Wayne_Well Abandonment_20241001

WELL ABANDONMENT RECORD rlrintenuil Use ON1.Y
This form:an be used for single or multiple wells
1•Well(brtracmr Information: WELL.ABANDONMENT DETAILS
Rich Lemire 7a.Number of wells being abandoned: 1
Well Contractor Nana lot Nell miner pcn,iiulh abandoning well air hesrlier prapcns I Feu• mniypre nih'n?I,ur or mwu-sourer supply we'll ONLY rrrh the mute
#Nlrfll(c f11 N,4114114.A 0It111-rlr ,,,r,,,n,,Nhn1,1 1.Nn t„1,1
2593A
N('Wcll ContractorCetiMeatinil Number
7b.Approximate%chum III wAter nntaming in well(aPONE (0)
SAEDACCO FOR WATER SL PPI Y N ELLS IN l\: ^•` �•.. a x ,r '
Conway%Name 7e.Tope of disinfectant used:
2.Well Construction Peru 0 I T Z 24
Peru*
!sr ell irppha ohh'41'0 heroin&(1.1-('rear,S7nne.t iJHW[Y.hoecinllt.err..'1l blowy
7d. Nniount of disinfectant used: Jr.`,:-s,rr r
Llitlf
3.WdI use(check w el)use):
Wager Llupph Well: Ye.Scaling material.cried(cheek all that apple):
❑Agricultural ❑Mtuucipal:Plibhc ❑ Neat Cement Grout W Bentonite Chips or Pellets
❑Geothermal(Hcating/C octfing Supply i ❑Residcrliat Water Supph(single) ❑Sand('enrcta Groat ❑ Dry Clay
❑hidtistrialiCommeruial ❑Residetatal Water Supph I shared) ❑Concrete Grout ❑ Doll(lnnngs
❑Irrigation 0 Specialty Grout ❑Gras el
Ner-Water Supply Well: 0 Bentonite Slum' LI Other(explain under 7g)
❑Moehoring ❑Recoseh
Nettles Wen: ' 7f.For each material:selected ahosc.pins ide amount of materials used:
❑Aquifer Recharge ❑Gmundsrater Remedtation
❑Aquifer Storage and Recovery ❑Salunn Hamer
❑Aquifer Test ❑SlommatttDrainage Bentonite.:501b ,Wtr:gal. _ BENTONITE Amount:50LBS
❑Expenntental l echnabgp ❑Substde,Ye C'utatul 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer
UCxothermal(HeatitlglCoolingRerum) �Other(explain utrder7gl PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
4.Date well(%)abandoned: 9-5-2024
Sam WcII Inc al ion:
FORMER FEDERAL OIL CO.
Factim.chance Name Facility lbw(ifapptrahtct R.Cenilkatirwr;
409 W. Vann St. Goldsboro, NC 27530 'h .�/hhwG. 9/5/2024
Pln steal Address.Cm.and Zip Signature of-.tified Well('muractnr or Well Outer Dare
WAYNE By signing liter torn., l hereby cernJ►1 thin the welics! was(were'abandoned or
Count, Nice]W.mufration No.MINI accordance with/14 MAC 0:C.0100 or 2C 0:00 Well Construction Standtmis
and that a copy of this record has been provided to the well owner.
Sit Latitude and longitude in degreciuminutesisecrmds or decimal degrees:
Orwell fc'Id,one latlori£,N Mau:sent1 9.Site diagram or additional well details:
You rams use the back of this page to pros ide additional well site details or well
N W' abandonment details. You elan'also attach additional pages if nnecessan
CONSTRUCTION DETAILS OF WELDS}BEING ABANDONED Sf'BMITTAI.INSTRUCTIONS
.1(Gxlr well eoavemonwi n¢nrd.st{7 avwluhk. I nO'multiple cJrrOarr CV'am-tidier supph•
wr•i!n'0:W-1'wall the mime o nAtre m.n uhlurlbamterut low con mnhmrl one loon 10a. For All Wells: Submit the In nit within 7O days of completion of well
6a-Well IDa:
IW-13 abandonment to the folk-mint)
Disision of Water Resources.Information Procinsing Unit.
1617 Mail Sees ice('en ter,Raleigh.N('2761)11-1617
61),'final will depth: 16.5 (R.)
lob.for lalectior Weill: In sniditiou to sending the Conn to the address w lua
reboil;diameter:2 abuse- also submit one cops of tins fort)ssithm 30 lots of completion of sseil
6r. tin.) abandonment to the following
Dhision of Water Resources,Underground Injection Control Program.
6d.Water k eI to ,Found surface: 8.8 (ft.l 1636 Mail Service('enter,Raleigh,N('27699-1636
Ilk.For Water Slain, & Ink'ctiou W'elit: In addition to sending the form to
Inc.Outer casing lcnh Id ko nj: (ft.) the address(es) abete. also submit one cops of this form within 30 days of
completion of well abandonment to the counts health department of the county
where abandoned
(if.Innercasingitubini:length if I:nnssni: (ft.)
6g.Screen length if I, n I: (MI
Form GW-3n Nonh Carolina Department of Ern ointment and Nanunt Resounds-Dis isnn of Water Resources Res KM August 20 IA

•
WELL ABANDONMENT RECORD For Internal Cie ONI.V
This form can be used for single of multiple wells
I.Well Contractor Information: W'F.LI.ABANDONMENT DETAILS
Rich Lemire 7a.Number of wells being abandoned: 1
Welt Collraclm Nana WWI w.Il to.IL!p'oo.i It i ankinng well an hrr;lai prawn%I For maw* rntecilun rw non-seater supply veils ONLY IPA the •
c'.Ns,eery(ttwl I? imhaal.Wabatis OM d fen VII1WI1?.MI✓IOl,u
2593A
71o.Appntximate lob ate of%alai remaining in w riles(NONE Igal.)
NC Well Contractor Certification Nambeh
SAEDACCO FOR WATER ER SI1PPI.Y V,FLISi O!tI l: t
ConWwl Name 7c.Ty ire of disinfectant used:
2.Wdl Caasutictlan Permit it:t r el 1 2024
Leo all appl&ahle well lwrmit (I.r.('usrYr,Sale.Iuriwwe.hvrciuin,elc.r ifbrow.,
d. %rnount of disinfectant used:
3.Well use(check well use): ,:,..a..'r:.••srrttia,>:-fit
Water Supply Well: 7e.Sealing material%used rchcrk all that apply):
❑Agricultural ❑MunicipilPublie ❑Not Cement Groot IN Bentonite Chips or Pellets
❑Geotherm l(Heangg:Cooling Supply t ❑Residential Water Supple'singlet 0 Sand('gram(smut 0 Dn Clan
❑hubs:nalr('ommercial ❑Residential Water Supply!shared) 0 Concrete Grout ❑Dnll Cuttings
❑lmgattun 0 Specialty Grout 0 Gravel
Non-Water Supply Well: ❑Bentonite Slurry. ❑Other(explain under 7g)
❑hlotutonug ❑Recover
Injection Well: 7f.For each material selected above provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Reniediation
0 Aquifer Storage and Recovers ❑Sahtun Darner
Bentonite.:501b ,Wtr:gal. BENTONITE Amount:SOLES
❑Aquifer Test ❑Stonmtater Drainage --
❑Expenmental Technology ❑Substdetre Control 7g.Pros irk a brief description of the abandonment procedure:
°Geothermal(Closed Loopt °Tracer
PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
°Geothermal(HeatingCooling Return) EOOthcr(explain under 7g)
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
4.Date wellii t abandoned: 9-5-2024
Sit.Ysrll location:
FORMER FEDERAL OIL CO.
hobod r,. .a v,nra I. :ilih IDM tifapplicabkt L'Certifiradamt
-
409 W. Vann St. Goldsboro, NC 27530 4. 9/5/2024
Pinned]Address.(in.and Zip Srwuuue of...tined Well Contractor or Well()weer Date
WAYNE lit signing this liar, 1 hereby.certify that the wanton was lwerei abandoned an
('a0151, a„i iJ;nil:_im;11 N.. TIN. accordance with 15A.'C:•IC 02C.0100 or:C 0200 Well Construction.i,ndlrmis
and that a copy of this record hay been provided to the well owner.
Sb.Latitude and longitude in dcires•s;nrinutruseeunds or decimal degrees:
Of well fell.one enamor t• r t. 9.Site diagram or additional well details:
You may use the back of this page to pros ide additional well site details or well
_.�.._..._._ W abandonment details. You may also attach wllittonal pages if necessary
(ONSl RI( I ION DEI AILS(IF 11 F:I.1.(SI BEING ABANDONED ,UBMITT.AL INSTRUCTIONS
..a.xir nail ct,RflrnJatul rrwar.l ar 17 mw,'1a'•;e. :or ma alp? SlatOIan w'rum-Bauer supply
wells ONLY with the some cumfrocruur afiaaoioaienc tam can whmtt one jam 10a. For All Wells: Stilton the Come within 7,0 days of completion of well
6a.W'ell ID/:IW-16 abandonment to the folk-ruing
Di',triton of Water Rrauarm,Information Processing Unit.
6b,Total well depth: 16.1 (ft.) 1617 Mail Sersice Center.Raleigh,NC27699-1617
tub.for Infection Web: In addition to sending the fort to the address in lila
6c Rdrnlwlc diameter:2 lin.l above. also submit one cops of this form%what 30 days of completion of well
:ihandomireru to the following
Division of Water Resources,Underground Injection Control Program.
oil,Water level helm% ground surface: 8.9 (ft.) 1636 Mail Senior('cater,Raleigh,NC 27699-1636
Irk.For Water Seoul',& Inkrtidtn Welli: In addition to sending the form to
6e.Outer casing length(if know nt: (ft.) the address(est abcne. also submit one cop) of this form within 30 days of
completion of well abandonment to the corn health department of the counts
where abandoned
of.Inner casing,,'tubinj length(if Lnuwn(: (ft.)
6g.Screen length(if knots 1: (ft.)
AMR GW-lit Noah Carolina Department of En%irnrieni and Natural Resources-DI.lston of Water Resources Res acd August ii)t s

WELL ABANDONMENT RECORD ,,,,,,a.nc,l, 'taxi�'
This form can be used for single or nn liple wells
1.Wee('oatrastnr Inhumation: N'F'LI.ARANDON61ENT DF:TAIIS
Rich Lamire 7a.Number of wells being abandoned: 1
Well Com Iciar Nang ao tall uta,.r p:naln:mlly:dm%knung'sell uo hit+ter propels!,, F,v wulnplr nite.rtwt rw rtim-wdrer supph wells ONLE rub Ilk mime
r.Nt.roH Vl, I oh nhwmrear.Ir,n tM raarNHHJI Wlr hewn
2593A
NC Well CcltamanrecniRealioa camber *
Approximate volume of water remaining in wdll.i1'O •
• I
FOR WATER SUPPLY WELLS ONLY:
a Rnacr0 followName 7c.'Is tie of disinfectant used: 0I ?024
2.Wdl Construction Pet 1 . It .'x'' a."
I to all,afrphttAir well I.r frt.n. (,mar.Starr.1 awa'rjwe brertfiun.ear. ,I krona •
-1rrd
7d. Amount of disinfectant used:_ f�+s.r.'�,.gv
3.Well use(check well use):
Water Supply well: le.Sealing materials used(check all that apple):
❑Agncnitural ❑hmtcipal:Publa ❑ Not Cement Gmtu ® Bentonite Chips or Pellets
❑(imthcrmal INconng'('aoting Suppl}I ❑Rcstderatal Water Supph 'single) El Sand('eneni Gmtht l7 Dry Clay
❑IrriustrialrComnicteial ❑Rcstdetital Water Smith.Ishared) ❑Concrete Groin 0 DnllCuttings
❑Ini)mtwn ❑ Specialty Gtuut 0 Gemmel
Non-Water Supply.Well: 0 Bentonite Slum- LI Other(explain under 7g)
❑Muuuonoe Okeco ery
Injection Well: 7f,For each material sleeted above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater kensedtatton
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test OSlonmsalerUrnnwge Bentonite.:501b ,Wtr:gal. _ BENTONITE Amount:50LBS
❑Experinten tal Technology ❑Subsidence Coiatul 7g.Provide a brief description of the abandonment procedure:
OGeotltenital(Closed Loop, LlTracer
❑Geothentmal(FieaunK+Cociline Return) PBOthcr(explain under 7g) PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
4.Date well(s)abandoned: 9-5-2024
5a.Well Inratllln:
FORMER FEDERAL OIL CO.
Facility Miner Narn Facilns ItNI of applistlfkh IL Certification:
409 W. Vann St. Goldsboro, NC 27530 'k i �..fi►tse�..t. 9/5/2024
--........O.._
Ph,seal Address.Ctn.and Ztp signature of 'Hied Well CONISCbr Pr Will Owner fare
WAYNE lit swung this form, 1 hereby cernk that the well(s)was(were,abandoned an
('auhh Pn:a Id.'nn,':r.nl;ul^.,, .Pitt accordance with 15.4.V(.i4CO2C.0100or2C.0200 We'll Construction Siamd,ards
and that a copy of this record has been provided to the well owner.
Sh,Latitude and longitude in dtgreeslminutrsrsc•csinds lie devimal degrees:
of w.tl fcld.one Lit long t..ntiwca) 9.Site diagram or additional well details:
You may use the back of this Paige to pros ide additional well site details or well
N W abandonment details. You may also attach aidnioiwl pages if necessary.
(O\sI RI( I ION DETAILS OF 1\E.I.IAS'lain\(:ABANDONED CI'RMLTTAL INSTRUCTIONS
.math wet!.u,L,7rs.J0na rl',t rd,:11 Jt uj tt k'. I',V rwldnpl:uy.a nwr war nua•wow rappty
wetly°ALI with the mwnr U.m,O.t 00$:ah4014wannu_11*can auhmN wee end. Ina. For All Wells: Sabina' this fomr within 30 days of completion of well
Well Illl:
IW-14 abandonment to ncc following6a.
Dis ision of Water Resources,Information Processing Unit.
1 16.5 1617 4Iail Service Center,Raleigh.NC 2 7699-1 6 17
lob,Tirtal well depth: (ft.)
Ittb.fur Inleedon Web: In addition to sending the form to the address w Ilia
abuse, also submit one cops of this form within 10 days of completion of well
be,Ikirrllole dlameler:2 linl
abandonment lu the following
8.75 Division of Water Resources,Underground Injection Control Program.
k od.Water yt-I below anoint surface: (ft,) 1636 Mail tier(ice('enter,Raleigh,N('27699-1636
Inc.For Water Sunnis tit lnkctitin Well;: In addition to sending the form to
6e.Outer casing length lif know n l: (ft.) the :widressl es r abuse. also submit one cops of this form within 30 days of
completion of well abandonment to the counts health depanntera of the counts
a h,rc abandoned
tf.Inner casing Lubin'length,if knn's II I: (ft.)
log.Screen length(if Lunn n I: (IL)
Fomi GW-fit North Carohin Department of Environment and Natural Resources-Dis ision of Water Resources Res wed August 2011

\ ELL ABANDONMENT RECORD For lama'Die 0141,Y
This form can be used for single or multiple hells
I.Well Contr•acmr Information: WELL ABANDONMENT DETAILS
Rich Lemire 7a.Number of i e1Ia being abandoned: 1
Weil t'oiaracior Nana art tell WA her;',rums))}abandon'tg acll on .i 'hotter r For mnlnlrk uak,tron or rem-water supjJ, ,,, ONLY trtth the same
oworrom.e,t hatdoii#rYal.urn at•tttth018'Mc F,rnt
2593A
NC Well toreador Certification Number7h.Approximate snlumr of water remaining in welltsdf0N (gild
SAEDACCO FOR WATER SUPPLY WELLS ONLY:
Colman):Name ^.' : , t ;j,
( I)Ix of diainfertant used: ,1
2.Well Construction Permit A:r , O C T d ! 2024
lw„li rNsryfhvhlr wrtl p<•rmatr ti e.Cwurfv,Starr,I arimn e• i v;r. Amartr
7d.Amount of disinfectant uxd:_
3.Well use(check w ell use): �' i Uji
Water Supply:Well: 7e.Sealingmaterials used(cheek all that a Is):
❑Agricnhural ❑Municipal:Public 0 Neat Cement(mot (X Bentonite Chips or Pellets
❑(i olhennal(Hcannr Cooling Siipply l ❑Residential Water Supph 'single) ❑ Sand C'enned Gram ❑ Dn Clay
❑hdustnall('ommcrcial ❑Residential Water Supply(shared) 0 Concrete Grout 0 Drill Cuttings
❑Irrigation 0 Spenalty Grout 0 Gras
Non-Water Supply Well: 0 Bentonite Slurry C7 Other(explain under 7g)
❑Monuonug ❑Rccuset)
Injection Well: 7f.For each material selected above,'seaside amount of materials used:
❑Aquifer Recharge ❑Groundwater Rentediatnn
❑Aquifer Stotage and Recosen ❑Salmis} Flamer
❑Aquifer Test ❑Stonmsalrr[)reiinage Bentonite.:501b ,Wtr:gal. _ BENTONITE Amount:50LBS
DExpain ettal Technology ❑Subsidence C'oiatul 7g.Prrn ide a brief description of the abanikrninetit pnwcdurc:
OGeothemal(Closed Loop) ❑Tracer
PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
OGeothemal 1Heating+Cooling Return) Ii9Other te'plain under 7g l
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
4.Date meats)abandoned: 9-5-2024
5a.11etI location:
FORMER FEDERAL OIL CO.
Ram(h t Va,n F.n l I,. It), f ippl�;n,lr. X.Certification;
7 n p
409 W. Vann St. Goldsboro, NC 27530 h V, 9/5/2024
Pits steal Address.Cry.and Zip sleiuiarc of ailed Well C'nnrracka ar Weil Omar Dare
WAYNE !3(.ogurr{g Om firm, 1 hereby certify that the trellis) was(were:abandoned in
COMA? PanciIdenirfwati tallo.tPINi aaurtlance with 15.4.kCACO2C.0100or:C.0:00WellConstruction,Ymrdatrds
and that a copy of this record has been provided to the well owner.
5h.)attitude and longitude in rkgrees+minutes!sceonds or decimal degrees:
cif well frill oat tat:long is gdna:rctai 9.Site diagram or additional nell details:
You may rise the back of this page to provide additional well site details or well
abaidonnten t details. You:may also attach additional pages if necessary.
( /NSTR1( llON DE:(Ails OF W ELI.AS!BEING ABANDONED SUBMITTAL,INSTRUCTIONS
.facade writ consi.M,nun recor f.ut j7 avad.bk. t.0 malmpte infection or nut I- supply
was ONLY'with the mower cwnrrenrion abamhtmwrru.ton can submit sure liar. 10a. For All Wells: Submit this form within 30 days of completion of well
[Dik
IW-15 abandonment to the following
6a.WeB
Division of Water Re,nroo,Information Processing L'nit.
1617)fail Service Ccntrr,Raleigh.NC 27699-1617
fib.Tout well depth: 15.3 at.)
IUb.Fur In►eetlon Wets: In addition to sending the form to the address in Ina
abuse.also submit oic copy of this form within 30 days of completion of well
6C.Borehole diameter:2 (in,) abandonment to the following:
8.21 Division of Water Resources,Underground Injection Camtnal Program.
fill.Water level bairnrrnu gnd surface: (ft.) 1636 Mail Service(Center,Raleigh.r('27699-1636
Inc.for Water Sunnis ,set Inketlon Wells: In addition to sending the fora to
no.Outercasin) leneih tit I:nuwn): the addresses) above. also submit one copy of this form within 30 days of
completion of sell abandonment to the counts health dcpannicm of the counts
where abandoned
6f.Inner c asin g!tu bin a length a i t'kn.iss H is (ft.)
6a,Screen length fit'1,1 it
Fomr GW-3o North Carohm bcpanmcm of Ensironmeni alai Natural Resources-Da cston of Water Roources Res red Angus 2I)I1

WELL ABANDONMENT RECORD Fur Internal Ilse ONLY.
'This form can be used for singk or multiple wells
I.Well Contractor Information: WELL ABANDONMENT DETAILS
Rich Lemire 7a.Number of walla being abandoned: 1
Well Contractor Name tar well uo is i p r oiialh atu,shmmng wal on MOW,puKxm i F.w m;/opfe urjeeno,, cw nun-xoter supply .. ONLY rat the sere
.rHuana the' iuphuiw.°ar t.'o mr.nhnN.•q.•M1mm
2593A
NC Well Cummd rCertificantion Hornier
7h.Approximate volume of ward.remaining in wclltsl ON husk)
SAEDACCO FOR WATER SUPPLY W'ELt ti ONLY:
Commas Name 7e,'Tvpe of disinfectant used:
2.Well Construction Perk N:r , (-)C r ti ! 2024
f ltr all opylfra whir NW!jwrmLr rte.(aunt.State.)'arrwx.-e./met-bri etc..!l$.m,wn
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Scaling materials used(cheek all that apply):
❑Aprwulturd ❑Mrmicipal;Pmihla 0 Not Cement Groot ®Bentonite Chips or Pellets
❑(kothcnred(Hca I' •Cooling Supplyt °Residential Water Supply.'singlet 0 Sand('emcnt Grout ❑Dry Clay
❑htdustrial.(lonulccresil ❑Residertial Water Supply tshared ❑COnereteGrout 0 Drill Cuttings
❑Irne:Awn 0 Specialty Grout 0 Gras el
Non-Water Supph Well: ❑Bentonite Slurry ❑Other texplain under 7g)
❑Mwatonng ❑Recover
Injection Well: 7r,For each material.elected Anse.provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remedi:nton
❑Aquifer Storage and Recovers ❑Salinity (tamer
❑AquifcrTeat ❑StonmsaterDreitwge Bentonite.:501b ,Wtr:gal. _ BENTONITE Amount:SOLES
❑Experuimental Technology ❑Stbsidenre C'ulrrul 7g.Provide i brief description of the abandonment procedure:
OGeotliennal(Closed Loop) ❑Tracer
PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
OGeotherenal(Healing/Cooling Return) llOther(explain under 7g I
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
4.Date went%)abandoned: 9-5-2024
5a.Well location:
FORMER FEDERAL OIL CO.
Faxila>'honer Nnmrc ricihi to t(if;'oi l.ahkl 8.Cetlifkeliou: �,s�
409 W. Vann St. Goldsboro, NC 27530 '� s/1�/'.�/IIMri�.ti 9/5/2024
Ph?seal Address.Cni.and Zip Signature of..:filed Wen Comrade or Welt(lobe Doe
WAYNE By signing this firm, 1 hereby certify that the+refits)was(were;abandoned in
C-,tdra, Panel Ideidificansia No.IPINI accordance with 1JA VGIC OX'.0100 or 2C.0200 tf'el/Construction,YYrnidarrls
and that a copy of this record has been provided to the well owner.
5h.latitude and lnngitutk in dcgrvo/minutes/smrnds or decimal degrees:
of ise It veld_ore tat hoe, i..nirkrciai 9.Site diagram or additional well details:
You may use the bad of this page to pros ide additional well site details or well
W' abandonment details. You may also attach additional pages if necessan.
CONSTRIIC;ION DE:TAILS OF W E1.L1st BEING ABANDONED SUBMITTAL.INSTRUCTIONS
:Math well conrtraclreo navrd;so tj multiple awa:na,or oon-Natter supply
wear ONLY with the slim cwrmvsrtwn i howinene ri.ewe can mMut cue!eon 10a. For All Wells: Submit Ihr_c form within 3() days of completion of well
ay Well D
IW-10 ab:iii dounreru In the following
Division of Water Resources.Information Processing Unit,
lob,Total well depth 15.1 (R.) 1617 Mail Service Center,Raleigh.h('27699-1617
dub.For lnhxllntn Wcllh: In addition to sending the form to the address in Ina
above_also submit one cops of thus form within 30 days of completion of well
6c.Borehole diameter:2 I In.) abandonment to the IOIIUw111L•
12.0 Dkision of Wader Resources,Underground Injection Control Program.
6d.Water level helms ground surface. (ft-1 1636 Mail Scn ice Center,Rakiph,N('27699-1636
Inc. For Water Sawn.,Ile lnketintn Atli: In addition to sending the form to
6c.Outer casing knoll III known): (ft.) the addressees) abuse. also submit one cops of this foam within 31) days of
completion of well abandonment to the counts health depannten of the county
a here abandoned
doncd
(if.Innercasing:tubing length ill'limosnt: (ft.)
leg.Screen length Of I.r m; (ft.)
Fenn GW-3n North Carolina Uepumrma of Ems rrounicnl and Namunal Rcsotaccs-lhs rslon of Water Rcaoamw.s Res wed August 21)13

WELL ABANDONMENT RECORD Fottirlern,,(-scONll'-
This form can be used for single or multiple Neils
I.Well Contractor Information: WELL ABANDONMENT DETAILS
Rich Leaden 7a.Number of wells being abandoned: 1
11'colt•I.L11L.IUIN.ii11:101 e1l'),IYI1\•!V1L111\o1E11►1011111gNal011II loerproven)) Fru• mulnl+k r,ttedrwr ur '' •I,;'r' (t.V/.) .rill il,l• .wnr
rurrwru,xI.r4nAl,gim,4,r.l.w„n, " „ "
2593A
7h.Approximate volume of water nrntaining in%%0011.4O1'1E (gal.)
NC Well Conlnclor rerlific..lhnn Nnn#icr
SAEDACCO FOR WATERSUPPI.V WELLS OhI.I: s..� �� +yr 1.1
Conpanl Name 7c.Type of disinfectant used: nr T -V` 1 �O�A
2.Wdl Construction Perdt 0:t Ji
Luis cdl app&ohlr 4.•1l permits ir.e.('uu,an'.Slat.)ar,wrre h!eriioe,etc.,it know
7d.,amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(cheek all that apply):
❑Agricultural OMunicipal.:Public ❑ Neat Cement Grout NI Bentonite Chips or Pellets
O(ieathcnnal(Hearing('oohng Su pplvi ❑Residential Water Supply(single) ❑ Sand Colloid°mot 0 Dry Clay
0lndustrial:Cmmnicrcial ORcsidettial Waver Supple'(shared) 0 Concrete Grout ❑ Doll Cuttings
❑lrrigauun ❑ Specialty Grout O Gras el
tuna-Water Supply Well: 0 Bentonite Slum Cl Other(explain under 7g)
OMwnlonne ORecusen
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge O(irouidwaier Remedutlon
❑Aquifer Storage and Recovery ❑Salinity Hamer
❑Aquifer Test OSlnnmlaterUrfitwgc Bentonite.:501b ,Wtr:gal. _ BENTONITE A/nount:50LBS_
❑Expeiimenlal Teclmologv ❑Strhsidetce Control 7g.Provitk a brief description of the alianrkmtnent procedure:
UGeothenual(Closed Loop) I_ITracer
PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
LlGeothennal(Heating''Cooling Return) XOther tevplain under 7g1
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
4.Date welltst abandoned: 9-5-2024
5a.Well location:
FORMER FEDERAL OIL CO.
(hsncr N9mc r.,.�l t, I1 _nfapplicalokl
R.Certlticallan:
409 W. Vann St. Goldsboro, NC 27530 9/5/2024
Physical Address.City,and Zip Signature of_..:ified wen comment nt wen(Denver Date
WAYNE Ili signing thts form, 1 hereby err,*that the wedfsl was(were,abandoned ur
Courts Parcel hkalrficaI%,u N.. ;I'1N I acconlan a with 154.VC-IC O:C,0100 or 2C 0200 Wen Construction.Standards
and that a copy of this record has heen provided to the well owner.
ib Latitude and longitude in dcgreesiminulatieconds or decimal degrees:
/if well falii am tavbng i.mingled 9.Site Diagram or additional well details:
You may use the back of this page to pros ide additional well site details or well
N W abandonment details. You mill also attach additional pages if necessary.
CONSTRtU(TIt)N DE TAILS OF%ELI AS!BI:IN(.ABANDONED SIIBMITTAI,INSTRUCTIONS
.triad,will cotarrueiiem,sevr ii,if available. Pio multiple Nlreenrm or non-water supply
wells ONLY with the mime cuw#,»rrunr atarnhmment I.,v rue mamma one form. Ina. For All Welk: Submit this form Within ;() days of completion of well
6a Well[Dd:IW-li abandonment to the following
Division of Water Resource.Information Processing unit,
1617 Mail Senice Center,Raleigh.1s(•2 7699-16 1 7
6b,Total well depth: 15.25 (ft.)
tub.Fur In le lion Web: In addition to betiding the form to the address in Ina
abuse,also submit one cops of thus tom)within +i)dads of completion of well
tie,Borehole diameter:2 (in.) abandonment to the following
12.5 Division of Water Resources,Undermined Injection Control Program.
bd.Water level below ground surface: (ft 1636 Mail Service('eater,Raleigh.NC 27699-1636
10c.For Water Sum*& lnicctlon Well: In addition to sending the form to
6e.Outer casing length'if Limn n): (ft.) the addresses) abuse. also suborn one cop) of this form within 30 days of
completion of well abandonment to the coti t) health department of the counts
where abandoned
(if.Inner casing/tubing length(if known is (ft.)
6g,Screen length(if know n I: (ft.)
Fora GW-to Nonh Carolina ikpani ea of Ens imnnknl and Natural Resoraces-Dis nun of Water Resources Res used August 2)13

WELL ABANDONMENT RECORD For Internal t'r GNI}
This form can be used for single or multiple wells
I.Well Contractor Information: WELL ABANDONMENT DETAILS
Rich Lenore 7a.Number of walla being abandoned: 1
Well('otvracror Nance lot hell oh tiler ,dtanhuung hell on lustier property i F1v mulupk ut ',iiur or sow-wor<r auppts re)O ONLM onto the
,,Nltrrlft foot Irhulkhol ,rv'r 1„1,.,111.Nha1Jr,NI.'6.r111
2593A
7b.Approximate s olutue of wind'remaining in w elks lxONE (gals)
NC Well Contractor(cnlfic:dwm Number
FOR VI'ATF:R SUPPLY WELLS ONI.Y: _ •
SAEDACCO .
Compan>Name 7e.'Ism of disinfectant used:
2.Wdl Construction Permit Ms r r Or_T ! ?)?4
/a.v1.J!oppr,c1,w1 aeb permits O.e.Cwwr,.N'hNr.I,r,u.i a /tyrtirorr.eft.,if Amnion
7d.Amount of disinfectant used: li,- - -
3.Wdl use(check well use): • .
Water Supply Well: 7c.Scaling materials used(check all that apply):
❑Agrwultural ❑Municipal:Public f] Not Comeau Grote 01 Bentonite Chips or Pellets
❑(icothemcd(Heatini%Cooling Supply.) ❑Residential Water Supply(single( D Sand(etntim Grunt ❑ Un Clay
❑bdustrialr('omittcreial ❑kesiderrt:l Water Supply(shared) ❑ Groin 0 Drill Cuttings
❑Irrigation 0 Specmlta Grout 0 Gravel
Non-Water Supply Well: ❑ Ben tonite Slum 0 Other testplain under 7g1
❑Monttonng ❑Recovet)
Injection Well: 71.For each material selected above.,provide amount of materials weed:
El Aquifer Recharge ❑Groundwater Reutediation
CI Aquifer Storage and kecosen ❑Salinity Hamer
❑Aquifer lest ❑SlomrwatcrDrainage Bentonite.:501b ,Wtr:gal. — BENTONITE Amount:SOLES
❑Escperimerual Technology ❑Sttbsidetrce Comm!
7c.Pins ide a brief description of the abandonment procedure:
❑Geolbennal(Closed Loop) ❑Tracer
PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
❑Geotl(ennal(Healing%Cooling Return) ISOtherlexplain under 7gt
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
4.Darr wcfl(s)abandoned: 9-5-2024
sa. V%ell location:
FORMER FEDERAL OIL CO.
ti.l,l. r I n I. Il, d.lpi,l, R.Cerlifleallon:
I
409 W. Vann St. Goldsboro, NC 27530 --K7 l� _.�i►stsri..4
9/5/2024
Ph.sisal Address.C'm.and ZIp N,cruthrr of d Cd W'ef(•ourcxlnr or well Omits Date
WAYNE Bs signing this form, 1 hereby cernit.that the wellfsi was tnen•,abandoned ur
COW* Pa,eet IJ-ui,t...iIs i,^..' :PI\I accordance witlr 15A.AC-IC 02C'.0100 or 2C.0200 Well Construction SJaruAsetiv
and that a copy,of this record has been provided to the well owner.
5b,Latitude and longitude in detprees/lnia rtea/sccnnds or decimal degrees:
(it sselt rend one tat-long rs solfiescM) 9.Site diagram or additional well dctalit:
You mas use the back of this page to pros ide additional well site details or well
N W' abandonment details. You real also attach additional pages if necessan
CONSTRUCTION DETAlI.s OF WE:LIAS!BEIN(.ABANDONED SUBMITTAL.INSTRUCTIONS
.mad,wen conririoliaw rrcord!s+J1 mw1W1k. Joe mwPopic avecOurf or non-wulrr supply
wells ONLY with the mime erueOs uurabandormwro-ioncanwhmu,.oarNorm. 10a. For All WelLs: Submit this form within ,li days of completion of well
6a.Well IDa:
IW-12 abaidonmew to the following
Dis ision of Water Rertmree-.Information Processing Unit.
1617 Mail Service('enter.Raleigh.1('27699-1617
6b.Total will depth: 15.45 1113
tub.fur Injection Webs: In addition to sending the form to the address in lea
abuse. also submit one copy of this fonu within 'O days of completion of well
t.e.Bo mitotic diameter:2 (in.) abandonment to the following
Dhision of Water Resources,Underground Injection Control Program.
tad.Water level bcl in sound surface: 9.1 Ift.l 1636 Mail tiers ice('enter,Raleigh,N('2 7 699-1 636
Inc.For Water Sunnis& Injection Wells: In addition to sending the form to
tic.Outer casing length lit Immo n t: (ft.) the address(esi above. also submit one copy of this fomt within In days of
completion of well abatdoiuncnt to the counts health depanniers of the counts
'Albeit.abandoned
(if.Innercasingtubing length iit ha' iii: -(ft.)
6g.Screen length lit'lentos.rut: (ft.)
Fern GW-io North Carolina Department of Ens imminent and Natural Resources -Dls roan of Water Resources Res road Aqua 201 A

WELL ABANDONMENT RECORD For Inland Use ONLY
This form can be used for singk or multiple wells
1.WelContraemr Information: WELL.ARANDONMYN'i DETAILS
Rich Lend re 7a.Number of wells being abandoned: I
Will('r,nraitor Name lot ncll u..i-t parsorolh akinlomuig ndl on laslieI propeos n For mir/nptr ayertros, or coo-water supph. .. ONLY with the some
rro iu1r7a the,,,hinkil)1iaienr 104,0.rnr+utte r,Nr.:I rni
2593A
7h.Appnixlmate volume of w atel remaining in nell(s)uONE (RaL)
NC Well CmtlmUorCertification Number
SAEDACCO FOR WATER SUPPI-Y WElA S ONLY:
Conpans Name ?c.'I's,ae of disinfectant used:_ f .. •, +. t s l `�
2.Well Ceustntetion Permit 0: t �¢
/swannivt+.,il/-eel/prrmite rr.r.t,avan,.N1,tr. i 'naves'.h t'efitnr it brown brown 20
7d.Amount of disinfectant used:
3.WdI use(check well use):
7e.Sealingmaterials used(cheek all that apply): ` . ' L,.1
Water Supph Well; tin.
❑Agricultural ❑hlmmicipal,Ptnhla ❑Neal Cement Grout MI Benitonite Chips or Pellets
❑Geothcrmvl(Heating/Cooling Supply, ❑Residetvial Water Supply'single) ❑Sind Cement Grout ❑ Dry Clay
❑btdustrial('omnucrcial ❑Residential Water Supply'shared) ❑Concrete Grout 0 Drell Cuttings
❑Img+ation 0 Specialty Grout 0 Gras el
Non-Water Supply Well: 0 Bentonite Shiny I_i Other(explain under 7g)
❑htuntionnt: ❑kecuser,
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑(iroundwaier Rennedimton
❑Aquifer Storage and Recovery ❑Salmi,) Darner
❑Aquifer Test ❑Sionmmater Drainage
Bentonite.:501b ,Wtr:gal. BENTONITE Amount:50LBS
❑Experimeival T hnologs ❑Subwdetce C'utatul 7g.Provide a brief description of the abandonment procedure:
UCxothernnal(Closed Loop) ❑Tracer
PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
I IGeotheruwil(Heating+Cooling Return) IO011ie r(explain under 7g)
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
(.Date%ents)abandoned: 9-5-2024
3.t.sell location:
FORMER FEDERAL OIL CO.
t n, r v.1,n,' I'vilos.tDW tifapplicabkl R.Certification:
409 W. Vann St. Goldsboro, NC 27530 —ham 9/5/2024
Pit.sisal Address.Ca),and Zip Sien nae of..:ititd Well('o,arack,r to Well Owner Dore
WAYNE liv signing this form, I hereby certify that the welltsi was)were) abandoned or
('triml) I'.,LC)td:mmlt. IM)u N„ :rt'r accordance with IJA.VC-IC 02C.0100 or:C 0200 Well Construction,S'iandarth
and that a copy of this retard has been provided to the well owner.
Sh.Latitude and longitude in dcgrees/minutes/secnnds or decimal degrees:
((fault Wel mid:Luriomg n adf,cicir) 9.Site diagram or additional well details:
You may tee the back of this page to pros ide additional well site details or well
N W abatdonuient details. You may also:mach additional pages if necessary.
('ONS'I RI'CT7ON DETAILS OF W ELL St BEING ABANDONED SUBMiTTAI.INSTRUCTIONS
.mach h well on is'1rLijnnrr,e'evrdeu hJ d.Ynlritlie. toe,ealnplr menus'ur non-want sun*.
wells ONLY with rlw same rwar eorrwn abandonment.ism/can rabmii cone Ben,. 10a. For All Wadi: Submit this form within 7,0 days of completion of well
6a Wet IDi.IW-� abandonment to the following
Din isian of Water Resources.Inlirrmation Processing(nit.
61i,Total well depth: 15.2 (h) 1617 Mail Smite Center,Raleigh.N('27699-1617
lob.For iiketion Wells: in addition to sending the form to the address in Ilia
abuse-also submit one cups of this form within 10 days of completion of well
6c,Ii,rrrhalc diameter:2 (In.) abandonment to the following-
Division of Water Resources,Un(kr'gruusd Injection Control Program.
red.Water lend below pound.surface: 12 (ft.) 1636 Mail Scm ice('enter,Raleigh.N('27699-1636
hate.For Water Sunnis d't Inection Wells: in addition to sending the form to
tie.Outer casing length of known): (ft.) the addresses) above. also submit one cope of this forum within II) days of
completion of well abandonment to the counts health depanntenn of the coma}
where abandoned
6f.Innercasingituhims length(if known): (ft.)
6g.Screen length(it'(drone): (ft.)
Font GW-30 Nonh Carolina Dcpanntcra of Ernironineta and Naomi Resources-Dv,tenon of Water Rooftrees noised Atip9 21)rem

WELL ABANDONMENT RECORD f.,r rqk rn:i,U9e ONLY
Tnq Gmn,an h.nscd for single or multiple wells
I.Well Contrattnr Information: 11'F1.1.AR.AVDONhIENT DETAILS
Rich Lemire 7al.Number of wdls bring abandoned: 1
toil t':auaucq Nang for well ow net Newton!.;dunlamug arlt on hit in p,opm, l u mulopie u,k'drw, eta won-bznrr supfd, bells ONL) with the Waif
.'.Ntrlrut fi.rn ahartaVvfiturrit.,op t,u,0/IVit(ogle hobo,
2593A
NC Wclt Contractor cenificahok Number
71).Approximate volume of vs Atli'remaining le well(s)ND (trod.)
FOR WATER SI1PPI.1'WELLS ONLY:
SAEDACCO
rc. pc of disinfectant used:_ c ' r 4..
2.\l sl l o :un u-uct C1d ! 2)24
ion Permit N:t
•r1l perrnllr Asti CQluft..til:Nr.l,,nd,oc e' i,,r,lrc:a.rA flan .
'J. )mount of disinfectant used:_
3.Weil use(chnic well use): ,
Te.Sealingmaterials used(check all that apply):
['
Water Supph Well:
❑AFrwultoral ❑Mtmicipal.Public 0 Neal Cement Gran ® Bentonite Chips or Pellets
❑(icotltermal IHcaun4'C'noling Supply1 ❑Rcsidcmal Water Supph mingle' 0 Sand Cement Grout 0 Dr ('las
❑bdusinal.('ommercial ❑Residential Water Supph tshared) ❑Concrete Grout ❑Unll Cuttings
❑linganon ❑ Specialty Grout 0 Grate!
Nino-Water Supply Well: ❑Bentonite Slum [I Other)explain under 7g)
❑Monitoring ❑Rcnuser
lojeetion Well: 71.For each material selected ahm'e provide amount of materials used:
❑Aquifer Recharge ❑Gmuidssater Reinediation
❑Aquifer Storage and Reconen ❑Sahtut} Hamer
❑Minter Test ❑Slomwt:ncrDrainage Bentonite.:501b ,Wtr:gal. _ BENTONITE Amount:50LBS
❑Expenntental Technologs ❑Subsiclettce C•otarol ?e.Pros uk a brief description of the abandonment pro enure:
OGeothenual(Closed Loop) I_ITracer
PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
DGeothennal(Heatingt ooling Return) P9Othcriexplain under'Jr:
i
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
4.DotieweU(s)abandoned: 9-5-2024
5a.Well location:
FORMER FEDERAL OIL CO.
Fit 1I. Facility li>a(if applicable)
R.Certification:
s
409 W. Vann St. Goldsboro, NC 27530 " `/Irtb..6r 9/5/2024
Ph.suuaI Adkess.Cite.and Zip Mani ere of..ailed Wed Co macko or Well Ouser Mite
WAYNE !)t.snpung this firm, 1 hereby cern*that the wellt's) was is•erer abandoned or
• n it I'n..l his:m,t:..n u,n N., :rt x: acconhamre with 15A.h(:AC 02e.0100 or 2t"0200 Well(nn.ssructrun,Sti naklrr/r
and that a copy ofthis record has been prodded t0 the well owner.
Sh.Latitude and Iongitwtk in ikgrcesJminutestseennds or decimal degrees:
lit well field o,a tat long w vdfu:.ctat 9.Site diagram or additional well detail,:
You Inas use the back of this page to preside additional well site details or well
N W abandonment details. You ma'. also attach additional pages if incessant
CONSTRUCTION DU AIl.i OF 11ELLiSt BEING ABANDONED SIIRMITTAI,INSTRUCTIONS
.Ittoch rid)cnnriruclron navrd.,v{!mwh,d,k. Par nruittple avein,m rue nun-rater ripply
kerb(ONLY with the morn,turelrsrrpur ul,urukumurnl_loco eon whma,ute gone. 10a. For All Welk: Submit tins font' within ;,i doss of completion of well
6a Well IW-4 abandonment io the following
I/is into n of Water Rrrourcc..Information Processing Unit.
15.3 1617 Mail Venice('enter.Raleigh.N('276$)-1617
fob,Total nal depth: Chet
IOb.fur Iuiection Wets: In addition 1u seinlulg the form to the address in 10a
abuse. also submit one cops of tins forth si,thni to dins of completion of well
be•Ron•ink.diamcler:2 lin.1 abandonment to the following
y it.B (ft.) Disision of Water Resources,Underground Injection Cadre!Program.
ode\1 Ater let d blow nwund surface: 1636 Mail Semitic Center,Raleigh.NC 27699-1636
foe.For Water Suouh & Ink'etion Web: in addition to sending the form to
6e.Outer easing length(if know n): (ft.) the addressiesi abuse. also submit one cope of this font within it dabs of
completion of nen abandonment to the comas heahh depannutr of the counts
'Akre ahandnne.d
6f.Innercasing...tubing length lit known): (ft.)
6g.Screen length of lei n t:_ (ff.)
Fenn GW-att Nonh Carolina Uepnnnx i of En.imminent and Natural Resolaces -Dn nein of Water Resources Rinsed Atignu 2)1 t

WELL ABANDONMENT RECORD For Internal Use ONl.1'
This form can be used for single or nmldtipk wells
I.Well('natracinr Information: W'ELL ABANDONMENT DETAII S
Rich Lernire 7a.Number of wall%befit;abandoned: 1
Well('oeamcror Nanr for ocll()NWT pnorull%alunknang acll on bullet proem I Frlr mdoph' fndrlhour or rw.wl-wafer supply writs ONLY with the weer
e.Nlrfrlft fhN,47h$11hlvu14lenf.1,04 1,wt yubn,Jf.Nlr'Irirll,
2593A
7b.Approximate volume of water remaining in neII(ri1110NE (1814
NC Well Contractor Certification Number
SAEDACCO FOR WATER SIIPPI.1'W EL1 S(INI 1: •• r• k Jr
-. '.. .... : . �...i.•
Coogan)Name 7e'fype of disinfectant used:
OC
2.WdI Construction Permit N:
d ! 2024
List ail acyllicublr well permur(Er('win.Vow.I,trlwrte lftrc1lon.etc.•d Anwar/
7d.Antonin of disinfectant used: ".
3.Will use(check well use): (% .
Water Suppy) Well: 7e.Sealing materials used(cheek alit that apply):
❑Agn ultural ❑MunkipalrPublic 0 Neat Cement Grout ®Bentonite Chips or Pellets
❑(irnthcnrnal(Hcanng;'('oohngSupply•i ❑Rcsidcrnal Water Supply'single) ❑ Sand Cement Grout ❑Dr,C'Lir
❑Irdustrial.Commcrcial ❑Rcsidetmal Water Supply'shame') 0 Concrete Grout 0 Drill('linings
❑Imptrtion 0 Specialty Grout ❑Grind
Non-Water Supply Well: ❑Bentonite Slum' ❑Other(explain under 7g)
❑Mon itonng ❑Recosrn
Injection Well: 7r.For each material ticketed above.provide amount Ili materials used:
❑Aquifer Recharge ❑Gruundw:ner Rentediaticm
❑Aquifer Storage and Recover ❑Salituh flamer
Bentonite.:501b ,Wtr:gal. BENTONITE Amount:50LBS
❑Aquifer Test ❑Stonmsater Drainage --
❑Expenmetmal lechnolcigy ❑SnbsIdenile Control 7g.Provide a brief description of the abandonment procedure:
LIGeothennal(Closed Loopt ❑Tracer
[1Geothemtal(HeatingCoolingR taro) IgOtlYCf(explain UnldM'gl PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
4.Dare nett(%)abandoned: 9-5-2024
5a.11ell litari in:
FORMER FEDERAL OIL CO.
Facilpy/0,m 'Name Fscil* Me(if applieablc)
R.Certification:
409 W. Vann St. Goldsboro, NC 27530 'h _.tj/MV..fi 9/5/2026
Pln sicat Address.Citr.and Zip Browne:of .arise'Well Contractor of Well Oomr [lose
WADE sit-.signing this farm, 1 hereby certify that the well(sn was(were'abandoned err
"lb P_I, l Idtn,tnatrn,No MINI arcorrlalu'c with f5.4.11Y dC(12C.0100 or 2C 0200 It'd!Construction,Sdmditrrll
and that a copy of this record has been provided to the well owner.
5h.Latitude and longitude in ekgtecsdminutes:scctinds or decimal degrees:
of welt fold,ore L'n tang a utn;crif i 9.Site diagram or additional well details:
You mat tee the back of this page to proside additional well site details or well
N 11 abandonment details. You mas also attach additional pages if necessan
('ONS'IRI('TION DETAii.i OF WE:LLi51 BEING ABANDONED SIIRhIITTAl.INSTRUCTIONS
.tfoich weld cyMmraclrun rrerlydJs7 mulfipi:ryrloote fu rk,11-11.1lcr supply
wells ONLY with the saute construction.a isetkirnurru_rear son whmu sowNlrm Ina. For All Wells: Submit this fcam within 30 days of completion of well
6a.Well IDE:
IW-6 abandonment to ncc following
Dirisi in of 11'titrr Resources,Information Processing Unit.
l 15.2 1617 Nail Service('enter,Raleigh.NC'27699-1617
6h, 1,11.11 men dr uli: m.l
Inb.For Inkrtion Wills: In addition to sending the form to the address in 10a
above.also submit one copy of this lone M111111 3O days of completion of well
6r.Rrinlriiler diaencler;2" un.l abatdoiuncia to the following
be'.Water level below trnrtund surface: 14.9 (tY.) Division of Water Resources,Underground Injection Control Program.
1636 Mail Scnice Center,Raleigh.NC'27699-1636
Inc.For Water Sum»Iv di Inketion Went: in addition to sending the form to
6e.fluter casing length(if knolln): (ft.) the address.esi abote. also submit one copy of this form within tat days of
completion of well abandonment to the counts health depatintent of the county
n Iscrc abandoned
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.l
Form GW-in Nonh Cambia 0.paris rd of En%imonent anal Natural Resources-Mims of Water Resources Re,asd August?II(1

WELL ABANDONMENT RECORD rot insem,tCscONl,
This form can be used for singk or nlultipk wells
I.Wel Contractor Information: WELL.ABANDONMENT DETAU S
Rich Lernire 7a.Number of wells being abandoned: 1
N'ert(•nnraeu+,Nave IC,,.el l un ref la•nauutk:ih:utlunurg well an holm prawn)) F•u• wulnplr utreaiuur •v non-u auer supply wells ONLY Wdt Me • ,.
,.n.rnr.null.4,vnhurprrat r,IN r,ua,unur,err 6.r1i
2593A
NC Well Contractor Certification Number
71i. \pi nr,tiniate%plume of vitality remaining in wcll!sINOME
FOB N 11E4',UPPLY WEI.ISONLY:
SAEDACCO
Canpnnm Name . I y pc of(hsinfectant used: ,r 4.
2.Wdl Construction Permit N:r , Q('T t! ' 2014
La ell upplr<aMr we/permits use.('win,Ma k.I Lrrwtce infra iron,ere.,q'A•n,•
d. \moun(ui disinfectant used:_
3.W'dl use(check well use): UAL
Water Supply Well: le.Sealing material.used,check all that apply): • ••
❑Agruulttiral ❑Munkipalrl'uhle. ❑Not Cement Grout IS Ben tonite Chips or Pellets
❑(kOthcrrnaI(Hcating/Caoling Supply' ❑Residcriial 1V'atcr Supply.,single) ❑ Sand('urine Grout 0 Dry Clay
❑I dustrial:Commercial ❑Rcsidcrital Water Supply(shared) 0 Concrete Grout 0 Doll Cuttings
El!motion ❑Specialty Grout 0 Gray el
Non-Water Supply Well: 0 Bentonite Slum U Other(explain under 7g)
❑Mouttonng ❑Reco%en
!ejection Well: 71.For each material selected ahmr,provide amount of taateriah aced:
❑Aquifer Recharge ❑Ciromdwaler Remediation
❑Aquifer Storage and Recos en ❑Sabnity Darner
Bentonite.:501b ,Wtr:gal. BENTONITE Amount:50LBS
❑Aquifer lest ❑StommalerDrainage ---
❑Erpenntental Technology ❑Snbsidenrce C'onirul -2.Pn„idc a brief description of the abandonment procedure:
ClGeothennal(Closed Loop) ❑Tracer
PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
❑Geothetmat(Heating+Cooling Return) Blather(explain under 7g)
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
4.Date well(a)abandoned: 9-5-2024
5a.N1ill Iocation:
FORMER FEDERAL OIL CO.
t., I•,+ (M MN Name Facility A(if applicabk) A.Certification:
409 W. Vann St. Goldsboro, NC 27530 'h �C.�/I�vrG. 9/5/2024
Pb'vocal Address.Cits.and Zip Signature or .tilled Well Contractor ar Wen°weer Dame
WAYNE fy swum:dim'form, 1 hereby cerh/y that the wellfsi was (were,abandoned lit
(weer, r e..I Ideldrfi:aua❑N., .It\ accordance with 15.4.VC-IC 02C.010)or 2C 0200 Well Constructors,Vundards
and that a copy of this record has been provided to the well owner.
Sly.Latitude and longitude in de12rers;minutrsrscnnds or decimal deX,ncs:
if well field.ore(:diking r.sdfe rcra 9.Site diagram or additional well details:
You may use the back of ibis page in provide additional well site details or well
N W abandonment details. You reran also attach addntonal peges if nrecessan
('ONs l RI(TION DETAILS OF R E1.LISI BEING ABANDONED SUBMITTAL INSTRUCTIONS
.wad,writ anrairaalrvnr reror.bs;It a,wlri'+h' Ise+mrif.pf rnrtaarson ry ramwafer supple'
wells ONLY with the flume arVttbMtYwn lihewtelowewr a ,cwl con.whmu mere.70 m 10a. For All Wells: Submit this fon n within 30 days of completion of well
6a Well IDl:IW-5 abandonment to ncc folloycmt
Di%isiun of Water Resou,Tes,Iniionnation Processing Unit.
Oh,Total well depth: 15.2 (ft.) 16l?Mail Senice(enter,Raleigh.N('27699-1617
lob.fur InkTilun Willa: In addition to sending the fomr to the address ni lea
alone. also submit one copy of this font wnhul ZO days of completion of welt
bc.Rer echoic diameter:2 fins abandonment to the following
.14•9 Division of Water Resources,Underground Injection Control Program.
bd.Water Ieu el hens ground surface: (ft,) 1630.Mail Senict Center,Raleigh.NC 27699-1636
Itte.For Water Sunnis & Injection W'ella: In addition to sending die fomr to
be.Outer casing length(if Meow nr: (ft.) the addresslest abase. also submit one copy of this fomr within in days of
completion of well abandonment to the county health department of the county
is here abandoned
Of.Innercasing/tubing length(if known): (ft.)
6g.Screen length(if know n is
Form GW-ill North Camhm Department of En%imminent aril Natural Resources-Dimtsnn of Water Resoutcec Res red August 201A

WELL ABANDONMENT RECORD For Internal Use(NIX
This form can be used for single or multiple wells
1.Well Contractor Information: WELL.ARANDONMENT DE'TAII S
Rich Lemire 7a.Number of wells being(abandoned: 1
N'dl('uuracrm Nan►lot'ad!„suer perumull)alunlsuung Neil on Ifcs;let propem t 1,v mtrlaph ok'ctorn cw new-rztor supply wells ONLY reds eke won,-
CNN,.A'4Lk1i NINk'Nt.nisi,xur rulorur,Nrr forth
2593A
NC well(onlefctnr fetltfr drnn suithet
'b. ‘pprnsimate tolumeof water•remaining in wdl(rt LONE (gal)
SAEDACCO
FOR VTER SI'PPI.I'WELLS
Coltman)Name s. I s pc of thsinfectani used:_ r •r 1!i
2.Wdl Carstruction Pert St. . L11_ v 1024
List ai upplavDk wet/permits we.County,57ate.I urrwnnr.intr<tirm etc'.,if know, sl. lortrtfnt nl disinfectant used:__
3.W'dl use(check well use):
Water Suppis Well: 7c.Scaling materials used(check all that apph):
❑Agnculturnl ❑Mrmtcipal.PttbI0. Ii Neat Cement Grout IX Bentonite Chips or Pellets
❑Grnthcrmal(Hcannge(•ooling Supply} ❑Rcsidetttnal Water Supph ,single) El Sand Censer Grout 0 Dry Clay
❑llydusinalrComnrcrcial ❑Rcsrdcnnal Water Supph(shared) ❑ C'onctete Grout 0 Drill Cuttings
❑Irngattutt 0 Specialty Grout ❑Grase!
Non-Water Supply Well: ❑Bentonite Slum' ❑Other(explain under 7g)
❑MOM lonug ❑Recosen
Injection Well: 7f.For each material selected above,pros ide amount of materials wsed:
❑Aquifer Recharge ❑(imundwaler Remedtatton
❑Aquifer Storage and Reccn'en ❑Salmin Barnet
Bentonite.:501b ,Wtr:gal. BENTONITE Amount:50LBS
❑Aquifer Test ❑ ms Swi atDrainage er --
❑Expennremal lechnology ❑Subsulenrce C'omotul 'i.Pros ide a brief description of the abandonment procedure:
❑Geotbennal(Closed Loop) ❑Tracer
PULLED WELL AND TREMIE TAGED CHIPS FROM BOTTOM TO TOP AND
❑Geothermal(HeatingCooling Return) OOOther 4explain under 7g)
CAPPED OFF TOP WITH 1' OF PORTLAND CEMENT.
J.Date wens)abandoned: 9-5-2024
5a.11r1f Inratiun:
FORMER FEDERAL OIL CO.
r•.s.Its Hirer N.1,r, I ,.ill, n, ,ir.gq,lc:rhkg R.Certification:
409 W. Vann St. Goldsboro, NC 27530 h tl1 ��e11NNs.rL+ 9/5/2024
fln seal Address.Cn).and Zip s:taut are of :ifipd W'etl Couirackrr ctt WWII Mitre, Dare
WAYNE Hy.s'rgrur{y thew form, 1 hereby cernfy that the well(sl was,Isere,abandoned'in
t'auaq I orccl Icl.ffllfe'I)Mml N„ ;lot\ acconlonce with 15.4 NC-!C 02C,0100 or 2C 0,200 Well Construction Standards
and that a cryn'of this record has been provided to the well owner.
Sh.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
sit oeII field ore larking N uiierewml 9.Site diagram or additional well details:
You mess me the back of this page to preside additional well site details or well
N W' abandonment details. You may also additional pages if necessary
('ONSTRI:CTION DETAILS OF%ELI.AS)BEING ABANDONED `UBNIITTAI.INSTRUCTIONS
.!teach well constrndran revord;or(1 acwlahk. 1•ar multiple Injection,u rxw-ruler rurpph'
wells ONLY wrtb,Ate suate rwenrectwn abandonment._low nun abm,l nose form. 10a. Far MI W Its: Snthrtut this form within 30 days of completion of well
6a.Well TN:IW-9 ahandounteru to the foltmung
Disisian of WaterReywrurses.Information Pnrcesrring Unit.
15.1 1617 flail Service('enter,Raleigh.NC 27699-1617
hb.Total well depth: (R.)
10b.for lnhytiun Went: In addition to sending the form to the address in lita
tics Borehole diameter;2 fin.) abuse. also submit one cops of this font within 30 days of completion of well
abandonment to the following
DisIsiau of Water Resources,Underground Injection Control Program.
ad.Water level brinw ground surface: 9.2 (ft.1 1636 Mail Service('enter,Raleigh.N('27699-1636
tics Outer casing length(if lanes n): (ft) Inc..for Water Stools & Injection\UJja: In addition to sending the form no
the addresstest abose. also submit one copy of this form within 10 days of
completion of well abandonment to the county health department of the county
where abandoned
Of.Inner easing tubing,length(if known): (ft.)
hg,Screen length(if know n u: ((I.)
Faint GW-.let Nonh Caro luu Depti meal of Ens imminent aril Nanurnt Renounces-Dis tsron of Water Resources Re,nod August 2.01 t