Mecklenburg_Well Abandonment_20221128

WELL ABANDONMENT RECORD F,riew u,towLy
This form can be used for single or mdliple wells
1.Wr0 Uontractrlr Information: \�\� WELL ABANDONMENT I ETAD_ti
Brian Ewing \\\ 7a.Number ofwdla lichit abandoned: )
waCooracior Nan.on wcllawaer pnamll)dunlom"MEen IwA pmgmlq) Fir walnpie rnµ'rlvw or mar+rrrr ""A. acds ONLY wnh Ib fete
o.wmwruw asamhwwcm.Nm Im nhwrl ww hips
62a0-B
Nc Well Comasnor fenifia ono Nnnikr 7h.Appmrimmc s olnmr of w atre remaining to welllsk Igal.l
FOR W ATER St PPIA N FIJS O%I N:
SAEDACCO Inc
C,nom.'Name I
C.1\pe of disidertant used:
I.WeN Ceeatmctbn Ptvmtt d:70003075, ,
lm dl,y.Idn rl,r, v,n;,nn,n,,.e Ceeab,.AaeJ goons.fyz6n erta dlnurn 'd.Amrmit of disinft"Anl uWda
J.Well we Ichecle well use)*
Water Supply Will: 7a Scaling matenals used(check all that apply l:
❑Alemuhurd Okflvucqul:MOW ® Near('groom Gmrn fl Bcnomtc Chips in Pclkts
❑(kahcnwd(Heamixt-Cooling Srryph'I ORes,denal Amer Soppb lsmgle) O S,md Cerrknl Omut ❑ Der Clay
lydustnal.Cownkrcnl OResdemal Water Supply iahaedl O Climacteric Urout ❑ Drill Culbop
❑hn•Iwo O 9Keulh Uoul ❑ Gmel
Nnn-Water Suppy%%ell: O Ben(onnc Slam I I(titter Icsphon wrier 7g)
NNlolntonoc OR¢oarn
Injection W'rII: 7f.For rach material rintrd ahme.pion iM•Ananmt of matcrfah ewd:
❑Aquila RcOurge O(imursdsraln Remedtann But Cem.:471b ,Wtr:3ga].. Sand Cem.:lb ,Wtr:gal.
❑Agmfa Storage and Rc o,en ❑Salina, Damcr
❑Aquifer 1'cA ❑Slomwsaer Uratnwge --
OEsymtllwrl Talmobey ❑S,bSuklre(onn'1 7g.Pnn irk a brief dewriptinn of for AhmdnmmkM poacedem:
OG dicmnml)Closed I mpl UTracer
tremi from the bottom to surface
OGamhemm llHe;atin �Caoltn Relnnn L.IOfMt ac sin mdtt'„
htC�=I'vT�.�' fCT"4T
1.Darr wdosl abandoned: 11-1-22
54-"ell location:
Norfolk Southern Intermodal Yard .1^l?`^Ck'r9:N) r.:
r.w.L,, lm,.,..�. ra,m.mna,pplka6l,
s I ndr„rear ,^;Wa,3,3G
333 Parkwood Ave, Charlotte, NC 28206 Brian_ Ewing _ 11/11/2022
IN scat Addk-.,Cm a1N Z,p uuuv. A(',Awwal K'al1 - Acmaw Dale
Mecklenburg 08301126 NI ogning thla)irm• 1 dear the stelim oar mere) ahmobored in
11r.11 I,k:ativmnn No.IN%, uuonhssa'e wide I,ia NCJ('0:('.0i4A(1 or '(- 0200 Nell ConyAFr6uu\mn,hvd•
,md elms a enpt W Itlr.r record hue bens pnowkh l In the well era ner.
.W I mitude and bnittmdt•in degnrUminutrr;Wtrmds err drcimal dryrnrc
1117.0(kIJ :uw her.bog,.•nlLuoa. 7.Site diagram or additional We$*Hails:
ou om me Ilk back of Ih11 page to prim idt addino al hell Nov details or Nell
N W abandunllkn detail, N till truer also aat ch addawoal pages If ncces] n
CONSTRUCTION DETAILS OF W'Ft14SI BPI%(: AB A%DONED SUBMITTAL INSTRUCTIONS
IeaKb oaf!warwu,.. ..a.m-avkr a"i,
+ell.(Pvt.) ."A IN `^^ 10a. For .All WcEs: Shcnort Ihls tom, oohm ;11 doss of canrpldwu of well
ea.Well ID r-TMW-1 abadonmen In the follower,
Disisian of W amr Rrwmno,Information Prunvmng 1 nit.
rib. fatal Ndl Acp1h; 27 I61T Mail Sa•n iec Ccoter.Ralesib,\('21600-1617
Inb. For Injection WtJls: It,addilrou to sc,dutg llk form to Ifte:ddica its too
I6,n•Iwle Alaneo•r:1 or.,
uhote. Am, sullom irk Qom of Iles font, wulnu to d"uys of completion of%ell
M. t
ao:udcnnlem to,he lollo%mi
11mmon of W Ater Rnrmrecr,lbderRmund Intextiun Comfort Pnogram.
od.W'Ater Mid hrinw Lround wrfmr: (ft.) 163t.flail Senior fewer,RAlciglu.N('2767)-I6Jfs
Inc. For Wafer Sunnis 6 lnhrfina Wells: In addnam to>"org the fo no to
oe.(Alter casing lrnirh of Lnun nc Iftl Ilk ;ddmssfesl abuse. also +uhnll one cups of this font, milon lff "S of
con,plerwn of sell .dsaadonnkna to the :auras hcabh dcpanmcn of the comet
w of.Inorn'asin-tulring 1lrntah,it I:nnw n is 17 IR.I into:Itvndon d
6g.Scorn Irn1.1h Iif know n 1:10 Ifl.l
1 „ar,u-:n �,-LLremlrc ,,;lunnc,a vl En.,ronrmmad Smuml Rcsoures Dl.sou nl Kawr Ro.wcc. flu noel Augur 9l;