Guilford_Well Abandonment_20240301

Iii,
W.ELL L-1.16L%.1NI fi1V 1VI.E 1'1 1 rie rj . V itll I For Internal Use ONLY:
his form can be used for single or multiple wells I,
•
I.Well Contractor Information: WELL ABANDONMENT DETAILS
Driller- Nathan D.Oldham 7a.Number of wells being abandonedd:
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 submit one form. /�
g� r 7b.Approximate volume of water remaining in well(s): a (gal.)
NC Well Contractor Certification Number
Pyramid Environmental & Eng., PC FOR WATER SUPPLY WELLSONLY:
'Company Name 7c.Type of disinfectant used:/✓A
2.Well Construction Permit#: WM 0401400 ;
List all applicable well permits(i.e.County,State,Variance,Injection,etc.)ifirnown 7d.Amount of disinfectant used: 1✓A
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(checkallthat apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout F I , pis DrnysCl�
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 66 ‘�- f L.4Dy1� .S'lttt gs
❑Irrigation ❑ Specialty Grout Mat.( V n 1 vel
Non-Water Supply Well: ❑ Bentonite Slurry gad
(explain under 7g)
O Monitoring ❑Recovery Irtforn-ativ n arm.
Injection Well: 7f.For each material selected abe amP
M .ounl or materials used:
DAquifer Recharge ❑Groundwater Remediation B 4 - Xi MS,
DAquifer Storage and Recovery ❑Salinity Barrier p /
DAquifer Test ❑Stormwater Drainage ! C� � !1i1�/t� • /S_ Si
❑Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer n/ 4 Pe ��
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) //,�/��
4.Date well(s)abandoned:
02 / 16 /2024 /2,die / u o CQ�•0%,J 4. ,
5a.Well location: i,
Southern Paint&Waterproofing DEQ # 49328 .
Facility/Owner Name Facility ID#(if applicable) 8•Cer'fication: /
3302 Liberty Road, Greensboro, NC 27406 0, ',,/ , oZ`6
Physical Address,City,and Zip Ignature of Certified Well Contractor or Well Owner Date
Guilford 130650 By signing this form, I hereby cert that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C i 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:
O You may use the back of this page to provide additional well site details or well
36o 0 ' N O 1 / ` 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 with the same construction/abandonment,you can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
6a.Well ID#: g)l,U
I
Division of Water Resources,Information Processing Unit,
1617 Mail Service'Center,Raleigh,NC 27699-1617
6b.Total well depth: ��7 (ft.)
10b.For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well .
6c.Borehole diameter: (in.) abandonment to the following:
31v Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: t (ft.) 1636 Mail Service'Center,Raleigh,NC 27699-1636
1
10c.For Water Supply&Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): /v (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013

VV L' LL 1HD1%1 II V1x11V1L`1' J. 1% L.. VI JJ For Internal Use ONLY: I
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS j
Driller- Nathan D. Oldham 7a.Number of wells being abandoned: /
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-wwdter supply wells ONLY with the same
construction/abandonment,you can submit one form.
��—A
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
Pyramid Environmental & Eng., PC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
h
2.Well Construction Permit#: - NA
List all applicable well permits(i.e.County,State,Variance,Injection,etc.)if known
7d.Amount of disinfectant used:
3.Well use(check well use): p
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 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 R Li, iv/ D Cuttings
❑Irrigation Cl Specialty Grout 0 ��❑.l jl Gravel
Non-Water Supply Well: ❑Bentonite Slurry MAR 1 ZO24I Other(explain under 7g)
OMonitoring ❑Recovery j:
Injection Well: 7f.For each mates(s kefdd Wait,'pa itII$Jtl'`itnt of materials used:
❑Aquifer Recharge ❑Groundwater Remediation z1 Do 9 ,;q us_
❑Aquifer Storage and Recovery ❑Salinity Barrier /1C 7� J��� ,.L t /e a
❑Aquifer Test ❑Stormwater Drainage
5
❑Experimental Technology ❑Subsidence Control 7g.Pro 'de a brief description f the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer 049— / )62/�gtA e
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) ,/ . e �
02 / 16 / 2024 4�,6�`,4j,�A9 '% j�/-i/
4.Date well(s)abandoned: i
5a.Well location: I,
JMP Bus. & Bldg. Svcs, LLC DEQ # 00002491 I,
Facility/Owner Name Facility IDff(if applicable) 8.Certification: j.
200 E. Seneca Rd., Greensboro, NC 27406 Signature of Certified Well Contractor:or Well Owner Date
Guilford 51836 By signing this form, I hereby certifi,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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36 C 3 6 -1-2 {, D You may use the back of this page to provide additional well site details or well
+ N % /, d` 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 injection or non-water supply
wells ONLY with the same construction/abandonment,you can submit one form. 10a. For All Wells: Submit this forth within 30 days of completion of well
6a.Well ID#: ,1w— abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 2.1 (ft.)
1617 Mail Service Center,Raleigh,NC 27699-1617
.
10b.For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter:. 00 .(in.) abandonment to the following:
Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: c �� (ft.) 1636 Mail Service.Center,Raleigh,NC 27699-1636
I.
.......� IOc.For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned. I:
6g.Screen length(if known): /0 (ft.)
•
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of WateriResources Revised August 2013
f
I.

VVL' LL L->IlL-V111JVl11r1111\1 iVLI.ViW For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Driller- Nathan D. Oldham 7a.Number of wells being abandoneIId /:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-+eir supply wells ONLY with the same
QQ q construction/abandonment,you can submit one form.
U U ° r4 7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Certification Number
Pyramid Environmental & Eng., PC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: - NA-
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)if known
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 E Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Gr•ut.�;*-r;ram,N , Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout ,`f L.I V brill Cuttings ,
❑Irrigation 0 Specialty Grout ❑ Gravel
MAft 0 1 2024
Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g)
lMonitoring ❑Recovery tlnn..,, ra-ja,,ien 9r C4'4'03644'1
Injection Well: 7f.For ach materi-al select�itto ovide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation e ffi ''_ _ 1 fAS
DAquifer Storage and Recovery 0 Salinity Barrier A��J� � wl , ��,c�- /g ��
❑Aquifer Test ❑Stormwater Drainage //� c E/ l/��
❑Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ,a --�n` %1 JJI,im i ,4 ,'i„g n A I •
OGeothermal(Heating/Cooling Return) ❑Other(explain under 7g) f��
4.)94' 1� jCP.�. //4.Date well(s)abandoned: 02 / 16 /2024 /
5a.Well location: 1
JMP Bus. & Bldg. Svcs, LLC DEQ # 00002491 ,
Facility/Owner Name Facility ID#(if applicable) 8.Certification: 41011.---
`�200 E. Seneca Rd., Greensboro, NC 27406 �!� /o''�T
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Guilford • 51836 By signing this form, I hereby certibl 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
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 with the
�same construction/abandonment,you can submit one form. 10a. For All Wells: Submit this I form within 30 days of completion of well
/► � V 6a.Well ID#: d � abandonment to the following: 1
Division of Water Resources,Information Processing Unit,
6b.Total well depth: (ft.)
at) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
!� Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: d 1 0 (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
10c.For Water Supply&Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
•
6g.Screen length(if known): 1 V (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Ri sources Revised August 2013
i
� 1

VV L' LL ALE14-V111 LM1111V1.Eil l 1 R EA.Vlty For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Driller- Nathan D. Oldham J, 7a.Number of wells being abandon'ed: /
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
� ` A/�1p construction/abandonment,you can submit one form.
7b.Approximate volume of water remainingl in well(s): (gal.)
NC Well Contractor Certification Number
Pyramid Environmental & Eng., PC FOR WATER SUPPLY WELLSIONLY:
Company Name 7c.Type of disinfectant used: .01
2.Well Construction Permit#: - NA-
•
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)if known '
7d.Amount of disinfectant used:',s1//j
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout', ,,z,,4 P}:ti 1., B.. tonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Groffl P......L.. t v Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout Drill Cuttings
0 Specialty Grout MAf� +7 '1 2020 Gravel
❑Irrigationp �'
Non-Water Supply Well: 0 Bentonite Slurt brma„;t,n pr-; ..,,gp, lLthher(explain under 7g)
❑Monitoring ❑Recovery D WQr$'
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation n -' 1 Q�I1 �-t3c
❑Aquifer Storage and Recovery ❑Salinity Barrier 8 /`V eftiT (mil f, r. M tif -'
❑Aquifer Test ❑StormwaterDrainage
❑Experimental Technology ❑Subsidence Control 7g.P ovide a brief description of the abandonment Axe&
rocedure:
OGeothermal(Closed Loop) OTracer � ACM 1
OGeothermal(Heating/Cooling Return) ❑Other(explain under 7g)
idib O lbW6 t , GA4/404f AP j// /� /4.Date well(s)abandoned: 02 / 16 /2024 VV
5a.Well location:
MADKKS, LLC DEQ # 00002491
Facility/Owner Name Facility ID#(if applicable) 8•Certification: /�
2809 Firestone Dr., Greensboro, NC 27406 ��� 7 j ie .0(
2.—/6-21
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Guilford 51843 - By signing this form, I hereby cert 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
//o N d You mayuse the back of this page to provide additional well site details or well
t G G l 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 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#: /W ". ~f abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lOb.For Infection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
{- Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: L "' (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): r� (ft.) 10c.For Water Supply&Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f.Inner casing/tubing length(if known):_ (ft.)
6g.Screen length(if known): I.5 (ft.) i
i
i
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013

W L'LL L-16E1o111 V 1N1V1L'111 1 R E.l.l.l1<V For Internal Use ONLY: I
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Driller - Nathan D. Oldham 7a.Number of wells being abandoned: i
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-wpteir supply wells ONLY with the same
,R1553
o53 9 ✓A construction/abandonment,you can submit one form.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Pyramid Environmental & Eng., PC FOR WATER SUPPLY WELLSIONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: - NA -
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)if known
7d.Amount of disinfectant used::
3.Well use(check well use): 1
Water Supply Well: 7e.Sealing materials used(check'all that apply):
❑Agricultural ❑MunicipalPublic El Neat Cement Grout D Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grits -, 74::. f, j Clay
❑ Concrete Grout f t'--�L.i V �• I Cuttings
❑IndustriaUCommercial ❑Residential Water Supply(shared) �� g
❑Irrigation 0 Specialty Grout MAN 0 1 20240
Gravel
Non-Water Supply Well: 0 Bentonite Slurry� 0 Other(explain under 7g)
IziMonitoring ❑Recovery forreaXic^a'1 Pr' +�nay
Injection Well: 7f.For each material seleEieyd•admarovrdi;"arilount of materials used:
❑Aquifer Recharge ❑Groundwater RemediationApoyyzik, I /e as
❑Aquifer Storage and Recovery ❑Salinity Barrier .�(J
❑Aquifer Test ❑Stormwater Drainage /1r y /Il!�
,igi5''
❑Experimental Technology ❑Subsidence Control 7g.Pro ide a brief d cription of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer e/se0)1/. L.A�eed-- r
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) J� //�� ;6
/AiN Zr
1,71,011-->ce,AdA, I
4.Date well(s)abandoned: 02 / 16 /2024
5a.Well location:
I,
JMP Bus. & Bldg. Svcs, LLC DEQ # 00002491
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
200 E. Seneca Rd., Greensboro, NC 27406 44; �Q� '� zl6-2V
Physical Address,City,and Zip Signature
of Certi led Well Contractor or Well Owner Date
Guilford 51836 By signing this form, I hereby cert 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
V Oa` /`� 79?d j J'} ] You may use the back of this page to provide additional well site details or well
lJ [ N (// ! '7� l t ( 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 injection or non-water supply
wells ONLY with the same construction/abandonrnent,you can submit one form. 10a. For All Wells: Submit this!form within 30 days of completion of well
sa
6a.Well ID#: / liV SS abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: /2\. (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) • abandonment to the following:
00 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service1 Center,Raleigh,NC 27699-1636
^� 10c.For Water Supply&Iniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned. I
1
6g.Screen length(if known): 1(/j� (ft.)
1
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013

VV 1LLL HISl'11'1111J11I1V1L'.01 1 _MEd 1. lltlf For Internal Use ONLY:
This form can be used for single or multiple wells
1
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Driller- Nathan D. Oldham 7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-w�rte� supply wells ONLY with the same
Ali39 `vf�7^ construction/abandonment,you can submit one form.
7b.Approximate volume of water relmaining in well(s): (gal.)
NC Well Contractor Certification Number
Pyramid Environmental & Eng., PC FOR WATER SUPPLY WELLSJONLY:
Company Name 7c.Type of disinfectant used: -
2.Well Construction Permit#: - NA -
List all applicable well permits(i.e.County,State,Variance,Injection,etc.)if known 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 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Gro t.., .,, .1 0 Dry Clay
0 Concrete Grout N` `\ ril Cuttings
❑IndustriaUCommercial OResidential Water Supply(shared) �•��t, i�/ �` g
❑Irrigation 0 Specialty Grout ?AA❑ Gravel
. 1 2�
Non-Water Supply Well: 0 Bentonite Slurry f] Other(explain under 7g)
OMonitoring ❑Recovery c = 1 ,
;rh,
Injection Well: 7f.For each materta�ste c �'�b, iVilael ri�unt of materials used:
❑Aquifer Recharge ❑Groundwater Remediation ,��, i - A.0 2- r
❑Aquifer Storage and Recovery OSalinity Barrier P f
❑Aquifer Test ❑Stormwater Drainage (ri1'�1KGt .I.. 7 (-cF//1/+ f T/ eccs.
❑Experimental Technology ❑Subsidence Control 7g.Pr vide a brief description of the aband i nment procedur :
❑Geothermal(Closed Loop) ❑Tracer ��_- Q . ��� 1 ,,n / t y .de i, 2
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) j�-�-�' i_SIM�F �� '' a (L
02 / 16 /2024
4.Date well(s)abandoned: ALOZA
° � G
i
5a.Well location: I.
JMP Bus. & Bldg. Svcs, LLC DEQ # 00002491 ,
Facility/Owner Name Facility ID#(if applicable) 8.C,�erti//�i'�cation:
200 E. Seneca Rd., Greensboro, NC 27406 i7/�f1 o` :2/6:�9
Physical Address,City,and ZipSignature of Certified Well Con for o r Date
YY,
Guilford 51836 By signing this form, I hereby cert that the well(s) 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 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:
36 v 0� 13 0 Y)CI 6 f /9 You may use the back of this page to provide additional well site details or well
(/ t a N < 1 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 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#: Ala ' 1 q abandonment to the following:
Division of Water Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
' 6b.Total well depth: (ft.)
lOb.For Infection Wells: In addition to sending the form to the address in 10a
6. above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: /60 (ft.) 1636 Mail Service,Center,Raleigh,NC 27699-1636
I 1
�1 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 sub'mi't 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): ID (ft.)
•
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013

VVLLL L�131-1,111JV11IIVIL'll 1 1(L' l_VI(11 For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS /
Driller - Nathan D. Oldham 7a.Number of wells being abandolneld:
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
f fJ tJ --b A
construction/abandonment,you can submit one form.
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Pyramid Environmental & Eng., PC FOR WATER SUPPLY WELLS/ONLY:
Company Name 7c.Type of disinfectant used: ''
2.Well Construction Permit#: - NA ,
List all applicable well permits(i.e.County,State, Variance,Injection,etc.)if known
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 T-- l Bentonite Chips or Pellets
".,
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grou f"' R*v — lay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout w 0 1 ❑q n1 Cuttings
❑Irrigation ❑ Specialty Grout MAN 1 2O4 Gravel
Non-Water Supply Well: 0 Bentonite Slurry �0r,i<, ,'r7.:11544.D Other(explain under 7g)
I?iMonitoring ❑Recovery
Injection Well: r�:I[�
7f.For each material selected I99be; vide amount of materials used:
,
❑Aquifer Recharge ❑Groundwater Remediation I �t5`
❑Aquifer Storage and Recovery ❑Salinity Barrier 1.1
�� (�� � �--��`i❑Aquifer Test ❑Stormwater Drainageat 6/
❑Experimental Technology ❑Subsidence Control 7g.Pr vide a brief description of the
I abandonment procddurre
OGeothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) � ,� 1 / � �ha i
4.Date well(s)abandoned:
02 / 16 /2024 ��' l" � '`; CeMe,G "%editr
•
5a.Well location: ;1
JMP Bus. & Bldg. Svcs, LLC DEQ # '00002491
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
200 E. Seneca Rd., Greensboro, NC 27406 41d,A ,114.4.PL A 1C--Z5L
• Physical Address,City, Zip and SignatureCertified ell Contractor or Well Owner Date
Y
Guilford 51836 By signing this form, I hereby cert that the well(s) was (were) abandoned in
County Parcel Identification No.(PIN) accordance with I5A NCAC 02C'.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
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:
6' D� !3 ©Plc?O 40 .�] � You may use the back of this page to provide additional well site details or well
c ► N r o�L� 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 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#: Ay -40 abandonment to the following:
6b.Total well depth: 23 (ft.)
Division of Water Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below ground surface: t� ` (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service;Center,Raleigh,NC 27699-1636
10c.For Water Supply&Injection Wells: In addition to sending the form to
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 tb the county health department of the county
where abandoned.
6f.Inner casing/tubing length(if known): (ft.) ,
/6g.Screen length(if known): 0 (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013
1

VV rilild tiDl-%l\JJlJ1' 1V1L'1\1 1N1�1.1J1W For Internal Use ONLY:
This form can be used for single or multiple wells
i
1.Well Contractor Information: WELL ABANDONMENT DETAILS /
Driller- Nathan D. Oldham 7a.Number of wells being aband Ined:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-rater supply wells ONLY with the same
construction/abandonment,you can submit one form.
g-"C61 r 7b.Approximate volume of water!r maining in well(s): (gal.)
NC Well Contractor Certification Number
Pyramid Environmental & Eng., PC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:.X,4
•
2.Well Construction Permit#: - NA-
List all applicable well permits(i.e.County,State,Variance,Injection,etc.)if known 7d.Amount of disinfectant used,vQ
•
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public 0 Neat Cement Grout El Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout_ _ _ ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout e t.L i\/l F ll uttings
❑Irrigation 0 Specialty Grout 0 ?❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry MAK 1 2OT�Other(explain under 7g)
RlMonitoring ❑Recovery . .'-
Injection Well: 7f.For each materii'£h`�s"Ieelet�a�ove(•`rovi atnidi ant of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 4-.i3O -- I, 1 - 22---4SS' -
❑Aquifer Storage and Recovery ❑Salinity Barrier �t � ti�T C �/j"Ravv..�. /C/L� /A6'
0 Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Pr ide a brief description of the abandonment procedure
❑Geothermal(Closed Loop) ❑Tracer c.?/1. 14C A4 itli� ll !-1/Je
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned:
02 / 16 /2024 �� � , Cam, I,.�� _J I
5a.Well location:
MADKKS, LLC DEQ # 00002491
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2809 Firestone Dr., Greensboro, NC 27406 /iI e id D/��G l J./ -2cl.
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Guilford _ 51843 By signing this form, I hereby certfy 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
3/ d �� G I ! I 4/A 7 �l/ You may use the back of this page to provide additional well site details or well
�/ N ( `I 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 injection or non-water supply
wells ONLY with the sa/mee�construction/abandonment,you can submit one form.. 10a. For All Wells: Submit this Ifortn within 30 days of completion of well
6a.Well ID#: /!(MO `. 11 abandonment to the following:
/ Division of Water Resources,Information Processing Unit,
6b.Total well depth: 2Jt-/ (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6 6b Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: c (ft.) 1636 Mail Service'Center,Raleigh,NC 27699-1636
lOc.For.Water Supply&Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
~— where abandoned.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): /0 (ft.)
1
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Resources Revised August 2013

W LLL 1-1.13.1-ILLII IN lin IV1L'lei I ic r,l.kirk], For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAIL'S
Driller- Nathan D. Oldham 7a.Number of wells being aband I n Id:
Well Contractor Name(or well owner personally abandoning well on his/her property) For multiple injection or non-rater supply wells ONLY with the same
construction/abandonment,you can submit one form.
7b.Approximate volume of water
l remaining in well(s): (gal.)
NC Well Contractor Certification Number
Pyramid Environmental & Eng., PC FOR WATER SUPPLY WELLS ONLY:
Company Name I,
7c.Type of disinfectant used: .-_
2.Well Construction Permit#: - NA -
List all applicable well permits(i.e.County,State,Variance,Injection,etc.)if known
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 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 1, ;IL,`i �C e.r� l
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout ❑ Drill uttings
❑Irrigation ❑ Specialty Grout MAH 0 1 Zanravel
Non-Water Supply Well: ❑ Bentonite Slurry i0_r {`n Pr Other(explain under 7g)
OMonitoring ❑Recovery R4cdCci+;�-� tq
Injection Well: 7f.For each material selected above,p"r'b3(de amount of materials used:
❑Aquifer Recharge OGroundwater Remediation � - 4 i- -- ? as
` - - -
❑Aquifer Storage and Recovery ❑Salinity Barrier � ��Q1�16'Q /v ��� /,�❑Aquifer Test ❑Stormwater Drainage
i
❑Experimental Technology ❑Subsidence Control 7g.Provt e a brief description of the abandonment procedure:oc�Je
❑Geothermal(Closed Loop) ❑Tracer c � Gdl12L/L�% ��
❑Geothermal(Heating/Cooling Retum) ❑Other(explain under 7g) '� ;2fl. ! e,
4.Date well(s)abandoned:
02 / 16 /2024 Li-J./lee/5 1 a,,,t EadA,
5a.Well location:
JMP Bus. & Bldg. Svcs, LLC DEQ # 00002491
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
200 E. Seneca Rd., Greensboro, NC 27406 _ ,/ idAPAI Zat Z-- 6=
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Guilford 51836 By signing this form, I hereby certij,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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
86 f7 Q�a, j� 1-2 9 Q 11`7"t7 W You may use the back of this page pages to provide additional well site details or well
(� N V , abandonment details. You mayalso attach additional if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
--- -Attach_we1L construction record(s)_if available. 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#:
'� I abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: � (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
ct lt- 10b.For Injection Wells: In addition to sending the form to the address in l0a
above, also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: 3, 2.5 (ft.) 1636 Mail Service'Center,Raleigh,NC 27699-1636
(/, 10c.For Water Supply&Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): / (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): 6 Z I (ft.) where abandoned. 1I
6g.Screen length(if known): 5 Ifi (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources-Division of Wate f Resources Revised August 2013

WELL ABANDONMENT RECORD For Internal Use ONLY: 1 '
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott M. Werle s
Y 7a.For Geoprobe/DPT or Closed=Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW1 30 is needed. Indicate TOTAL NUMBER of
3344-A wells abandoned:One
NC Well Contractor Certification Number 7b.Approximate volume of water relmaining in well(s): 1 .0 (gal.)
ECS Southeast, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well consbvction permits(i.e.UIG County,State, Variance,etc.)if known
7d.Amount of disinfectant used::
3.Well use(check well use):
Water Supply Well: 7e.Sealing material,i se411check ill that apply):
❑Agricultural ❑Municipal/Public II Neat Cement Gro it\:"" Jr'r I'?el onite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ) Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout MAN 0 1 20240 Drill Cuttings
❑Irrigation ❑ Specialty Gro ❑ Gravel
Non-Water Supply Well: f tFil��r' '48IBtlier(explain under❑ Bentonite Slurry ( p 7g)
IMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 20 to 5 ft bgs - 10 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage Neat Cement 5 ft bgs to surface ^' 15 lbs
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer +
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Remove 1-inch screeniand riser; gravity feed
gravity feed bentonite. to 5' bgs;
4.Date well(s)abandoned: 2/14/2024 pour neat cement 'to surface.
5a.Well location:
Worth Industries, Inc. NA
Facility/Owner Name Facility ID#(if applicable) 8 e tification: '
206 Bruce Street, Greensboro, NC 27403
2/15/2024
Physical Address,City,and Zip Signature o Certified We I out or or Well Owner Date
Guilford 7854524498
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 b'eeiu provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I I
(if well field,one latllong is sufficient) 9.Site diagram or additional well details:
36.06238 N 79.82742 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)ifavailable. 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
T
6a.Well ID#: f W-1 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 20 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 3.25 (in.) above, also submit one copy of this iform within 30 days of completion of well
abandonment to the following:
I I
8.46 Division of Water Resources,Underground Injection Control Program,
6d.Water level below ground surface: (ft.)
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one'copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 5 (ft.) abandoned.
6g.Screen length(if known): 1 5 (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
11 i
1.Well Contractor Information: WELL ABANDONMENT DETAILS
Scott M. Werle
Y 7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GWI 30 is needed. Indicate TOTAL NUMBER of
3344-A wells abandoned:one
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): 0'8 (gal.)
ECS Southeast, LLC FOR WATER SUPPLY WELLStONLY:
Company Name C
7c.Type of disinfectant used: I •
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,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 a Neat Cement Gro t-.c, ,-.,,— �4' -Been ontte Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Gro&ti la ii-'I v lay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout p Drill Cuttings
PP Y MAR �, 1 2�2`t
❑hrigation ❑ Specialty Grout ; ❑ Gravel
Non-Water Supply Well: ❑ Bentonite sturryin¢ofw F;1 Fir:7.4-. 44E2Q(h t(explain under 7g)
®Monitoring ❑Recovery tti'C 306
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 20 to 5 ft bgs ^' 10 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
Neat Cement 5 ft bgs to surface — 15 lbs
❑Experimental Technology ❑Subsidence Control I
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer It
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g) Remove 1-inch screen;and riser; gravity feed
gravity feed bentonite to 5' bgs;
4.Date well(s)abandoned: 2/14/2024 pour neat cement'Ito surface.
5a.Well location:
Worth Industries, Inc. NA
Facility/Owner Name Facility ID#(if applicable) 8.Ce-tifica• n: I
206 Bruce Street, Greensboro, NC 27403 L 2/15/2024
Physical Address,City,and Zip Signature of Certified We Contr tor oc Well Owner Date
Guilford 7854524498
By signing this form, 1 hereby cent(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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
36.06238 N 79.82742 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)ifavailable.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#: TW-2 abandonment to the following:
Division of Water Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: 20 (ft.)
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 3'25 (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: 10.16 (ft.) Division of Water Resources,(Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply&Iniection Wells: In addition to sending the form to the
address(es)above,also submit one:copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 5 (ft.) abandoned. ,
I
6g.Screen length(if known): 15 __(ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY:
it
1.Well Contractor Information: WELL ABANDONMENT DETAIILS
Scott M. Werley 7a.For Geoprobe/DPT or ClosedjLl op Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 G I-3I is needed. Indicate TOTAL NUMBER of
3344-A wells abandoned:One
NC Well Contractor Certification Number 7b.Approximate volume of wate I r I maining in well(s): 1'5 (gal.)
ECS Southeast, LLC FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: NA
List all applicable well construction permits(i.e.UIC,County,State, Variance,etc.)if known
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 II Neat Cement rout- ,.,,, _ II Bentonite Chips or Pellets
❑Geothennal(Heating/Cooling Supply) ['Residential Water Supply(single) ❑ Sand CemenbCRoltt,L.(:t i if, Lsr Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑ Concrete Grout Ku 0 1 I ❑ Drill Cuttings
❑Irrigation 0 Specialty Grout Z4 ❑ Gravel
Non-Water Supply Well: 0 Bentonite ,ltiy y�-APO�r �.._le Other(explain under 7g)
at
IJMonitoring ❑Recovery Sao '3 t
Injection Well: 7f.For each material selecteda ove,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation Bentonite 30 to 5 ft bgs ^' 20 lbs
❑Aquifer Storage and Recovery ❑Salinity Barrier
['Aquifer Test ❑Stonnwater Drainage
Neat Cement 5 ft bgs to surface — 15 lbs
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of,the abandonment procedure:
❑Geothermal(Closed Loop) OTracer
['Geothermal(Heating/Cooling Return) ['Other(explain under 7g) Remove 1-inch screen and riser; gravity feed
gravity feed bentonite 2/14/2024 to 5' bgs;
4.Date well(s)abandoned: pour neat cementi'to surface.
5a.Well location:
Worth Industries, Inc. NA
Facility/Owner Name Facility ID#(if applicable) 8. us- ation:
206 Bruce Street, Greensboro, NC 27403 j ' 2/15/2024
Physical Address,City,and Zip Signature of Certified Well o ctor or Well Owner Date
Guilford 7854524498
By signing this form, I hereby ecru'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¢e m 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:
36.06238 N 79.82742 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)ifavailable.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#: TW-3 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 30 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 3.25 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following: 1
6d.Water level below ground surface: 11 .66 (ft.) Division of Water Resources Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): NA (ft.) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): 1 0 (ft.) abandoned. ! ;
i
6g.Screen length(if known): 20 (ft.)
Form OW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

WELL ABANDONMENT RECORD For Internal Use ONLY: �
I
1.Well Contractor Information: WELL ABANDONMENT DETAILS
GarySimcox l ,
7a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only I GW!30 is needed. Indicate TOTAL NUMBER of
2944-B wells abandoned: III 1
NC Well Contractor Certification Number 7b.Approximate volume of waterjremaining in well(s): '5 (gal.)
1, -
S&M E, Inc. FOR WATER SUPPLY WELLS;ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#: •
List all applicable well construction permits(i.e.UIC,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):
0 Agricultural ❑MunicipaVPublic 0 Neat Cement GroutuF I Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout;7—. `�".•'I'l 1 f•r§3,D Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout - L )Cuttings
❑Irrigation _, 0 Specialty Grout MAN 0 1 2024 Gravel
Non-Water Supply Well: 0 Bentonite Slurry . ❑ Other(explain under 7g)
•Monitoring ❑Recovery a r3:; F,7 pry„ •
Ugat
Injection Well: 7E For each material sele armgrovtae ount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 15 lbs
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control I
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer Removed 10' of well!casing and backfilled
0 Geothermal(Heating/Cooling Return) 0 Other(explain under 7g)
TD-16 granular bentonite.
4.Date well(s)abandoned: 2/9/24
5a.Well location: 1,
Peter Dalldorf
Facility/Owner Name Facility ID#(if applicable) 8.Certification: i.
514 South Elm St., Greensboro, NC 27406 ..Z. 2/16/24
Physical Address,City,and Zip Signature of Certified Well Contractor or rell Owner Date
Guilford Bysigning thisform, 1 herebycern that the well(s) was were abandoned in
SnS fY' (were)
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:
36° 04' 00.73" N 790 47' 28.81" `,l, 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)ifavailable.For multiple injection or non-water supply wells
ONLY with the same construction/abandonment,you can submit one form.
IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: TMW-1 abandonment to the following: I,
•
Division of Water Resources,Information Processing Unit,
6b.Total well depth 20.1 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
i .
10b.For Injection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: (in.) above,also submit one copy of this;form within 30 days of completion of well
abandonment to the following: 11
6d.Water level below ground surface: 7.41 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
I
6e.Outer casing length(if known): (ft) 10c.For Water Supply&Injection�'Wells: In addition to sending the form to the.
address(es)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): (ft.) abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources 1 Revised 2-22-2016
`1

i!
it
•
WELL ABANDONMENT RECORD For Internal Use ONLY:
( ;
1.Well Contractor Information: WELL ABANDONMENT DETAII!S
Gary Sim cox 7a.For Geoprobe/DPT or Closed)LI op Geothermal Wells having the same
Well Contractor Name(or well owner personally abandoning well on his/her property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
2944-B wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): '7 (gal.)
S&M E, Inc. FOR WATER SUPPLY WELLS ONLY:
Company Name .
• 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if known
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 0 Neat Cement Grout a Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement G out;r-• ,,.,, -., rI, 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout \Rm k„.1'12i II Di Cuttings
❑Irrigation 0 Specialty Grout MAR. 0 Gravel
Non-Water Supply Well: ❑Bentonite Slurry 0 1 2�Z4❑ Other(explain under 7g)
)Monitoring ❑Recovery '
Injection Well: 7f.For each mlOgraikt2diroUOUVILIaltount of materials used:
OAquiferRecharge ❑Groundwater Remediation 15lbs DWCu3QG
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage -
❑Experimental Technology ❑Subsidence Control 1'
7g.Provide a brief description of Idle abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Removed 10' of well casing and backfilled
❑Geothermal(Heating/Cooling Return) 0 Other(explain under 7g) ,
TD-16 granular bentonite.
4.Date well(s)abandoned: 2/9/24 II
5a.Well location:
Peter Dalldorf
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
514 South Elm St., Greensboro, NC 2740621;I, 2/16/24
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Guilford By signing this form, I hereby certify that the well(s)was(were) abandoned in
County Parcel Identification No.(PIN) accordance with I5A NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: l ,
(if well field,one lat/long is sufficient) 9.Site diagram or additional wellidetails: •
36° 04' 00.64" N 79° 47' 2$.40" 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)ifavailable.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#: TM W-2 abandonment to the following:
it
Division of Water Resources,Information Processing Unit,
20.11617 Mail Service Center,Raleigh,NC 27699-1617
6b.Total well depth: (ft.)
10b.For Injection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: (in.) above,also submit one copy of tliis'form within 30 days of completion of well
abandonment to the following: l;
I'
6d.Water level below ground surface: 9.79 (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
YI
6e.Outer casing length(if known): (ft.) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(es)above,also submit one;copy of this form within 30 days of completion
. of well abandonment to the county health department of the county where
6f.Inner casing/tubing length(if known): (ft.) abandoned.
6g.Screen length(if known): _ (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016