WI0800219_Permit (Completion)_20241002 (6)

WELL ABANDONMENT RECORD For Internal UseOKY.
This ftnrn can be used for single or mullip'e wells
I.Well Contractor information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned:
Well Coctractor Name(or wel:owner personally abandoning well on his/her pro,erty) hor multiple injection or non-iroler supply ivelks ONLY with the .came
c 4421 rmuirnetion abatulonarent you con submir one form.
5'0
NC Well Contractor Certification Number
7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
list all applicable well consirucrion perniis ti.e.Couirl}C Mate.Itariarice,ere.)tfktmrrn
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Olrri ation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: IZI Bentonile Slurry D Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge OGroundwater Remediation 6.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology OSubsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/28/22
5a.Well location:
MCB - CAMP LEJEUNE
Facility/Owner Name Facility ID#(if applicable) 8•Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 �'"`�'�"'""" 01/09/23
Physical Address,City,and Zip Signature ofCertifred Well Contractor or Well Owner Date
0 NS LO W By signing this form, 1 hereby certify that the wells) was (were) abandoned to
County Parcel Identification No.(PIN) accordance with 1 SA 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:
(tfwell field one latllong is sufficient) 9.Site diagram or additional well details:
340 44' 27.59" 770 22' 16.74" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary.
CON�TRUCf10N DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach irell catutructioir recard(st if arailable. For multiple injection or non-crater supply
wells ONLY frith the sane coirsrrnrr::,n abanFlonnrent,)ou com submii one form. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.1Ve11 ID#:
SW M U 350-IW-55 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 40.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For lniection Wells: In addition to sending the form to the address in 10a
Gc.Borehole diameter: 2.0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 9.0 (ff.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Sunnly& lniection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Enviromnent and Natural Resources-Division of Waler Quality Revised March 2013
Enclosure 5

WELL ABANDONMENT RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) l'or multiple injection or nonnrorcr supply irells ONLY u•iih the some
consirtiction abandonment)ru can submit one forni.
C -4421
7b.Approximate volume of water remaining in well(s): 5.0 (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit 0:
List all applicable well cwmrrticnatt permiis(i.e.Cotuuy,State,Variance,etc.)ifknown 7d.Amount of disinfectant used-
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public O Neat Cement Grout ❑ Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) OResidcntial Water Supply(single) O Sand Cement Grout O Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑Irri alion ❑Specialty Grout ❑Gravel
Non-Water Supply Well: O Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remedialion 6.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
OAquifer Test OStormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
OGcothennal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 11/28/22
5a.Well location:
MCB - CAMP LEJEUNE
Facility•Ownc:Nalw Facility ION(ifapphcable) 8.Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 """" 01/09/23
Physical Address,City,and Zip Signature ofCemfied Well Contractor or Well Owner Date
ONSLOW By signing lhrs form. 1 hereby cerrif that file irell(s) teas(were) abandoned in
County Parcel Identification No.(PIN) accordance with 1 SA NCAC 02C.0100 or 1C.0100 Well Construction Standards
and Thal a copy of ills record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field one Iavlong is sufficient) 9.Site diagram or additionaI well details:
340 44' 27.00" 770 22 16.31 You may use the back of this page to provide additional well site details or well
N W abandonment details You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(q)jaratlable. I•irr multiple injecting or brut-pater supply
wells ONLY with die sane construction obamionment.)wit enr mobam osw prtn. IOa. For All Wells- Submit this form within 30 days of completion of well
6a.Well IDd:
SWMU350-IW-56 abandonment to the following
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 40.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Inme li n Wells: In addition to sending the form to the address in IOU
6c.Borehole diameter: 2.0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following
9.0 Division of Water Quality,Underground injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer rasing length(if known): (ft) 10c. For Water Sumily& Iniection Wells: In addition to sending the form to
the address(cs) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casingltubing length(if known): (ft.) where abandoned
6g.Screen length(if known): (ft.)
Fcnn G W-3o Notih Cnrolina Department of Environment and Natural Resources-Division of Water Quality Revised March 2013
2

WELL ABANDONMENT RECORD For internal Use ON[Y
This form can be used for single or multiple wells
1.Well Contractor Information: WELL AB NDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on hisltter property) For Puthiple hyeclion or non-mater supply +,•ells ONLY a irh do %wth
conrtructimrabamlannienl)vu can submit one form!.
C -4421
7b.Approximate volume of water remaining in well(s): 5.0 (gal.)
NC Well Contractor Cert:ficafon Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit N:
List all applicable u•eliconstructioulvrnrils(i.e Coum).Stare.Yarionce.etc)rfknowr 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑MumcipaliPublic o Neat Cement Grout ❑ Bentomte Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) o Sand Cement Grout O Dry Clay
❑Industriai/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Olrri ation O Specialty Groul O Gravel
Non-Water Supply Welt: IZI Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
OAquifer Recharge ❑Groundwater Remediation 6.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwatcr Drainage
oExperimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) oTracer ABANDONED VIA TREMIE PIPE 1MTH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/28/22
5a.Well location:
MCB - CAMP LEJEUNE
Facility/Owner\arnr Facility ID1! ifapplicable) g•Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 01/09/23
Physical Address.(-.q,aid tip Signatbre ofCenifred Well Contractor or Well Owner Date
ONSLOW By signing this form, I hereby certify that the ivell(s)was (were) abandoned tit
County Parcel Identification No.(PIN) accordance with 15A NCAC 01C.0100 or 1C.0200 Well Construcfioir Standards
and 1hal a copy of this record has been provided io fire well owner
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one]at/long is sufficiertl 9.Site diagram or additional well details:
34°44' 27.86" N 77° 22' 14.92° W abandonment details. You You may use the back of tma Pallsso attach ae to dditional onalde oagenal s ifnecessaell site tails or well
Y pages iY
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Arlaclr well conviruction revard(v)if available. For muhlple itryecti,m ar iron.water supply
is-ells ONLY irithihe.sanrecrmstriectiouabamlannienl too ransuhntit,or lrrni. 10a. For All Wells- Submit this form within 30 days of completion of we
6a.Well lDu: SWMU350-IW-57 abandonment to the following
Division of WaterQuality,Information Processing Unit,
6b.Total well depth:
40.0 (ff.) 1617 Mail Service Center,Raleigh,NC 27699-1617
_
10b. For Iniection_Wells: In addition to sending the form to the address in I(.a
6c.Borehole diameter: 2.0 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonr:ient to the following
6d.Water level below ground surface: --- (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply& Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) 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 abandoned.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
on"GW-30 North(Aroli,a Department of Environment and Natura:,Resources-Division of Water Quality Revised March NI",
3

WELL ABANDONMENT RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) 1•irr araltiple rrleciion or norr-water supply wells 01v1.Y teeth the Bann
earstrreeti°n abamhwtnem,yew can submit one form.
C - 4421 2.5
7b.Approximate volume of water remaining in well(s): (gal.)
NC Well Contractor Cenification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable to-ell comirticnan perntirc(i.e.Comep:Stare,i/ariance,etc.)ifknotrn 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 O Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) 0Residential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑industrial/Commercial ❑Residential Water Supply(shared) O Concrete Grout ❑ Drell Cuttings
01rri ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: O Benlonite Slurry ❑Other(explain under 7g)
ClMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 4.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test I OStorm«ater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) OTracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Conlin Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/28/22
59.Well location:
MCB CAMP LEJEUNE
FacilitylOwnerNaim Facility ID-1(ifapplicable) 8•Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 �" """"" 01/09/23 _
Physical Address,City.and Zip Signature of Certified Well Contractor or Well Owner Date
ONSLOW By signing this form. I 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 laillong is sufficient) 9.Site diagram or additional well details:
340 44' 27.86" N 770 22' 14.92" W abandonment detaiYou may use the ls. You ck of tmta page to provide also attach additional pages necesll site sa rails or well
Y Pg ry
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach it-ell construction record(s)rf arailable Lor multiple injection or iron-water supply
hells ONLY frith the same ctmsirisetion abandonment.post car submit are jorm. 10a. For All Wells- Submit this form within 30 days of completion of well
6a.Well ID#:
SWMU350-IW-57A abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 25.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For lniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2.0 {in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 9.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) l0c. For water Sunnly& 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 abandoned
6f.Inner casingitubing length(if known): (fit')
6g.Screen length(if known): 00
Fonn OW North C srolina Department cf Fnvuonment and Natural Resources-Division of Water Quality Revised March 2013
4

WELL ABANDONMENT RECORD For Internal I Ise ONLY
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAIL5
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) 1-or nndriple in/ecticn ar non-irarer supply wells ONLY with h, ,anw
cmtstruciion abar(larwrenr.gnu can submii one form.
C - 4421
7b.Approximate volume of water remaining in well(s): 5.0
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permil#:
1.tst all applecams,..eu,amsrraciian permits(i.e.Coumy.Stair.Variant,%etc)ifktwu-n 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultura ❑Municipal/Public O Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(HeatinpCooling Supply) OResidenlial Water Supply(single) O Sand Cement Grout ❑ Dry Clay
❑Ind uslrial,'Commercial OResidential Water Supply(shared) Cl Concrete Grout ❑ Drill Cuttings
❑Irri ation O Specialty Grout ❑Gravel
Non-Water Supply Well: O Benlonite Slurry ❑Other(explain under 7g)
ElMonitoring ORecovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 6.5 GALLONS
❑Aquifer Storage and Recovery OSalinity Barrier
❑Aquifer Test ❑Stormwater Drainage
OExperimenta:Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeolhermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Healing/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/28/22
58.Well location:
MCB - CAMP LEJEUNE
Fa:ilily/Owner Name Facility IDH(ifapplicable) 8•Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 " 01/09/23
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
O N S LOW By signing flits form. 1 hereby certify Iliat the wells) teas(were) abandoned in
County Parcel Idewifica[ion No.(PIN) accordance with 1 SA NCAC 02C.0100 or 1C.0200 Well Construction Standards
and that a copy of this record has been provided to the well ou-ner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwefl Rei(L one lavlony,is sufficient) 9.Site diagram or additional well details:
34°44' 27.32" N 770 22' 16.60" N abandonYou ment details. Youuse the back of pallse to provide soattach additional pages i necessaal%yet I site tails or well
' Y pages rY
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Auoch wed construction recard(s)if available. hbr multiple u jeclion or ion-water supply
ue is ONI.Y with ihe.same construction abandonment,gnu can submit one form. 10a. For All Wells: Submit this form within 30 days of completion of Weil
6a.Well ID#: SWMU350-IW-58 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth:
40.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
lob. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2'0 {in.} above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
9 0 Division of Water Quality,Underground Injection Control Program,
6d.Water level belot+ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
length if known): (ft.) 10c. For Water Sunnly& Infection Wells: In addition to sending the form to
6e.Outer casing g ( ) 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
6C Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form(i W-36 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
5

WELL ABANDONMENT RECORD For Internal L'se ONLY
This form can be used for single or multiple wells
I.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells bei rig a bandoned: 1
Well Contractor Name(or well owner personally abandoning well on hrs%er property) hor malriple oyection or non-it•oler supply is-ells ONLY whit rite same
consireciron abandolonem,you can submit one frrrne.
C -4421
7b.Approximate volume of water remaining in well(s): 2.5 (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit N:
1.rsiall applicable well construction permiis il.e ('ounry.Slow.Variance etc.)Jkmmwor 7d.Amount of disinfectant used:
3.Well use(thee k well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public ❑Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heat inglCooling Supp:y) ❑Residential Water Supply(single) ❑Sand Cement Grout ❑Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
❑lm ation ❑ Specialty Grout ❑Gravel
Non-Water Supply Well: O Bentonite Slurry O Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well. 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 4.0 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
0Aguifer Test ❑Stormwater Drainage
❑Expertmental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
OGeothermal(Hea(m Coolin Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 1 1/28/22
58.Well location:
MCB - CAMP LEJEUNE
Facility/Owner Name Facility IDN(if applicable) 8.Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 �""""" 01/09/23
Physical Address,City,and Zip Signature ofCenifted Well Contractor or Well Owner Date
ONSLOW By signing this form 1 hereby certify that the ivell(s)was (were) abandoned tit
County Parcel Identification No.(PIN) accordance ivilh 15A NCAC 01C.0100 or 1C.0200 Well Construction Standards
and that a copy of this record has been provided to the srell owner.
5b.Latitude and longitude in degrees/minufes/seconds or decimal degrees:
(if well field one Wilong is sufficient) 9.Site diagram or additional well details:
340 44' 27.51" 770 22' 14.82" You may use the back of this page to provide additional well site details or%sell
N W abandonment details. You may also attach additional pages if necessary
CONSTRUCTION DETAILS OF WELLS)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Ateaeb irell carictructiorr reca-d(s)if'ai•ailable. I-or mulliple hyec lion or non+tat�r supply
welts ONLY wifli the same construction abandomnero,)rm car subniil one fornr I Oa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: SWMU350-IW-58A abandonment to the following.
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 25.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2'0 {in.) above,also submit one copy of this form within 30 days of completion of we'l
abandonment to the following.
6d.Water level below ground surface: 9.0 (ft.) Division of Wafer Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply& Infection Wells: In addition to sending the forin to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of wel: abandonment to the county health department of the county
6E Inner casingltubing length(if known): (ft.) where abandoned
6g.Screen length(if known): (ft.)
I owl GW-30 North Carolina Department of Cnvi,onmem arid hamra'Resources Division of Water Quality Revised March 2013
6

WELL ABANDONMENT RECORD For Imernsl Use ONL Y
This form can be used for smg'e or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally aliwidoning well on his/her property) 1-or anthiple ayeettan er non-wafer supply wells ONLY frith the awv
construction abandanntem,parr can submit one form.
C - 4421
7b.Approximate volume of water remaining in well(s): 5.0 (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit a:
List off opplicable well construction pertrtits(i.e.Coutily.State,Variance,etc)ifkmnrn 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) OResidential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout O Drill Cuttings
❑Irri ation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: O Bentonite Slurry ❑Other(explain under 7g)
OMonnorng ❑Recovery
Injection Well: 711 For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 7.5 GALLONS
❑Aquifer Storage and Recovery OSalinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Hearing/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 12/31/22
5a.Well location:
MCB - CAMP LEJEUNE
Facility+Owner Name Facility IDN(if applicable) 8.Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 "'T ""'"` 01/09/23
Physical Address,City,and Zip Signature ofCenified Well Contractor or Well Owner Date
ONSLOW By signing this form, 1 hereby certify that the ivelgs)ivas(were) abandoned in
County Parcel Identification No(PIN) accordance with 1 SA NCAC 02C.0100 or 2C 0200 Well('anstruction Standards
and that a copy of this record has been prorided to fire ivell owner
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one larlong is sufficient) 9.Site diagram or additional well details:
34°44' 25.35" 770 22' 14.32" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages ifnectwary
CONSTRUCTION DETAILS OF WELL BEING ABAND NED SUBMITTAL INSTRUCTIONS
Anoch irell construction record(s)if available. 1•irr ntuuiple injection or non-Hater supply
wells ONI.Y with 11k sonre construction abonlonntent,you can.stibina onefonn IOa. For All Wells: Submit this form within 30 days of completion of well
6a.R'ell lDN: SWMU350-IW-60 abandonment to the following
Division of WaterQuality,Information Processing Unit,
6b.Total well depth:
45.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in I{4t
2 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following
6d.Water level below round surface: 15.0 (ft.) Division of Water Quality,Underground injection Control Program,
g 1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.} 10c. For Water Sumnly& Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 3� days of
completion of well abandonment to the county health department of the cotmh
6L Inner casing/tubing length(if known): (ft.) where abandoned
6g.Screen length(if known): (ft.)
Font OW-30 North Carolina Department of Enviromneni and Natural Resources Divsion of Water Quality Revised March X,1 t
7

WELL ABANDONMENT RECORD For Initmal t1se ONLY
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on hislher property) Far nnrnriple injection or non-water steely rreNs ONLY with 11re •one
construction abandarrnrenr,you cone submit one form.
C - 4421
$'0
7b.Approximate volume of water remaining in well(s):
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit N:
l,rst all applicable rrel/conrinrcrion pernuts(i.e.Counr,State,Variance etc)ii(known 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all Ihat apply):
❑Agricultural ❑Mutucipal/Public O Neat Cement Grout O Bentonite Chips or Pellets
OGeothermal(Healing/Cooling Supply) ❑Residential Water Supply(single) O Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) O Concrete Grout O Drill Cuttings
Olrri ation O Specialty Grout ❑Gravel
Non-Water Supply Well: o Bentonite Slurry ❑Other(explain under 7g)
M Monitoring ❑Recovery
Injection Well: 7L For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 7.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
OAquifer Test OStormwater Drainage
OExperimental Technology OSubsidence Control 7g,Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tmccr ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
OGeothermal(Heating/Cooling Return) ❑Other(explain under 7 )
4.Date well(s)abandoned: 12/31/22
5a.Well location:
MCB - CAMP LEJEUNE
Facibtylowner Manse Facility IDA(ifapplicable) S.Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 " 01/09/23
physical ACdrtss,City,and Zip Signature ofCerlifted Well Contractor or Well Owner Date
ONSLOW By signing dais form. 1 hereby certify that the wells) ivas(were) abandoned in
County Parcel Idenlificahon No.(PIN) accordance wah 15A NCAC 01C.0100 or 1C.0100 Well Construction Standards
and that a copy of this record has been provided to the irell owner.
5b.Lalitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one latnong is sufficient) 9.Site diagram or additional well details:
34°44' 24.54" 770 22' 14.26" You may use the back of this page to provide additional well site details or we:
N W abandonment details. You may also attach additional pages if necessary.
C N TRUCTION DETAILS OF WELLS BEING ABANDONED SUBMITTAL INSTRUgi'IONS
Attach well concrruclran record(sJ if available. Par multiple itye(Lion or mo-neater supple
wells ONLY with the some crHurrac7ian abardonmvnr,you can suhmrt on a form. 10a. For All Wells: Submit this form within 30 days of completion of cell
6a.Well IDa: SWMU350-IW-61 abandonment to the fo:lowing:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 45'0 (ft.) 1617 Mail Service Center,Raleigh,NC 2 7699-1 6 1 7
10b. For Inicclion Wells: In addition to sending the form to the address in l0a
6c.Borehole diameter: 2'0 {in.) above,also submit one copy of this form within 30 days of completion of%ve
abandonment to the to'.lowing:
6d.Water level below round surface: 14•0 (ft-) Division of Water Quality,Underground Injection Control Program,
g ) 1636 Mail Service Center,Raleigh,NC 27699-1636
Ge.Outer casing length(if known): (fit) 10c. For Water Sunnly& infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned
6E Inner casing/tubing length(if known):
6g.Screen length(if known): (ft.)
Fonn GW 3o \^rth Carolina Department oft'-avirontnent and Natural Resources-Division of Water Quality Revised March,tn'
8

WELL ABANDONMENT RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on hWhar property) I-or "triple infection or non-water supply wells ONLY wilt the runt.
consrraclion abandonment you can submit one foror.
C - 4421
7b.Approximate volume of water remaining in well(s): 5.0 (gal.)
NC Well ContractorCenification Number
GEOLOGIC EXPLORATION FOR WATER SL'PPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable it-ell cmufruction pernrirs(1.e.County.Stare Variance,erc)ifknown 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgricullural ❑Municipal/Public ❑ Neat Cement Grout ❑ Benlonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) O Sand Cement Grout ❑ Dry Clay
❑Industrial/Com mere ial OResidential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Olrri ation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑Other(explain under 7g)
O Monitoring O Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
QAquifer Recharge ❑Groundwater Remediation 7.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology OSubsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heatin Coolin Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 12/31/22
58.Well location:
MCB - CAMP LEJEUNE
Facfity/Owner Name Facility IDk(if applicable) $-Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 �""' "�'"'"` _ 01/09/23
Phy"I Address,City,and Zip Signatire ofCemfied Well Contractor or Well Owner Date
ONSLOW By signing tins form 1 hereby crr1 fy Thar the irell(s) was(were}abandoned In
County Parcel Identification No(PINT 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 lailtong is sufficient) 9.Site diagram or additional well details:
34°44' 25.15" 770 22' 15.42" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary
CONSTRUCTION DETAILS OF WELL BEING ABAND NED SUBMITTAL INSTRUCTIONS
.Ainn-h well convnrction record(s)if available hor multiple byectinn or iron-iraier supply
DNl.Yirandresonrecarerrrucrinnahmrdnnrncvrt,ynucmrsubnritoneJorm IOa. For All Wells- Submit this form within 30 days of completion a: %%ell
6a.Well IDN:
SWMU3S0-IW-62 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 45.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For]nee tin Wells: In addition to sending the form to the address in 10a
tic.Borehole diameter: 2.0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: 14.0 (ft) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
IOc. For Water Sunnly& Inieclion Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6f.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): __ (ft.)
Forr:J W-3:: North Carolina Department of Environment and Natural Resources—Division of Water Quality Pevtsed March 2013
9

WELL ABANDONMENT RECORD For Iniernat Use ONLY
This form^an be used for single or multiple wells
1.Well Contractor Information: 1VELL A$A DONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on hi%4ier property) 1•nr nmluple injechfon or non-water .supply wells ONLY iriih the satin
construction abandonnrent you can submit one form.
C -4421
7b.Approximate volume of wafer remaining in well(s): 6.0 (gal.)
NC Well Conlractor Certi Gcalion Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Nan•e 7c.Type ofdisinfectant used:
2.Well Construction Permit#:
list all applicable wet!conuruction prrnricc(i.e.Comity.Srate,variance,eic.)ij invirrr 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgncultural OMumcipaVPublic ❑ Neal 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
Olrri ation O Specialty Grout ❑Gravel
Non-Water Supply Well: El Bentonile Slurry O Other(explain under 7g)
ElMomtoring ❑Recovery
Injection Well: 7L Foreach material selected above,provide amount of materials used:
OAquifer Recharge OGroundwater Remediation 7.5 GALLONS
QAquifer Storage and Recovery OSalmity Barrier
OAqui Per Test ❑Storm water Drainage
❑Experimental Technology USubsidence Control 7g.Provide a brief description of the abandonment procedure:
OGeothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Dale well(s)abandoned: 1 2/31/22
So.Well location:
MCB - CAMP LEJEUNE
Facdirv/Owner Name Facility 1011(ofapptcable) 8•Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 "` 01/09/23
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
ONSLOW By signing this form, 1 hereby certfy that the wells) eras (were)abandoned in
County Parcel identification No.(PIN) accordance n•ith 15A NCAC 02C.0100 or 2C.0200 Well Consrruction Standards
and that a copy of this record has been provided to the ire//owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latllong is sufficient) 9.Site diagram or additional well details:
340 44` 28,22" 770 22' 15 70" You may use the back of th-s page to provide additional well site details or well
N W abandonment details You may also attach additional pages if necessary
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Auach tie!!crnrstrrtcnan rernrd(.cJ ijm•ailahle l•irr nndnple in/rcrion nr rmrr•unrcr supply
cH.ONLY irihh the sarne construction abandnnmern.you can subnut otre jinn. 10s. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: SWMU350-IW-63 abandonment to the following
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 45.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in b7a
6c.Borehole diameter: 2.0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to t..e following
6d.'V\'ater level below round surface: 8.0 (ft Division of Water Quality,Underground Injection Control Program,
g ) 1636 Mail Service Center,Raleigh,NC 27699-1636
I0c.For Water Sunnly& iMeclion Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6Innercasing/tubinglength(ifknown): (ft.) ��hereabandoned
f.
6g.Screen length(if known): (ft.)
Foy ni GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013
10

WELL ABANDONMENT RECORD for Internal Use ONLY
This form can be used for single or multiple wells
I.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned:
Well CaniraClUt Na-nc(or well owner personally abandoning well on his/her property) For muhiple mJecnon or nor-water supply wells ONLY wrth I/& a :.
construction abandormteni,)vu car submit one form.
C - 4421
7b.Approximate volume of water remaining in well(s): 8.5 (gal.)
NC Well Contractor Cen:ticatior.Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Compary Narne 7e.Type of disinfectant used:
2.Well Construction Permit a;
l.isioll applicable well mnvructiouperreils(I.e.Counlp,late,Variance.etc.)ifknorrn 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 O Neat Cement Grout ❑ Bentomte Chips or Pellets
❑Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) O Sand Cement Grout O Dry Clay
Olndustrial/Commercial oResidential Water Supply(shared) O Concrete Grout O Drill Cuttings
Olrri ation O Specialty Grout O Gavel
Non-Water Supply Well: O Bentonite Slurry O Other(explain under 7g)
OMonitoring ORecovery
Injection Well: 7L For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 9.75 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test OStormwater Drainage
0Experimental Technology OSubsidcnce Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 12/31/22
5a.Well location:
MCB - CAMP LEJEUNE
FacilityrOwner Name Facility IDa(pfapplicable) 8•Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 ""'"` 01/09/23
Physical Address.City,and Zip Signature of Certified Well Contractor or Well Owner Date
ONSLOW By signing this form. I hereby certify that the ivell(s)was (Were) abandoned ill
County Parcel Idenufcation No!P:W accordance Will 1 SA NCAC 02C.0100 or 2C.0200{Yell Construclion Standards
and that a copy of this record has been provided to the ire//owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field,one la-long is sufficient) 9.Site diagram or additional well details:
34c 44' 27.51„ N 770 22' 18.58" 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(SI BEING ABANDONED SUBMITTAL INSTRUCTIONS
Alloch u-eli corutnufioir reconllq iJ arailablr 1•or nrnlirple nryectinnr or non-water supply
hells ONt.Y walh the.same cnnslrrrcuon abandonment,}m con suhnnl nrtr fornn l0a. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDa: SWMU350-IW-64 abandonment to the following:
Division of WaterQuality,Information Processing Unit,
6b.Total well depth: 60.0 (ft) 1617 Mail Service Center,Raleigh,NC 27699-1617
l9b. For Infection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2.0 (in.) above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
7.0 Division of Waler Quality,Underground Injection Control Program,
6d.Water level below ground surface: (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply& Infection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this forth within 30 days of
completion of well abandonment to the county health department of the county
where abandoned.
6f.Inner casing/tubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Fonn GIN 10 North Caro:ma Department of Envronnicni and%ataral Resources-Division of Water Quality Revised March 2013
11

WELL ABANDONMENT RECORD For Internal I_ise ONI Y
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on his/her property) I•or nhultiple injection or non-water supply welly ONLY with tra %row,
C - 4421 cansimcdon abandonment you can submit one famr.
7b.Approximate volume of water remaining in well(s): 5'S
NC Well Comraclor Certification Number (gal.)
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List oil applicable well coerinivtion perintis(i.e.County,State.Variance,etc.)ifknown
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public O Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) DResidential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
0Industrial/Commercial ❑Residential Water Supply(shared) O Concrete Grout O Drill Cuttings
Olrri ation O Specialty Grout ❑Gravel
Non-Water Supply Well: a Bentonite Slurry O Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 6.5 GALLONS
❑Aquifer Storage and Recovery OSalinity Barrier
OAquifer Test OStormwaler Drainage
❑Experimental Technology OSubsidence Control 7g.Provide a brief descriplion of the abandonment procedure:
❑Geothermal(Closed Loop) OTracer ABANDONED VIA TREMIE PIPE VVITH BENTONITE SLURRY
OGeothermal(Heating/Cooling Return) ❑Other(explain under 7 )
4.Date well(s)abandoned: 12/31/22
58.N'ell location:
MCB - CAMP LEJEUNE
Facility/Owner Name Facility IDH(ifapplicable) 8.Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 01/09/23
Physical Address,City,and Zip Signature ofCerti6ed Well Contractor or Well Owner Date
ONSLOW By signing ihis fornl. thereby certify that the wells)ivas (were) abandoned in
County Parcel Identification No (PIN) accordance with 1 SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy ojtlrrs record has been provided io the+veil owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field one lot/long is sufficient) 9.Site diagram or additional well details:
340 44r 27.62" 770 22' 1 5.82" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary
CONSTRUCTION DETAILS OF WELL($)_BEING�ABANDONED SUBMITTAL INSTRUCTIONS
Auaclr well conririictior recard(s)if available Iwr mhdtipie iujenion or iron-ii tiier supply
ivel/s ONLY with the satire construction abandonrrreat.)nu cap;subnat one form. 10a. For All Wells: Submit this fort within 30 days of completion of well
6a.Well ID#: SW M U350-IW-65 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth:
40.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Infection Wells: In addition to sending the form to the address in 10a
2 above,also submit one copy of this form within 30 days of completion of well
6c.Borehole diameter: (in.) abandonment to the following:
6d.Water level below round surface: 7.0 (ft.) Division of Water Quality,Underground Injection Control Program,
g 1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Supply& Injection Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
6E Inner casing/lubing length(if known): (ft.) where abandoned.
6g.Screen length(If known): (ft.)
Fonn GW-30 North Carolina Department of Envaoninent and Natural Resources-Division of Water Quality Revised March 2013
12

WELL ABANDONMENT RECORD r
r Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAM ES MORRISON 7a,Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) hor multiple trtteciton or non-crater supply wells ONLY u•rih the same
consrruction'abandonnre o you can submit one form.
C - 4421
7b.Approximate volume of water remaining in well(s): 5'5 (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit t1:
List all applicable to-ell construction permits(i.e.L oun(r,state.Variance.eic.)ifkrmavn 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural r)Munscipal/Public O Neat Cement Grout ❑ Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Ind ustrial/Commercial I:Residential Water Supply(shared) O Concrete Grout ❑ Drill Cuttings
❑Irri ation ❑ Specialty Grout O Gravel
Non-Water Supply Well: 0 Bentonite Slurry ❑Other(explain under 7g)
OMonitoring ❑Recovery
Injection Well: 7E For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 6.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test OStormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cool m Return) ❑Other(explain under 7 )
4.Date well(s)abandoned: 12/31/22
So.Well location:
MCB - CAMP LEJEUNE
g•Certification:
Facility/Owner Name Facility Wit(if applicable)
2720 PINEY GREEN ROAD JACKSONVILLE 28547 01/09/23
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
ONSLOW By signing this form. 1 hereby certify that the ivell(s)was (it-ere) 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 tltis record has been provided to lire well oirner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one latilong is sufficient) 9.Site diagram or additional well details:
34°44' 28.39" 770 22' 19.50" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary
CONSTRI iON DETA I LS OF WELL BEING ARAN DONE SUBMITTAL INSTRUCTIONS
Attach irell construction record(.s,if available. !-or itrnitiple it jection or ran-water supple
wells ONLY nvrh the some anrcinrcitort bbandanmetrt,you can submit otte farm 10a. For All Wells: Submit this form within 30 days of completion of well
Ga.1Ve11 iDfl:
SWMU350-IW-67 abandonment to the following
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 40.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address in I('oa
6c.Borehole diameter: 2.0 (in.) above,also submit one copy of this form within 30 days of completion of we:
abandonment to the following.
Division of Water Quality,Underground Injection Control Program,
6d.Wafer level below ground surface: 7'0 (ft.) 1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Sunnly At Inieclion Wells: In addition to sending the form to
6e.Outer casing length(if known): (ft.) the address(es) above, also submit one copy of this form within 1) days o
completion of well abandonment to the county health department of the count\
where abandoned
6E Inner casingltubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised Marc!2C 11
13

WELL ABANDONMENT RECORD For Internal Use ONLY
This form can be used for singe or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAM ES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) 1--or multiple injection or iron-u•aler supply wells ONLY +rich der r:
cwrsrrunrarr obarrdonnten{ivu can subndl ane farm.
C - 4421 55
7b.Approximate volume of water remaining in well(s): . (gal.)
NC We]:Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Na,+e 7c.Type of disinfectant used:
2.Well Construction Permit If:
List all applicable well construckoa permas(i.e.Coun(y.State.Variance,ere.)ifkrmtra
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 Pel'els
❑Geothermal(Heating/Cooling Supply) OResideniial Water Supply(single) ❑ Sand Cement Grout ❑ Dry Clay
❑Industrial/Commercial ❑Residential Water Supply(shared) O Concrete Grout O Drill Cuttings
[Arrigation O Specialty Grout ❑Gravel
Non-Water Supply Well: O Bentonitc Slurry ❑Other(explain under 7g)
©Monitoring ORecovery
ial selected above,provide amount of materials used:
Injection Well: 7f.For each mater
OAquifer Recharge ❑Groundwater Remediation 6.5 GALLONS
OAquifer Storage and Recovery ❑Salinily Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology OSubsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) OOther(explain under 7g)
4.Date well(s)abandoned: 12/31/22
59.Well location:
MCB - CAMP LEJEUNE
Facility/Owner Nan:e Facility I04(ifapplicable) 8•Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 �""'"�""'"' 01/09/23
Physical Address,City.and Zip Signature of Certified Well Contractor or Well Owner Date
ONSLOW By signing thus fornr. 1 hereby certify that the ivell(s)ivas(were) abandoned in
County Parcel Identification No (PIN) accordance+vilh 15A NCAC 02C.0100 or 1C.0100 1Vell Consltrtclion Slandarris
and that a copy of this record has been provided to the is-elf owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one taillong is sufficient) 9.Site diagram or additional well details:
340 44' 28.89" 77" 22' 18.68" You may use the back of this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary
CONSTRI CTION DETAILS OFWELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
anuc•!r u•el!r•arestrucrirrn records)if arailable. !rot nnrltrple inlrcrion ar wrn•a•arer supply -
c ONLY+ri1b the sanre consrrucuurr abarrJnnmcnr.�rnr can submit aneJrrrnr. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well IDN• SW M U350-IW-68 abandonment to the following:
Division of WaterQuality,Information Processing Unit,
66.Total well depth:
40.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For lniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2•0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
6d.Nater level below round surface: 7•0 (ft.) Division of Water Quality,Underground Injection Control Program,
g 1636 Mail Service Center,Raleigh,NC 27699-1636
10c. For Water Sunnly& lniection Wells: In addition to sending the form to
6e.Outer casing length(if known)- __—(ft.) the address(es) above, also submit one copy of this form within 30 days of
comp:euon of well abandonment to the county health department of the county
6f.Inner casingltubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
F:rn»GA-31) North Carolina Department of Envnronmem and Naiural Resources Division of Water Quality Revised March 201
14

WELL ABANDONMENT RECORD For Internal Use ONLY
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAIL
JAMES MORRISON 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her properly) 1-or nuthiple injection or non-,rarer supply wells ONLY mid) the same
cwtsimchan abandonment you can submit one faro,.
C -4421
7b.Approximate volume of water remaining in well(s): 5.5 (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List applicable well comirticitaa permits(i.e County,Stare.Variance.etc,,ifbutm,r 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
OAgricullural OMunicipal/Public Q Neat Cement Grout O Bentonite Chips or Pellets
❑Geothermal(Heating/Cooling Supply) OResidenlial Water Supply(single) 0 Sand Cement Grout ❑ Dry Clay
0 Ind usirial/Commercial ❑Residential Water Supply(shared) ❑Concrete Grout ❑ Drill Cuttings
Olrri ation U Specialty Grout 0 Gravel
Non-Water Supply Well: a Bentonite Slurry O Other(explain under 7g)
O Monitoring ❑Recovery
Injection Well: 7f.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remedialion 6.5 GALLONS
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Slormwater Drainage
ElExperimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heating/Cooling Return) OOther(explain under 7g)
4.Date well(s)abandoned: 12/31/22
5a.Well location:
MCB - CAMP LEJEUNE
Facility/Owner Name Facility IDN(if applicable) 8•Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 �"'�"""" 01/09/23
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
O N S LOW By signing this form 1 hereby certify that the ivell(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 15A NCAC 02C 0100 or 2C 0200 Well Catstrre-iton Standards
and that a copy of this record has been provided to the well owner
5b.Latitude and longitude in degrees/minules/seconds or decimal degrees:
(if well Be:d,one laVong is sufficient) 9.Site diagram or additional well details:
34°44' 28.85" 770 22' 18.44" You may use the back or this page to provide additional well site details or well
N W abandonment details. You may also attach additional pages if necessary
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Aaacb well comtrucrion record(s)if available. 1-i,r nwldple in1icoan or non-srarer supply
wells ONLY with die sonre consrnrcrinn abandnnmrnr.Ivni con subma wre firm. 10a. For All Wells: Submit this form within 30 days of comp:aon of we'
6a.Well ID#• SWMU350-IW-69 abandonment to the following
Division of WaterQua[ily,Information Processing Unit,
6b.TolaI well depth: 40.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
10b. For Iniection Wells: In addition to sending the form to the address r• i0a
2.0 above,also submit one copy of this form within 30 days of compaction of well
6c.Borehole diameter: (in.) abandonment to the following.
6d.Water level below ground surface- 7.0 (f(,) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if known): (ft.) 10c. For Water Supply& Iniection Wells: In addition to sending the torm 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
w*.ere abandoned
61 Inner casingitubing length(if known): (ft.)
6g.Screen length(if known): (ft.)
Fonn GW-313 North Carolina Department ofEnvironment and Natural Resources Division of Water Quality Revised Marc►2013
15

WELL ABANDONMENT RECORD For Internal Uic ONLY
This form can be used for single or multiple wells
1.Well Contractor Information: WELL ABANDONMENT DETAILS
JAMES MORRISON 7a.Number of wells being abandoned:
Well Contractor Name(or well owner personally abandoning well on hivt,tr property) Far anrhiple iiyeetion or non-u•oler supply irellr ONLY '-wh rile -ionic
con h-tiC ion abandonment,you con subsirit one form.
C - 4421
7b.Approximate volume of water remaining in well(s): 6.0 (gal.)
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
List all applicable cell convirucsion permits(i.e.County.Srme,Variance.ere.)ifknown 7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
DAgricultural OMunicipal.'Public O Neat Cement Grout D Bentomte Chips or Pellets
❑Geothermal(Heating/Cooling Supply) ❑Residential Water Supply(single) ❑Sand Cement Grout D Dry Clay
Dlndustrial/Commercial ❑Restdcntnal Water Supply(shared) O Concrete Grout O Drill Cuttings
❑Irri ation ❑Specialty Grout ❑Gravel
Non-Water Supply Well: O Bentomte Slurry O Other(explain under 7g)
ElMonitoring ❑Recovery
injection Well: 7E For each material selected above,provide amount of materials used:
OAquifer Recharge ❑Groundwater Remediation 7.5 GALLONS
OAquifer Storage and Recovery OSalmity Barrier
❑Aquifer Test ❑Slormwater Drainage
❑Experimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
❑Geothermal(Closed Loop) ❑Tracer ABANDONED VIA TREMIE PIPE WITH BENTONITE SLURRY
❑Geothermal(Heat in Cool i ng Return) ❑Other(explain under 7g)
4.Date well(s)abandoned: 12/31/22
5a.Well location:
MCB - CAMP LEJEUNE
Fazilit%/Owner same Facility IDN(if applicable) g•Certification:
2720 PINEY GREEN ROAD JACKSONVILLE 28547 "` _01/09/23
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
ONSLOW By signing this form. I hereby certify that the iiell(s)is-as (were)abandoned in
Comty Parcel Identification No(PIN) accordance itilh 15A NCAC 02C.0100 or 2C.0200 Well Constructions Standards
and that a copy of this record has been provided to the ivell owner.
5b.Latitude and longitude in degrees/minuies/seconds or decimal degrees:
(ifwell field one Iattlong is sufficient) 9.Site diagram or additional well details:
34a 44' 29.Q9" 77" 22' 19.82" You may use the back of this page to provide additional%veil site details or well
N W abandonment details. You may also attach additional pages if necessary
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach reAcatutrucrion record(s)ifarailable I•or mulriple royecrion or non-irarer.Supply
wr/G ONI.Y irith Ilse sante consrruciion abmxlonmens,you can.sisbisdrone farm. IOa. For All Wells: Submit this form within 30 days of completion of well
6a.Well ID#: SWMU350-IW-70 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 45.0 (fit) 1617 Mail Service Center,Raleigh,NC 27699-1617
IOb. For lniection Wells: In addition to sending the form to the address in 10a
6c.Borehole diameter: 2.0 (in,) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Gd.Water level below ground surface: 7.0 ((}.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
length d known): (fit. IOc. For Water Supply& Injeclion Wells: In addition to sending the form to
6e.Outer casing g ( ) ) the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
where abandoned
6f.Inner casingltubing length(if known): _(ft.)
6g.Screen length(if knoll n): (ft.)
Frrcr GW-3o North Carolina Department of Environment and Natural Resources Division of Water Quality Revised March 2013
16