MO-9309_40771_CA_O_20230406_TTTRESULTS

Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24556 Visit #25678 3/22/2023
CW# 400000078
Overll
Service Items
Item Qty
Services
Jermaine Jones
Brian Imho
Equipment #Grade Overll Type Result
005 Premium Overll Drop Tube Pass
Overll Verication 1.00
NC-Overll Operability Check 1.00
First Hour Travel/Labor/Truck 2.00
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24556 Visit #25678 3/22/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24556 Visit #25678 3/22/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24556 Visit #25678 3/22/2023
CW# 400000078
Diagram - Site Diagram (v2)12345678
9
10
11
12
13
1: Dispenser - 3/4
2: Dispenser - 1/2
3: Dispenser - 5/6
4: Dispenser - 7/8
5: Dispenser - 9/10
6: Dispenser - 13/14
7: Dispenser - 11/12
8: Steel Tank - Premium
9: Steel Tank - Kerosene
10: Steel Tank - Diesel
11: Steel Tank - Regular 2
12: Steel Tank - Regular 1
13: Road - Highway 64-70 SE
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24556 Visit #25678 3/22/2023
CW# 400000078
Visit Verication
CUSTOMER
Speedway LLC
LOCATION
#44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
CONTACT
Speedway LLC
SCHEDULED
03/22/2023 12:00am (EDT)
ASSIGNED TO
Jermaine Jones, Brian Imho
SERVICE REASON
Maintenance
PRODUCTS & SERVICES
Item Qty
Services
CONFIRMATION
By signing this verication you are agreeing that we have performed and/or provided services and parts listed above.
Approver's Name
Tracy Rollins Email
Signature Status
Captured
Overll Verication 1.00
NC-Overll Operability Check 1.00
First Hour Travel/Labor/Truck 2.00
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24923 Visit #26050 4/05/2023
CW# 400000072
Spill Bucket Test (Hydro / Vacuum)
UST Monitor
Service Items
Item Qty
Services
Jermaine Jones
Brian Imho
Equipment #Grade Spill Bucket Type Wall Type Result
005 Premium Spill Bucket: Fill Double Pass
005 Premium Spill Bucket: Fill Double Pass
Form Name Result
UST Monitor Pass
Spill Buckets 1.00
Spill Bucket Outerwalls 1.00
NC-Triennial UST Spill Bucket Integrity Testing 1.00
NC-Annual ATG Retest 1.00
Monitor Certication Retest 1.00
First Hour Travel/Labor/Truck 2.00
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24923 Visit #26050 4/05/2023
CW# 400000072
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24923 Visit #26050 4/05/2023
CW# 400000072
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24923 Visit #26050 4/05/2023
CW# 400000072
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24923 Visit #26050 4/05/2023
CW# 400000072
Diagram - Site Diagram (v2)12345678
9
10
11
12
13
1: Dispenser - 3/4
2: Dispenser - 1/2
3: Dispenser - 5/6
4: Dispenser - 7/8
5: Dispenser - 9/10
6: Dispenser - 13/14
7: Dispenser - 11/12
8: Steel Tank - Premium
9: Steel Tank - Kerosene
10: Steel Tank - Diesel
11: Steel Tank - Regular 2
12: Steel Tank - Regular 1
13: Road - Highway 64-70 SE
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-24923 Visit #26050 4/05/2023
CW# 400000072
Visit Verication
CUSTOMER
Speedway LLC
LOCATION
#44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
CONTACT
Speedway LLC
SCHEDULED
04/05/2023 12:00am (EDT)
ASSIGNED TO
Jermaine Jones, Brian Imho
SERVICE REASON
Compliance Retest
PRODUCTS & SERVICES
Item Qty
Services
CONFIRMATION
By signing this verication you are agreeing that we have performed and/or provided services and parts listed above.
Approver's Name
Tracy Rollins Email
Signature Status
Captured
Spill Buckets 1.00
Spill Bucket Outerwalls 1.00
NC-Triennial UST Spill Bucket Integrity Testing 1.00
NC-Annual ATG Retest 1.00
Monitor Certication Retest 1.00
First Hour Travel/Labor/Truck 2.00
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
EZY-3 Tank Test
Leak Detector
Petro-tite Line Test
Spill Bucket Test (Hydro / Vacuum)
Service Items
Item Qty
Labor
Products
Services
Equipment #Grade Result
001 Regular Pass
002 Regular Pass
003 Diesel Pass
004 Kerosene Pass
005 Premium Pass
Equipment #Grade Pump Type Result
001 Regular Mechanical (MLLD)Pass
002 Regular Mechanical (MLLD)Pass
003 Diesel Mechanical (MLLD)Pass
004 Kerosene Mechanical (MLLD)Pass
005 Premium Mechanical (MLLD)Pass
Equipment #Grade Result
001/002 Regular Pass
003 Diesel Pass
004 Kerosene Pass
005 Premium Pass
Equipment #Grade Spill Bucket Type Wall Type Result
001 Regular Spill Bucket: Fill Single Pass
002 Regular Spill Bucket: Fill Double Pass
003 Diesel Spill Bucket: Fill Single Pass
004 Kerosene Spill Bucket: Fill Single Pass
005 Premium Spill Bucket: Fill Single Fail
Labor: 2 Men 6.25
Adapter Dry Break Swivel
4 in. OPW Swivel Dry Break
1.00
Adaptor Swivel - Fill
4 in. OPW Brass Swivel Fill
1.00
All Tank Systems (tanks, lines, leak detectors)5.00
NC-Triennial UST Spill Bucket Integrity Testing 1.00
Spill Buckets 1.00
First Hour Travel/Labor/Truck 2.00
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Jermaine Jones
Brian Imho
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Diagram - Site Diagram (v2)12345678
9
10
11
12
13
1: Dispenser - 3/4
2: Dispenser - 1/2
3: Dispenser - 5/6
4: Dispenser - 7/8
5: Dispenser - 9/10
6: Dispenser - 13/14
7: Dispenser - 11/12
8: Steel Tank - Premium
9: Steel Tank - Kerosene
10: Steel Tank - Diesel
11: Steel Tank - Regular 2
12: Steel Tank - Regular 1
13: Road - Highway 64-70 SE
Crompco LLC
1815 Gallagher Rd
Plymouth Meeting, PA 19462
Speedway LLC
Location #44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
[phone]
W-20076 Visit #21166 3/09/2023
CW# 400000078
Visit Verication
CUSTOMER
Speedway LLC
LOCATION
#44696/7967
1835 HIGHWAY 64-70 SE
HICKORY, NC 28603
CONTACT
Speedway LLC
SCHEDULED
03/09/2023 12:00am (EST)
ASSIGNED TO
Jermaine Jones, Brian Imho
SERVICE REASON
Maintenance
PRODUCTS & SERVICES
Item Qty
Labor
Products
Services
CONFIRMATION
By signing this verication you are agreeing that we have performed and/or provided services and parts listed above.
Approver's Name
Tracy Rollins Email
Signature Status
Captured
Labor: 2 Men 6.25
Adapter Dry Break Swivel
4 in. OPW Swivel Dry Break
1.00
Adaptor Swivel - Fill
4 in. OPW Brass Swivel Fill
1.00
All Tank Systems (tanks, lines, leak detectors)5.00
NC-Triennial UST Spill Bucket Integrity Testing 1.00
Spill Buckets 1.00
First Hour Travel/Labor/Truck 2.00
UST-17B UST Suspected Release 7 Day Notice
 This form must be used to report to DEQ, within 7 days of discovery, the investigation results for a Suspected Release from any of the following:
a) Failed or inconclusive leak detection or tightness test results. This includes positive test results, such as “Increase”, which indicates the level in the
UST system has increased more than 0.2 gph.
b) Unusual operating conditions which can include, but are not limited to, the erratic behavior of dispensing equipment; the unexplained presence of
water in the tank; the presence of fuel in containment sumps or interstitial spaces; or the degradation of any equipment or element of an underground
storage tank system to the point where that equipment or element can not reasonably be expected to perform its intended function.
c) Internal inspection results such as, perforations, corrosion holes, weld failures, or other similar defects that indicate a release could have occurred.
 If you have more than four UST systems to report suspected release investigations, then attach additional sheets of the UST-17B form.
 Please submit this form along with the supporting documentation to:
NCDEQ/DWM, UST Section
1646 Mail Service Center
Raleigh, North Carolina 27699-1646
OR
Fax to [phone] OR [e-mail]
I. UST OWNER II. UST FACILITY
Name:

Name:

Facility ID:

Address:

Address:

City:

State:

Zip:

City:

County:

Person Reporting:

Title of Person Reporting:

Telephone Number:
( )
III. INVESTIGATION RESULTS
Tank Number / Size: / / / /
Product Stored:
Reason for Suspected
Release Investigation
(Check all that apply):

You must attach the
supporting documentation
specified in the footnote for
the reason(s) selected.
Data entry error 1
Dispensing fuel while
test is being conducted 2
Faulty equipment 3
Incorrect stick or meter
reading 1
Incorrect tank chart 4
Internal Inspection 5
Meter not calibrated 6
Other (Attach
explanation)1
Tank/Dispenser
containment sump contains liquid 7
Tilted tank 8
Unknown 1
Data entry error 1
Dispensing fuel while
test is being conducted 2
Faulty equipment 3
Incorrect stick or meter
reading 1
Incorrect tank chart 4
Internal Inspection 5
Meter not calibrated 6
Other (Attach
explanation)1
Tank/Dispenser
containment sump contains liquid 7
Tilted tank 8
Unknown 1
Data entry error 1
Dispensing fuel while
test is being conducted 2
Faulty equipment 3
Incorrect stick or meter
reading 1
Incorrect tank chart 4
Internal Inspection 5
Meter not calibrated 6
Other (Attach
explanation)1
Tank/Dispenser
containment sump contains liquid 7
Tilted tank 8
Unknown 1
Data entry error 1
Dispensing fuel while
test is being conducted 2
Faulty equipment 3
Incorrect stick or meter
reading 1
Incorrect tank chart 4
Internal Inspection 5
Meter not calibrated 6
Other (Attach
explanation)1
Tank/Dispenser
containment sump contains liquid 7
Tilted tank 8
Unknown 1
1 Conduct a tank and/or line tightness test and attach the results, along with all of the supporting data sheets for the test method, to this form for submittal.
The summary page listing the results by itself is not acceptable. If the tightness test results are fail, then you must repair or replace your UST system and
conduct a site check in accordance with 15A NCAC 2N .0603.
2 Provide sales receipts or other comparable documentation that shows fuel was being dispensed from the UST during the test.
3 Provide invoices (with a description of the work completed) or other documentation that shows the equipment has been repaired.
4 Correct your leak detection results using the correct tank chart and submit copies with this form.
5 Repair the UST in accordance with the manufacturer’s instructions or a national standard (e.g., PEI API 1631) and conduct a site check in accordance with
15A NCAC 2N .0603. If the UST is not repaired, then it must be permanently closed in accordance with the latest version of the UST Sections Guidelines
for Tank Closure.
6 Correct your leak detection results using the amount your meter was adjusted following calibration and submit copies of the meter calibration and leak
detection results with this form.
7 Conduct a tightness test (e.g., hydrostatic test) of the sump and submit the test result along with this form. If the test results are fail, then you must repair
or replace the containment sump and conduct a site check in accordance with 15A NCAC 2N .0603.
8 Submit documentation from your UST equipment contractor explaining how they determined the UST was tilted. Correct your leak detection results using a
tank chart adjusted for the tilt and submit with this form.
Note: Tank, piping, spill bucket and containment sump replacements must be done in accordance with 15A NCAC 2N .0900
UST-17B Revised 10/2015 http://www.wastenotnc.org/web/wm/

Speedway LLC
500 Speedway Dr
EEnon OH 45323
Speedway # 7967 007587
1835 US Highway 70 SE
Hickory Catawba
Daniel Gum Environmental Specialist 937 301-2689
5 10,000
PUL