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I would check / eliminate all of the belt driven accessories as potential culprits before you automatically jump to valvetrain issues or internal damage. You should also check the bolts on the harmonic balancer to make sure they’re tight. They’ve been known to stretch and work loose.
Dealership said they believe its the water pump and are replacing it. Also replacing the serpentine belt and some pulley because of some bearing noise.
Edit: BUTTTTT They said the waterpump is on back order with no ETA and then told me I shouldnt drive my truck LOLOL. Funny.