Onslow_Well Abandonment_20240827 (3)

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
2.Well Construction Permit#:
N/A CERCLA site lc.Type of disinfectant used:
List all applicable well construction permits(i.e.IIIC,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 ❑ Bentonite Chips or Pellets
OGeothennal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
0 Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge II Groundwater Remediation Portland Cement _ .30 5 Sii q s
DAquifer Storage and Recovery ❑Salinity Barrier
0 Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer Tremie grout
❑Geothermal(Heating/Cooling Return) MOther(explain under 7g)
4.Date well(s)abandoned: 6-I I d /
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494 � �`�'Q
Facility/Owner Name Facility ID#(if applicable) S.Certification:
2127 Lejeune Blvd, Jacksonville NC, 2854 ,ZG��/ l _g_311
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 By signing this form, I hereby certtfv that the well(s) was(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:
34.741400 N 77.366600 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.
6
/ 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#• 14 C— l J C.- abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: r
C I q (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lOb.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:
6d.Water level below ground surface: (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft,) 10e.For Water Snooty&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(mown): (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

1.11 TERRATHERM ISTD Heater Boring Construction Detail Revision#: 0
•c.c.s,c_ync,, Release date: 5 12 23_
iC)/ ?1•'•F - j/7 Approved by: St
Well ID HC-06C t1 f/i/i of IIt?Ynr-4Z// Date S -,ra -6+j 6 - 3 -�-
Oversight .,. l Job# R23-104
Driller Q• • >r ,,14,t IJ /4/M.,h 6h/�/
/ Constructed
(fill out if
Design different) Notes
-Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? Ground(in) 3'/30"
Thermocouple Length �5-9�
-Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) 0.5'/li"
Ground Surface 0.0'
Heater Can Conductive HT Grout— Ild
Th /
I.Angle from Horizontal 48"/ ✓
Schedule 80
.
Borehole Diameter 7" _
Top of#00 Sand 2'
t.
• Top of Screen 4'
Heater Can Length 79 ft = 5 Gal Buckets of Graphite 0.75
Heater Can Diameter 3 / in - Bogs of Silica 1
— Screen Length 1 0 }d't ft _- Bags of Cement 3.5
Riser Length (9` ft =
Screen Diameter 1 in 'Bottom of Screen 17.5' t -u
1
Installation Method
Direct Push Bags of#00 Sand 33
onic
ow Stem Auger Gallons of Crushed
Mud Rotary
Limestone 33
Other: -
Bottom of#00 Sand 67.5'
i
i.
Bottom of Heater Can 76'
Bottom of Borehole 76'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: xl`t t C•a./ Reading: O.( PPM
Depth to bottom of well[ft bTOC 79' Time: 1 V`,4 ,,I.,0 S. Reading: PPM
if greater than or equal to 1ft less than designed alert the office Time: O .0 0 <•?.; Reading: (:7_O PPM
2)Confirm grout plug reaches ground surface Time: Cl: s.(5 Reading: 17 0
PPM
repeat daily until depth to grout is Oft Time: \C t, 1 (.9 Reading: 0 ,0 PPM
Date Depth to Grout[ft bgs] Notes: )
_ '� _ ek1.3a— \\'.to

•
WELL ABANDONMENT RECORD LIntemal
Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: N/A CERCLA site
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 ❑Mimicipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑lndustrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge lGroundwaterRemediation Portland Cement
❑Aquifer Storage and Recovery ❑Salinity Barrier
0 Aquifer Test ❑Stormwater Drainage _
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer Tremie grout
❑Geothermal(Heating/Cooling Return) &Other(explain under 7g)
4.Date well(s)abandoned: -' I Ir t
Sri.Well location: CI .t
ABC One Hour Cleaner,Superfund Site N C D024644494 S � 'r c ti e
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 2854 `1 _3 - a y
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 By signing this form,I hereby certijv that the well(s) was(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:
34.741400 N 77.366600 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 with the same construction/abandonment,you can submit one form.
10s. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID NC#: — 0 C 6 abandonment to the following:
Division of Water Resources,Information Processing Unit,
p
6b.Total well depth: O.)-S t a2•S(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: On-) 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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Sunaly&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

!STD Heater Boring Construction Detail Revision#: 0
TERRATHERM Release date:_5/12/23_
Approved by: SL
Well ID HC-06B Date —7- , I 23
Oversight 1 t C)34A0. ' ) Job# R23-104
Driller ` t Fr(-- 1 - 1, n 6//e///;►9.G'r r y
Constructed
(fill out if
AP
Design different) Notes
— —Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? Ground(in) 3e/30_ `i
Thermocouple Length 87.67' -Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) / 2
Ground Surface 0.0'
_J,pter Can Conductive HT Grout— Pi'
.� Angle from Horizontal 35°
/ Schedule 80
i —
f Borehole Diameter 7"
—
iia
Top of#00 Sand 3' _
Top of Screen 5'
,
Heater Can Length 91 ft r
S Gal Buckets of Graphite
w.
Heater Can Diameter 3 in Bags of Silica )
1.5
ft-
s
Screen Length 17 ft Bags of Cement 1.6)
. ,
Riser Length 7 ft m
Screen Diameter 1 in Bottom of Screen 22.5'
Installation Method
Direct Push Bags of#00 Sand 28 ��
Soni
Ho ow Stem Auger Gallons of Crushed
Mud Rotary Limestone 28
Other:
Bottom of#00 Sand 76.5'
Bottom of Heater Can 87.5'
Bottom of Borehole 87.5' 8 7,5
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model: _
1)Confirm well is free of grout Design Constructed Time: 7 3( Reading: Q. PPM
Depth to bottom of well[ft bTOC 91' Time: ' 7 Reading: O� 0 PPM
if greater than or equal to ift less than designed alert the office Time: 9,f 30 Reading: O v' PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes:

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: N/A CERCLA site
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)if blown
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
0 Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: If.For each material selected above;provide amount of materials used:
❑Aquifer Recharge UGroundwaterRemediation Portland Cement _ 5 -/10ll 5
❑Aquifer Storage and Recovery ❑Salinity Barrier
0 Aquifer Test ❑Stormwater Drainage
0 Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Tremie grout
❑Geothermal(Heating/Cooling Return) UOther(explain under 7g)
•
4.Date well(s)abandoned: - I 1G-a? //
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494 S � a`ti d Q
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28548- -7 07_
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818
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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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 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#• f-1 C-- d LA abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: S T 5 Z 5(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: (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (g,) 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

TERRATHERM SIW Boring Construction Detail Revision#: 0
Release date:_5/12/23_
Approved by: SL
Well ID HC-06A Date 7 fc.ar?
Oversight JO .5k944Lc.
Job# R23-104
Driller 662A-( ..4 4V,/i -4 ttif/ Design Constructed Notes
l% (fill out if
different)
1/2"Thermocouple pipe? _
Thermocouple Length 59.17' ---Heater Stick Up Height 30" Z Z"
----SIW Stick Up Height 18" .., t Z~l
Ground Surface 0.0'
_________......
Conductive HT Grout— "'4 Angle from Horizontal 78"
Heater Can
Schedule 80 .-
G :
Heater Can Length 60 -!
� Borehole Diameter 7"
Heater Can Diameter 3' -
x
;% S Gal Buckets of Graphite 2.25
S1W -
Riser Length 51.5 ='
ft Bags of Silica 3
Screen Length 2 ft .-
Screen Material ? Bags of Cement 10
Stainless Steel —
Fiberglass Top of#00 Sand 30'
Other:
SIW Slot Size 10 Bags of Sand 7.5
Screen Diameter 1"
Gallons of Limestone 7.5
Installation Method
Sbnizy
Top of Screen 50.5'
Direct Push
Hollow Stem Auger —
Mud Rotary —.
Other: Bottom of Screen 52.5'
—
Bottom of#00 Sand 54.5'
Conductive High Temp Grout------
Bottom of Borehole 57.5'
Post-Installation QC(to be performed 24hrs after installation) PND Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: f i-f;/t1 Reading: / .
Depth to bottom of well[ft bTOC]: 60' Time: i S;[ �, Reading: / a PPM
if greater than or equal to Zft less than designed alert the office Time: k t.c Reading: O:0 PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes:

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-3 0 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
N/A CERCLA site _
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 0 Bentonite Chips or Pellets
0 Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
0 Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge eGroundwaterRemediation Portland Cement 3
5gll�<, 5
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
—
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer
❑Geothermal(Heating/Cooling Return) WOther(explain under 7g) Tremie grout
4.Date well(s)abandoned: �= - t i' r-f
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494 � a c Q
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546 ��/(
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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. Far 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#: !-► L' I) SE abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: L 5 t C•• C (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: (i)t) 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 Resources,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 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

TERRATHERM ISTD Heater Boring Construction Detail Revision#:_1
Release date:_6/14/23_
Approved by:
d.
Well ID HC-05E Date - r a 3
Oversight -7 Job q R23-104
Driller L. I
Constructed
(fill out If
Design different) Notes
--Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? No 1 Ground(in) 5'/30"
Thermocouple Length 77.29'
-Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) 1.5'/6"
Ground Surface 0.0'
Heater Can Conductive HT Grout— r
Angle from Horizontal 22'
Schedule 80
Borehole Diameter 7"
Top of#00 Sand 21.5'
Top of Screen 26.5'
Heater Can Length 81.5 ft • 5 Gal Buckets of Graphite 2.5
Heater Can Diameter 3 in Bags of Silica 3.5
•
Screen Length jg .a ft Bags of Cement 11
Riser Length 29 ft
Screen Diameter 1 in Bottom of Screen 34.5' `?
Installation Method
Direct Push Bogs of#00 Sand 15
Sonic
Hollow Stem Auger Gallons of Crushed
Mud Rotary Limestone 15
Other: T
Bottom of#00 Sand 61.5'
Bottom of Heater Can 76.5'
Bottom of Borehole 76.5'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well Is free of grout Design Constructed Time: y jr7 Reading: [),O PPM
Depth to bottom of well[ft bTOC Rt 5' Time: 5-:al) Reading: O-O PPM
if greater than or equal to ift less than designed alert the office Time: Reading: PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgsl Notes:

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
2.Well Construction Permit#:
N/A CERCLA site lc.Type of disinfectant used:_
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifbtown
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) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge sGroundwaterRemediation Portland Cement a. s O s.
Lc
DAquifer Storage and Recovery ❑Salinity Barrier
0 Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer
❑Geothermal(Heating/Cooling Return) ROther(explain under 7g) Tremie grout
4.Date well(s)abandoned: ' I - Y •
5a.Well location: ' d
ABC One Hour Cleaner,Superfund Site NC D024644494
Facility/Owner Name Facility 1D#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546
Physical Address,City,and Zip
Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 By signing this form, I hereby certify that the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with ISA NCAC 02C.0100 or 1C.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:
34.741400 N 77.366600 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 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#• /' C—O S 0 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:(-" * �'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
6c.Borehole diameter: (ip,) 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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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

ISTD Heater Boring Construction Detail Revision#:_0
11110 TERRATHERM
Release date:_5/12/23_
Approved by:_SL_
' Well ID HC-05D Date
Oversight J : 7k Jo Job# R23-104
Driller --2L},.-),L-►.-,'�/�,)•%/- 6r��
/ Constructed
(fill out If
Design different) Notes
-Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? Ground(in) 2.5'/30"
Thermocouple Length 61.75'
-length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) 0.5'/6"
Ground Surface 0.0'
Heater Can Conductive HT Grout—
ill •ngle from Horizontal 66"
Schedule 80
ai' Borehole Diameter ez
Top of no Sand 2'
Top of Screen �7
f!
Heater Can Length 64.5 ft k „ Gal Buckets of Graphite 0.75 1i
Heater Can Diameter 3 in N Bogs of Silica 1 1
Screen Length 1 N Bags of Cement 3 3
Riser Length w.` �
Screen Diameter 1 in Bottom of Screen 14' /'
Lim
Installation Method
Direct Push Bogs of#00Sand 20
c._Sbnic-)
Hollow Stem Auger Gallons of Crushed _
Mud Rotary Limestone 20 5 $,;:,k:-.tSS
Other:
Bottom of#00 Sand 54.5'
Bottom of Heater Can 62'
Bottom of Borehole 6'/
Pest-Installation QC(to be performed 24fhrs after installation) PI, D L.oy:Make/Modch
1)Confirm well Is free of grout Design Constructed Time: - K-, Reading: p .t-7 PPM
Depth to bottom of well[ft bTOC 64 S' Time: 0-g i 0 Reading: .(7 PPM
if greater than or equal to ift less than designed alert the office Time: C' c.Ga Reading: c7. 0 PPM
2)Confirm grout plug reaches ground surface Time: 0 ct. Z,} Reading: Q PPM
repeat doily until depth to grout is Oft. Time: c-.q,. I—, Reading: 4,.C PPM
Date Depth to Grout[ft bgs) Notes: .
- '..o • P,v - CJ .0 \f -F` Z.

• WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:_
2.Well Construction Permit#: N/A CERCLA site
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)((laic wn
7d.Amount of disinfectant used:_
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Mu nicipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout ❑Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
:Aquifer Recharge •GroundwaterRemediation Portland Cement 3 o Q O/1
%/ ,
❑Aquifer Storage and Recovery ❑Salinity Barrier — 5
0 Aquifer Test ❑Stormwater Drainage
❑Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Traccr Tremie grout
❑Geothermal(Heating/Cooling Return) lliOther(explain under 7g) .
4.Date well(s)abandoned: C-11- 7 `{ `
5a.Well location: '
S
ABC One Hour Cleaner,Superfund Site NC D024644494 � a c Q
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28548 ,�,Z Gt��( -1-,)- a y
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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 1C.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:
34.741400 N 77.366600 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 with the same construction/abandonment you can submit one form.
/ / 10a. For All Wells: Submit this form within 30 days of completion of well
ID f 6a.Well #: 't (.'Q S (_ abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:-7(a t 1 Y (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: (n,) 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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Sootily&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

•
.P 0TERRATHERM ISTD Heater Boring Construction Detail Revision#:_0
ac. c Release date:_5/12/23_
i
1c jr Z 7j/( Approved by: SL_
(Ai/ f c ✓re✓1, (i ei Well ID HC-O5C Date 5 - ', ,,)-
Oversight c.,-*w d- . Job# R23-104
Driller l 1 c2A-rZ)4-L,1 //tig..71ty-4,
Constructed
(fill out if
Design different) Notes
-Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? Ground(in) 3'/30'
Thermocouple Length 5 ill ' -Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) 0.5'/6"
Ground Surface 0.0'
Meater Can Conductive HT Grout— lig
Angle from Horizontal 48° _
Schedule 80 -
Borehole Diameter 7"
:a
Top of#00 Sand 2'
y'
Top of Screen 4'
Heater Can Length 79 ft : 5 Gal Buckets of Graphite 0.75
Heater Can Diameter 3 in - Bags of Silica 1
`1 Screen Length , 01 33 ' ft = -Bags of Cement 3.5
Riser Length ).V 4 5.5 ft —_ t
Screen Diameter 1 in Bottom of ScreenZ, LI
Installation Method
Direct PUSh Bags of#00 Sand 33
onic -T
Hollow Stem Auger Gallons of Crushed
Mud Rotary Limestone 33
Other:
Bottom of#00 Sand 67.5'
Bottom of Heater Can 76'
--
Bottom of Borehole vfiT.7
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: \t•. %d Reading: , a PPM "
Depth to bottom of well[ft bTOC 79' Time: 41 t• 0 3 Reading: a • 0 PPM i'r/
if greater than or equal to Zft less than designed alert the office Time: +,a_ Reading: — PPM
2)Confirm grout plug reaches ground surface Time: J 3;D rJ Reading: . •.. PPM 5 Z
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes: o o ,1.3
�� 1X2SL J& s "- '— ` 5C+0;p-

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
2.Well Construction Permit s«:
N/A CERCLA site 7c.Type of disinfectant used:
List all applicable well construction permits 0.e.UIC,County,State,Variance,etc.)if know:
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) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge •GroundwaterRemediation Portland Cement 5 gar/cm,5
❑Aquifer Storage and Recovery ❑Salinity Barrier
0 Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer
❑Geothermal(Heating/Cooling Return) 1110ther(explain under 7g) Trem ie grout
4.Date well(s)abandoned: i r
5a.Well location:
ti Q cl
ABC One Hour Cleaner,Superfund Site NC D024644494 `' •t`
Facility/Owner Name Facility IDl1(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546 \ Z � _z
Physicaly
Address,City,ty,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 By signing this form, 1 hereby certify that the well(s) was(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:
34.741400 N 77.366600 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#: i-4 (. 0 S p abandonment to the following:
O Division of Water Resources,Information Processing Unit,
6b.Total well depth: 0)• S t' 3 (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: (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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

ige;
, _ : ss ,q IST D Heater Boring Construction Detail Revision#: 0_
Release date:_5/12/23_
.." Approved by: 5!_
Well IC HC-05B Date - //- S
,'e .)i- �C/l-e lob= R23-104
- �nly / //,t).Id,,,,t,er'I j
' Constructed
(fill out if
Design different) !Notes
--Length cf Car Stck-Up!f`t/ l
iiii. rieTV,e;`Can Stick-up Above
i
eist,n'V-H Stick-Up(ftl/
rlcrSnt of ee SLICK•Up n.Pme
�,ccnd nn( 1A: 11. / Q'/
Ground Surface 0.0'
drama ter Can Conductive HT Grout— '
u �� Angle from Horizontal 35')
1
Borehole Diameter Or
Top of z00 Sand 3'
Top of Screen 5'
-eater Can Length 9Z ft - S Gal Buckets of Graphite 1
-eater Can Diameter 3 in Bags of Silica 1.5 a
Screen Length 17.5 / ft - - Bags of Cement 4.5
...... Rrcor Length ` 7/ ft
i
Screen Diameter 1 in Bottom of Screen / Q.
lnstatlaoon Method
Direct Push Bags of# 0Sand .284' a Y
Scnpc
:rioHow Stern Auger Gallons of Crushed
Mud Rotary Limestone 3a
Other
Bottom of 000 Sand 76-5
Bottom of Heater Can 87-5
Bottom of Borehole r------
7.5"
Post-InstaUation QC(to be performed 24hrs after installation) P/D Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: f i ;30 Reading: (J.e, PPM
Depth to bottom of well(ft bTCC 91' Time: 1-92•, Reaping: n ,/� PPM
if greater than or equal to Zft less than designed alert the office Time: I _ Reading: PPM
2)Confirm grout plug reaches ground surface Time: Reading. PPM
repeat dal!),Lind%depth to grout is . Time: Reading PPM
Date Depth to Grout[ft bgsj Notes:
J 35 °

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
2.Well Construction Permit#:
N/A CERCLA site 7c.Type of disinfectant used:
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 ❑Mtmicipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0 Residential Water Supply(single) ❑ Sand Cement Grout 0 Thy Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
0 Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge eGroundwaterRemediation Portland Cement
3 5��0-1 S
❑Aquifer Storage and Recovery 0 Salinity Barrier — a
❑Aquifer Test ❑Stormwater Drainage _
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑T'acer Tremie grout
❑Geothermal(Heating/Cooling Return) NMather(explain under 7g)
4.Date well(s)abandoned: (' 1 1 -) / I
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494 5 � `t c�+e -
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546 �z G4�y' •-)- I - 2 H
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 By signing this form, I hereby certif.,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:
34.741400 N 77.366600 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 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#: t-f C-0 5 A abandonment to the following:
/ Division of Water Resources,Information Processing Unit,
6b.Total well depth: 5). 5 + 3 (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: (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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

} a Revision#: 0
3 ,,;*,.,. TERRATHERM ISTD Heater Boring Construction Detail
Release date:_5/12/23_
1 Approved by: SL_
L
r
e Well ID HC-05A
Date 6-p -�,�
Oversight ,� .. n��/1 Job# R23-104
J
i •
Driller L A-eih k1 /IZ l /0 /
(/ Constructed
(fill out if
Design different) Notes
-Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? 11111.16 Ground(in) 2.5'/ a i//
Thermocouple Length 57.17'
-Length of VEW Stick•Up lb)/
Hecht of Riser Slick-Up Above /r7
Ground(in) 0.5'/6"
Ground Surface 0.0'
Heater Con Conductive HT Grout--
Angle from Horizontal 78*
Schedule 80
Borehole Diameter 7"
Top of#00 Sand 1'
•
Top of Screen 3'
Heater Can Length 60 ft 5 Gol Buckets of Graphite 0.5
Heater Can Diameter 3 in Bags of Silica 0.75
Screen Length 10 ft Bags of Cement 2.75
Riser Length 4.5 ft
Screen Diameter 1 in
Bottom of Screen 13'
Installation Method
Direct Push Bogs of 1100 Sand 19 *_
��oni�
Nollow Stem Auger Gallons of Crushed
Mud Rotary Limestone 19
Other:
Bottom of#00 Sand S0.5'
Bottom of Heater Con 57.5'
Bottom of Borehole 57.5'
Post-Installation QC(to be performed 24hrs after Installation) PID Log:Make/Model:
1 1)Confirm well Is free of grout Design Constructed Time i 1;Q •'�(tf t Readin• PPM
Depth to bottom of well)ft bTOC ___ Time: C{( '3 �/1_._ _,Readin•: ), PPM
iif greater than or equal to I ft less than designed alert the office Time://) r t7 yA ,.` _Reading: ) PPM
2)Confirm grout plug reaches ground surface Time:`tt, 33C /�y-` Readin: f�rr PPM
repeat daily until depth to grout is Oft. Time:9C;en Reading: o PPM
Date Depth to Grout Ift bgs) Notes:
4
e
(
t
•-...r y

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
N/A CERCLA site
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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
0 Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
:Aquifer Recharge UGroundwaterRemediation Portland Cement _ 3 J 3 Q(/Ct./1 5
❑Aquifer Storage and Recovery OSalinity Barrier
❑Aquifer Test ❑Stormwater Drainage _
❑Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracec Tremie grout
❑Geothermal(Heating/Cooling/Return) &Othher(explain under 7g)
•4.Date well(s)abandoned: - I q 1-a /
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494 5 `1'
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 285467" �Z�� _ - Z y
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 By signing this form, I hereby certrfv 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:
34.741400 N 77.366600 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 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#: C— y (f abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:--1L 5 , 36 4 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: (lo) 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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft,) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
address(m)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
6E 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

r
TERRATHERM ISTD Heater Boring Construction Detail Revision#: 1
Release date:_6/14/23_
Approved by:
Well ID HC-04Et '" i:a
Date ... )Z t a �i
Oversight `J, tB
� �( n ��� / Job# R23-104
Driller c r n0 t\1,- 1 /i Z?L'7osCel'.
Constructed
(fill out if
Design different) Notes
—Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? Ground(in) 5'/30"
Thermocouple Length 77.29'
-Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) 1.5'/6"
Ground Surface 0.0'
Heater Can Conductive HT Grout—
Schedule 80 •• gle from Horizontal 22°
r. Borehole Diameter 7"
Top of#00 Sand 21.5'- Top of Screen 26.5' Li t
Heater Can Length 81.5 ftve
5 Gol Buckets of Graphite 2.5
Heater Can Diameter 3 in M Bags of Silica 3.5
Screen Length j4) ` ' ' ft 1. Bags of Cement 11
Riser Length 29 ft N -
Screen Diameter 1 in Bottom of Screen 34.5' 3/„°(a)
installation Method W
Direct Push Bogs of#OOSand 15
Sonic
Hollow Stem Auger Gallons of Crushed
Mud Rotary Limestone 15
Other:
Bottom of#00 Sand 61.5'
Bottom of Heater Can 76.5'
Bottom of Borehole 76.5'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: q;, G
Depth to bottom of well[ft blOC Ri 5' ct'7� Reading: Q, PPM
Time: /0 2QA ,, Reading: Q PPM
if greater than or equal to Ift less than designed alert the office Time: yyy
14j0�� Reading: d 7 PPM
Time:2)Confirm grout plug reaches ground surface I lrx.._ Reading: Q ,a PPM
repeat daily until depth to grout is Oft. Time: `
Date Depth to Grout[ft bgsj Notes: Reading: 0 ,� PPM

• WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal-)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
7c Type of disinfectant used:
2.Well Construction Permit#:
N/A CERCLA site
List all applicable well construction permits(i.e.UIC,County,State.Variance,etc.)if knovm
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) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout ❑ Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge RIGroundwaterRemediation Portland Cement _ a 5 5m./Jo/t 5-
:Aquifer Storage and Recovery 0 Salinity Barrier
DAquifer Test ❑Stormwater Drainage
❑Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
0 Geothermal(Closed Loop) ❑Tracer Tremie grout
❑Geothermal(Heating/Coolingg/Return) U770thher(explain under 7g)
4.Date well(s)abandoned: h.- f 1-d /
5a Well location:
ABC One Hour Cleaner,Superfund Site N C D024644494 S qa '2 ,t
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546 ,,y2_��—, -)_ f- 21
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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 with the same construction/abandonment,you can submit one form.
(' t/ 10a. For All Wells: Submit this form within 30 days of completion of well
6a Well BO: � v--0 / Q abandonment to the following:
/ Division of Water Resources,Information Processing Unit,
6b.Total well depth: Cc t /Y (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
lOb.For Iniection Wells: in addition to sending the form to the address in 10a
6c.Borehole diameter: lip,) 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 Resources,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 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

•
TERRATHERM ISTD Heater Boring Construction Detail Revision#:_0
c _x Release date:_5/12/23_
Approved by:_SL
,-N Well ID HC-04D Date CCj — 3
..._
,l R
Oversight J: SS 0,\A l\PI Job# R23-104
Driller L r� I�,t / ! iti,,,2,Ae iy
Constructed
(fill out if
Design different) Notes
—Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? Ground(in) 2.5'/30"
Thermocouple Length 61.75' Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) 0.5','6"
Ground Surface 0.0'
Heater Can Conductive HT Grout— P
ill Angle from Horizontal 66"
Schedule 80
Borehole Diameter 7'
Top of#00 Sand 2'
Top of Screen 4'—
Heater Can Length 64 ft 5 Gal Buckets of Graphite 0.75 1
Heater Can Diameter 3 in - Bags of Silica i
Screen Length 10 ft — Bags of Cement 3 3
Riser Length alg ft
Screen Diameter in Bottom of Screen 14 1 Li
Installation Method
Direct Push Bogs of#00 Sand 26.5 (1
Hollow Stem Auger ii Gallons of Crushed .�
Mud Rotary Limestone 26.5 S J tom,f- s
Other:
Bottom of#00 Sand 54.5'
Bottom of Heater Can 62'
Bottom of Borehole 62' (J
Post-Installation QC(to be performed 24hrs after installation) PID Lou:Make/Model:
1)Confirm well is free of grout Design Constructed Time: /0`0 0 6--2„ Reading: ©,p g PPM
Depth to bottom of well[ft bTOC 64_S' Time: ( • )i Reading: ,,Q PPM
if greater than or equal to Ift less than designed alert the office Time: 10 K G Reading: 670 4,PPM
2)Confirm grout plug reaches ground surface Time: V.•, e 0 Reading: , LPPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs) Notes: `
Cob a . .e,r. to-15 Lt 7.F-
b,Z.sCA-.P.z

R 5
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
N/A CERCLA site _
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 ❑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) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: If.For each material selected above,provide amount of materials used:
❑Aquifer Recharge RIGroundwaterRemediation Portland Cement _ 30 54-lle7A 5
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) i0ther(explain under 7g) T re m i e grout
4.Date well(s)abandoned: G 1 1-a /
5a.Well location: ,U U L
ABC One Hour Cleaner,Superfund Site NC D024644494 5 �c 11 e
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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 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#: P IC—O c f( abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth:-.)�' t (ft.)
1617 Mail Service Center,Raleigh,NC 27699-1617
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 this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: (ft,) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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

r •
• TERRATHERM ISTD Heater Boring Construction Detail Revision#:_0
°C'""`'` Release date:_5/12/23_
146 lc/ o/ I.L / Approved by: SL
V --r Well ID HC-04C I,(4_,, Ii�i�'S �'' �/ e Date '7 - 3 1 j �,� 3
Oversight C--0a�o
�� ���/ Job# R23-104
Driller C - t—ZL»iL4.,i-c �!/"`,i>"�61r/y
j Constructed
(fill out if
Design different) Notes
—Length of Can Stick-Up(ft)/
Height of Can Stick-up Above
1/2"Thermocouple pipe? Ground(in) 3'/_,0"
Thermocouple Length -Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) 0.S'/6"
Ground Surface 0.0'
Heater Can Conductive HT Grout— Ili �
Angle from Horizontal 48''
Schedule�0 ,
Borehole Diameter ! 7"
=15 (—
``i
Top of#00 Sand 2'
Top of Screen 4'
1 l
Heater Can Length 79 ft = 5 Gal Buckets of Graphite 0.75
Heater Can Diameter 3 in = Bags of Silica 1
"� __Screen Length ) m ft _ Bags of Cement 3.5
Riser Length — 5 ' ft = /*E t
Screen Diameter 1 in Bottom of Screen /
iq
Installation Method
Direct Push Bags of#00 Sand 33
I
Hollow Stem Auger Gallons of Crushed
Mud Rotary Limestone 33
Other:
Bottom of#00 Sand 67.5'
Bottom of Heater Can 76'
Bottom of Borehole 76',
Post-Installation QC(to be performed 24hrs after installation) PlD Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: \Z,'.Lc) Reading: . 0 PPM
Depth to bottom of well[ft bTOC 7g' Time: t ;.,4 R Reading: O.0 pPM
if greater than or equal to ift less than designed alert the office Time: 14 L@ Reading: n .0 PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes:

W t_,.L ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
N/A CERCLA site _
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 ❑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 ❑ Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge UGroundwaterRemediation Portland Cement
❑Aquifer Storage and Recovery :Salinity Barrier — J //� 5❑Aquifer Test ❑Stormwater Drainage
❑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) Tremie grout
i 20"
4.Date well(s)abandoned: (-
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494 4 "c�'
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 2854b` -y�
-1-1-z
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 B signing thisform, I herebycerti that the wells was (were) abandoned in
Y Sn S h' O
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:
34.741400 N 77.366600 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.
J 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: /7 C- C.)`1 8 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 5 .$ *" c))-5 (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: (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (IL) 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): (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

I .
TERRATHERM ISTD Heater BoringConstruction ct on Detail Revision#: p
Release date:_5/12/23_
Approved by: SL_
Well ID HC-04B q
Date 7-'' l — .23
Oversight 7 ��y //
/ . Job# R23-104
Driller G/ ir. e 4 klt/ji- fa /- / Y
Constructed
(fill out if
Design different) Notes
t~ —Length of Can Stick-Up(ft)/ _
Height of Can Stick-up Above
1/2"Thermocouple pipe? Ground(in) 3.5'/30"
Thermocouple Length 87,67 i a
il)
-Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground(in) 1'/6"
Ground Surface 0.0'
Heater Can Conductive HT Grout—
Angle from Horizontal 35°
Schedule 80
Borehole Diameter 7,,
2
Top of#00 Sand 3'
Top of Screen 5'
E.
Heater Can Length 91 ft = 5 Gal Buckets of Graphite 1
Heater Can Diameter 3 in a
Bags of Silica 1.5
Screen Length 17.5 ft N. Bags of Cement 4.5
Riser Length 7 ft _-
Screen Diameter 1 in Bottom of Screen 22.5'
Installation Method
Direct Push
Sonic Bogs of#00 Sand 28
Hollow Stem Auger
Mud Rotary Gallons of Crushed
Other:
Limestone 28
Bottom of#00 Sand 76.5'
Bottom of Heater Can 87.5'
Bottom of Borehole 87.5' �;' 7,
Post-Installation QC(to be performed 24hrs after installation) (>
1)Confirm well is free of grout Design PID Log:Make/Model:
1)C f bottom of free
[ft ign Constructed Time: ; ?O leading:g: ���
Time: Reading: /f r PPM
if greater than or equal to 1ft less than designed alert the office Time: �t
2)Confirm grout plug reaches ground surface )( Reading: / , PPM
Time: a r� Beading: s PPM
repeat daily until depth to grout is Oft.
Time: heading: PPM
Date Depth to Grout[ft bgsj
Notes:

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
2.Well Construction Permit#:
N/A CERCLA site 7c.Type of disinfectant used:
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)Ifbwwn
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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout ❑ Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above.,provide amount of materials used:
:Aquifer Recharge •GroundwaterRemediation Portland Cement 3.0 5, $.
❑Aquifer Storage and Recovery 0 Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage _
❑Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) *Other(explain under 7g) Treime grout
4.Date well(s)abandoned: t - ' 1 //
5a Well location:
a
S Z rL «c N rc
ABC One Hour Cleaner,Superfund Site NC D024644494 /(
Facility/Owner Name Facility ID#(if applicable) 8.Certification: �'
2127 Lejeune Blvd, Jacksonville NC, 28546 'Z 41 !✓ (-1 `1.— / —,7•(
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818
By signing this form, I hereby certify that the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with ISA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
56.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:
34.741400 N 77.366600 `,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)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#: hi' 3.2 abandonment to the following:
( + t Division of Water Resources,Information Processing Unit,
C
6b.Total well depth: J �� (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: (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) IOc.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): ( ) abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016

SIW Boring Construction Detail Revision#:_0
TERRATHERM Release date:_5/12/23_
Approved by: SL
Well ID H-32 Date F- 2(0 y '
Oversight ' / lob# R23-104
1
Driller l.>= Design Constructed Notes
(fill out if
different)
1/2" pipe?Thermocouple 4_
P
Thermocouple Length 58.67' ---Heater Stick Up Height 30"
--SIW Stick Up Height 18"
Ground Surface 0.0'
Conductive HT Grout r Angle from Horizontal 90°
Heater Can
Schedule 80
Heater Can Length 59.5' Borehole Diameter 7"
Heater Can Diameter 3'
v
4 Gal Buckets of Graphite 2.25 )
SIW =;
Riser Length 51.5 ft Bags of Silica 3 _
Screen Length 2 ft
Screen Material Bags of Cement 10
Stainless Steel F 4,
Fiberglass Top of#00 Sand 30' _
Other:
SIW Slot Size 10 Bags of Sand 7.5 = i
Screen Diameter 1"
Gallons of Limestone 7-5
Installation Method
Sonic Top of Screen 50'
0
Direct Push
Hollow Stem Auger
Mud Rotary
Other: Bottom of Screen 52'
Bottom of#00 Sand 54'
Conductive High Temp Grout-- -
Bottom of Borehole 57'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make(Model:
1)Confirm well is free of grout Design Constructed Time: j Reading: 0. PPM
Depth to bottom of well[ft bTOC]: 59 5' Time: Reading: PPM
if greater than or equal to Ift less than designed alert the office Time: Reading: PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs) Notes:

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining I.well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
2.Well Construction Permit#:
N/A CERCLA site 7c.Type of disinfectant used:_
List all applicable styli construction permits(i.e.UIC,County,State,Variance,etc.)i(fbtown
7d.Amount of disinfectant used:_
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
['Agricultural ❑Municipal/Publi.c 0 Neat Cement Grout 0 Bentonite Chips or Pellets
0 Geothermal(Heating/Cooling Supply) [Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge 11GroundwaterRemediation Portland Cement 5 0 Aquifer Storage and Recovery ❑Salinity Barrier I t4 J10,4
❑Aquifer Test ❑Stormwater Drainage
['Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer Tremie grout
0 Geothermal(Heating/Cooling Return) Other(explain under 7g)
4.Date well(s)abandoned:
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494 � a`�'Q
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546� �Z�� -�-a-a 41
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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:
(if well field,one lat./long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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 with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
2
6a.Well ID#• - J C abandonment to the following:
3 Division of Water Resources,Information Processing Unit,
6b.Total well depth: to (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: (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Supply&Injection Wells: In addition to sending the form to the
addresses)above,also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
6E 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

TERRATHERM
ISTD Heater Boring Construction Detail Revision#: 0
�.c�r.��o Release date: 5/12/23
Approved by: SL
Well ID H-36 Date 7T q-(Z'
Oversight l9 � � Job# R23-104
/
•
Drillerr Ja/S� !/" •(/ViAL r1`/
Constructed
(fill out if
D:sign different) Notes
--Stick Up Height
1/2"Thermocouple pipe? 24' 4,:a•5
Thermocouple Length 37.67'
Ground Surface 0.0'
Heater Can Conductive HT Grout— Angle from Horizontal '30'
Schedule 40
Borehole Diameter 6" (t'
Heater Can Length 38 ft f
gt � 5 Gal Buckets of Graphite 1.75 i
Bags of Silica
Heater Can Diameter 3 in
Bags of Cement 8.25 If
}
Installation Method
Direct Push {` •
Sonic
Hollow Stem Auger
Mud Rotary •
Other:
Bottom of Heater Can 36'
•
tI. ,
Bottom of Borehole 36' ��I
Post-Installation QC(to be performed 24hrs after installation) PlD Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: 7 ry,CJ Reading: ®' - PPM
Depth to bottom of well[ft bTOC 111' Time: ,•' Reading: CP PPM
if greater than or equal to Ift less than designed alert the office Time: g/ Reading: 9r PPM
2)Confirm grout plug reaches ground surface Time: j ! 3© Reading: ® PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes: ye/essow_l1ot„,

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: N/A CERCLA site
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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) CO Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
0 Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge eGroundwaterRemediation Portland Cement 7 c, c�iJOn S
❑Aquifer Storage and Recovery ❑Salinity Barrier J
❑Aquifer Test ❑Stormwater Drainage _
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) tliOther(explain under 7g) Tremie grout ; 9
4.Date well(s)abandoned: t._20 Z,`!✓ �;U ' t r
5a.Well location: .:l:; '•y'
ABC One Hour Cleaner,Superfund Site NC D024644494 5 e "`�'e L. t='
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546=�-�.
� � � 7-z-zY
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818
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 1C.0200 Well Construction Standards
56.Latitude and longitude in and that a copy of this record has been provided to the well owner.
>;? degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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 with the same construction/abandonment,you can submit one form.
10a. For All Wells: Submit this form within 30 days of completion of well
m 6a.Well # -
abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: S (ft-) Division
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: (in.) above, also submit one copy of this tbrm within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (n) 1Oc.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

. quip 1t.KiAiHct:I1M 131 u neater Boring Construction Detail Revision#: 0
Qw,cr ,,•,pr,,
Release date: 5/12/23
'' Approved by: SL elk, well ID H-1
Date .--7 -- a0 ` ..Q3
Oversight tit ..6v(�, I
�" J /1 j) / Job# R23-104
Driller P... ri A- `4.,e+e+b1e,.
Constructed
(fill out if
—Stick Up Height Design different) Notes
1/2"Thermocouple pipe?
Thermocouple Length 58.67' 24p
Ground Surface 0.0'
Heater Conductive HT Grout— .
•ogle from HorizoiKnl 90*
Schedule 40
Borehole Diameter
PV
Heater Can Length 59 ft 5 Gal Buckets of Graphite 3 ,
II
(:.
� Bags of Silica 4 aHeater Can Diameter in
Bags of Cement _ 13 / /
0
Installation Method
Dire Push
dap
. ow Stem Auger
Mud Rotary
Other:
Bottom of Heater Con 57'
r
Bottom of Borehole 57'
Post-Installation QC(to be performed 24hrs after installation) PID tog:Make/Model:
1)Confirm well is free of grout Design Constructed Time: )3 i e _- Reading: Q.*g PPM
Depth to bottom of well[ft bTOC SIT Time: t y i Reading: 0 . PPM
if greater than or equal to lit less than designed alert the office Time:
151611 Reading 0 PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgsj Notes:

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: N/A CERCLA site
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)((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
0 Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: If.For each material selected above,provide amount of materials used:
❑Aquifer Recharge FIGroundwaterRemediation Portland Cement a gck//Qn S
❑Aquifer Storage and Recovery 0 Salinity Barrier —
❑Aquifer Test ❑Stormwater Drainage
0 Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) "'Other(explain under 7g) Tremie grout
4.Date well(s)abandoned: G- I r! /
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494
Facility/Owner Name Facility ID#(if applicable) 8.Certification: T
2127 Lejeune Blvd, Jacksonville NC, 28546 _ Z
Physical Address,City,and Zip �� � � _/-Z ys ty. Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818
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:
(if well field,one lat./long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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 with the same construction/abandonment,you can submit one form.
M 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: /,' — � 5 abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: 3 C (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: Om) 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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (g,) 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): (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

Multi-Phase Extraction Well Revision#: 0
TERRATHERM Release date:_5/12/23_
Construction Detail
Approved by: SL
Well ID M-15 ` Date
Oversight V Job# R23-104
Driller
Design Constructed Notes
(fill out if
Well Diameter 4" different)
Borehole Diameter 8" Stick Up Height 36"
Ground Surface 0.0'
HT Grout
Angle from Horizontal 90°
Top of#00 Sand 1'
Casing Material
Carbon Steel — Top of Screen 3'
Other:
Riser Length 6 ft
Screen Length 27 ft Bags of#00 Sand 18.25
Bags of Cement 1.25
Bags of Silica 0.5
—
Screen Material
Stainless Steel - Borehole Diameter 8"
Fiberglass
PVC
Other: —�
Slot Size 10 Bottom of Sand 30'
Bottom of Screen 30'
1• atlo Method
oni HT Grout—
Hollow Stem Auger Sump Length 2'
Mud Rotary
Other: Bottom of Sump 32'
Bottom of Borehole 32'
Post-Installation QC(to be performed 24hrs after installation) P!D Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: 1 1,p Reading: O_ 5' PPM
Depth to bottom of well[ft bTOC]: 35' Time: Reading: PPM
if greater than or equal to lit less than designed alert the office Time: Reading: PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat doily until depth to grout is Oft bgs Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes:

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: N/A CERCLA site
List all applicable well construction permits(i.e.UIC,County,State.Variance,etc.)if blown
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
0 Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: If.For each material selected above,provide amount of materials used:
❑Aquifer Recharge •GrotmdwaterRemediation Portland Cement �//04 S
❑Aquifer Storage and Recovery 0 Salinity Barrier — 5
❑Aquifer Test ❑Stormwater Drainage _
❑Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer
❑Geothermal(Heating/Cooling Return) MOther(explain under 7g) Tremie grout
4.Date well(s)abandoned: C - 90 y
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494 5 � �`
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546- � � _Z_2 Y
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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 1C.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:
34.741400 N 77.366600 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(SI 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.
` Z 10a. For All Wells: Submit this form within 30 days of completion of well
— 3 6a.Well ID#• V� abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: y / r 3 (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: (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft,) 10c.For Water Sunplv&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

VEIN Boring Construction Detail Revision#:_1
4110 TERRATHERM Release date:_6/27/23_
ac --=wY C.,,aa.v
Approved by: EH
Well ID V-3 Date -"R - Z
Oversight ?rtLLLtPs Job# R23-104
Driller C }•yZ A r'-L c. -: / f/,a.)- 1 '�
Constructed
(fill out if
Design different) Notes
T
-- `k
—VEW Stick-Up Height 18" 5 2
Ground Surface 0.0'
Conductive HTGrout—
• gle from Horizontal 22° a, -
Borehole Diameter 6" 6"
Top of#00 Sand 13.5'
l Top of Screen 26.5'
a
5 Gal Buckets of Graphite 1
Riser Length _ Bags of Silica —
Screen Length ft
— Screen Diamter 1 in - Bags of Cement 4
Bags of#00 Sand 9.5 _ 1
Installation Method - Gallons of Limestone 9.5 ti.<A/4..1
Direct Push idopp
-o ow Stem Auger
Mud Rotary
Other: -
_ Bottom of Sand and Screen 41.5'
rr'' ' rl
Bottom of Borehole 41.5'
1l
Post-Installation QC(to be performed 24hrs after installation) P►D Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: 7;OU Reading: 0 , �8) PPM
Depth to bottom of well[ft bTOC 43 ft Time: 5f:c5 Reading: PPM
if greater than or equal to 1ft less than designed alert the office Time: q ;S'7 Reading: (9, PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes: d_ e (vet/
J

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
2.Well Construction Permit#:
N/A CERCLA site lc.Type of disinfectant used:
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):
0 Agricultural ❑Municipal/Public 0 Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
0 Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑Bentonite Slurry 0 Other(explain under 7g)
0 Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge INGrotmdwaterRemediation Portland Cement 5jy l/�
0 Aquifer Storage and Recovery ❑Salinity Barrier — J
0 Aquifer Test ❑Stormwater Drainage _
❑Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) $Other(explain under 7g) Tremie grout .
4.Date well(s)abandoned: G a 0- y
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494 5 4 �G 2
Facility/Owner Name Facility ID#(if applicable) 8.Certification: ��.•�/// /
2127 Lejeune Blvd, Jacksonville NC, 28546�� , --?-d _d y
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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 MC V — a abandonment to the following:
6b.Total well depth: V
t/
,,.]] Division of Water Resources,Information Processing Unit,
(ft-) Division
Mail Service Center,Raleigh,NC 27699-1617
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 this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: (ft.) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (g,) IOc.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

A TERRATHERM VEW Boring Construction Detail Revision 4: 1
Release date:_6/27/23_
Approved by: EH
9 Well ID V-2
Date _ �:III - Z
Oversight '\' kitu_Ies
lob# R23-104
Driller --. k-'`LRJtLI.I - b
Constructed
(fill out If
Design different) Notes
i
I---VEW Stick-Up Height 18" Zf.{ LLt
Ground Surface 0.0. j
T
Conductive HT Grout— /
i
Angle from Horizontal 22*
Borehole Diameter 6"
Top of#00 Sand 13.5' 1
I
Top of Screen 26.5' r
1
\ 5 Gal Buckets of Graphite 1
Rise- eigrti ci ft _ Bogs of Silica 1.25 i`E
S:ee- _ems^ 15tt
S:reer Diatnte- 1 in = Bags of Cement 4
Er Bags of#00 Sand 9.5 k t, tj
en Method 1
Gallons of Limestone 9.5 Z
D rE^;J5,-
_ mac'''
nohow Ste"'Alger
3
MJc Ftota'ti a
Cr e r m
M , 1
Bottom of Sand and Screen 41.5'
aw
Bottom of Borehole 41.5' hi '--1
Post-installation QC(to be performed 2Ahrs after Installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: 1•.Go Reading: O.Q PPM
Depth to bottom of well jft PTO( 43h Time: 1..` Reading DT?
Time: ;QQ
0•
if greater than or equal to 1ft less than designed alert the office Reading: O. PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat doily until depth Co grout is Time: Reading: PPM
Date �r tr:to Grout jft c>i Notes: l.t{-itit J J - -,g -Z_3
SR-'( PPM
Ad3 Lk.

—,#
WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: N/A CERCLA site
List all applicable well construction permits(i.e.UIC,County,State,Variance,etc.)ifbiown
7d.Amount of disinfectant used:_
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural OMunicipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Thy Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout 0 Drill Cuttings
Irrigation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: ❑Bentonite Slimy 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
El Aquifer Recharge •Groundwater Remediation Portland Cement
/�n
❑Aquifer Storage and Recovery ❑Salinity Bather
❑Aquifer Test ❑Stormwater Drainage
El Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandon pent procedure:, ---�
OGeothermal(Closed Loop) ❑Tracer Tremie grout `Saw';.••e`•
❑Geothermal(Heating/Cooling Return) •Other(explain under 7g) AUGA r G ( O A
`t
4.Date well(s)abandoned: —
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC D024644494 4a c e
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28540 - �Z� 7-0)_
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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#• )
— 1 abandonment to the following:
11 Division of Water Resources,Information Processing Unit,
6b.Total well depth:`it (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 (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft) 10c.For Water Sunnlv&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

• TERRATHERM VEIN Boring Construction Detail Revision#:_1
Release date:_6/27/23_
Approved by: EH
4 Wet ID V-1 Date n•f• 2 3
Oversight R tk VA-('6 Job IS R23-104
Driller C • rZ f1JV- -�L . 10, iv ,. y —
Constructed
(fill out if
Design different) Notes
---VEW Stick-Up Height 18" w Lt
Ground Surface 0.0'
Conductive HT Grout—
Angle from Horizontal 22°
Borehole Diameter 6"
Top ofP00 Sand 13.5'
Top of Screen 26.5'
` 5 Gal Buckets of Graphite 1
Riser Length a$q ft - Bogs of Silica 1.25
IDScreen Length 15 ft
Screen Diamter 1 in = Bags of Cement 4
El
ra
Bogs of P00 Sand 9.5
installation Method = Gallons of Limestone 9.5 .) ..�..,..-a 5
`:e:P.sh
tioliow Stem Auger
Muc Rotary
Other.
w.
ff-
Bottom of Sand and Screen 41.5'
k
Bottom of Borehole 41.5'
Post-installation QC(to be performed 24hrs after Installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: 6\_i i) Reading: p,,- PPM
Depth Lc,bottom of well)ft bTOC 43 ft Time: \O.4 0 Reading: 0, C) PPM
if greater than or equal to lit less than designed alert the office Time: \\'. '.6 Reading: 1 .C' PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
•repeat daily until depth to grout is Oft. Time: Reading: PPM
.Date Deuen to Grout(ft bg.) Notes:' 1$t C . c. J —1•7-23
-V N t, L-1 a it-A -4-ScitS T'
3b". S-rsk..� vZ.

• WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: N/A CERCLA site
List all applicable well construction permits(i.e.UJC,County,State,Variance,etc.)if lawny!
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 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge •GroundwaterRemediation Portland Cement c. X j-,il/oa5
❑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
OGeothermal(Heating/Cooling Return) IDOther(explain under 7g) Tre m i e grout
4.Date well(s)abandoned: G ' I g -a? ! AU6 ! r''
Sa Well location: 7 2024
N C D024644494 5" �tfR`�'e d
ABC One Hour Cleaner,Superfund Site Ir,`;.:FAA: '."' 7"".'314'.:t Ua�'
Facility/Owner Name Facility ID#(if applicable) 8.Certification: [,~i,i..3':-,j
2127 Lejeune Blvd, Jacksonville NC, 28546 ,Z���� 7—3-?
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 `,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)if available.For multiple injection or non-water supply wells
ONLY with the same cons n/abandonment,you can submit one form.
10a. For All Wells: Submit this font. within 30 days of completion of well
6a.Well ID#• 5, l c\\ fj-C (// abandonment to the following:
C, Division of Water Resources,Information Processing Unit,
6b.Total well depth: . 5 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: Om) 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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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

} = SIW Boring ConstructionDetail Revision k:_0
two TERRATHERM Release date:_04/02/24_
Approved by:_DS/EH
Well ID S-1(SB-04) Date 4/2/2024
Oversight Danny Saak Job II R23-104
Driller Spencer Williams Design Constructed Notes
(fill out if
different)
SIW Stick Up Height 18"
Cover Surface 1.0'
Ground Surface 0.0' 1
Grout
Borehole Diameter 6"
SIW
Riser 1"CS
Riser Length 55.5 ft Bags of Cement 14.50 14.5
Screen Length 2 ft
Screen Material SS Bags of Silica 4.75 4.75
SIW Slot Size 10
Screen Diameter 2" Bags of Sand 2.0 2
Installation Method
Sonic
Direct Push
Hollow Stem Auger
Mud Rotary
Other: Top of 1100 Sand 51 51
Top of Screen 53 53
_ _ Bottom of#00 Sand 55 55
and Screen
—
Bottom of Borehole 55 55
Post-Installation QC(to be performed 24hrs after installation) MD Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: Readin : PPM
Depth to bottom of well[ft bTOC]: Si S Time: Reading: PPM
if greater than or equal to Ift less than designed alert the office Time: Reading: PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes:

•
. WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: N/A CERCLA site
List all applicable well construction permits(i.e.U/C,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 ❑Neat Cement Grout 0 Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑ Bentonite Slurry 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge SGroundwaterRemediation Portland Cement S /2 5cAl
0 Aquifer Storage and Recovery ❑Salinity Bather
0 Aquifer Test ❑Stormwater Drainage
❑Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) &Other(explain under 7g) Trem i e grout
4.Date well(s)abandoned: ( -I 5 - l /
5a.Well location: j:x.
ABC One Hour Cleaner,Superfund Site NC D024644494
Facility/Owner Name Facility 1D#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546 �� 7-3-a y
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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 with the same construction/abandonment,me ou can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: S(-9CS g-OL� abandonment to the following:
< Division of Water Resources,Information Processing Unit,
6b.Total well depth: S J (ft-) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Inflection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: (lo,) 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: (g,) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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
6E 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

4,
• SIW Boring Construction Detail Revision#:_0
lug TERRATHERM Release date:_04/02/24_
Approved by:_DS/EH_
Well ID 5-2(5B-06) Date 4/2/2024
Oversight Danny Saak Job# R23-104
Driller Spencer Williamc Design Constructed Notes
(fill out if
different)
SIW Stick Up Height 18"
Cover Surface 1.0'
Ground Surface 0.0'
Grout--------
Borehole Diameter 6"
S1W
Riser 1"CS
Riser Length 55.5 ft Bags of Cement 14.50 14.5
Screen Length 2 ft
Screen Material SS _ Bags of Silica 4.75 4.75
SIW Slot Size 10
Screen Diameter 2" Bags of Sand 2.0 2
Installation Method
Sonic
Direct Push
Hollow Stem Auger
Mud Rotary
Other: Top of#00 Sand 51 51
Top of Screen 53 53
Bottom of#00 Sand 55 55
and Screen
Bottom of Borehole 55 55
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: Reading: PPM
Depth to bottom of well[ft bTOC]: 57 5 Time: Reading: PPM
if greater than or equal to Ift less than designed alert the office Time: Reading: PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes:

A'
`WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 72.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
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gaL)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name
7c.Type of disinfectant used:
2.Well Construction Permit#:
N/A CERCLA site
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 ❑Neat Cement Grout 0 Bentonite Chips or Pellets
O Geothermal(Heating/Cooling Supply) ❑Residcetial Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
0 Irrigation 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑Bentonite Slurry 0 Other(explain under 7g)
0 Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge eGrotmdwaterRemediation Portland Cement _ a ? s-
ip Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage _
O Experimental Technology 0 Subsidence Control
7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer .
Tremie grout
OGeothermal(Heating/Cooling Return) Mother(explain under 7g)
4.Date well(s)abandoned: C — ✓
5a.Well location:
ABC One Hour Cleaner,Superfund Site NC DO24644494 � R G 2
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546— �z ' -3 -a
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 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,ontin/ you can submit one form. lOa For All Wells: Submit this form within 30 days of completion of well
6a Well W# / t / abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: (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: (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft) 10c.For Water Snooty&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

140 TERRATHEPM ISTD Heater Boring Construction Detail Revision a: 0
Release date: 5/12/23
Approved� by•
,_St,
Well ID H-4 Date Z — d 1 -O 3
Oversight V t EciN h lobB R23-104
Driller Fs hors e
Constructed
Ifill out if
Design different) Notes
-Stick Up Height T r
1/2"Thermocouple pipe? - 24" s
Thermocouple length 8.67'
i
r
Ground Surface 0.0' ki
Heater
/ Conductive HT Grout- Angle from Horizontal dc'
Schedule 40
1.
1 I Borehole Diameter
•
ater Can Length AIP ft 5 Got Buckets of Graphite 3 )
.•.•s of Silica 4 e.
er Can Diameter 3
Bags of Cement 13 /,
ation Method
hush
Hollow Stern Auger
Mud Rotary
Other
Bottom of Heater Can 57'
Bottom of Borehole
Post-Installation QC(to be performed 24hrs after installation) BID log:Make/Model._
1)Confirm well is free of grout Design Constructed Time f jQ Reading O.C7 PPM
Depth to bottom of well(ft bTOC SW Time: 9; ,15- Reading. 0 . 0 PPM
if greater than or equal to lft less than designed alert the office Time: t p 3(J Reading: et . Q PPM
2)Confirm grout plug reaches ground surface Time: //. 7VS Reading: Q,Q PPM
repeat doily until depth to grout is Oft. Time. Reading: PPM
Date Depth to Grout(ft bgs) Notes:

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223-A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name p/� 7c.Type of disinfectant used:
2.Well Construction Permit#: N/A CERCLA site
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 ❑Neat Cement Grout 0 Bentonite Chips or Pellets
0 Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
❑Monitoring 0 Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge •GroundwaterRemediation Portland Cement / S •4//�.�) S
❑Aquifer Storage and Recovery ❑Salinity Barrier -
0 Aquifer Test ❑Stormwater Drainage _
0 Experimental Technology 0 Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Ter Tremie grout
❑Geothermal(Heating/Cooling Return) ,Other(explain under 7g)
4.Date well(s)abandoned: v-- I R 7
5a.Well location:
cl
ABC One Hour Cleaner,Superfund Site NC D024644494 S e 4 �G e
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546c- �Z� � 7 - 3 - Y
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 By signing this form, I hereby certify that the well(s) was(were) abandoned in
County Parcel Identification No.(PIN) accordance with/5A 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:
34.741400 N 77.366600 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 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# // abandonment to the following:
/ Division of Water Resources,Information Processing Unit,
6b.Total well depth: 3 (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 (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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

VTERRATHERM ISTD Heater Boring Construction Detail Revision#: 0
Release date: 5/12/23
Approved by: St
Well10 H-37 Date 7(2i-‘).3
Oversight 0, /A,r/Ikks' lob rl R23 104
Driller A??a A¢/-Ss
Constructed
(fill out if
Design different) Notes
Stick Up Height
1/2"Thermocouple pipe? 24
Thermocouple Length Iliti.1
Ground Surface 0.0'
jlig
Heater Can Conductive HT Grout-- f• AAngle from Horizontal 90'
Schedule 40
i
I
Borehole Diameter 6"
Heater Can Length A1P ft 5 Gal Buckcts of Graphite 1.75
I
i Bogs of Silica 2.5 a
Heater Can Diameter 3 in I
1'll Rags of Cement 8.25
1
{ 1
Installation Method
D I
ire •ush
.i•..i
ow_ Stem Auger
Mud Rotary
Other:
Bottom of Heater Con 36'
Bottom of Borehole 36'
Post-Installation QC(to be performed 24hrs after installation) PIO Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time /3 TT/� ,., Reading. CY.O PPM
Depth to bottom of well(ft bTOC RR' Time j Ni[l A Reading. Q.49 PPM
if greater than or equal to 1ft less than designed alert the office Time 15 1 a Reading: 0_ n PPM
2)Confirm grout plug reaches ground surface Time Reading. PPM
repeat daily until depth to grout is Oft. Time. Reading. PPM
Date Depth to Grout(ft bgs) Notes:

WELL ABANDONMENT RECORD For Internal Use ONLY:
1.Well Contractor information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
wells abandoned:
3223-A
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name p
2.Well Construction Permit#:
N/A CEfZCLA site
7c.Type of disinfectant used:
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 ❑ 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
❑Irrigation ❑ Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge P Groundwater Remediation Portland Cement , y a(�c,? S
❑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) ❑TraceT Tremie grout °,' ',1 _,,
❑Geothermal(Heating/Cooling Return) 1l0ther(explain under 7g)
/ AUG 2 7 ti G 2 4
4.Date well(s)abandoned: C.
5a.Well location: 4e.
/
p NC D024644494 Sew �> a
ABC One Hour Cleaner,Superfund Site
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546
Physical Address.City.and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 By signing this form, 1 hereby certify That the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with/5A 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:
34.741400 N 77.366600 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 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#: 4 1 — abandonment to the following:
Division of Water Resources. information Processing Unit,
6b.Total well depth: /` (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: (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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
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

a
I 4 � f ,
40
Multi-Phase Extraction Well Revision II: 0_
TERRATHERM Release date:_5/12/23_
Construction Detail
Approved by. St_
Well ID M-16 Date 7^o2.. ' Q3
Oversight �C+V,fA•Npc Job It R23-104
Doter rr ,O(,/'•f'G-__
Design Constructed Notes
(fill out if
Well Diameter 4" different)
Borehole Diameter KW ------Stick Up Height Atii
11, Or
Ground Surface 0.0'
HT GroutIII---
Angle from Horizontal 90'
Top of#00 Sand 1'
• 'Ve,•, . riol
Carbon Steel Top of Screen 3'
Riser Length b t
Screen Length 27 ft Bogs of#00 Sand 18 �'
Bags of Cement „2" i
---. Bags of Silica D rs
—S ial
: _
Swink s -eel _ — Borehole Diameter 8" _
Fiberglass _ _
froN PVC —.—
Other:
-
Slot Size 10 Bottom of Sand 30'
Bottom of Screen 30'
Installation Method —
(
oni HT Grout---
0 ow Stem Auger Sump Length 2'
Mud Rotary ~
Other. Bottom of Sump 32'
Bottom of Borehole
dir
Post-Installation QC(to be performed 24hrs after installation) PIO Log:Make/Model:
1)Confirm well Is free of grout Design Constructed Time: :AO Reading: 441.2 PPM
Depth to bottom of well Ift bTOCJ: 35' - _____ Time: ;{1 Reading Q•O PPM
if greater than or equal to ift less than designed alert the office Time: ki:, Reading: D 8 PPM
2)Confirm grout plug reaches ground surface Time. f i,i Gi Reading: 0, PPM
repeat daily until depth to grout is Oft bgs Time: Reading' PPM
Date Depth to Grout[ft bgsj Notes:

• WELL ABANDONMENT RECORD ForintemalUseONLY:
1.Well Contractor Information: WELL ABANDONMENT DETAILS
David Wilcox 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 GW-30 is needed. Indicate TOTAL NUMBER of
3223—A wells abandoned:
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
Cascade Drilling FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#: N/A CERCLA site
List all applicable well construction permits(i.e.UJC,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 ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) 0 Sand Cement Grout 0 Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑Drill Cuttings
❑Irrigation ❑ Specialty Grout 0 Gravel
Non-Water Supply Well: 0 Bentonite Sluny 0 Other(explain under 7g)
❑Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge eGroundwaterRemediation Portland Cement 3.3 j /rn S
:Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage _
❑Experimental Technology ❑Subsidence Control
7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer
❑Geothermal(Heating/Cooling Return) &Other(explain under 7g) Tre m e grout
4.Date well(s)abandoned: & I I 1
Sa Well location: ' S es7"Aa c 11 Q
ABC One Hour Cleaner,Superfund Site NC D024644494
Facility/Owner Name Facility ID#(if applicable) 8.Certification:
2127 Lejeune Blvd, Jacksonville NC, 28546
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
Onslow 439613047818 By signing this form, 1 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:
(if well field,one lat/long is sufficient) 9.Site diagram or additional well details:
34.741400 N 77.366600 �, 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 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#• /7 C O (IA abandonment to the following:
Division of Water Resources,Information Processing Unit,
Q
6b.Total well depth: 5 rJ 1" /3 t (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b.For Injection Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: (m,) 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 Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c.For Water Sunaly&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

I CRIZl�,F,,,.."
Y '' Release date:_5/12/23_
�
Approved by:_SL_
Well ID HC-04A Date J c•726-7'
'ght ' t.1 L47 / Job it — R23-104
Driller C—�. Pat il/i1/' J. j,,, ,�ated7
Constructed
(fill out if
Design different) Notes
—Length of Can Stick-Up(ft)/ —
Height of Can Stick-up Above
1/2"Thermocouple pipe? Ground(in) 2.5'/30"_—z2 Y
Thermocouple Length 57.17'
-Length of VEW Stick-Up(ft)/
Height of Riser Stick-Up Above
Ground Ground(in) 0.5'/6"
Ground Surface_0.0'
Heater Can Conductive HT Grout— lir w ---
'le from Horizontal 78" ,---
Schedule 80
Borehole Diameter 7"
€' "
Top of#00 Sand 1'
F.)
Top of Soren 3'Heater Can Length 60 ft r Col sud:41salGraphite 0.5 —
Hr.-`°r Can Diameter 3 in of Silica 0.75
Sct en Length 10 ft F. Bags of Cement 2.75
Riser Length 4.5 ft i'
Screen Diameter 1 in • • •• of Screen 13'
Installation Method
Direct Push • •• of#00 Sand 19
S�ic
Hoilow Stem Auger Gallons of Crushed
Mud Rotary Limestone 19
Other:
:•ttom of WO Sand 50.5' ^—
F
Bottom of Heater Can 57.5'
Bottom of Borehole 57.5' y)$',0
s
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model: Reading:—
©. PPM
1)Confirm well is free of grout Design Constructed Time: I 1! /0 PPM
Time: / r �5` C NL Reading: r r�
Depth to bottom of well[ft bTOC � � 1 � Reading: �r� PPM
Time: ; PPM
if greater than or equal to lft less than designed alert the office �' Reading:
Time: PPM
2)Confirm grout plug reaches ground surface Reading:
repeat daily until depth to grout is Oft. Time: —
Depth to Grout[ft bgs] Notes.
i