Iredell_Well Abandonment_20230112 (3)

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I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned:
1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-watIer I supply hells ONLY with the .value
construction/abandonment,you can submit"one form.
C -4421
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 2'S (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: AF
2.Well Construction Permit#: 1 v 20123
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown 7d.Amount of disinfectant used: IRs,„'.,•, �a'-.<^;� ?,i:._
3.Well use(check well use): "s"-b'G('t, %.7
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: 0 Bentonite Slurry ❑ Other(explain under 7g)
MMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 25.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 11/18/22
5a.-Well-location:-- - — - -- -'I - ---- - - - — -- -
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) g•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"'�'ti'"''"` 11/30/22
Physical Address,City,and Zip Signature o£Certified Well Contractor or Well Owner Date
IREDELL By signing this forni, I hereby certify that the ivell(s)ivas (tivere) abandoned in
Comity Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35o 47' 17.64" N 80o 54' 56.36" W 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 SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For nnultiple injection or non-water supply
wells ONLY with the same construction✓abandonment,you can submit one form. 10a. For All Wells: Submit this'form within 30 days of completion of well
6a.Well ID#: MP-2 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 39.0 (ft-) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 4.0/2.0 (in) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
I
Gd.Water level below ground surface 35•0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
1 II
6e.Outer casing length(if known): (ft.) 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 folthe county health department of the county
6E Inner casing/tubing length(if known): (ft.) where abandoned.
I
6g.Screen length(if known): (ft.)
Font GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

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WELL ABANDONMENT RECORD t:=
LY: j
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
DAVID HALL 7a.Number of wells being abandLl d:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-{i,aler supply wells ONLY with the same
A -4459 consiructim✓abandonment,you can submit;one form.
11
7b.Approximate volume of water remaining in well(s): 0'25 (gal.)
NC Well Contractor Certification Number i I
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: "-
2.Well Construction Permit#: A lU1
List all applicable we//construction permits(i.e.County,Slate,Variance,etc)ifknown 7d.Amount of disinfectant used- a 201.
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout j ❑Gravel
Non-Water Supply Well: 0 Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 1.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g•Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 10/21/22
5a.Well location:, _ I -
LOOKOUT SHOALS DAM
Facility/Owner Name Facility lD#(ifapplicable) 8.Certification:
678 LOOKOUT DAM ROAD STATESVILLE 28625 11/04/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the,vell(s) ivas (were)abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 46' 00.27" 810 03' 42.07" 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.
1
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction records)if arailable. For multiple h jecuon or non-water supply
wells ONLY with the some construction abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: LS-36 abandonment to the following: ;
i
Division of Water Quality,Information Processing Unit,
46.0 1617 Mail:Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b.For Iniection Wells: In addition to sending the form to the address in 10a
10 above,also submit one copy of this form within 30 days of completion of well
.
6e.Borehole diameter: (in.) abandonment to the following:
i
6d.Water level below ground surface 9.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
10c.For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned. i
611 Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Form OW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
f �

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells I
1.Well Contractor Information: WELL ABANDONMENT DETAIIL'S
DAVID HALL 7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply wells ONLY with the .scone
constructionlabandonment,you can submit one form.
A - 4459 I
NC Well Contractor Certification Number
7b.Approximate volume of water remaining in well(s): 0.25
(gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS'ONLY:
Company Name 7c.Type of disinfectant used: 2 -o
2.Well Construction Permit#: I A I" i
List all applicable well construction permits(i.e.County,State,variance,etc.)if J/i V known 7d.Amount of disinfectant used: 2 2023
3.Well use(check well use): n,"'i" ":^� ?i+.�,•:;;;; i t r,e
7e.Sealing materials used check all that apply): �r-•V ou
Water Supply Well: g ( PP Y)�
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: El Bentonite Slurry ❑Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 1.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 10/21/22
Sa,_Welllocation: -- _
LOOKOUT SHOALS DAM
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
678 LOOKOUT DAM ROAD STATESVILLE 28625 11/04/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this fornt, I hereby certify that the wells)was (were)abandoned in
County Parcel Identification No.(PIN) accordance ivith 15A NCAC 02C.0100 or 2C.0200 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 46' 00.27" 810 03' 42.07" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple it jection or non-water supply
wells ONLY with the sante construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: OW-2 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 33.5 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
1O above,also submit one copy of this form within 30 days of completion of well
.
6c.Borehole diameter: (in.) abandonment to the following: p
6d.Water level below ground surface 22.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Sunnly&Iniection'Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit bne copy of this form within 30 days of
completion of well abandonment too the county health department of the county
where abandoned.
611 Inner casing/tubing length(if known): (ft.)
i
6g.Screen length(if known): (ft.) `
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
I �
I

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
DAVID HALL I I 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-,iiwter supply wells ONLY with the same
construction/abandonment you can submit one form.
A -4459 1, 17.5
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:,
Company Name 7c.Type of disinfectant used: y t•a :1 1
c y«
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown JA11� �. � l�
7d.Amount of disinfectant used: `d 2023
3.Well use(check well use): ••.,r,r•:;.^� s. Hi
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
RIMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 26.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 10/21/22
Sa.We II location: I --
LOOKOUT SHOALS DAM
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
678 LOOKOUT DAM ROAD STATESVILLE 28625 �1�'t? 11/04/22
Physical Address,City,and Zip Signature of Certified Well Contractor o�Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)was (were)abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one hit/long is sufficient) 9.Site diagram or additional well details:
35 46' 00.27" 81 03 42.07 W You may use the back of this page to provide additional well site details or well
N
0 o abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(v)if orailable. For multiple injection or non-water supply
wells ONLY with the same construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
INC-1 abandonment to the following:
�
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 72.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. For Infection Wells: In addition to sending the form to the address in 10a
2.75 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
I �
Gd.Water level below ground surface 24.0 (ft•) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Clenter,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 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
6E Inner casing/tubing length(if known): (ft.)
where abandoned.
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
1
i

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor information: WELL ABANDONMENT DETAILS
JAMES MORRISON I l 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-wdierj supply wells ONLY with the same
construction/abanmmnent,you can submit one form.
C - 4421
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: JAN
L&I all applicable well construction permits(i.e.Corny,State,Variance,etc.)}fknotvn 7d.Amount of disinfectant used:
����
3.Well use(check well use): r�'s•
Water Supply Well: 7e.Sealing materials used(check all that apply): "" -;;�
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7f•For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 13.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/18/22
5a._Well location:
KINDER MORGAN '
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"` '"'^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivell(s)was(were)abandoned in
County Parcel identification No.(PiN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 17.44" N 800 54' 56.02" W 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 SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or non-water supply
wells ONLY ivith the saute construction/abandonment,you can submit one form. 10a. For All Wells: Submit this,form within 30 days of completion of well
6a.Well ID#:
EW-11 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 20.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Iniection Wells: In addition to sending the form to the address in 10a
4.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service CIenter,Raleigh,NC 27699-1636
10c. For Water Suonly&Iniection,Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

i
i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON ' 1
7a.Number of wells being abandoned-
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-wateri supply hells ONLY with the same
C - 4421
constructioniabandonment,you can submit one form.
NC Well Contractor Certification Number 7b.Approximate volume of water Ie Raining in well(s): 0 5 (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY: (t`�
Company Name tl '> •'' �' r,
7e.Type of disinfectant used: ;--,
2.Well Construction Permit#: _ u
List at/applicable well construction permits(i.e.County,State,Variance,etc.)ifknowtn 7d.Amount of disinfectant used
3.Well use(check well use): ,'s:;.,•,,, .o",
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 5.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 5/22
Sa.Well location: F
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 "'"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the tvell(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one hit/long is sufficient) 9.Site diagram or additional well details:
350 47' 20.12" N 800 54' 58.78" W 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 SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple it jection or non-water supply
wells ONLY with the same construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-7S abandonment to the following:
Division of Water Qualityy,Information Processing Unit,
Gb.Total well depth: 30.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: 2.0 _(in.) above,also submit one copy of this,'form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface 27.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c. For Water Supply&Iniection Wells: In addition to sending the form to
the address(es) above, also submitiorie copy of this form within 30 days of
completion of well abandonment to Ithe county health department of the county
where abandoned.
6E Inner casing/tubing length(if known): (ft.)
I
6g.Screen length(if known): (ft.) `
I
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Qual�ity Revised March 1013

i
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) ror multiple injection or non-iv.. supply u'elis ONLY with the saine
C —4421
construction/abandonnient,you can submit one form.
NC Well Contractor Certification Number
7b.Approximate volume of water lremaming I in well(s): 4.75 (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY: y..` ',
Company Name 7c.Type of disinfectant used: A nn ""
2.Well Construction Permit#: 'fit
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown Ini
7d.Amount of disinfectant used: ❑ ,:....
f
3.Well use(check well use): "�������?,,; '•
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: 21 Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stornwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
5a.Well.location: .. - l I -
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8.Certification:
201 PHOENIX STREET STATESVILLE 28677 TM""`^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)was(were)abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.99" N 800 54' 59.16" W 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 SUBMITTAL INSTRUCTIONS I'
Attach well construction record(s)if available. ror multiple b jection or non-water supply
wells ONLY with the scone consiruct/mdabandminiem,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-58 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth: 60.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in l0a
2.0 above,also submit one copy of this form within 30 days of completion of wet l
Gc.Borehole diameter: (in.) abandonment to the following:
Gd.Water level below ground surface: 27.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Sunaly& Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length(if known): (ft.) Where abandoned.
I '
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD Far Internal Use ONLY:
This form can be used for single or multiple wells
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON I 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-irate{ supply wells ONLY with the saute
C -4421
conso•uction/abandonntent,you can subntit one Jortn.
NC Well Contactor Certification Number 7b.Approximate volume of water I`re!aining in well(s): S'0 (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: _ " ._..
List all applicable ire//construction permits(i.e.County,State,Variance,etc.)ij'known Jq I'
7d.Amount of disinfectant used:
3.Well use(check well use):
7e.Sealing materials used check all that apply):
Water Supply Well: g ( C,�•:=.�.(,
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout I ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑Other(explain under 7g)
ElMonitoring ❑Recovery
injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 10.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
.5a.Well location: l 'I
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 " "°"'^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this fonn, 1 hereby certify that the ivell(s)was (were) abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one hat/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.94" N 800 54' 59.28" W 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 SUBMITTAL INSTRUCTIONS
Attach well construction record(()if available. Far multiple h jection or non-crater supply
irel/s•ONLY with the same construction/abandonment,you can submit one fonn. 10a. For All Wells: Submit this'form within 30 days of completion of well
6a.Well ID#: MW-57 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 61.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in IOa
2.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface 25.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
IOc. For Water Suonly&Iniection`Wells: in addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
611 Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2113

r i
WELL ABANDONMENT RECORD For Internal Use ONLY: I {
This form can be used for single or multiple wells I`
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on Iris/her property) For multiple injection or non-crater supply molls ONLY arid the aante
construction/abandonment,you can submit one form.
C -4421
7b.Approximate volume of water remaining in well(s): 4.5 (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS'ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: IiI
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used: Ift;;, -.•:
3.Well use(check well use): a,;;< •:,4.,';�`••%-�,,�
Water Supply Well:
7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
[]Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
5a.Well location: —
KINDER MORGAN
Facility/Owner Name Facility iD#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivell(s)was (were) abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one laulong is sufficient) 9.Site diagram or additional well details:
350 47' 19.91" 800 54' 58.26" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach hell construction record(s)if available. For multiple h jection or non-crater supply
wells ONLY with the sane construction/abandonment,you can submit one jortu. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well iD#: M W-66 abandonment to the following:
Division of Water Quality,Information Processing Unit,
58.0 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b.For Infection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
Gd.Water level below ground surface: 31.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment Ito the county health department of the county
where abandoned.
611 Inner casing/tubing length(if known): (ft.)
I i
6g.Screen length(if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

i
WELL ABANDONMENT RECORD For internal Use ONLY: '
This form can be used for single or multiple wells
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandol ed: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple h jection or non-water .supply wells ONLY with the same
cmtstructionlabandonntew,you can subntrt one form.
C -4421
NC well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5'0 (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY: _
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: p
List a//applicable well construction permits(/.e.County,State,Parlance,etc.)tit known 7d.Amount of disinfectant used: JArI w 2021- y.
7
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 9.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 °^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivell(s) was (were) abandoned it?
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.76" N 800 54' 56.80" W 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 SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For nndliple ii jection or non-water supply
wells ONLY with the same construction/abandonmeni,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well iD#: MW-78 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 59.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in l0a
2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
Gd.Water level below ground surface 28•0 (ft,) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Supply&Iniectioti Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
611 Inner casing/tubing length(if known): (ft.) where abandoned. '
I
6g.Screen length(if known): (ft.)
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 1113

1 '
WELL ABANDONMENT RECORD For Internal Use ONLY: i
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON P I 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For muitiple injection or non-wate� supply irells ONLY with the same
construction/abandonment,you can subn it one form.
C -4421
NC well Contractor Certification Number 7b.Approximate volume of water irel aining in well(s): 5.0 (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS;ONLY: " -•• s
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used:.
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑lrri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ZI Bentonite Slurry ❑ Other(explain under 7g)
O Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 5/22
5a.Well location: I - -
646ER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"`' •.. 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the wells)was(were) abandoned in
County 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 ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.61" 800 54' 56.54" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(y)if arailable. For multiple it jection or non-water supply
wells ONLY with the same construction/abandomnent,you can submit one force 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• M W-80 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 59•0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob.For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter 2 0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
27.0 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Sunaly&Injectiod Wells: In addition to sending the form to
6c.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.) i
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

i '
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON
7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) ror multiple it jection or non-water supply hells ONLY with the same
consiruction/abandonntent,you can submit one form.
C -4421 1 1 5.0
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name t •`,;,y
P y 7c.Type of disinfectant used: i:' -• )
2.Well Construction Permit#: JA N 1 ,R
List all applicable well construction permits ro.e.County,State,variance,etc.)ifknown 7d.Amount of disinfectant used: 2 LQZ3
3.Well use(check well use): �"' ;''�`�r ,.�..,;;_';,•�J i;t,;;
7e.Sealing materials used check all that apply):
Water Supply Well: 1; (
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 9.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 11/15/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 '"'"" 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 at-2C.0200 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 19.55" 800 54' 56.42" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS,
Attach well construction record(()if available. ror multiple injection or non-water supply
wells ONLY with the sane construction%abandonntent,you can submit one forme 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-81 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 59.0 (ft,) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
2 0 above,also submit one copy of tliis form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
26.5 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit'one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
611 Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Fonn GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

CI
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply wells ONLY with the same
construction/abandonment,you can subnnt one form.
C -4421 4.5
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: JA N
List all applicable well construction permits(i.e.County,State,Marione,etc.)ifknown ~ 2023 7d.Amount of disinfectant used:'
-
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑lrri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g•Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
__- Sa.Well location: — - -
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"` '"`^" 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
35o 47' 20.13" N 80o 54' 58.98" W 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 SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple it jeclion or non-water supply
wells ONLY with the same construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-60 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth:
58.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2 0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following: !,
6d.Water level below ground surface 30•0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Sunnily&Infection'Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of water Quality Revised March 2013

i
WELL ABANDONMENT RECORD For Iatemal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON , 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or noimv ter, supply hells ONLY with the same
construction/abandonment,you can submit one form.
C - 4421 1 '
4.75
NC Well Contractor Certification Number 7b.Approximate volume of water re maining in well(s): (gal.)
—71
(,
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name h= / J�
7c.Type of disinfectant used: _
2.Well Construction Permit#: ]IV9 20 3
List all applicable we//construction permils(i.e.County,State,Variance,etc.)ifknoirn Info7ii;,=K
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ZI Bentonite Slurry ❑ Other(explain under 7g)
El Monitoring ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 9.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 5/22
in.-Well location:- -- - - - --
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"" """^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivell(s)ivas (were) abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one hit/long is sufficient) 9.Site diagram or additional well details:
35o 47' 20.08" 80 54' 59.06 You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if arailable. For multiple it jection or non-,rater supply
wells ONLY with the same consiruciiortlabmn[lotnmetn,you can submit one form. 10a. For All Wells: Submit this,form within 30 days of completion of well
6a.Well ID#: MW-59 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 57.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in l0a
2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (i�•) abandonment to the following:
6d.Water level below ground surface: 27•0 (ft•) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Iniection'Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length(if known): (ft.) where abandoned.
i
I
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

l
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandonetl: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-hale I supply wel/s ONLY with the .saute
construction/abandonment,you can subnnft one form.
C -4421 ' '
NC Well Contractor Certification Number
7b.Approximate volume of water,remaining in well(s): 4.75 gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
2.
Company Name a ti 3
7c.Type of disinfectant used: _ r
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknoum 7d.Amount of disinfectant used: Jq 1� � u 20 J
t _
3.Well use(check well use): ""'ts.L-,
Water Supply Well: 7e.Sealing materials used(check all that apply): 0
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) El Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: IZI Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/1 5/22
-- - - -_-ia.Well_location: - - - - -- - — - -
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
201 PHOENIX STREET STATESVILLE 28677 �" "'`^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivell(s)was (were) abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 20.08" 800 54' 58.60" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. Tor multiple it jection or non-water supply
we/Ls ONLY with the same constructionlabandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
Ga.Well ID#:
MW-63 abandonment to the following:
,
Division of Water Quality,Information Processing Unit,
6b.Total well depth:
57.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Infection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface 31.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Summlv&Iniection-Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
611 Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.) `
Form OW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013

I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply hells ONLY frith the sonre
consiructioniabandonment,you can subnttt one form.
C - 4421 ' 4.75
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
f'
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY: I'
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: /11
LR
Listall applicable well constructionpermits(i.e.County,State,Variance,etc.)ifknown 7d.Amount of disinfectant used: tn``"i+=. .:,� lt2P
3.Well use(check well use): !;�,� �-•: !117:i
7e.Sealing materials used check all that apply):
y t'
Water Supply Well: g (
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothennal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
[Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring El Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.25 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g•Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothennal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/15/22
--_5a..Welllocation:_ _-- - -- - --- — _ — - — — -- _--.—_—
----- j
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �'"'�''a- 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivell(s))Pas(here) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 20.03" N 800 54' 58.46" W 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 SUBMITTAL INSTRUCTIONS
Auach well construction record(s)if available. For multiple h jection or non-water supply
wells ONLY with the some cmtstrmctioniabandotmteni,you call submit one forni. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-64 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 57•0 (ft-) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
20 above,also submit one copy of this form within 30 days of completion of well
•
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 30.5 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
10c.For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length(if known): (ft.) where abandoned. '
I
6g.Screen length(if known):
Farm GW-30 Notch Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

i
WELL ABANDONMENT RECORD For internal Use ONLY:
This form can be used for single or multiple wells
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandolcdl• 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple itjection or non-walerl supply wells ONLY with the same
construction/abandonment,you can submif one form.
C - 4421 l
7b.Approximate volume of water remaining in well(s): 1.25 (gal)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used: -
2.Well Construction Permit#: Jq1,I
List all o tlicable well construction erntits i.e.County,State,Variance,etc. i knoirn V ~'
pl p ( y �f 7d.Amount of disinfectant used: i
3.Well use(check well use):
Water Supply Well: 7e.Scaling materials used(check all that apply):
[Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothennal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: Rl Bentonite Slurry ❑ Other(explain under 7g)
Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 7.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothennal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) [Other(explain under 7g)
d.Date well(s)abandoned: 1 1/18/22
5a.Well location: i
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 ""°"'° 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivell(s) was (were)abandoned in
County Parcel Identification No.(PIN) accordance ivith 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 16.96" 800 54' 58.06" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Altach hell construction record(s)if available. For multiple itjection or non-haler supply
nrelis ONLY with the same constructiotdabandonnient,you can submit one Jbrm.
10a. For All Wells: Submit this form within 30 days of completion of well
Ga.Well ID#:
MW-17S abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth: 43•0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For infection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: (in.) abandonment to the following:
i
Gd.Water level below ground surface 35.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i
10c. For Water Supply&iniecti n Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit!one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
Gf.Inner casing/tubing length(if known): (ft.) where abandoned.
Gg.Screen length(if known): (ft.)
i
Form GW30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-water supply wells ONLY with the .same
construction/abandonment,you can subtu t Ine form.
C -4421 1.25
7b.Approximate volume of wateriremaining in well(s): (gal.)
NC Well Contractor Certification Number i
GEOLOGIC EXPLORATION FOR WATER SUPPLYWELLSONLY:
Company Name 7c.Type of disinfectant used: %
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,Slate,Variance,eic.)ifknown 7d.Amount of disinfectant used: _ Q3 r
3.Well use(check well use):
7e.Sealing materials used check all that apply):
Water Supply Well: g ( (
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: O Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 7.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/17/22
5a.-Welllocation: f l
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"r"'"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the well(s)ivas (were) abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 12.99" N 800 54' 56.48" W 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 SUBMITTAL INSTRUCTIONS
Attach well construction record(()if available. I-or undtiple h yection or non-water supply
wells ONLY with the same construction/abandonment,you can submit one fbrn' 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: M W-4S abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 44•0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Injection Wells: In addition to sending the form to the address in 10a
2.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following: ' '
6d.Water level below ground surface: 35•0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Iniectiori Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f.Inner casing/tubing length(if known):
I
6g.Screen length(if known): (ft.)
li
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

WELL ABANDONMENT RECORD For Internal Use ONLY: I,
This form can be used for single or multiple wells
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON ned
7a.Number of wells being abandod: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple infection or non-,voter supply wells ONLY with the same
caiis7ruction/abandonment,you can submit one form.
C — 4421 1.25
NC Well Contractor Certification Number 7b.Approximate volume of wateriIremaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS'ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown 7d.Amount of disinfectant used: JA N ] 9
C
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply): l`- (f r.!
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or f�eilel"sti'
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: 171 Bentonite Slurry ❑Other(explain under 7g)
RlMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 7.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stonmwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/17/22
5a.Well-location: i t
KINDER MORGAN
Facility/OwnerNarne Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)was (were) abandoned in
County Parcel identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 14.40" N 800 54' 59.12" W 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 SUBMITTAL INSTRUCTIONS
Attach ire/1 construction record(s)if available. Far inultiple it jecfion or non-water supply
wells ONLY with the.same consiructimi/abandomoent,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.WellID#: MW-3S abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 44•0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2•0 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following: i
6d.Water level below ground surface: 30.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
611 Inner casing/tubing length(if known):
I �
6g.Screen length(if known): (ft.)
Fonn OW-30 North Carolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
I

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandlnJd:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple h jecdon or non-water supply wells, ONLY with the .value
conalruction/abandonment,you can submit one form.
C -4421 � '
1.25
NC Well Contractor Certification Number
7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name y
7e.Type of disinfectant used:
2.Well Construction Permit#: JAM —
List all applicable well construction permits(i.e.County,Slate,Mariance,e(c.)ifknown J.
7d.Amount of disinfectant used: w LC►i i
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) O Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: El Bentonite Slurry ❑Other(explain under 7g)
EMonitoring ❑Recovery
injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 7.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/17/22
__Sa.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �"' '""'^� 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the well(s) ivas (were) abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one]at/long is sufficient) 9.Site diagram or additional well details:
350 47' 13.79" N 800 54' 57.44" W 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 SUBMITTAL INSTRUCTIONS
Allach well construction record(v)if arailable. For umlliple injection or non-crater supply
welly ONLY with the same conslructioniabandomnent,you can subtllit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: MW-5S abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 42.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter- 2.0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 31.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i
10c. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit done copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6E Inner casing/tubing length(if known): (ft.)
' I
6g.Screen length(if known):
Form G W-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
I

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON i 1
7a.Number of wells being abandoned:
Well Contractor Name or well owner personally abandoning well on Iris/her property) For mulliple injection or iron-u ester supply wells ONLY +rich the sane
( P Y 6 P P Y) n
con.+•trucrion/abandonment,you can s•ubnrrt onei form.
C - 4421 1
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 5'S_(gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown
7d.Amount of disinfectant used:
3.Well use(check well use): ✓ ^
Water Supply Well: 7e.Sealing materials used(check all that apply):in-a-, :;�'i•
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑Bentonite Chip�',6rtelle.ts
:�
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Uri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well 7E For each material selected about,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 10.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/17/22
5a.Well location: i f
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �" `""`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the well(s)was (were)abandoned in
County Parcel identirication 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one W/long is sufficient) 9.Site diagram or additional well details:
35e 47' 13.77" N 80o 54' 57.44" W 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 SUBMITTAL INSTRUCTIONS
Attach+re//construction record(s)if arailable. For nudtiple injection or non-+rater supply
we/Is ONLI'with the sane construction/abandonntett,you cat submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDY: MW-5I abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 66.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2•0 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 33.0 (g) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
loc. For Water Sunaly&Injection Wells: in addition to sending the form to
6c.Outer casing length(if known): (ft.) the address(es) above, also submit;one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
Gf.Inner casing/tubing length(if known): (ft.)
where abandoned.
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
i

i
I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned:I 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For nhultiple injection or non-[rater supply wells ONLY with the same
constructionlabandonment,you can submit one form.
C - 4421 i I
NC Well Contractor Certification Number 76.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit 0: JA N j �
List all applicable well construction permits(i.e.County,State,Variance,etc.)ij'knoivn 7d•Amount of disinfectant used: U 2023
3.Well use check well use
+titCa G
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: 21 Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 19.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/17/22
Sit.Well location: f
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 " '"`^� 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s) was (were) abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
35e 47' 13.84" N 800 54' 57.60" W 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 SUBMITTAL INSTRUCTIONS
Alloch well construction record(s)if orailable. hot•multiple injection or non-water supply
wells ONLY with the same mnsiructiotnnbandonnteni,you can submit one jornt, 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: EW-27 abandonment to the following:
Division of Water Quality,Information Processing Unit,
fill.Total well depth: 30•0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
4.0 above,also submit one copy of this form within 30 days of completion of well
Gc.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
i
10c. For Water Supply&Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit 'one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/tubing length(if known): where abandoned.
(ft.)
fig.Screen length(if known): (ft.)
Form OW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
i

I '
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
i
1.Well Contractor Information: WELL ABANDONMENT DETAIIts
JAMES MORRISON I I 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or not-il,ater supply wells- ONLY frith the same
construction/abandonment,you can subn it one form.
C - 4421
NC Well Contractor Certification Number 7b.Approximate volume of water,remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: �• — t+. . �r
2.Well Construction Permit#: n 11�
List all applicable well construction permits(i.e.County,Slate,Variance,etc.)ifknown 7d.Amount Of disinfectant used:
H j' 2
3.Well use(check well use):
7c.Sealing materials used check all that apply):
Water Supply Well: g (
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: El Bentonite Slurry ❑Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 19.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/17/22
5a.Well location:
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �""�' "°"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the ivell(s)was (were) abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one Iat/long is sufficient) 9.Site diagram or additional well details:
350 47' 14.03" N 800 54' 58.04" W 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 SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple h jection or non-crater supply
wells ONLY with the same construction/abandontew,you can submit one form 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDII: EW-28 abandonment to the following:
Division of Water Quality,Information Processing Unit,
Gb.Total well depth: 30.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
6e.Borehole diameter: 4.0 (in•) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
Ge.Outer casing length(if known): (ft.) loc. For Water Suouly&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
Gf.Inner casing/tubing length(if known): (ft.) where abandoned.
Gg.Screen length(if known): (ft.)
Form OW-30 North Carolina Department of Environment and Natural Resources—Division of Water Qf uality Revised March 2013
I �

WELL ABANDONMENT RECORD
For Internal Use ONLY: f
This form can be used for single or multiple wells If
1.Well Contractor Information: ILS
JAMES MORRISON i I 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-hater supply rvefls ONLY with the sane
C -4421 construction/abandonment,you can submif 6nefornt.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: h`•;' ~::ram:
2.Well Construction Permit#: yy+•- .
List all applicable irel/construction permits(i.e.County,State,variance,etc.)ifknoun J 7d.Amount of disinfectant used: A 1v e�
3.Well use(check well use): , W
Water Supply Well: 7e.Sealing materials used(check all that apply): " 7 r :-
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or1PelleiO,2.
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: E Bentonite Slurry ❑ Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑AquiterRecharge ❑GroundwaterRemediation 26.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/16/22
-------Sa.Well-location::
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �'"' '"`^` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, 1 hereby certify that the ivell(s)ivas(were) abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one lat/long is sufficient) 9.Site diagram or additional well details:
350 47' 18.73" N 800 54' 57.50" W 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 SUBMITTAL INSTRUCTIONS
Attach well construction record(v)if available. For multiple injection or non-water supply
rveliv ONLY with the same con.struction/abondonuneni,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: EW-18 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 41.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in 10a
4.0 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
l0c. For Water SuDPIV&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit bne copy of this form within 30 days of
completion of well abandonment to fhe county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
i
i
6g.Screen length(if known):
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013

it
I: I
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells 6
I.Well Contractor Information: WELL ABANDONMENT DETMIJS
JAMES MORRISON I. I 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple it jection or non-water supply wells ONLY with the sane
C - 4421 construction/abandonment,you can sub flit one form.
3.25
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: V I
List all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown JAFI
7d.Amount of disinfectant used: w %n D
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply): ;:
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: 21 Bentonite Slurry ❑ Other(explain under 7g)
RMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑GroundwaterRemediation 29.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain tinder 7g)
4.Date well(s)abandoned: 1 1/16/22
-
KINDER MORGAN
Facility/Owner Name Facility ID#(ifapplicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �'"' ""'�"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this forni, I hereby certify that the well(s)was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lattlong is sufficient) 9.Site diagram or additional well details:
350 47' 18.89" N 800 54' 58.86" W 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 SUBMITTAL INSTRUCTIONS
Attach well catstructiott records)if available. l,or ntulliple it jection or non-water supply
wells ONLY with die same construction/abandonment,you can submit oneJbrnt. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#:
EW-15 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 45.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
[{•Q above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: 40.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
Ge.Outer casing length(if known): (ft.) 10c. For Water Sunoly&Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
Gf.Inner casing/tubing length(if known): (ft.) where abandoned.
i
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 3013
I I
1 i

i
II
WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 1
7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on Isis/her property) For multiple it fection or non-seater supply wells ONLY with the same
consiruction/abandonment,you can sub
mit one form.
C - 4421 I
NC Well Contractor Certification Number
7b.Approximate volume of water remaining in w...(sp 8'S (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used: /a�`�
2.Well Construction Permit#: t'2�
Lim all applicable well construction permits(i.e.County,State,Variance,etc.)ifknown r r
7d.Amount of disinfectant used:. rfts�i%
3.Well use check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑ Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: El Bentonite Slurry ❑ Other(explain under 7g)
ElMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 31.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g•Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/16/22
Sa.-Well-loci]tion: — — ------ --- _-- t I --
KINDER MORGAN
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
201 PHOENIX STREET STATESVILLE 28677 �°"'� "`"` 11/30/22
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
IREDELL By signing this form, I hereby certify that the well(s)was (were) abandoned in
County Parcel Identification No.(PIN) 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.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one Wilting is sufficient) 9.Site diagram or additional well details:
350 47' 18.72" N 800 54' 59.72" W 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 SUBMITTAL INSTRUCTIONS
Altach well construction record(s)if assailable. For multiple it fection or ear-water supply
wells ONLY with the satire construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
Ga.Well ID#:
EW-13 abandonment to the following:
Division of Water Quality,Information Processing Unit,
48.0 1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b. For Infection Wells: In addition to sending the form to the address in 10a
4•0 above,also submit one copy of this•form within 30 days of completion of well
Gc.Borehole diameter: (in.) abandonment to the following:
35.0 Division of Water Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
:1 1
10c. For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit bne copy of this form within 30 days of
completion of well abandonment to the county health department of the county
Gf.Inner casing/tubing length(if known): (ft.) where abandoned.
i
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013