
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DJAM ETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
R.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPIACEM ENT M ETHOD S AMOUNT
ft.
ft.
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIA L
EMPLACEMENT METHOD
ft.
ft.
ft.
rt.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
0.0 ft•
TO
39.0 n•
DESCRIPTION (color, hardness, soilfr°ek type, grain sue. eta.)
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
fit.
ft.
4.
ft.
ft.
R.
21. REMARKS
iP-C13,IP-1(1
22. Certification:
Signature of Certified Well Contractor
11/21/22
Date
Hy srxriing this form, i hereby rerNfy that the mell(s) was (were) constructed en accordance wnh
f5A AA(' 02C 11 i00 or i5A Alf 'AC 92t' .0200 Well Construction Slandardr and that a cop)
of this record has been provided to the ...en owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessar
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-I617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Fonn GW-1
North Carolina Department of Environmental Quality • Division of Water Resources
Revised 6-6.2018

WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit N:
List all applicable well construction permits (i.e. WC, County, State. Variance. etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
O Irrigation
Non -Water Supply Well:
❑ Monitoring
OMunicipal/Public
❑Residential Water Supply (single)
OResidential WaterSupply(shared)
❑ Wells> 100,000 GPD
❑ Recovery
Injection Welt:
OAquifer Recharge
DAquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
OGeothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:
Sa. Well Location:
KNITRONICS
MGroundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
DOther (explain under N21 Remarks)
09/19/22 - 10/21/22
Well DM SEE REMARKS
Facility/Owner Name Facility ID# (ifapplicabte)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address. City, and Zip
GASTON
County Parcel Idenuficaoon No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
35° 22' 10.10" N 81° 24' 02.60"
6. Is(are) the well(s): ❑Permanent or I!JTemporary
W
7. is this a repair to an existing well: ❑Yes or ir1No
If this is a repair, fill out known wt11 construction information and explain i e nature oldie
repots under '.21 remarks section or on the back of this form.
8. For Ceoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: 6
9. Total well depth below land surface:
For multiple wells list all depths f different (example- 3Q200' and 2Q100')
41.0
10. Static water level below top of casing:
"'water level is above rasing, use ' "
11. Borehole diameter: 2.25 (in.)
12. Well construction method: DPT RODS
-(ft.)
(ft.)
(re auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of lest:
13b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
re.
R.
ft.
ft.
15. OUTER CASING (for multi -eased wells OR LINER (If a
lieable)
FROM
TO
DIAMETER THICKNESS
MATERIAL
R.
rt.
in.
]
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
R.
in.
ft.
ft
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
R.
R.
rt.
R.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEM ENT METHOD
n.
fL
ft.
fl.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, snit/reek type, grain size, etc.)
0.0 rl•
41.0 ft'
DIRECT PUSH
ft.
n.
fl,
ft.
re.
R.
rt.
rt.
ft.
ft.
fL
rt.
21. REMARKS
IP-LA, IP-N2, IP-N3, IP-N6, IP-N7, IP-03
22. Certification:
11/21/22
Signature ofCenified Well Contractor Date
By signing this form, I hereby certify that the well(s) was (here) constructed in accordance with
154 NCAC 02C 0100 or ISA NCAC 02C 0200 Well Construction Standards and Mtn a ropy
of this record has been provided to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Umt, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Cop). to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCL IA
Permit Program, 1611 MSC. Raleigh, NC 27699-1611
Form GW-I
North Carolina Department of Environmental Quality - Division of Water Resources
Rev sed 6-6.2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
Lear all applicable well construction permits 1.e. I11C, Cottony. State, Variance. etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
Non-Waler Supply Well:
OMonitoring
OMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
❑Recovery
Injection Well:
❑Aquifer Recharge
['Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
4. Date Well(s) Completed:
5a. Well Location:
KNITRONICS
f5Groundwater Remediation
❑Salinity Barrier
❑ Stormwater Drainage
OSubsidence Control
❑Tracer
❑ Other (explain under #21 Remarks)
09/19/22 - 10/21/22
Facility/Owner Name
we111D# SEE REMARKS
Facility IDIr (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City and Zip
GASTON
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lot/long is sufficient)
35° 22' 10.10" N 81° 24' 02.60"
6. Is(are) the well(s): GPermanent or I!JTemporary
7. is this a repair to an existing well: ❑Yes or ONo
ff this is a repair. fill out known well construction information and explain die nature of the
repair under = 21 remarks section or on the hack of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: t
9. Total well depth below land surface: 42'0 (ft.)
For wnitiple wells ha all depths ifdiffereiu (example- 3 a 00 • and 2(3100')
10. Static water level below top of casing: (ft.)
!l Roger level gn abate casing. use "
11. Borehole diameter: 2•25 (in.)
DPT RODS
12. 1VelI construction method:
(i.e auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
FROM
ft.
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
rt.
rt.
15. OUTER CASING (for multi -cased wells) OR LINER (if op licable)
THICKNESS 1 MATERIAL
n.
DIAMETER
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
n.
ft.
in.
n.
n.
in.
J
-
I7. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
R.
n.
in.
ft.
ft.
in.
18. GROUT
FROM
n.
TO
re.
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicabte)
FROM
TO
MATERIAL
EM PLACEM ENT METHOD
n.
ft.
ft.
rt.
20. DRILLING LOG (allaeh additional sheets if necessary)
FROM
0.0 R.
TO
42.0 ft
DESCRIPTION (color, hardness, soil/reek type, Irvin size, eir.)
DIRECT PUSH
n.
ft.
h.
ft.
fr.
ft.
ft.
n.
n.
n.
ft.
21. REMARKS
IP-L1
22. Certification:
11/21/22
Signature ofCertified Well Contractor Date
By signing this Jornt,1 hereby certify that the well(s)was (mere) constructed ns accordance with
1 SA NCAC 02C .0100 or ISA NCAC 02(' 0200 Well Construction Standards and that a copy
of this record has been prorided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box) You may also attach additional pages if necessan
24. SUBMITTAL INSTRUCTIONS
Submit This GW-I within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR).
Information Processing Unit, 16I 7 MSC. Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Cop+ to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCIJA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
TO
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 6.6.2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well ('pnlraclar Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit N:
list all applicable well construction permits (i.e. fII(. County. State. Variance. etc.
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ lndustrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
Non -Water Supply Well:
❑ Monitoring ❑ Recovery
Injection Well:
DAquiler Recharge
❑Aquifer Storage and Recovery
°Aquifer Test
❑> xperimental Technology
❑Geothennal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
(9Groundwater Remediation
❑Salinity Barrier
❑Slormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 421 Remarks)
4. Date Well(s) Completed: /19nz 10/21/22Well IDN SEE REMARKS
5a. Well Location:
KNITRONICS
Facihty.,Owner Name Facility IDN IA -applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Ph}semi Address, City, and Zip
GASTON
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(limit field, one i /long is eufficaenl)
35° 22' 10.10" N 81° 24' 02.60"
6. Is(are) the well(s): ❑Permanent or l9Temporary
7. Is this a repair to an existing well: ❑Yes or BNo
!f rk., is a repair. fill out known well construction information and explain the nature oldie
repair corder = 2l remarks section or on the back of this farm.
8. For GeoprobelDPT or Closed -Loop Geothermal Wells having the same
construction, on:y. 1 GW I is needed Indicate TOTAL NUMBER of wells
drilled 6
9. Total well depth below land surface: 43.0 (ft.)
i er ncs.,, pie wells list all depths if dia Brent (example- 3@200 • and 2©100)
10. Static water level below top of casing: (ft.)
1/+niter level r.r above caring. rise "
II. Borehole diameter: 2.25 (in.)
12. Well construction method: DPT RODS
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRII'TEON
ft.
ft.
ft.
rt.
IS. OUTER CASING (for multi -cased welb) OR LINER (If ap
licable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
f1.
ft.
in.
n.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD &AMOUNT
ft.
ft.
n.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
R.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
To
DESCRIPTION (color, hardness, soil/rack type, gmin size, ear.)
OA n•
43.0 ft'
DIRECT PUSH
O.
ft.
n.
ft.
ft.
ft.
ft.
ft.
D.
ft.
ft.
ft.
21. REMARKS
IP-D10, IP-G1, IP-G3, IP-I2, IP-L2, IP-MS
22. Certification:
fy
11/21/22
Signature of Certified Well Contractor Dale
By signing this form, 1 hereby certify that the well(s) War (were) constructed m accordance with
1 SA NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well ,Construction Standards and that a cop}
r faaris record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction .nfo
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR).
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (II..'C)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
coon environmental health department of the county caber installed
(Le auger, rotary, cable, direct push, etc )
county pa o y e
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Font GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 6.6-:0I S

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well {'ontrac..r Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
I,. r..11 applicable well construction permits (.e. UIC County, State. Variance, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
❑Monitoring
❑Municipal/Public
❑Residential Water Supply (single)
DResidential Water Supply (shared)
❑ Wells > 100,000 GPD
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Expenmenlal Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:
5a. Well Location:
KNITRONICS
09/19/22 - 10/2
O Groundwater Remediation
❑ Salinity Ranier
❑Stonnwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
1/22
Welum SEE REMARKS
Fac.I iry+Owner Name Facility I D6 (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
35° 22' 10.10" N 81° 24' 02.60" Nr
6. Is(are) the well(s): ❑Permanent or OTemporary
7. Is this a repair to an existing well: ❑Yes or La)No
1] ilas is a repair. fill out known well construction infarmation and explain lee nature of Me
repair rester 021 reewrkc section ar on the back of this farm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 44.0 (ft.)
bar multiple trolls list all depim if different (example- 3@200. and 2Q100)
I0. Static water level below top of casing: (ft.)
if water level is above rasing.. i e "+ "
11. Borehole diameter: 2'25
(in.)
12. Well construction method: DPT RODS
(i.c. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
n.
15. OUTER CASING (for multi -cased wells) OR LINER (if ape
Iicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
R.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
H.
in,
ft.
ft.
In.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
I ti, GROUT
FROM
TO
MATERIAL
EMPLACEM ENT METHOD & AMOI NT
ft.
ft.
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft.
R.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain size, etc)
0.0 m
44.0 n'
DIRECT PUSH
h,
ft.
fit.
ft.
ft.
rt.
ft.
ft.
n.
n.
ft.
ft.
21. REMARKS
IP-M4
22. Certification:
Signature ofCenifred Well Contractor
11/21/22
Date
By signing this farm, I hereby certify that the u•ell(s) was (were) conseructedin accordance with
ISA NCR(' 02C 0100 ar ISA NCA(' 02(' .0200 Well Con,sructan .VRndardr and its a a roper
aphis record h os been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional wcII construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessan
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground ln;cction Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells Qlroducing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
F.. inGW I
North Carolina Depanmem of Environmental Quality - Division of Water Resources Revised 6-6-201 R

WELL CONSTRUCTION RECORD fGW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
list all applicable well construction permits (i.e. UIC. County, Slate, Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Dlrrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
DAquifer Test
°Experimental Technology
°Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
MGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
°Subsidence Control
❑Trager
❑Other (explain under N21 Remarks)
09/19/22- 10/21/22
4. Date Well(s) Completed:
5a. Well Location:
KNITRONICS
welllDfi SEE REMARKS
Facility/Owner Name Facility IDk (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County Parcel ldennfica;ion No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
if Will fi Id• one Iat/long is sufficient)
35' 22' 10.10" N 81° 24' 02.60"
6. Is(are) the well(s): f]Permanent or 1JTemporary
7. is this a repair 10 an existing well: . Yes or LINO
Oita Is a repair, fry: out mown rretl construrtiw, information and explain the nature t fthe
repair order 21 remarks section or an the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled'
9. Total well depth below land surface: 45'0 (ft.)
!•ar nwhiple wells 1;st all depths ../ different fexanple- 3 rr 00' and 2QI00)
10. Static water level below top of casing: (ft.)
If water level is abore casing, use " "
11. Borehole diameter: 2.25 (in.)
12. Well construction method: DPT RODS
(re. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
PROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER
CASING (for
multi -eased wells) OR LINER (if op livable)
FROM
TO
DIAMETER
THICKNESS i MATERIAL
ft.
ft,
in.
fl
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft
ft.
in.
n.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD &AMOUNT
rt.
fL
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK
(If applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
n.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (calor, hardness, soiltrock type, grain sae, etc.)
0.0 n-
45.0 ft'
DIRECT PUSH
It.
ft.,
ft.
n.
R.
ft.
ft.
ft.
n.
ft.
ft.
ft.
21. REMARKS
IP-I1
22. Certification:
Signature ofCenilied Well Contractor
11/21/22
Dale
ay.signmg this form. !hereby certify that the ue!1(.$) was (were) constructed in accordance with
1 SA NCAC 02C 0100 or ISA NCAC 02C .0200 Well Construction Standards and that a caps
of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box) You may also attach additional pages if necessary
24. SUBMITTAL INSTRUCTIONS
Submit This GW-I within 30 days of well completion per the following:
24a. For Ali Wells: Original form to Division of Water Resources (DWR).
Information Processing Unit, 1617 MSC, Raleigh. NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground ln;ection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699- 1 636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, C CPC UA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Fonn GW-1 North Carolina Department of Environmental Quality - Division of Water Resources
Revised 1.....'::IS

WELL CONSTRUCTION RECORD (GW-I)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
list all applicable well construction permits (i e UIC, County Stale. Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ lndustrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑ Residential Water Supply (shared)
❑ Wells> 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
lnjeclion 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
❑Other (explain under #21 Remarks)
09/19/22- 10/21/22 SEE REMARKS
4. Date Well(s) Completed: Well ID#
5a. Well Location:
KNITRONICS
Facility/Owner Name Facility lDM (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address. City, and Zip
GASTON
County Parcel Identification No. (PIN)
56. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lalllong is sufficient)
35° 22' 10.10n N 81° 24' 02.60" W
6. Is(are) the well(s): ❑Permanent or ©Temporary
7. Is this a repair to an existing well: ❑Yes or 19No
If this Ls a repair. fill out known a well cmastrur tian infarn+alirun and explain the nature r jthe
repair under 021 remarks seam or an the back of this Jnrn+.
S. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-I is needed. Indicate TOTAL NUMBER of wells
drilled: 2
9. Total well depth below land surface: 46•0 (ft.)
For nmluple wells list all depths ifdi,(Jerent (exannple- 3@200' and 2@I00')
10. Static water level below lop of casing: (ft.)
!f n rarer level is above casing. use "+ "
11. Borehole diameter: 2-25 (in.)
12. Well construction method: DPT RODS
(i.c. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15.OUTER
CASING (for multi -cased wells) OR LINER (if ap licable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
In.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLUT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
1& GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT'
ft.
ft.
ft.
ft.
fr.
ft.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
rat PLACEMENT METHOD
ft.
ft.
ft.
ft.
20. DRILLING
LOG (attach
additional sheets If necessary)
FROM
TO
DESCRIPTION (color. ha.dnesa, soil/rock type, grnin the, etc.)
0.0 ft•
46.0 n•
DIRECT PUSH
f1.
it
r.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
IP-D9,IP-J2
22. Certification:
Signature of Certified Well Contractor
11/21/22
Dale
By signing this Jnrm, / hereby crrufy that the well(s) was (were) consrructeriin accorr/ante a i+Ir
ISA NOW 02(' .0100 or 15.4 N('AC 02C 0200 Well Con.Oruclion Siamlards and Mai a copy
of d+ts record has been provided to the ti+ell owner.
23. Site diagram or additional well derails:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR).
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699.1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 1100 000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 276i99 1611
Fonn GW-I
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 6-6-2015

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
List a0 applicable well construction permits (i.e. 111(', County. State. Variance_ ere.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑MunlcipalrPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells> 100,000 GPD
Non -Water Supply Well:
❑Monitoring
ORecovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑ Geothermat(Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Dale Well(s) Completed:
5a. Well Location:
KNITRONICS
C7Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
09/19/22 - 10/21/22
Well ID# SEE REMARKS
Facility/Owner Name Facdir. IDF i'.fnpplicablei
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and hp
GASTON
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one la/long is sufficient)
35° 22' 10.10" N 81° 24' 02.60"
6. Is(are) the well(s): ❑Permanent or Temporary
7. Is this a repair to an existing well: LYes or f!lNo
if this is a repair, fill our known well construction informalNin and explain the nature of ilk
repair rider 21 remarks section or on the back of this form
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW- I is needed Indicate TOTAL NUMBER of wells
drilled: a
9. Total well depth below land surface:
itr muhiplr welt, ria al! depth, ifderent (example- 3
47.0
200 and 2l 1 y'r 1
(ft.)
10. Static water level below top of casing: (ft.)
!Rarer Rarer level is abo,,. casing. use'
I I. Borehole diameter: 2.25 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of lest:
13b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if au Stable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
IL
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
It
in.
ft.
R.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ri.
R.
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENTMETHOD
ft.
ft.
ft.
ft.
20. DRILLING LOG (arta h additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, sniUroek type, grain size, etc.)
0.0 ft-
47.0 IL
DIRECT PUSH
R.
rt.
ft.
ft.
ft.
n.
ft.
ft.
R.
ft.
R.
ft.
21. REMARKS
IP-G4, IP-G5, IP-G6, IP-H4, IP-H6, IP-H7, IP-I3, IP-K3
22. Certification:
11/21/22
Signature of Certi Pied Well Contractor Date
By .signing this farnr.1 hereby cent.* that the well(s)was (here) constructed in accordance will,
15A N('A(' 02(' 0100 or 15A NCAC 02C .0200 Well Construction Standards and that a copy
of this record has been provided to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over in Remarks Box) You may also attach additional pages if necessary
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR).
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IL;C)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCCIA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GM -I North Carolina Department of Environmental Quality - Division of Water Resources
Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Naine
2. Well Construction Permit #:
List all applicable well construction permits (i.e. 1/1(', County, State, Variance, etc)
3. Well Use (check well use):
1VaterSupply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Wells n 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aqutter Storage and Recovery
DAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
IJGroundwater Remedlation
❑Salinity Barrier
❑Stormwater Drainage
❑ Subsidence Control
❑Tracer
❑Other (explain under 621 Remarks)
4. Date Well(s) Completed: 09/19/22- 10/21/22 Well IDSE SEE REMARKS
5a. Well Location:
KNITRONICS
Facility:Owner Name Facility 1DN (it -applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one latllong is sufficient)
35° 22' 10.10" N 81° 24' 02.60"
6. is(are) the well(s): ❑Permanent or EITemporary
7. Is this a repair to an existing well: ❑Yes or 121No
if tbn is a repair, Jill out known well construction information and explain the nature oldie
repair tinder ; 21 remarks section or an the back of this firm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: is
9. Total well depth below land surface: 48'0 (ft.)
For nulriple wells list all depths ifd erem (example- 3 4200 • and 2Q100)
10. Static water level below top of casing:
• ...Mr level is above casing, use "4
11. Borehole diameter: 2.25 (in.)
DPT RODS
12. Well construction method:
(fi.)
e auger, rosary, cable, direct push, etc )
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -cased wells) OR LINER (if ap
Ikable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft,
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
R.
ft.
in.
ft.
ft.
in.
1g. GROUT
FROM
TO
MATERIAL
EMPWCEMENTMETHOD &AMOUNT
ri.
ft.
h.
ft.
ft.
fr.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
R.
ft.
fr.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type.grain Sinn, etc.)
0.0 n
48.0 ft'
DIRECT PUSH
ft.
ft.
ft.
ft.
t.
fr.
rt.
ft.
R.
Ft.
ft.
R.
21, REMARKS
IP-C12, iP-E8, IP-E9, IP-El0, IP-Ell, IP-F7, IP-G2,
IP-HS, IP-H8, IP-IS, IP-I6, IP-17, IP-J3, IP-K2, IP-N5
22. Certification:
11/21/22
Signature of Certified Well Contractor Date
By signing this farm, i hereby cerl that the well(s) was (were) constructed in accordant* with
15A NCAC 02e 0100 or 1SA NCO' 02C .0200 IVeAConstruction Standards and that a ropy
of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessar)
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form 10 Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC Raleigh, NC 27699-1617
24b, For Injection Wells: Copy to DWR, Underground Injection Control (1UC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCI!A
Permit Program, 1611 MSC, Raleigh, NC 27699-I611
Fonn GW-1
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit N:
1.in all applicable well construction permits (i.e UI('. County. State. Variance, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells> 100,000GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
EIGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 821 Remarks)
09/19/22- 10/21/22 SEE REMARKS
4. Date Well(s) Completed: Well IDR
5a. Well Location:
KNITRONICS
Facility/Owner Name Facility It fifapplicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Phys;cal Address. City, and'Cip
GASTON
Cnnv}• Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
i if we ll Field, one lat/long is sufficient)
35' 22' 10.10" N 81° 24' 02.60"
6. Is(are) the well(s): C Permanent or (!Temporary
7. Is this a repair to an existing well: ❑Yes or 121No
• /rh,. , .r repair, fill out known woe construction information and explain the nature of the
repair under 21remarks see nun r•infloebockofthisJnrm-
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled 14
9. Total well depth below land surface:
1 •itr multiple wells lost all depths if different (example- 3 ril 00' and 2 r(1)100)
49.0
(ft.)
10. Static water level below top of casing: (ft.)
11'water level is ohoae rasing. use "
11. Borehole diameter: 2.25
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc.)
ty pa n y
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING (for multi -eased welb) OR LINER (itap !tellable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
re.
ft.
in.
16. INNER CASING OR TU81NGJeothermal
closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft,
in.
fl.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
ft.
ft.
ft.
ft.
19. SAND/GRAVEL
PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft.
ft.
20. DRILLING
LOG_fattaeh additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, sail/rock type, grain size, etc)
0.0 ft'
49.0 ft'
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
IP-C8, IP-C10, IP-C11, 1P-E12, 1P-E13, IP-E14, IP-E15,
IP-F9, IP-F10, IP-F11, IP-HI, IP-H2,1P-H3, IP-M6
22. Certification:
11/21/22
Signature of Certified Well Contractor Date
By signing this form,1 hereby certify that the well(s)was (were) constructed in accordance with
15A NC -AC 02C 0100 or 1 SA N('AC 02C .0200 Well Construction Standards and that a rope
of this record has been provided to the well corner
23. Site diagram or additional well details:
You may use the back of this page to provtde additional well construction info
(add 'See Over' in Remarks Box), You may also attach additional pages if necessary
24. SUBMITTAL INSTRUCTIONS
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Submit this GW-I within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supplyand Open -Loop Geothermal Return Wells: Copy to the
coup environmentalt health de rime t of the count where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh. NC 27699-1611
Edna GW-I
Nonh Carolina Department of Ennronmental Quality - Division of Water Resources Revised 6-6.2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit if:
List all applicable well construction permits (i.e. UiC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑lrrigetion
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells> 100,000 GPD
Non -Water Supply Well:
❑Monitoring DRecovery
Injection 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
❑Other (explain under 421 Remarks)
09/19/22 - 10/21/22
4. Dale Well(s) Completed:
5a. Well Location:
KNITRONICS
Wcll ID# SEE REMARKS
Facility/Owner Name Facility IDe (ifapplicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latilong is sufficient)
35° 22' 10.10" N 81° 24' 02.60"
6. Is(are) the well(s): ❑Permanent or TITemporary
7. Is this a repair to an existing well: ❑Yes or MNo
if ?his a a repair, fill our known well construction information and explain the nature of the
repair under 21 remarks section or on the back of this form,
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW-1 is needed Indicate TOTAL NUMBER of wells
drilled 5
9. Total well depth below land surface: 50•0
For multiple wells list all depths ifd Jirenl fesanrple- 3Q200' and 2!:4 100'!
10. Static water level below top of casing:
If hater level is above casing, use "-
11. Borehole diameter: 2.25 (in.)
DPT RODS
12. Well construction method:
(i.e auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
fi.
ft.
ft.
15. OUTER
CASING (for mu1N-cased wells) OR LINER (1f ap
citable)
Stable)
FROM
TO
DIAMETER
THICKNESS
ft.
R.
in.
I6. INNER
CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
h.
ft.
in.
ft.
ft.
in.
17, SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
re.
ff.
in.
re.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
ft.
ft.
ft.
ft.
ft.
ft.
19, SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EM PLACEMENT M ETHOD
ft.
ft.
It
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness wit/rock type, tram size, ole.)
0-0 ft•
50.0 ft•
DIRECT PUSH
ft.
R.
ft.
ft.
ft.
ft.
B.
11.
ft.
ft.
ft.
ft.
21. REMARKS
iP-C9, IP-D11, IP-E16, IP F8, IP-F12
22. Certification:
•
11/21/22
Signature ofCenified Well Contractor Date
By .signing this fornr, i hereby terrify that the welts) was (were) constructed M accnrckrnce wrrlr
15A NCAC 02C 0100 or 15A NCAC 02C .0200 Well Construction Standards and Mai a copy
of'rhis retard has been provided to the well owner
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessar)
24. SUBMITTAL INSTRUCTIONS
Submit This GW-1 within 30 days dwell completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR).
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (1UC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d, For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW- I
North Carolina Department of Environmental Quality - Division of Water Resources
Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit tt:
List all applicable well construction permits (i.e. U1C, County. State, Variance. err
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Wells> 100,000 GPD
Non -Water Supply Well:
°Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
[]Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatinj/Cooling Return)
©Groundwater Remediation
❑Salinity Barrier
❑Stormtvater Drainage
❑Subsidence Control
DTracer
❑Other (explain under N21 Remarks)
09/19/22 - 10/21/22
4. Date Well(s) Completed:
5a. Well Location:
KNITRONICS
We111Df{ SEE REMARKS
Facility/Owner Name Facility IDif (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County Parcel Identification No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one 1at/long is sufficient)
35° 22' 10.10" N 81° 24' 02.60" W
6. ls(are) the well(s): ❑Permanent or PJTemporary
7. Is this a repair to an existing well: ❑Yes or MNo
If this is a repair, fill out known well construction Information and explain the nature of the
repair under s 21 remarks section or on the back of this farm.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only I GW- I is needed Indicate TOTAL NUMBER of wells
drilled: 3
9. Total well depth below land surface:
For multiple wells list all depths rfd rrem (example- 3@200' and 2 rc l00)
51.0
10. Static water level below top of casing: (ft.)
II !rater derel i5above ca3itg, ILI
11. Borehole diameter: 2.25 (in.)
12. Well construction method: DPT RODS
(i.e. auger, rotary, cable, direct push, etc,)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER
CASING (for
multi -eased welh) OR LINER (if op Stable)
FROM
TO
DIAMETER
THICKNESS MATERIAL
ft.
ft.
in.
16. INNER
CASING OR TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
In.
15. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOI NT
ft.
ft.
h.
re.
ft.
h.
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
h.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness. soit/reck type, grain size, etc.)
0.0 ft•
51.0 h•
DIRECT PUSH
ft.
ft.
ft.
ft.
ft.
h.
h.
ft.
ft.
n
ft.
It
21. REMARKS
IP-M1, IP-N1, IP-02
22. Certification:
Signature of Certified Well Contractor
11/21/22
Dale
Hy signing this furor, I hereby certify that the wells) was (were) constructed in accordance with
1 SA NCAC 02(' 0100 or ISA NCAC 02C .0200 Well Construction Standards and that o copy
of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction Into
(add 'See Over' in Remarks Box). You may also attach additional pages if necessar)
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
24a, For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 2-7699-1611
Form GW-1
North Carolina Department of Environmental Quality - Division of Water Resources Revised 6-6-2015

WELT CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (I.e. 111C, County, State. Variance. etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (HeatinglCooling Supply)
❑ Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
Non -Water Supply Well:
❑Monitoring
❑ Recovery
Injection Well:
°Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date Well(s) Completed:
5a. Well Location:
KNITRONICS
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
09/19/22 - 10/21/22
Well ID# SEE REMARKS
Facility/Owner Name Facility ID(/ (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and hip
GASTON
County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
if well field, one tat/long is sufficieni)
35° 22' 10.10" N 81 ° 24' 02.60"
6. Is(are) the well(s): ❑Permanent or EITemporary
7. Is this a repair to an existing well: ❑Yes or MINo
1/ tins is a repair. Jill nut known well construction tnfarnration and explain the nature of the
repair under 21 remarks -sector or on the back of this form,
S. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 OW-1 is needed. Indicate TOTAL NUMBER of wells
drilled. 2
9. Total well depth below land surface: 53.0 (ft.)
Par multiple wells list all depths if different (example- 3Q200' ansi 2 100)
10. Static water level below top of casing:
lfwater level is above casing, use ". •
1i. Borehole diameter: 2.25 (in.)
12. Well construction method: DPT RODS
(ft)
(i.e. auger, rotary, cable. direct push, etc,)
FOR WATER SUPPLY WELLS ONLY:
I3a. Yield (gpm) Method of test:
I3b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
fL
n.
ft.
15. OUTER CASING (for multi -cued wells) OR LINER (if Bp liable)
FROM
TO
DIAMETER
THICKNESS q MATERIAL
n.
ft.
in.
16. INNER CASING OR TUBING (geothermal elosed-loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft,
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL.
EMPLACEM ENT METHOD & AMOUNT
ft.
ft.
ft.
ft.
O.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain sire, eft.)
0.0 ft.
53.0 ft•
DIRECT PUSH
ft.
ft.
ft.
n.
n.
ft.
ft.
ft.
ft.
n.
ft.
n.
21. REMARKS
IP-K4, IP-N4
22. Certification:
Signature of Certified Well Contractor
11/21/22
Date
By signing this farm, 1 hereby cent& that the ,ell(%) was (were) constructed in accordance ,tali
1 SA N('A(' 02(' .0100 or 1SA NCAC 02(' .0200 Well Construction Standards arid that u cap%
rfthis record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box), You may also attach additional pages if necessar
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For Alt Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100 000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Font GW- I North Carotins Department of Environmental Quality - Division of Water Resources
Revised 6-6-2018

WELL CONSTRUCTION RECORD (GW-1)
I. Well Contractor Information:
STEPHEN SLOAN
Weil Contractor Name
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit N:
Lest all applicable well construction permits (i.e. 111C, Catmry, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
°Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
elGroundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Dale Well(s) Completed: 09/19/22 - 10/21/22 Well Mt/SEE REMARKS
Sa. Well Location:
KNITRONICS
Facility/owner Name Facility I DO (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
PI ,steai.iJJress, City. w J Zip
GASTON
County Parcel Identification No (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
fifwell field, one lai I.)ne is sane enil
35° 22' 10.10" N 81° 24' 02.60n
6. Is(are) the well(s): ❑Permanent or (!Temporary
7. Is This a repair 10 an existing well: flYes or MNo
11 this a a repair. fill our known well construction information and explain the nature of the
repair under =21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW- I is needed Indicate TOTAL NUMBER of wells
drilled 5
9. Total well depth below land surface: 54.0
.T multiple wells Jai all depths if el Brent [example- 3®]00' and 2 t 100)
(ft.)
10. Static water level below top of casing: (ft.)
lfwarer level is above casing. nxr " t "
11. Borehole diameter: 2.25 (in,)
DPT RODS
12. Well construction method:
(i.e auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of lest:
13b. Disinfection type: Amount:
For Internal Use Only:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
IS. OUTER CASING (for multi -eased wells) OR LINER (if ap
likable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
ft.
ft.
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
ft.
ft.
in.
R.
ft.
in.
15. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD &AMOUNT
ft.
R.
ft.
ft.
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
fL
ft.
ft.
20. DRILLING
LOG (attach additional aheeb if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, train size, etc.)
0.0 f•
54.0 f`•
DIRECT PUSH
ft.
ft.
ft.
R.
ft.
ft.
n.
ft.
It
ft.
D.
ft.
21, REMARKS
IP-L3, IP-L6, IP-M2, IP•M3, IP-01
22. Certification:
11/21/22
Signature ofCerlified Well Contractor Dale
By signing this form, I hereby certify that the well(s)was (were) constructed in accordance with
I SA NCAC 02C .0100 or 1SA NCAC 02C .0200 Well Conseraction Standard; and that a ropy
of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessan
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days dwell completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPC1. A
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
Form GW- I North Carolina Department of Environmental Quality - Division of Water Resources
Revised 6-6-201E

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
For Internal lise ONLY
I. Well Contractor information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2, Well Construction Permit tf:
List all applicable well conoruction permits (i.e. County, State, Variance. etc.) if known
3. Well use (check well use):
Water Supply Well:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
°Monitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑ Aquifer Storage and Recovery
❑ Aquifer Test
❑ Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
I0Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned:
09/19/22 -- 10/21/22
5a. Well location:
KNITRONICS
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 3
tor multiple injection or non -water supply wells ONLY with the .swot
construction abandonment. you can submit one form.
7b. Approximate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfeetant used:
7e. Sealing materials used (check all that apply):
0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
° Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
0 Bentonite Slurry
7f. For each material selected above, provide amount of materials used:
6.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-I4, IP-J1, IP-L5
FacilitylOwner Name Facility I Dil (if applicable) 8- Certification:
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Addles', City, and Zip
GASTON
County
Signature of Certified Well Contractor or Wel] Owner
11/21/22
Date
By signing this form, 1 hereby cert f that the well(s) was (were) abandoned nr
Parcel Identification No. (PIN) accordance with I5A NCAC 02C .0I00 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one IaiiJpng is sufficient)
35° 22' 10.10° N 81° 24' 02.60° w
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction recont(s) if available. For multiple it jeclion or non -water supply
4 ells ONLY with the same construction abandonnien , you can submit one farm.
6a. Well ID#: SEE REMARKS
6b. Total well depth: 36.0 (ft.)
6c. Borehole diameter: 2.25 (in.)
6d. Water level below ground surface: (ft)
6e. Outer casing length (if known): (ft.)
6f. Inner easing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
corm Gw-36
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
10n. 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: ]n 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
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
For Internal Use ONLY.
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name for well owner personally abandoning well on his/her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit 1:
Lest all applicable well construction permits (i.e. Comm,. State. Variance. ere) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aqui fer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date well(s) abandoned:
5a. Well location:
KNITRONICS
EGroundwater Remediation
❑Salinity Barrier
❑Stonnwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
09/19/22 — 10/21/22
Facility/rner Name Facility ID# (trapphcable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physic* Address City, and Zip
GASTON
Coney Parcel Identificaurn No (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
Kura field, ooe Wong is sufficient)
35° 22' 10.10" N 81 ° 24' 02.60"
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple injection or non -water supply wells ONLY with the soo.e
construction abandonment, you can submit one farm.
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):
i Neat Cement Grout 0 Bentonite Chips or Pellets
❑ Sand Cement Grout
U Concrete Grout
I t Specialty Grout
O Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
6.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
[P-M7
8. Certification:
Signature of Certified Well Contractor or Well Owner
11/21/22
Date
By signing this form. I hereby certify that the well(s) was (were) abandoned in
accordance with l5A 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 wel:
►� abandonment details You may also attach additional pages if necessary
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Amach well construction recnrd(.r) if avallabte ',or multiple *diem or non. water snppiy
wells ONLY atilt the same constrr, tiwr abands n ent. you can submii wee form.
6a. Well1DN: SEE REMARKS
6b. Total well depth: 3f'� (ft.)
6c. Borehole diameter: 2.25
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner casing/tubing length (if known): M.)
6g. Screen length (if known): (ft.)
NellGW-30
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
'Ob. For Iniection 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 Sunoly & Iniection Wells: In addition to sending the forth 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
N; rth Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 201;

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
For Internal Use ONLY.
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well on his: her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Naine
2. Well Construction Permit #:
Limon applicable well construction permits (i.e County, State. Variance. etc j 4fknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Irrig tuon
Non -Water Supply Well:
❑Monitoring
[ iMunictpa:'Public
❑Residentia; Water Supply (single)
LJResidential Water Supply (shared)
fl Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
IZ1Groundwater Remedlation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned:
09/19/22 - 10/21/22
5a. Well location:
KNITRONICS
Facility/Owner Name Facility IDN (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
CoFnry Parcel Identification No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
f r.tll field one larllong is sufficient)
35° 22' 10.10u N 81° 24' 02.60" �v
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED
.drurch well construction record(i) if arailable. hot multiple injection or non -water supply
...tits ONLY with the same construction abandonment, you can .submit one form,
6a. Well ION:
SEE REMARKS
6b. Total well depth: 39.0
6c. Borehole diameter: 2.25
((L)
6d. Water Level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6E Inner casingltubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
on!) t; W-30
WELL ABANDONMENT DETA1L,5
7a. Number of wells being abandoned: 2
For multiple Injection or non -water supply wells ONLY with the .rw.•
construction abandonment. you can submit one form.
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
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
O Bentonite Slurry
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
6.5 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-C13, IP-K1
8. Certification:
Signature of Certified Well Contractor or Well Owner
11/21/22
Date
By signing this form. I hereby certj that the well(s) was (were) abandoned in
accordance with I5A 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 s.te details or well
abandonment details. You may also attach additional pages if necessary
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this font within 30 days of completion of well
abandonment to the following.
Division of Water Quality, Information Processing Unit,
1617 Mail Service Censer, Raleigh, NC 27699-1617
1011. For Infection Welk: In addition to sending the form to the address 1- Ilia
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
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 count)
where abandoned.
North Carolina Department of Envtronment and Natural Resources - Division of Water Quality Revised March 2011

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
For Internal t se ON .Y
I. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Mama
2. Well Construction Permit ti:
all applicable well construction permits (.e Counry, Stare. Variance. etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ IndustnalfCommerc la!
❑Irrigation
C Munic ipal/Publ is
i Residential Water Supply (single)
0 Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
(]Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
II Groundwater Remediation
CSalinity Barrier
❑Stormwater Drainage
USubsidence Control
flTracer
❑Other (explain under 7g)
4. Dale well(s) abandoned: 09/19/22 10/21/22
Sa. Well location:
KNITRONICS
FacihtyfOwnerNarne Facilityfapplicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County
Parcel Identification No, (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field one !al/long is sufficient)
35° 22' 10.10" N 81 ° 24' 02 60"
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 6
For nut,tple infection or non -water supply wells ONLY
conslructu.n abandonment you can submit ate form.
with ilk
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
❑ Sand Cement Grout
❑ Concrete Grout
i 1 Specialty Grout
I 1 Bentonite Slurry
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
0 Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
6.75 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-L4, IP-N2, IP-N3, IP-N6, IP-N7, IP-03
8. Certification:
Signature of Certified Well Contractor or Well Owner
11/21/22
Date
By signing this form. I hereby terrify that the well(s) was (were) abandoned in
accordance with 15,4 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 welt c,nrslracann recorsi/s) if arailable.. Ior multiple injection or non -water supply
wells ONLY wuh the sane .Yrtstratcdon'abandannlem. you can submit acre form.
6a. Well IDtt: SEE REMARKS
6b. Total well depth: 41.0 (ft.)
6c. Borehole diameter: 2.25 (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.)
Form G W -30
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, a.so 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 Censer, Raleigh, NC 27699-1636
IOc. For Water Sunray & lniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
conipletton of well abandonment to the county health department of the county
where abandoned
Mardi Carolina Department rf Env n_ mnent and Natural Resnarsrs - D; r .sion of Water Quality Revised March ',OH

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
For Internal Use ONLY
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning wel: on hither propenyi
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
List all applicable ,well construction permits (i.e. ('amity, State variance. etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
OIndustrial/Commercial
❑Irrigation
❑Municipal.Public
[]Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑ Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑ Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
I21Groundwater Remedlation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑ Other (explain under 7g)
4. Dale wells) abandoned:
09/19/22 10/21/22
Sa. Well location:
KNITRONICS
El Neat Cement Grout
❑ Sand Cement Grout
❑ Concrete Grout
= Specialty Grout
IB Bentonite Slurry
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned:
l or multiple inea ion or non -water supply wells ONLY N,rli the Bann
construction abandonment. }ou con submit one form.
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:
7c. Sealing materials used (check all that apply):
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
0 Gravel
❑ Other(expla n tinder 7g)
7f. For each material selected above, provide amount of materials used:
6.75 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-L1
Facility/Owner Name Facility ION Of applicable)
8. Certification:
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Phypca! Address, City, and Zip
GASTON
County
Parcel Identification No (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one let/long is sufficient)
35° 22' 10.10" N 81° 24' 02.60"
Signature of Certified Well Contractor or Well Owner
11/21/22
Date
By signing this form. 1 hereby certify that the tvell(s) was (were) abandoned in
accordance with 1SA 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 additiona' weE site detat.s or v.e
►� abandonment details You may also attach additional pages if necessary
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
.tisuch wet/ construction recorr!(s) if available. For multiple injection or ion -water supply
uYih ONLY with the same construction obandonmem you can submit one form.
SEE REMARKS
6a. Well ID#:
6b. Total well depth: 42.0
6c. Borehole diameter: 2.25
(ft.)
6d. Water level below ground surface:
6e. Outer casing length (if known):
6f. Inner easing/tubing length (if known):
6g. Screen length (if known):
Fenn GW-30
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of m..11
abandonment to the following
Division of Water Quality, Information Processing Unit,
I617 Mail Service Center, Raleigh, NC 27699-1617
10b. For Infection Welts: In addi:ion to sending the form to the address in
above, also su`rn:t o::e 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
North Carolina Depanment of Environment and Natural Resources — Division of Water Quality Revised March 2011

WELL ABANDONMENT RECORD
This form can be used for single or multiple welts
For Internal Use ONLY
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name or we I owner personally abandoning well on his/her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
List all applicable a -et! canrinrcfion permits (i.e County, State, Variance, etc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑Recovery
Injection Well:
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
❑Aqui ter Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned:
09/19/22 — 10/21/22
5a. Well location:
KNITRONICS
Facility/Owner Name Facility ID# (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 6
For multiple .rite lion or tare -water supply wells ONLY with the .rams
construciion'abandanment you can .submit one forte.
7b. Approximate volume of water remaining in well(s):
(gal.)
FOR WATER SUPPLY WELLS ONLY:
7e. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
O Bentonite Slurry
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
7.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-D10, IP-G1, IP-G3, IP-I2, IP-L2, IP-M5
8. Certification:
Signature of Certified Well Contractor or Well Owner
11/21/22
Date
By signing this form, 1 hereby certify that the well(s) was (were) abandoned in
Parcel Identification No. (PIN) accordance with I5A NCAC 02C .0100 or 2C.0200 Well Construction Standards
and that a copy alibis record has been provided to the we) owner.
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well freed, one lat/long is sufficient)
35° 22' 10.10" N 81° 24' 02.60" N,
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Mach well constrrrciion record(s) if ararlahle. tier multiple injection or non -water supply
well.,' ONLY with the saute construction abandonment, you Can submit one form.
6a. well IN:SEE REMARKS
6b. Total well depth: 43'0
(f1.)
6c. Borehole diameter: 2.25 (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.)
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 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
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
Font GW-30 North Carolina Department of Environment and Natural Resources - Division or Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
For Internal Use ONLY
I. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit N:
List all applicable id! ronstrucrion permits (r.e. County. State. Variance, etc j if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑ Geothermal (Heating/Cooling Supply)
❑lndustria. Commercial
❑ Irrigation
❑MunicipallPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑ Monitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑ Experi mensal Technology
°Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
Groundwater Remediatton
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned:
09/19/22 — 10/21/22
5a. Well location:
KNITRONICS
Facility/Owner Naine Facility (DtI (ifappticable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
I$ysical Address, City, and Zip
GASTON
Count}
C Neat Cement Grout
❑ Sand Cement Grout
O Concrete Grout
❑ Specialty Grout
0 Bentonite Slurry
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
Tar multiple injection or non -wafer supply wells ONLY
canstrucrinn abandonment. you can submit one form.
7b. Approximate volume of water remaining in well(s):
the .ran...
(gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-M4
8. Certification:
Signature of Certified Well Contractor or Well Owner
11/21/22
Date
By signing this form. I hereby certt& that the well(s) was (were) abandoned in
Parcel Identification No (PIN) accordance with ISA NCAC 02C.0100 or 2C 0200 Well Construction Standards
and that a copy alibis 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
N Hr abandonment details. You may also attach additional pages if necessary
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
I: f well field, one la. long is sufficient)
35° 22' 10.10" 81 ° 24' 02.60'.
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
An,uh hell ennstrucnmi rec-arcl0) i/ aroilablr 1 .r multiple injection or non -water supply
vxllti ONI.Ywith the same (ar<rrucu(w abandonment. you can submit one form.
6a. well IDt1; SEE REMARKS
6b. Total well depth: 44.0 (ft.)
6c. Borehole diameter: 2.25 (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6f. Inner easing/tubing length (if (mown): (ft)
6g. Screen length (if known): (ft.)
formtiW-30
SC BMITTAL INSTRUCTIONS
10a. For All Welts: Submit This Poem 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
IOb. For Infection Wellg: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion or well
abandonment 10 the following:
Division of Water Quality, Underground Injection Control Program,
I636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & 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.
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
For Internal Use ONLY.
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well oe his/her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
List all applicable wet construction permits (i.e. County. State. Variance, etc) if known
3. Well use (cheek well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Ind ustrial/Commercial
❑Irrigation
DMunicipal/Public
flResidential Water Supply (single)
f]Residenttal Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑ Geothermal (Heating/Cooling Return)
4. Date well(s) abandoned:
5a. Well location:
KNITRONICS
▪ Groundwater Remediatio
❑Salinity Barrer
❑Stormwater Drainage
❑Subsidence Control
❑ Tracer
❑ Other (explain under 7g)
09/19/22 -- 10/21/22
Facil:i}'/Ownei Naric Facility ID# (.fappIiCaO4e)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City. and Zip
GASTON
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one tat/long is sufficient)
35° 22' 10.10" N 81° 24' 02.60"
❑ Neal Cement Grout
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
© Bentonite Slurry
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 1
For multiple injection or non -water .supply wells ONLY with the some
construction abandonment'. you can submit one Dorn.
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):
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-11
8. Certification:
Signature of Certified Well Contractor or Well Owner
11/21/22
Date
By signing this form. I 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
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
,#rm l well construction record(s) if available For multiple injection or non -water supply
'b ONLY n oh the sane construction' abandonment. you can submit one jirnr.
6a. well ID#: SEE REMARKS
6b. Total well depth: 45'0 (f1)
6e. Borehole diameter: 2.25 (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.)
Form OWXI
SUBMFFTAL 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 I(:a
above, also submit nne 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 Censer, Raleigh, NC 27699-1636
10c. For Water Sootily & Iniection 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 wel: abandonment to the county health department of the county
where abandoned
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2011

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
For Internal Use ONLY.
I. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 2854
NC Well Contractor Cen.ficatron Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
Lict all applicable well construction permits (i.e. County. Store, Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
Non -Water Supply Welk
❑Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
0Groundwater Remedlation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned:
09/19/22 — 10/21/22
5a. Well Location:
KNITRONICS
Facility/Owner Name Facility IN (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lalflong is sufficient)
35° 22' 10.10" N 81° 24' 02.60" `v
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(s) rf (tradable. 1'ior multiple infection or non -water supply
wells ONLY with the same construction abandonment, you can submit one form.
SEE REMARKS
6a. Well ID#:
6b. Total well depth: 46'� (ft.)
6c. Borehole diameter: 2.25 (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6E Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
Form GW-30
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 2
I+v multiple injection or nun -waxer supply, wells ONLY with rh.
rrmstrs. elan abando nrent i., a can submit one form.
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
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
0 Benlon_te Slurry
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
7.5 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-D9, IP-J2
8. Certification:
11/21/22
Signature of Certified Well Contractor or Well Owner Date
By signing this form. I hereby certify that the well(s) was (were) abandoned in
Parcel Identification No. (PIN) accordance with ISA NCAC 02C .0I00 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 [: nit,
1617 Mail Service Center, Raleigh, NC 27699-1617
lOb. 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 wel
abandonment 10 the following:
Division of Water Quality, Underground Injection Control Program,
I636 Mail Service Center, Raleigh, NC 27699-1636
10c. For Water Sunnly & Iniection 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
North Carolina Department of Environment and Natural Resources - Division :f Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or mi.lt ip1e wells
For Internal Use ONLY
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or weal owner personally abandoning well on his/her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit a:
all applicable well crnrctrucrion permits (i.e. ('aunty. Stare. Variance. etc) if known
3. Welt use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
° Industrial/Commerc ial
❑ Irrigation
❑ Municipal+Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
OMonitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aqua er Storage and Recovery
°Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
°Geothermal (Heating/Cooling Return)
IDGroundwater Remediation
❑ Salinity Barrier
OStormwater Drainage
❑Subsidence Control
❑ Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/19/22 10/21/22
5a. Well location:
KNITRONICS
Faci' ity/Owner % ai nr Facility I Dt (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address. City, and Zip
GASTON
County Parceltdennficauon No (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well Feld, one lat/long is sufficient)
3S° 22' 10.10" N 81° 24' 02.60"
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 8
For nruhiple infection or non -water supply wells ONLY with the .son.
construction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s): (gal.)
FOR WATER SUPPLY WELLS ONLY:
Tc. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neat Cement Grout
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
El Bentonite Slurry
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
8.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-G4, IP-G5, IP-G6, IP-H4, IP-H6, IP-H7, IP-I3, IP-K3
S. Certification:
Signature ofCerlified Well Contractor or Well Owner
11/21/22
Dale
By signing this form. 1 hereby certify that the well(s) 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
H abandonment details You may also attach additional pages if necessary
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED
.mine)) well construction record(s) if available /•or multiple injection or non -water supply
netts ONLY iruh the same canstrucurnr'abandonment you can submit one fora;
6a. well MN:SEE REMARKS
6b. Total well depth: 47'0
(ft.)
6c. Borehole diameter: 2.25 (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.)
Form OW-30
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 addit:on to sending the form to the address in Et?a
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 Sum:4v & Iniection 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
North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This Corm can be used for single or multiple wells
For Internal Use ONLY
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Comfy, State. Variance, etc.) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ lnduslrial/Commercial
❑irrigation
❑Municipal/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
OGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Olher(explain under 7g)
4. Date wells) abandoned: 09/19/22 10/21/22
5a. Well location:
KNITRONICS
Facilay/L'.vner Name
acility I Dx (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Plaiskal Address, City, and Zip
GASTON
County
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 15
hor multiple injection or non -crater supply wells ONLY with the
construction abandonment, you can submit one form.
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):
0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
0 Bentonite Slurry
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
8.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-C12, IP-E8, IP-E9, IP-El0, IP-El 1, IP-F7, IP-G2,
IP-H5, IP-H8, IP-I5, IP-I6, IP-17, IP-J3, IP-K2, IP-N5
8. Certification:
11/21/22
Signature ofCenifed Well Contractor or Well Owner Dale
By signing this form 1 hereby cerrtfy that the well(s) was (were) abandoned in
Parce. Identification No. (PIN) accordance with 1SA NCAC 01C .0100 or 1C 0100 Well 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:
Orwell field. one larllong is sufficient)
35° 22' 10.10" N 81 ° 24' 02 60"
CONSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Math Hell construction record(s) J available, bar mulaple injection or non -water .supple
ON1. Y with the same construction abandonment. you ran subnut one form.
6a. Well ID#:
SEE REMARKS
6b. Total well depth: 48'0 (ft.)
6c. Borehole diameter: 2.25
6d. Water level below ground surface:.
6e. Outer casing length (if known):
6E Inner casing/tubing length (if known):
6g. Screen length (if known):
(ft.)
(ft.)
(ft.)
(ft.)
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
IOb. 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
IOc. 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 weil abandonment to the county health department of the county
where abandoned.
nnn (i 44-30 North Carolina Department of Environment and Natur,I Resources - Division of Water Quality
Revised March 2013

WELL ABANDONMENT RECORD
This form can he used for single or multiple wells
For Internal Use ONLY
1. Well Contractor Information:
STEPHEN SLOAN
Well Coninetcr Naine (or well owner personally abandoning well on hrs+ber property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit Il:
Lot all applicable well construction permits (A,e. County, Stale, Variance. eta) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑irrigation
C Municipal/Public
[ Residential Water Supply (single)
0 Residential Water Supply (shared)
Non -Water Supply Welt:
❑Monitoring
❑Recovery
Injection Well:
QAquifer 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; 09/19/22 10/21/22
5a. Well location:
KNITRONICS
Facility/Owner Name Facility IDt1(ifappticab'el
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Addre€,, C'irv, and Zip
GASTON
County
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 14
For multiple injection or non -water supply wells ONLY
construction abandonment, you ran submit one form.
7b. Approximate volume of water remaining in well(s):
with the .sank
(gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all that apply):
❑ Neal Cement Grout
Q Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
0 Bentonite Slurry
❑ Bentonite Chips or Pellets
Q Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
8.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-C8, IP-C10, IP-C11, IP-E12, IP-E13, IP-E14, IP-E15,
IP-F9, IP-F10, IP-F11, IP-H1, IP-H2, IP-H3, IP-M6
8. Certification:
11 /21 /22
Signature of Certified Well Contractor or Well Owner Date
By signing this form. I hereby certi that the well(s) was (tvere) abandoned in
Parcel Identification No. (PIN) accordance with 15,4 NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one:at.'long is sufficient)
35° 22' 10.10" N 81" 24' 02.60"
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(S1 BEING ABANDONED
,4tta,4 well a....o-arction record(s) if n'adahle. I'or multiple irlecirnt or nun -,rater supply
wells ONLY •', ! ' -,ante ce,o'1 ucrlon abanhnrmenr. you can submit one form
6a. Well ID#: SEE REMARKS
6b. Total well depth: 49'0 (ft.)
6c. Borehole diameter: 2.25 (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (f1.)
6f. 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 Injection Wells: In addition to sending the form to the address in I0a
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 & lnieclion 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.
h orrn ;i',w .30 Nuri li Carolina Department of Em iromnent and Natural Resource; — Divis n,n of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
For Internal Use ONLY
I. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit 4:
List all applicable well construction pernrils (Le {bunny, Slate, Variance, etc) ,fknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
❑MunicipallPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑Recovery
Injection 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
❑Other (explain under 7g)
4. Date well(s) abandoned:
09/19/22 — 10/21/22
5a. Well location:
KNITRONICS
Foe ility/O . net !tame Facility I Df (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County Parcel Identification No (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell Feld one IaUlong is sufficient)
35° 22' 10.10" N 81° 24' 02.60"
W
CONSTRUCTION DETAILS OF WELLUS1 BEING ABANDONED
.4rieth well ro :rur:ion record(s) rJ arallabli For multiple injection or non -rater supply
r xiks ONLY with tihe sane cm/structioee'abandonment, you ran submit one form.
6a. Well 1D#: SEE REMARKS
6b. Total well depth: 50.0 (r1.)
6c. Borehole diameter: 2.25 (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):
Foal Gw-30
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 5
For multiple injection or non -waxer supply wells ONLY
construction abandonment, you can submit one form.
7b. Approximate volume of water remaining in well(s):
with the same
(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
❑ Sand Cement Grout
❑ Concrete Grout
0 Specialty Grout
0 Bentonite Slurry
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
0 Other (explain under 7g)
7E For each material selected above, provide amount of materials used:
8.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-C9, IP-D11, IP-E16, IP-F8, IP-F12
8. Certification:
Signature of Certified Well Contractor or Well Owner
11/21/22
Date
By signing this form 1 hereby cert(fy that the wells) was (were) abandoned in
accordance with ISA 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.
Divisionof Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
10b. For lniection Wells: In addition to sending the form to the address is 10a
above, also submit one copy of this form within 30 days of completion of v.ell
abandonment to the following
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
IOc. For Water Suonly & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form with:n 30 days of
completion of well abandonment to the county health department of the county
where abandoned
tionh CAN lina Department of Environment and Natural Resources - Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for .mgle or multiple wells
For Internal Use ONLY
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well on his(her property)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit N:
List all applicable well construction permits (le ('minty, Stan, Variance, etc.) ifknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
O I nd u st r i a l/C om m e rc i a l
❑ Irrigation
❑Municipal/Public
OResidential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑ Recovery
Injection Well:
OAquifer Recharge
❑Aquifer Storage and Recovery
❑ Aqui ter Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
0Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned:
09/19/22 - 10/21/22
5a. Well location:
KNITRONICS
Facility/Owner Name Facility IDii (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
County
WELL ABA D I NMENT DETAILS
7a. Number of wells being abandoned: 3
For multiple inyeelion or mur-waler supply wells ONLY with the .Vann
construction abandonment you can sabmil one farm.
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
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
L Bentonite Slurry
❑ Bentonite Chips or Pellets
0 Dry Clay
❑ Dnll Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
8.25 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-M1, IP-N1, IP-02
8. Certification:
Signature ofCenified Well Contractor or Weil Owner
11/21/22
Dale
By signing this form. 1 hereby cert fy that the wells) was (were) abandoned in
Parcel Identification No. (PIN) accordance with 15,4 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
N W abandonment details You may also attach additional pages if necessary
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one hit/long us sufficient)
35° 22' 10.10" 81 ° 24' 02.60"
CONSTRUCTION DETAILS OF WELLS) BEING ABANDONED
uucb conunrnion recard(s) if available. hire multiple nyectior or .;.Uhwa5'r supply
••ri'� ONLY with the .same cnnaructirm abandonment, you can submit aneJ..rn
6a. Well IDIi: SEE REMARKS
6b. Total well depth: 51.0
6c. Borehole diameter: 2.25
(ft.)
6d. Water level below ground surface: (It.)
6e. Outer casing length (if known): (ft.)
6I Inner casing/ubing length (if known): (fl.)
6g. Screen length (if known): (ft.)
F'rmi Ci O -30
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of ‘ve;l
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 completior: 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
the addresses) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of t-e county
where abandoned.
North Carolina Department ;fEnvironment and N:.tur_t Re„+crces — Divis i:n of Water Quality Revised March 2013

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
For internal Use ONLY
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well on his/her property)
A - 2854
NC Well Contractor Cenifrcation Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (.e County State. Variance. etc, fknown
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑industrial/Coin merc ia!
❑ lrrlgal ion
❑Municipal.'Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquiter Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
OGroundwaler Remediatton
❑Salinity Barrier
❑Stormwaler Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
4. Date well(s) abandoned: 09/19/22 — 10/21/22
Sa. Well location:
KNITRONICS
Facility/Owner Name Facility ION (if applicable)
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Physical Address, City, and Zip
GASTON
Counry Parcel Identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one laulong is sufficient)
35° 22' 10.10" N 81° 24' 02.60"
C9NSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
Attach well construction record(%) if available. Jromultiple injection or nun -water supply
hells ONLY with the sanre construction abandonment. you can submit one form.
6a. well DM:SEE REMARKS
6b. Total well depth: 53'0 (ft.)
6c. Borehole diameter: 2.25
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (ft.)
6E Inner casing/tubing length (if known): (fl.)
6g. Screen length (if known): (ft.)
Fo 11Gw-30
1 Sand Cement Grout
0 Concrete Grout
Specialty Grout
RI Bentonite Slurry
WELL ABANDONMENT DETAILS
7a. Number of wells being abandoned: 2
bar multiple injection or non -wafer supply wells ONLY with the some
construction abandonment you can submit one farm.
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):
U Neat Cement Grout 0 Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
8.5 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-K4, IP-N4
8. Certification:
11/21/22
Signature of Certified Well Contractor or Well Owner Date
By signing this form. 1 hereby certify that the well(s) was (were) abandoned en
accordance with 1SA NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of thrs 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 1NSTRU9TIONS
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 •n '• .a
above, a so submit one copy of this form within 30 days of completion of we •
abandonment to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
IOc. For Water Sunnily & Iniection Wells: In addition to sending the form to
the address(es) above, a:so submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned
Nash Carolina Department of Environment and Natural Resources - Division of Water Quality Revised March Y. 13

WELL ABANDONMENT RECORD
This form can be used for single or multiple wells
For Internal ,'se ONI Y
1. Well Contractor Information:
STEPHEN SLOAN
Well Contractor Name (or well owner personally abandoning well on higher propeny)
A - 2854
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION
Company Name
2. Well Construction Permit N:
Lest all applicable well construction permits (i.e County, &tale. Variance. etc) if known
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ I nd u st ria l/Co m m e rc is l
❑ Irrigation
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Monitoring
❑ Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
4. Date well(s) abandoned:
5a. Well location:
KNITRONICS
0Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 7g)
09/19/22 -- 10/21/22
FiciIily/ilwner Name Facility IDl! (if apphcablet
1515 WEST ACADEMY STREET CHERRYVILLE 28021
Phy sk.ni Address, City, and Zil.
GASTON
County Parcel Identification Nu !PIvl
5b. Latitude and longitude in degrees+minules/seconds or decimal degrees:
Of well field one laI IUrg is sutTicicr,ll
35° 22' 10.10" N 81 ° 24' 02.60"
❑ Neat Cement Grout
❑ Sand Cement Grout
❑ Concrete Grout
❑ Specialty Grout
D Bentonite Slurry
WELL ABANDQNMENT DETAILS
7a. Number of wells being abandoned: 5
I nr multiple in)rctiun or non -water .supply wells ONLY
constnartian'abandonmenl y..0 ran .submit one form.
7b. Approximate volume of water remaining in well(s):
with the +„
(gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all That apply):
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
❑ Gravel
❑ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
9.0 GALLONS
7g. Provide a brief description of the abandonment procedure:
ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
IP-L3, [P-L6, IP-M2, IP-M3, IP-01
S. Certification:
Signature of Certified Well Contractor or Well Owner
11/21/22
Dale
By signing this form, 1 hereby certify than the well(s) was (were) abandoned in
accordance wah I5A NCAC 02C 0100 or 2C .0200 Weil Construction Standards
and that a copy of thrs 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
Anach well construction record(.$) if available /or multiple inierrion or nun -water supply
wells ONLY with the same consirucnon abandonment. you can suborn one form
6a. Well ID#:
SEE REMARKS
6b. Total well depth: 54.0
(ft.)
6c. Borehole diameter: 2.25 (in.)
6d. Water level below ground surface: (ft.)
6e. Outer casing length (if known): (fl.)
6f. Inner casing/tubing length (if known): (ft.)
6g. Screen length (if known): (ft.)
onn MY W..1O
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
IOb. 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 & lnieclion 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 depanmeni of the county
where abandoned
North Caroline Department of Environment and Natural Resources Division of Water Quality
Revised March 2013