FA-3092_29289_CA_MRP_20230523

WithersRavenel
Our People. Your Success.
115 MacKenan Drive | Cary, NC 27511
t: 919.469.3340 | f: 919.467.6008 | www.withersravenel.com | License No. F-1479
Asheville | Cary | Charlotte | Greensboro | Lumberton | Pittsboro | Raleigh | Southern Pines | Wilmington

GROUNDWATER MONITORING REPORT

Jimmy’s Superette
NCDEQ Incident # 29289
UST # : FA-3092
8700 NC HWY 742 South
Wadesboro, Anson County, North Carolina
WithersRavenel Project No. 23-0307-CD

Prepared for:
State of North Carolina Department of Environmental Quality Division of Waste Management Underground Storage Tank Section Federal & State Lead Program 1646 Mail Service Center Raleigh, North Carolina 27699-1646
Prepared by:
WithersRavenel
115 MacKenan Drive
Cary, North Carolina 27511
North Carolina Firm License No. F-1479
May 23, 2023

WithersRavenel
Our People. Your Success.
115 MacKenan Drive | Cary, NC 27511
t: 919.469.3340 | f: 919.467.6008 | www.withersravenel.com | License No. F-1479
Asheville | Cary | Charlotte | Greensboro | Lumberton | Pittsboro | Raleigh | Southern Pines | Wilmington
May 23, 2023
State of North Carolina Department of Environmental Quality Federal & State Lead Program Division of Waste Management-Underground Storage Tank Section
1646 Mail Service Center Raleigh, North Carolina 27699-1646 Attn: Mr. Hassan Osman Re: Groundwater Monitoring Report Jimmy’s Superette 8700 NC HWY 742 South Wadesboro, Anson County, North Carolina Groundwater Incident Number: 29289
UST Number: FA-3092 Site Rank: I115D WR Project Number: 23-0307-CD
Mr. Osman:
WithersRavenel, Inc. (WR) has completed this Groundwater Monitoring Report to document
monitoring well installation, top-of-casing elevation surveying, and groundwater sampling activities completed at the facility in association with our proposal, numbered TA-01, for the above referenced site, approved by the Federal & State Lead Program on March 14, 2024. Due to site conditions encountered during monitoring well installation, a Change Order (CO-01) was submitted and approved on April 26, 2023 for additional footage for two monitoring wells. The
enclosed report summarizes results of the recently completed monitoring activities. WR appreciates the opportunity to be of service to the Federal & State Lead Program. Should you have any questions regarding the attached, please contact us at [phone].
Cordially, WithersRavenel
David C. Vail, E.I. Elizabeth A. Allyn, P.G. Environmental Scientist II Environmental Project Geologist II
WithersRavenel
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Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023 i
TABLE OF CONTENTS

SECTION A. SITE INFORMATION ..................................................................................................................... 1
SECTION B. EXECUTIVE SUMMARY ................................................................................................................ 3
SECTION C. SITE HISTORY AND CHARACTERIZATION ............................................................................ 5
SECTION D. MONITORING WELL INSTALLATION – APRIL 2023 .......................................................... 7
SECTION E. GROUNDWATER SAMPLING – APRIL 2023 .......................................................................... 8
SECTION F. CONCLUSIONS AND RECOMMENDATIONS ........................................................................ 9

FIGURES
Figure 1 General Location Map
Figure 2 Site Map
Figure 3 Potential Receptor Map
Figure 4 Groundwater Elevation Contour Map – April 2023
Figure 5 Groundwater Analytical Results Map – April 2023

TABLES
Table B-1 Site History: UST/AST System & Other Release Information
Table B-4 Summary of Groundwater Analytical Results
Table B-5A Public & Private Water Supply Well Information
Table B-5B Additional Receptor Information
Table B-5C Adjacent Property Information
Table B-7 Monitoring Well Construction Information & Liquid Level Data

APPENDICES
Appendix A Field Notes & Photographic Record
Appendix B Boring Log & Well Construction Record
Appendix C Laboratory Analytical Report and Chain-of-Custody
Appendix D General Standard Operating Procedures

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Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023 1
SECTION A. SITE INFORMATION
1. Site Identification
Date of Report: May 23, 2023
Facility I.D.: 00-0-0000034891
Incident No.: 29289
UST No.: FA-3092
Site Risk: Intermediate
Site Rank: I115D
Land Use Category: Residential
Site Name: Jimmy’s Superette
Site Location: 8700 HWY 742 South
Nearest City/Town: Wadesboro
County: Anson
Description of Geographical Data Point: UST Basin
Location Method: Google Earth
Latitude: 34.839258°
Longitude: -80.093782°
2. Contact Information
Responsible Party: Jimmie M. Hough (deceased 2/24/2013)
Address: Not Applicable
Phone: Not Applicable

Property Owner: Richard G. Melton, etal
Address: 4141 NC HWY 190 South, Wadesboro, NC 28170
Phone: Not Available

Property Occupant: 5 Points Junction / Melton Bros Store
Address: 8700 NC HWY 742, Wadesboro, NC 28170
Phone: [phone]

Consultant/Contractor: WithersRavenel
Address: 115 MacKenan Drive, Cary, NC 27511
Phone: [phone]

Analytical Laboratory: Waypoint Analytical, Inc.
State Certification Number: ENV402
Address: 449 Springbrook Rd., Charlotte, NC 28217
Phone: [phone]

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Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023 3
SECTION B. EXECUTIVE SUMMARY

1. Summary of Activities Associated with Current TA WithersRavenel, Inc. (WR) supervised the installation of and surveyed two monitoring well (MW-2 and MW-3), as well as sampled the newly installed wells and previously installed MW-1 at the
Jimmy’s Superette site located at 8700 NC HWY 742 South in Wadesboro, Anson County, North
Carolina in association with task authorization (TA) TA-01 under North Carolina Department of Environmental Quality (NCDEQ) Contract #N70522-C.
2. Groundwater and LNAPL Assessment Information Soil
Soil samples were not collected as part of this TA. According to a Site Check Report by Philip
Thompson P.G. dated May 5, 2006, five soil borings were advanced along the product piping from the dispenser island to the UST basin and four soil borings were advanced around the UST basin. The samples collected around the dispenser and product lines did not contain total petroleum hydrocarbons (TPH) gasoline range organics (GRO) above the laboratory detection limits. Two of
the soil borings (SB-6 130 mg/kg and SB-9 14 mg/kg) around the UST basin contained TPH GRO
detections above the NCDEQ action level of 10 milligrams per kilogram (mg/kg) that were in effect at that time. On May 24, 2006, an additional soil boring was advanced in the location of SB-6. A sample was collected from 10-11.5-ft below ground surface (BGS) and analyzed by Environmental Protection Agency (EPA) Method 8260 and Massachusetts Department of Environmental Protection (MADEP) Method Volatile Petroleum Hydrocarbons (VPH). Results of this soil sampling
indicated six compounds that were found to exceed the Soil to Groundwater Maximum Soil Contaminant Concentrations (MSCCs), but were below the Residential MSCCs.
Groundwater Groundwater samples were collected from monitoring wells MW-1, MW-2, and MW-3 on April
19, 2023, and analyzed for volatile organic compounds (VOCs) by Standard Method 6200B plus
oxygenates. Laboratory results indicated the following:
• None of the compounds were present above the Gross Contamination Levels (GCLs).
• MW-1 and MW-3 contained at least one compound at concentrations above the North
Carolina Groundwater Quality Standards (2L Standards).
• Monitoring well MW-2 contained chloroform above the laboratory method detection limits (MDL) but below the 2L Standard.

Light Non-Aqueous Phase Liquid (LNAPL) No LNAPL was measured in MW-1, MW-2, or MW-3 when these wells were gauged on April 19, 2023. LNAPL has not historically been detected at the site.
3. Receptor Information
In November 2022, WR conducted a receptor survey for the site. WR identified one water supply well within 1,000-ft of the site (WSW-1) that is assumed to be inactive based on the associated residence having an active municipal water account. A second inactive WSW (WSW-2) was
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Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023 4
identified 1,360-ft west of the site. The well was associated with an abandoned, dilapidated mobile home. A third WSW was identified 2,100-ft east of the site.

WR also identified one potentially sensitive receptor, the New Hope Methodist Church (21 Maysville Road) located on the south adjacent property. Additionally, WR also reviewed the NCDEQ Source Water Assessment Program (SWAP) Info 2.0 website for records of community water supplies within 1-mile of the site as well as the U.S. Fish
& Wildlife Service Wetlands Mapper website to identify any potential receptors. WR did not identify any public water sources or community wells with 1-mile of the site. Several riverine and wetland habitats were identified on the U.S. Fish & Wildlife website.
4. Remediation Activities No remedial activities were performed at the site during the activities associated with this TA. No remedial activities are known to have been performed at the site to date.

5. Recommendations Based on the results of assessment and monitoring activities conducted at the site in association with this TA, WR recommends the following:

• Conduct quarterly monitoring for one year to determine trends prior to fate and transport modeling;
• If contamination levels remain the same, consider fate and transport modeling as a means
for closure under G.S. 143.215.94V.
• Petition the owner of WSW-1 to abandon their water supply well since they have an active municipal water account.
• Conduct a site-wide ground penetrating radar (GPR) event to determine if relic USTs remain on the property.

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Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023 5
SECTION C. SITE HISTORY AND CHARACTERIZATION

The following information summarizes the site history and characterization.
1. UST Information Limited historical information is available regarding the underground storage tanks (USTs) at this
site. Based on historical documentation, it was reported that three 3,000-gallon gasoline USTs
were installed at the site in the late 1950’s. It is unknown if the site contained USTs prior to this set of tanks, but it should be noted the site building was constructed in the 1940s. It is also unknown if these three USTs were removed from the site. Two 3,000-gallon gasoline USTs were registered under facility ID# 00-0-0000034891 (Melton Bros Store Inc.). These two USTs are listed as current in the UST Facility Tank Database and were installed in 1979. UST closure reports
or associated information was not discovered during the review of historical files. The site location is shown on Figure 1 and Figure 2 shows the location of the historical UST system. Historical UST information is provided in Table B-1.

2. Description of Release/General Assessment History
The following summary of the assessment history is based on WR’s review of historical files for the subject incident including:
• May 5, 2006: Site Check Report prepared by Philip R. Thompson P.G. Geological and
Environmental Services. This report describes the collection of soil samples around the dispenser island, fuel lines, and UST basin. Two soil borings were advanced adjacent to the dispenser island, three borings adjacent to the fuel lines, and four borings were advanced around the UST basin. Analytical results for two samples (SB-6 and SB-9) collected by the UST basin detected total petroleum hydrocarbons gasoline range organics (TPH-GRO) at
concentrations that exceeded the applicable NCDEQ Action Levels in place at that time. This report determined that the release was old and possibly from an overfill of the USTs.
• June 5, 2006: Limited Site Assessment Report prepared by Philip R. Thompson P.G. Geological
and Environmental Services. This report describes the collection of a soil sample (SB-1) from the location where SB-6 was previously collected. After the collection of the soil sample, the boring was advanced to groundwater and a 1-inch Type II monitoring well was installed at the site. The soil sample was analyzed by Environmental Protection Agency (EPA) Method 8260
for volatile organic compounds and Massachusetts Department of Environmental Protection
(MADEP) Method for Volatile Petroleum Hydrocarbons (VPH). Analytical results for the soil sample reported numerous exceedances of the Soil-to-Groundwater Maximum Soil Contaminant Concentrations (MSCCs) in place at the time of sampling. A groundwater sample was collected from the newly installed monitoring well the following day and analyzed by
Standard Method (SM) 6200B. The analytical results reported numerous exceedances of the
North Carolina Groundwater Quality Standards (2L Standard) and an exceedance of the Gross Contamination Levels for 1,2-Dibromoethane.
• January 13, 2023: Receptor Survey & Groundwater Monitoring Letter Report: prepared by WR.
This report identified one WSW within 1,000 feet, and a second WSW within 1,500-ft of the
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source of the release. A church was identified on the south adjacent property. WR did not identify any public water sources or community wells with 1-mile of the site. Several riverine
and wetland habitats were identified on the U.S. Fish & Wildlife website. Municipal water is
available to all properties within the vicinity of the site. MW-1 was sampled by WR while on-site. Four of the fifteen targeted compounds that were detected in the sample were found to be at a concentration exceeding the 2L Standard. No GCL violations were reported.
3. Brief Description of Site Characteristics
The Jimmy’s Superette site is located at 8700 NC HWY 742 South, Wadesboro, Anson County, North Carolina (Figure 1). The property includes one parcel which is occupied by “5 Points Junction” according to a sign on the building, but is listed online as “Melton Bros Store” a one-
story brick structure operating as a convenience store and gas station. The site has a asphalt paved
parking lot to the northeast, east, and southeast. A gravel drive and parking area is located to the north, northwest, southwest, and south of the structure. The area further west is a grassy field.
The subject property includes 0.89 acres of land, approximately 1/3 of which is developed with structures and/or asphalt and gravel paved areas. The remainder of the parcel is covered with
grass. The North Carolina Parcel Identification Number (NC PIN) for the property is
637900187117.
Based on review of information provided on the Anson County GIS website, the property and surrounding areas are not assigned zoning codes. Photographs of site conditions observed during the April 2023 sampling event are included in Appendix A.

4. Information on Receptors/Potential Receptors In November 2022, WR conducted a receptor survey for the site. WR submitted a list of addresses within 1,000-ft of the site to Anson County Utilities Department. WR requested that it be verified
if these addresses had an active municipal water account. Anson County’s Assistant Utilities
Director responded to the request and provided a response to whether each of the twenty properties within 1,000-ft of the site have an active municipal water account. One of the properties with an active municipal water account was also observed to contain a water supply well (8876 NC HWY 742 S). This well is assumed to be inactive based on the active municipal water account. Additionally, a second water supply well was identified at an abandoned mobile
home (272 Deep Creek Rd), this well was located approximately 1,360-ft west of the source of the release and was reported by the owner to be inactive. Lastly, a property with habitable structures was reported to not have municipal water and replied to WR’s mailing and responded that they have a potable water supply well. The well is located over 2,100-ft away from the source area to the east southeast. Water supply well ownership and address information is provided in Table 5-A. During the receptor survey, WR identified one potentially sensitive receptor, the New Hope Methodist Church (21 Maysville Road) located on the south adjacent property. WR also reviewed the NCDEQ Source Water Assessment Program (SWAP) Info 2.0 website for
records of community water supplies within 1-mile of the site as well as the U.S. Fish & Wildlife Service Wetlands Mapper website to identify any potential receptors. WR did not identify any
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public water sources or community wells with 1-mile of the site. Several riverine and wetland habitats were identified on the U.S. Fish & Wildlife website. The site, potential receptors including
the neighboring church, and adjoining parcels are depicted on Figure 3. Potentially sensitive
receptor information and adjacent property ownership information is included in Tables B-5B and B-5C.
5. Regional and Site Geology and Hydrology
The Geologic Map of North Carolina depicts the site is located in the Coastal Plain Physiographic
Province of North Carolina (Coastal Plain) underlain by sedimentary rock of Cretaceous age. The
site is mapped as lying within the Middendorf Formation, and materials are described as “Sand, sandstone, and mudstone, gray to pale gray with an orange cast, mottled; clay balls and iron-cemented concretions common, beds laterally discontinuous, cross-bedding common.”
According to the United States Department of Agricultural (USDA) Natural Resources
Conservation Service (NRCS) Web Soil Survey, the source area is underlain by Candor sand (1 to 8 percent slopes). Candor sand is described as somewhat excessively drained with a low runoff classification. These soils are typically found on crests/summits and are derived from sandy and loamy marine deposits and/or eolian sands.
Soils indexed by WR personnel during the installation of the site monitoring wells MW-2 and MW-3 included sands to approximately 20 feet below ground surface (ft-BGS) and silty sands to approximately 23 ft-BGS. No bedrock was encountered during the installation of MW-2 or MW-3.
Surface drainage through the area generally follows surface topography and drains to the west or flows to roadside wet weather ditches. The closest surface water to the source of the release found through site reconnaissance and review of topographic maps was an unnamed pond – located approximately 510-feet west of the source of the release.
Depths to groundwater ranged from 10.73 feet below top-of-casing (BTOC) in MW-2 to 11.58 feet BTOC in MW-3. Groundwater flow direction was generally to the south-southwest. A groundwater elevation contour map is included as Figure 4. Field notes documenting the monitoring well installation activities are included in Appendix A and the boring logs for MW-2 and MW-3 are included in Appendix B.

SECTION D. MONITORING WELL INSTALLATION – APRIL 2023
On April 19, 2023, WR oversaw the installation of two Type II monitoring wells (MW-2 and MW-
3) by AmeriProbe, LLC. Prior to the installation of the monitoring well, Probe Utility Locating
Services provided utility locating services in the vicinity of the planned monitoring well to ensure that underground utilities would not interfere with the installation of the monitoring wells. Monitoring wells MW-2 and MW-3 were advanced using a track mounted GeoProbe 7720DT drill rig using 4.25” diameter hollow-stem augers. Both monitoring wells were advanced to a total depth
of 23 ft-BGS. The boring logs and well construction records for MW-2 and MW-3 are included in Appendix B, while construction details are included in Table B-7.
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Monitoring wells MW-2 and MW-3 were both constructed with 15 ft of 2 in diameter Schedule 40 PVC slotted well screen and 8 ft of 2 in diameter Schedule 40 PVC riser. Following
emplacement of the screens and risers, #2 well sand was emplaced to extend from the base of the
borings to approximately 2 ft above the top of the screens. The well sand was capped with a 3 ft thick bentonite seal and finished to grade with neat cement in both wells. The wells were completed at surface grade with a locking well caps enclosed in 8 in dia. flush-mounted steel manholes. After the well installation, MW-2 and MW-3 were developed.

SECTION E. GROUNDWATER SAMPLING – APRIL 2023
On April 25, 2023, WR personnel gauged, purged, and sampled monitoring wells MW-1, MW-2, and MW-3. The following paragraphs describe the sampling activities and associated laboratory
analytical results.
Groundwater Sampling Activities Prior to the purging and sampling of site monitoring wells as described below, WR personnel gauged the wells with an electronic oil-water interface meter to determine the depth to LNAPL and groundwater at each well location. During the performance of these activities, LNAPL was
not identified in the monitoring wells.
The depth to groundwater measurements in the monitoring wells across the site ranged from 10.73-ft BTOC in MW-2 to 11.58 ft-BTOC in monitoring well MW-3. The depth to water in all monitoring wells was within the screened interval. Based on groundwater elevation measurements on April 25, 2023, the direction of groundwater flow is generally towards the south-southwest.
Groundwater flow as determined based on these measurements is shown on Figure 4.
Groundwater elevation measurements for this event are presented in Table B-7. Field notes are included in Appendix A.
Following gauging, the monitoring wells were purged and sampled with separate, disposable polyethylene (PE) bailers for each well. Samples from the wells were decanted into pre-preserved laboratory provided sample containers. Samples collected from wells were submitted to Waypoint
Analytical, Inc. under proper chain of custody procedures for testing by Standard Method (SM) 6200B plus oxygenates. Laboratory Results
Analytical results for groundwater samples obtained from site monitoring wells on April 19, 2023
indicated the following:
• None of the compounds were present above the GCLs.
• MW-1 and MW-3 contained at least one compound at concentrations above the 2L
Standards.
• Monitoring well MW-2 contained chloroform above the laboratory method detection limits (MDL) but below the 2L Standard.
Current and historical groundwater analytical results are summarized in Table B-4. Current
groundwater analytical results are shown on Figure 5.
Copies of the laboratory analytical report and chain-of-custody are included in Appendix C. WR’s generalized standard operating procedures are provided in Appendix D.
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Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023 9
SECTION F. CONCLUSIONS AND RECOMMENDATIONS

This report documents the results of field activities conducted at the site for TA-01, which included the installation of monitoring wells MW-2 and MW-3, surveying all three site monitoring wells, as well as gauging, purging, and sampling monitoring wells MW-1 through MW-3.
Conclusions based on observations, analytical data and research relating to the release at the site
combined with historical information include the following:
• The site is currently occupied by 5 Points Junction / Melton Bros Store (gas station and convenience store).
• Several potentially sensitive receptors have been identified. These potentially sensitive receptors include one church located within 500-ft of the site and one water supply well (WSW-1) located approximately 835 feet south of the source of the release. Two
additional water supply wells were identified at distances greater than 1,000-ft away from
the source of the release (WSW-2 located approximately 1,360-ft west of the source and WSW-3 located approximately 2,100-feet east of the source).
• No bodies of water were discovered within 500-ft of the source of the release during this
assessment.
• Monitoring wells MW-2 and MW-3 were installed, developed, and sampled.
• Monitoring well MW-1 was located, gauged, purged, and sampled.
• LNAPL was not identified in MW-1 through MW-3 and has not historically been detected.
• None of the compounds were present above the GCLs in site monitoring wells.
• MW-1 and MW-3 both contained targeted compounds at concentrations exceeding the
2L Standard.
• Monitoring well MW-2 contained chloroform above the laboratory MDL but below the 2L Standard.
• The groundwater elevation data indicated a south-southwesterly groundwater flow direction. Based on the results of assessment and monitoring activities conducted at the site in association
with this TA, WR recommends the following:

• Conduct quarterly monitoring for one year to determine trends prior to fate and transport modeling;
• If contamination levels remain the same, consider fate and transport modeling as a means for closure under G.S. 143.215.94V.
• Petition the owner of WSW-1 to abandon their water supply well since they have an active
municipal water account.
• Conduct a site-wide ground penetrating radar (GPR) event to determine if relic USTs remain on the property.
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FIGURES
© 2022 Microsoft Corporation © 2022 TomTom
ACTIVE USTs
DCV
EAA
DRAWN BY:
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SCALE:FIGURE NO.:
PROJECT NO.:DATE:APPROVED BY:
JIMMY'S SUPERETTE TF#29289
8700 NC HWY 742 SOUTH
WADESBORO, ANSON COUNTY, NC
GENERAL LOCATION MAP
1"=2000 '
GRAPHIC SCALE
1 inch = 2000 ft.
0 20001000 4000
WithersRavenel
Engineers | Planners | Surveyors
115 MacKenan Drive | Cary, NC 27511 | t: 919.469.3340 | license #: F-1479
www.withersravenel.com
SUBJECT SITE
± 0.89 ACRES
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1 inch = 30 ft.
3015 600
LEGEND
TYPE II MONITORING WELL LOCATION
MUNICIPAL WATER LINE
NOTES:
1.) AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT.JIMMY'S SUPERETTE TF#292898700 NC HWY 742 SOUTHWADESBORO, ANSON COUNTY, NCW
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WATER SUPPLY WELL LOCATION
MUNICIPAL WATER LINE
POND
STREAM
ADDITIONAL RECEPTOR LOCATION
ADJACENT PROPERTY IDENTIFICATION
NOTES:
1.) AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT.JIMMY'S SUPERETTE TF#292898700 NC HWY 742 SOUTHWADESBORO, ANSON COUNTY, NCW
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1 inch = 30 ft.
3015 600 DCVEAADRAWN BY:05/17/202323-0307-CD4SCALE:FIGURE NO.:PROJECT NO.:DATE:APPROVED BY:GROUNDWATERELEVATION COUNTOURMAPWithersRavenelEngineers | Planners | Surveyors115 MacKenan Drive | Cary, NC 27511 | t: 919.469.3340license #: F-1479 | www.withersravenel.comLEGEND
GROUNDWATER ELEVATION (FT)
GROUNDWATER ELEVATION CONTOUR (FT)
(DASHED WHERE INFERRED)
CALCULATED GROUNDWATER FLOW DIRECTION
TYPE II MONITORING WELL LOCATION
MUNICIPAL WATER LINE
NOTES:
1.) AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT.JIMMY'S SUPERETTE TF#292898700 NC HWY 742 SOUTHWADESBORO, ANSON COUNTY, NCW
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SUPERETTE
TF# 29289
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MW-2
MW-3 J:\23\0307-CD-Jimmy's Superette\Enviro\CAD\TF#29289_Jimmy's_Superette_05.17.2023.dwg- May 19, 2023 - DVAIL1"=30 'GRAPHIC SCALE
1 inch = 30 ft.
3015 600 DCVEAADRAWN BY:05/17/202323-0307-CD5SCALE:FIGURE NO.:PROJECT NO.:DATE:APPROVED BY:GROUNDWATERANALYTICAL RESULTSMAPWithersRavenelEngineers | Planners | Surveyors115 MacKenan Drive | Cary, NC 27511 | t: 919.469.3340license #: F-1479 | www.withersravenel.comLEGEND
TYPE II MONITORING WELL LOCATION
MUNICIPAL WATER LINE
NOTES:
1.) AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT.JIMMY'S SUPERETTE TF#292898700 NC HWY 742 SOUTHWADESBORO, ANSON COUNTY, NCW
WithersRavenel
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TABLES

UST IDNumberCapacity(in gallons)ConstructionDetailsTankDimensions (diameter x length)Description ofAssociatedPiping & PumpsDate of TankInstallationStatus ofUSTWas release associated with UST System? (Y/N)1 3,000 Single Wall Steel Unknown Single Wall FRP June 1, 1979 Current N2 3,000 Single Wall Steel Unknown Single Wall FRP June 1, 1979 Current N--- 3,000 Unknown 64" x 18' Unknown 1950's Unknown Y--- 3,000 Unknown 64" x 18' Unknown 1950's Unknown Y--- 3,000 Unknown 64" x 18' Unknown 1950's Unknown YIncidentNumberMaterialReleasedDateofRelease29289 Gasoline13-Apr-06Notes:1) UST Information obtained from NCDEQ tank and ownership publications.Table B-1Site History: UST/AST System & Other Release InformationJIMMY'S SUPERETTEOn April 13, 2006, a Site Check was performed and soil samples were collected around the dispenser island, the product lines, and the USTs at the site. Two of the soil samples collected from the area surrounding the USTs contained total petroleum hydrocarbon (TPH) gasoline range organics (GRO) at concentrations of 130 milligrams per kilogram (mg/kg) at SB-6 and 14 mg/kg at SB-9. Both of these samples were above the regulatory action levels of 10 mg/kg TPH GRO in place at that time. Further analysis indicated that soils at SB-6 (later called SB-1 and where MW-1 was installed) reported numerous exceedances of the Soil-to-Groundwater Maximum Soil Contaminant Concentrations (MSCCs) in place at the time of sampling. A groundwater sample collected from MW-1 indicated numerous exceedances of the North Carolina Groundwater Quality Standards (2L Standard) and an exceedance of the Gross Contamination Levels for 1,2-Dibromoethane.8700 NC HWY 742 SWADESBORO, NC 28170Description of ReleaseIncident # 29289 | WR Project # 23-0307-CDCurrent/LastContentsGasolineGasolineGasolineGasolineGasolinePage 1 of 1
CalculatedBenzene Chloroform Dibromoethane, 1,2‐ Dichloroethane, 1,2‐ Ethanol Ethylbenzene Isopropyl Ether Isopropylbenzene (Cumene) Methyl‐tert‐Butyl Ether Naphthalene Propylbenzene, n‐Styrene tert‐Amyl Alcohol (TAA)Toluene Trimethylbenzene, 1,2,4‐Trimethylbenzene, 1,3,5‐Xylenes, total C5‐C8C9‐C12C9‐C2271‐43‐267‐66‐3 106‐93‐4 107‐06‐264‐17‐5 100‐41‐4 108‐20‐398‐82‐8 1634‐04‐491‐20‐3 103‐65‐1 100‐42‐575‐85‐4 108‐88‐395‐63‐6 108‐67‐8 1330‐20‐705/25/054100NR19044NR3500 190NR ND450NR NR NR22000NR NR19200 8300 12000ND11/08/2212/09/22327 1.56 4.75<0.500 <200131 5.14 2.26 5.06 8.32 5.39 0.847 472 13.8 32.8 15.6 205NA NA NA04/25/238.05<0.500 <0.500 <0.500 <2006.76<0.500 <0.500 <1.00 <1.00 <0.500 <0.500 <10.042.2 2.27 1.35 41.7NA NA NAMW‐204/25/23<0.5000.746<0.500 <0.500 <200 <0.500 <0.500 <0.500 <1.00 <1.00 <0.500 <0.500 <10.0 <0.500 <0.500 <0.500 <0.500 NA NA NAMW‐304/25/231060<5.00 <5.00 <5.003290 395 20.6 12.8<10.050.4 37.9<5.00307 4510 339 81.3 2130NA NA NA1 70 0.02 0.4 4000 600 70 70 20 6 70 70 40 600 400 400 500 400 700 2005,000 70,000 50 400 4,000,000 80,000 70,000 30,500 20,000 6,000 26,100 70,000 40,000 260,000 28,500 24,100 50000 NL NL NLNotes:1)All results provided in ug/L (micrograms per liter) or parts per billion.2)3)4)GCLs for Groundwater = NCDEQ UST Section Gross Contamination Levels for Groundwater (Comprehensive Tables for Corrective Action Guidelines, January 2021).NA / ND / NR= Compound Not Analyzed, Not Detected, or Not ReportedResult= Result Exceeds Laboratory Detection Limits.Result= Result Exceeds 2L Standard.Result= Result Exceeds GCL Value.Compounds analyzed for by laboratory but not listed were not detected above laboratory detection limits. See the laboratory report included  in the Appendix for a full list of constituents. GCLs for GroundwaterNC 2L Standard NC 2L Standard ‐ North Carolina Groundwater Quality Standard as per NC Administrative Code 15A NCAC 02L (Comprehensive Tables for Corrective Action Guidelines, January 2021).Samples Lost By Eurofins Environment Test AmericaMW‐1TABLE B-48700 NC HWY 742 SIncident # 29289 | WR Project # 23-0307-CDJIMMY'S SUPERETTESUMMARY OF GROUNDWATER ANALYTICAL RESULTSSampleIDDateCollectedAnalytical Method6200B ‐ Volatile Organic CompoundsWADESBORO, NC 28170MADEP VPH/EPHPage 1 of 1
Notes: 1)Well location address and property owner information was obtained during the receptor survey completed by WR on 11/7/2022, from information gathered on the Anson County GIS website on 11/10/2022, and information provided by property owners within 1,000-ft of the source.Property Owner AddressTABLE B-5APUBLIC & PRIVATE WATER SUPPLY WELL INFORMATIONJIMMY'S SUPERETTEIncident # 29289 | WR Project # 23-0307-CD8700 NC HWY 742 SWADESBORO, NC 28170Well ID Property Address County Property OwnerWell Casing Depth (feet)Well UseWell Depth(feet)Well Screen Interval(feet)Well Distance from Source Area(feet)CommentsUnknownWSW-1AnsonJean GardnerTimberlands PlantationPotable3511 Cason Oldfield RdMorven, NC 281193513 Cason Oldfield RdMorven, NC 28119WSW-2AnsonJoe Howard & Sadie Swaringern EddinsAssumed Inactice8876 NC HWY 742 SMorven, NC 281198876 NC HWY 742 SMorven, NC 28119WSW-3Active municipal water account1,360-ft WestAbandoned Mobile Home(704) 562-0438(704) 851-9286Unknown 2,100-ft EastUnknown 835-ft South272 Deep Creek RdWadesboro, NC 28170Anson Charles & Jennifer Porter2312 Hemby PlaceCharlotte, NC 28270InactiveUnknown245UnknownUnknown278UnknownPage 1 of 1
Easting Northing001 New Hope Methodist Church South of SiteNew Hope Methodist Church51 Mayesville RoadMorven, NC 28119Religious Facility150 Unknown 1671737.4299 397918.9868002 Unnamed Farm Pond West of SiteLillian Marie Medlock8664 NC 742 SWadesboro, NC 28170Unknown 505 Unknown 1671284.1738 398141.9197003 Unnamed Farm Pond North of SiteLillian Marie Medlock8664 NC 742 SWadesboro, NC 28170Unknown 590 Unknown 1671522.6903 398794.6833004 Riverine Habitat (R4SBC) West of SiteCharles Porter III & Jennifer PorterHemby PlaceCharlotte, NC 28270Unknown 920 Unknown 1670833.3528 398235.0332005Freshwater Forested/Shrub Wetland Habitat (PFO1A)Northwest of SiteCharles Porter III & Jennifer PorterHemby PlaceCharlotte, NC 28270Unknown 940 Unknown 1670822.0990 398411.1055006 Freshwater Pond Habitat (PUBHh) Southeast of SiteTimberlands Plantation, Inc.3511 Cason Oldfield RdMorven, NC 28119Unknown 1250 Unknown 1672994.9078 397533.38151)WADESBORO, NC 28170TABLE B-5BADDITIONAL RECEPTOR INFORMATIONJIMMY'S SUPERETTEIncident # 29289 | WR Project # 23-0307-CD8700 NC HWY 742 SWR performed a receptor survey on 11/07/2022.Location Relative to Groundwater FlowLocation of Significant Points(NC State Plane NAD 83 Feet)Notes: Receptor IDDescription LocationContactInformationUsageDistance from Source Area(feet)
Richard G Melton Et/Al3067 Blonnie Ross RdMarshville, NC 28103Lillian Marie Medlock8664 NC HWY 742 S Wadesboro, NC 28170Jesse James CampbellPO Box 300Morven, NC 28119Cheryl G. & James M. Brower3933 Cason Oldfield RdMorven, NC 28119New Hope Methodist Church51 Mayesville Rd Religious Structure 130 ft South Cross‐gradientMorven, NC 28119James Christian & Wanda T. Steele321 Mayesville Rd Wooded Land 340 ft Southwest Cross‐gradientMorven, NC 28119Lillian Marie Medlock8664 NC HWY 742 S Wadesboro, NC 28170Notes: 1)2)3) Locations relative to groundwater flow are estimated based on surface topography.451003 Deep Creek RdWadesboro, NC 2817051 Mayesville RdMorven, NC 28119WADESBORO, NC 28170Location Relative to Groundwater FlowSITEActive Gas Station and Convenience Store‐‐‐ ‐‐‐Property ID Property Address Property Owner & Address UsageTABLE B‐5CADJACENT PROPERTY INFORMATIONJIMMY'S SUPERETTEIncident # 29289 | WR Project # 23‐0307‐CD8700 NC HWY 742 SDistance/Direction from Source Area8700 NC HWY 742 SWadesboro, NC 281701Residential 50 ft North Cross‐gradient8664 NC HWY 742 S Wadesboro, NC 28170Cross‐gradient3Residential 150 ft Southeast Cross‐gradient2Residential 115 ft East3933 Cason Oldfield RdMorven, NC 281193884 Cason Oldfield RdMorven, NC 28119Property owner information from the Anson County GIS Service, data current as of May 17, 2023.Distances shown from source area are measured from location of monitoring well MW‐1 and the nearest property boundary of the adjacent property.6Pasture 255 ft West Down‐gradient80 Deep Creek RdWadesboro, NC 28170
Well ID Date InstalledTop of Casing Elevation(ft)Well Diameter (in)Well Depth(ft-BGS)Screen Interval (ft-BGS)Date of MeasurementDepth to LNAPL (ft-BTOC)Depth To Water (ft-BTOC)LNAPL Thickness (ft)Groundwater Elevation(ft)05/25/06 -- 12.00 -- 289.6911/08/22 -- 14.75 -- 286.9412/09/22 -- 14.25 -- 287.4404/25/23 -- 11.06 -- 290.63MW-2 4/19/2023 301.55 2.00 23.00 8 - 23 04/25/23 -- 10.73 -- 290.82MW-3 4/19/2023 302.00 2.00 23.00 8 - 23 04/25/23 -- 11.58 -- 290.421)2)3)4)5)TABLE B-7MONITORING WELL CONSTRUCTION AND LIQUID LEVEL DATAJIMMY'S SUPERETTEWADESBORO, NC 281708700 NC HWY 742 SIncident # 29289 | WR Project # 23-0307-CDIf LNAPL present groundwater elevation calculated by [TOC-DTW]+[LNAPL thickness x 0.8581].NM = Not Measured.BGS - Below Ground Surface.BTOC - Below Top of Casing.Notes: Top of Casing (TOC) elevation survey completed on 4/25/2023 by WR using a 1969 USGS Benchmark of 303-ft elevation located on the existing dispenser island.MW-1 6 - 1616.001.00301.695/25/2006Page 1 of 1
WithersRavenel
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APPENDIX A
FIELD NOTES & PHOTOGRAPHIC RECORD

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Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023

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Our People. Your Success.
Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023

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Our People. Your Success.
Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023
PHOTO 1 Site building and dispenser island. Note utility markings.
PHOTO 2 View marked utilities. Note private locator using ground penetrating radar in background.
WithersRavenel
Our People. Your Success.
Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023
PHOTO 3 View of monitoring well MW-2 during installation.
PHOTO 4
View of monitoring well MW-2 post-installation.
WithersRavenel
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Jimmy’s Superette – NCDEQ Incident #29289 WR Project # 23-0307-CD Groundwater Monitoring Report May 2023
PHOTO 5 View of monitoring well MW-3 post-installation.
PHOTO 6 View of monitoring well MW-1 adjacent to tank pit.
WithersRavenel
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APPENDIX B BORING LOG & WELL CONSTRUCTION RECORD

Well ID: Job Name:
Date: Site Loc.:
W&R Rep: Driller:
Notes:
0 - 3 ft Concrete Grout
3 - 6 ft Bentonite
6 - 23 ft #2 Clean-Washed
Torpedo SAND
0 - 8 ft 2" Dia.
PVC Casing
8 - 23 ft 2" Dia.
0.010-Slot PVC
Well Screen
3.) TOC - Top of Casing
Page 1 of 1
115 MacKenan Drive Cary, North Carolina 27511 tel:[phone] fax:[phone] www.withersravenel.com
1.0 - 5.0 Light Brown Sand, Damp
5.0 - 20.0
20.0 - 23.0
Reddish Brown Sand, Damp but not wet
1.) Boring Terminated at 23' BLS
2.) BLS - Below Land Surface = Groundwater Level (Measured Beneath TOC), 04/25/2023
Brown Silty Sand, Saturated
0.0 - 1.0 Asphalt & Gravel Base Course (0.0-0.2)
Dark Organic Sand, Dry (0.2-1)
NC NAD83 Easting:1671848.8952 NC NAD83 Northing:398246.9024
Depth in
Feet Soil Description
(Field USCS Classification)
Well Construction
0 Ground Surface
April 19, 2023 Wadesboro, NC TOC EL:301.55
C. Nobles AmeriProbe, LLC GW EL:290.82
BORING & WELL CONSTRUCTION LOG
MW-2 Jimmy's Superette (TF# 29289)Job #:23-0307-CD
Well ID: Job Name:
Date: Site Loc.:
W&R Rep: Driller:
Notes:
19 - 20
20 - 23 Tan Silty Sand, Saturated
0 - 3 ft Concrete Grout
3 - 6 ft Bentonite
6 - 23 ft #2 Clean-Washed
Torpedo SAND
3.) TOC - Top of Casing
Page 1 of 1
115 MacKenan Drive Cary, North Carolina 27511 tel:[phone] fax:[phone] www.withersravenel.com
0.75 - 2.5 Brown Sand, Dry
2.5 - 10 Light Brown Sand, Dry
10 - 13 Light Red Brown Sand, Dry. Slight Petroleum Odor
8 - 23 ft 2" Dia.
0.010-Slot PVC
Well Screen
1.) Boring Terminated at 23' BLS
2.) BLS - Below Land Surface = Groundwater Level (Measured Beneath TOC), 04/25/2023
13 - 19 Light Red Brown Sand, Dry. Strong Petroleum Odor
Red Brown Silty Sand, Moist, Moderate Petroleum Odor
0.0 - 0.75 Asphalt & Gravel Base Course (0.0-0.25)
Brown Organic Sand, (0.25-0.75)
0 - 8 ft 2" Dia.
PVC Casing
NC NAD83 Easting:1671834.6620 NC NAD83 Northing:398182.3204
Depth in
Feet Soil Description
(Field USCS Classification)
Well Construction
0 Ground Surface
April 19, 2023 Wadesboro, NC TOC EL:302.00
C. Nobles AmeriProbe, LLC GW EL:290.42
BORING & WELL CONSTRUCTION LOG
MW-3 Jimmy's Superette (TF# 29289)Job #:23-0307-CD
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
Form GW-1 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1.Well Contractor Information:
Well Contractor Name

NC Well Contractor Certification Number

Company Name
2.Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3.Well Use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply)□Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrigation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop)□Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under #21 Remarks)
4. Date Well(s) Completed: Well ID#
Facility ID# (if applicable)
Physical Address, City, and Zip

County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
6.Is(are) the well(s): □Permanent or □Temporary
7. Is this a repair to an existing well: □Yes or □No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: (ft.)
For multiple wells list all depths if different (example- 3@200’ and 2@100′)
10.Static water level below top of casing: (ft.)
If water level is above casing, use “+”
11. Borehole diameter: (in.)
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
FROM TO DESCRIPTION
ft.ft.
ft.ft.
15. OUTER CASING (for multi-cased wells) OR LINER (if applicable)
FROM TO DIAMETER THICKNESS MATERIAL
ft.ft.in.
16. INNER CASING OR TUBING (geothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
ft.ft.in.
ft.ft.in.
17. SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
ft.ft.in.
ft.ft.in.
18. GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
ft.ft.
ft.ft.
ft.ft.
19. SAND/GRAVEL PACK (if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
ft.ft.
ft.ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.ft.
ft.ft.
ft.ft.
ft.ft.
ft.ft.
ft.ft.
ft.ft.
21. REMARKS

22.Certification:
Signature of Certified Well Contractor Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
John Allen
4196-B
AmeriProbe
4/19/23 MW-2
8700 NC-742, Wadesboro, NC 28170
Anson
34.8393096 80.0936788
23'
14'
8 1/4''
Auger
4/28/23
14 23
0 8 2'' SCH40 PVC
8 23 2'' 0.010 SCh40 PVC
0
3
6
3
6
23
Neat Cement
Bentonite
#2 Sand Poured Through Augers
Poured Through Augers
See Consultant's Logs
2' X 2' Concrete Flushmount Pad
Print Form
Poured Through Augers
5a. Well Location:
Jimmy's Superette TF# 29289
Facility/Owner Name
X
X
X
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
Form GW-1 North Carolina Department of Environmental Quality - Division of Water Resources Revised 2-22-2016
1.Well Contractor Information:
Well Contractor Name

NC Well Contractor Certification Number

Company Name
2.Well Construction Permit #:
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc.)
3.Well Use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply)□Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrigation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater Remediation
□Aquifer Storage and Recovery □Salinity Barrier
□Aquifer Test □Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop)□Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under #21 Remarks)
4. Date Well(s) Completed: Well ID#

Facility/Owner Name Facility ID# (if applicable)

Physical Address, City, and Zip

County Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
N W
6.Is(are) the well(s): □Permanent or □Temporary
7. Is this a repair to an existing well: □Yes or □No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: (ft.)
For multiple wells list all depths if different (example- 3@200’ and 2@100′)
10.Static water level below top of casing: (ft.)
If water level is above casing, use “+”
11. Borehole diameter: (in.)
12. Well construction method:
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
FROM TO DESCRIPTION
ft.ft.
ft.ft.
15. OUTER CASING (for multi-cased wells) OR LINER (if applicable)
FROM TO DIAMETER THICKNESS MATERIAL
ft.ft.in.
16. INNER CASING OR TUBING (geothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
ft.ft.in.
ft.ft.in.
17. SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
ft.ft.in.
ft.ft.in.
18. GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
ft.ft.
ft.ft.
ft.ft.
19. SAND/GRAVEL PACK (if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
ft.ft.
ft.ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.ft.
ft.ft.
ft.ft.
ft.ft.
ft.ft.
ft.ft.
ft.ft.
21. REMARKS

22.Certification:
Signature of Certified Well Contractor Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
John Allen
4196-B
AmeriProbe
4/19/23 MW-3
8700 NC-742, Wadesboro, NC 28170
Anson
34.8391365 80.0937126
23'
14'
8 1/4''
Auger
4/28/23
14 23
0 8 2'' SCH40 PVC
8 23 2'' 0.010 SCh40 PVC
0
3
6
3
6
23
Neat Cement
Bentonite
#2 Sand Poured Through Augers
Poured Through Augers
See Consultant's Logs
2' X 2' Concrete Flushmount Pad
Print Form
Poured Through Augers
5a. Well Location:
Jimmy's Superette TF# 29289
WithersRavenel
Our People. Your Success.

APPENDIX C LABORATORY ANALYTICAL REPORT & CHAIN OF CUSTODY

Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.

5/9/2023
Withers & Ravenel Matt James
115 Mackenan Dr. BUILDING 117 Cary, NC, 27511
Ref: Analytical Testing
Lab Report Number: 23-118-0006 Client Project Description: Jimmy's Superette
Dear Matt James:
Waypoint Analytical, LLC (Charlotte) received sample(s) on 4/28/2023 for the analyses presented in the
following report.
The above referenced project has been analyzed per your instructions. The analyses were performed in accordance with the applicable analytical method.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all parameters were performed in accordance with guidelines established by the USEPA (including 40 CFR 136
Method Update Rule May 2021) unless otherwise indicated. Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as-received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report. Please do not hesitate to contact me or client services if you have any questions or need additional information. Sincerely,
Angela D Overcash Senior Project Manager
Page 1 of 26
Certification Summary
Laboratory ID: WP CNC: Waypoint Analytical Carolina, Inc. (C), Charlotte, NC
State Program Lab ID Expiration Date
07/31/202337735State ProgramNorth Carolina
12/31/2023402State ProgramNorth Carolina
07/31/202399012State ProgramSouth Carolina
12/31/202299012State ProgramSouth Carolina
Page 1 of 1 00016/23-118-0006
Page 2 of 26
Report Number:
Sample Summary Table
Client Project Description:
23-118-0006
Jimmy's Superette
Lab No Client Sample ID Matrix Date Collected Date Received
04/25/2023 11:30Aqueous 95102 MW-1 04/28/2023 12:00
04/25/2023 13:10Aqueous 95103 MW-2 04/28/2023 12:00
04/25/2023 12:15Aqueous 95104 MW-3 04/28/2023 12:00
Page 3 of 26
Summary of Detected Analytes
QualifiersAnalyzedUnitsResult
Report Number:
Client Sample ID
Method Parameters
Lab Sample ID
23-118-0006
Report Limit
Project:Jimmy's Superette
V 95102MW-1
8.05 05/05/2023 06:256200BBenzeneµg/L 0.500
6.76 05/05/2023 06:256200BEthylbenzeneµg/L 0.500
42.2 05/05/2023 06:256200BTolueneµg/L 0.500
2.27 05/05/2023 06:256200B1,2,4-Trimethylbenzene µg/L 0.500
1.35 05/05/2023 06:256200B1,3,5-Trimethylbenzene µg/L 0.500
18.8 05/05/2023 06:256200Bo-Xylene µg/L 0.500
22.9 05/05/2023 06:256200Bm,p-Xylene µg/L 1.00
41.7 05/05/2023 06:256200BXylene (Total)µg/L 0.500
V 95103MW-2
0.746 05/05/2023 06:526200BChloroformµg/L 0.500
V 95104MW-3
1060 05/07/2023 12:046200BBenzeneµg/L 50.0
20.6 05/05/2023 10:586200BDi-Isopropyl Ether (DIPE)µg/L 5.00
3290 05/05/2023 10:586200BEthanolµg/L 2000
395 05/05/2023 10:586200BEthylbenzeneµg/L 5.00
12.8 05/05/2023 10:586200BIsopropylbenzeneµg/L 5.00
50.4 05/05/2023 10:586200BNaphthaleneµg/L 10.0
37.9 05/05/2023 10:586200Bn-Propylbenzene µg/L 5.00
307 05/05/2023 10:586200Btert-Amyl Alcohol (TAA)µg/L 100
4510 05/07/2023 12:046200BTolueneµg/L 50.0
339 05/05/2023 10:586200B1,2,4-Trimethylbenzene µg/L 5.00
81.3 05/05/2023 10:586200B1,3,5-Trimethylbenzene µg/L 5.00
707 05/05/2023 10:586200Bo-Xylene µg/L 5.00
1420 05/05/2023 10:586200Bm,p-Xylene µg/L 10.0
2130 05/05/2023 10:586200BXylene (Total)µg/L 5.00
Page 4 of 26

Client: Withers & Ravenel CASE NARRATIVE
Project: Jimmy's Superette Lab Report Number: 23-118-0006
Date: 5/9/2023
Volatile Organic Compounds - GC/MS Method 6200B Analyte: tert-Amyl alcohol QC Batch No: V32831/V32830
Relative Percent Difference (RPD) for the duplicate analysis was outside of the allowable QC limits.
Analyte: Vinyl acetate QC Batch No: V32877/V32830
Relative Percent Difference (RPD) for the duplicate analysis was outside of the allowable QC limits.

Page 5 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-1
95102 Matrix:
4/25/2023 11:30
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<10.0 µg/L 10.0Acetone 1 05/05/23 06:25 6200BMSA
8.05 µg/L 0.500Benzene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Bromobenzene 1 05/05/23 06:25 6200BMSA
<1.00 µg/L 1.00Bromochloromethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Bromodichloromethane 1 05/05/23 06:25 6200BMSA
<5.00 µg/L 5.00Bromoform 1 05/05/23 06:25 6200BMSA
<1.00 µg/L 1.00Bromomethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500n-Butylbenzene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500sec-Butyl benzene 1 05/05/23 06:25 6200BMSA
<2.00 µg/L 2.00tert-Butyl benzene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Carbon Tetrachloride 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Chlorobenzene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Chlorodibromomethane 1 05/05/23 06:25 6200BMSA
<1.00 µg/L 1.00Chloroethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Chloroform 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Chloromethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5002-Chlorotoluene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5004-Chlorotoluene 1 05/05/23 06:25 6200BMSA
<2.00 µg/L 2.001,2-Dibromo-3-Chloropropane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,2-Dibromoethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Dibromomethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,2-Dichlorobenzene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,3-Dichlorobenzene 1 05/05/23 06:25 6200BMSA
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 6 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-1
95102 Matrix:
4/25/2023 11:30
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<0.500 µg/L 0.5001,4-Dichlorobenzene 1 05/05/23 06:25 6200BMSA
<5.00 µg/L 5.00Dichlorodifluoromethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,1-Dichloroethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,2-Dichloroethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,1-Dichloroethene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500cis-1,2-Dichloroethene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500trans-1,2-Dichloroethene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,2-Dichloropropane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,3-Dichloropropane 1 05/05/23 06:25 6200BMSA
<2.00 µg/L 2.002,2-Dichloropropane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,1-Dichloropropene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500cis-1,3-Dichloropropene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500trans-1,3-Dichloropropene 1 05/05/23 06:25 6200BMSA
<200 µg/L 200Ethanol 1 05/05/23 06:25 6200BMSA
6.76 µg/L 0.500Ethylbenzene 1 05/05/23 06:25 6200BMSA
<3.00 µg/L 3.00Hexachlorobutadiene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Di-Isopropyl Ether (DIPE)1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Isopropylbenzene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5004-Isopropyl toluene 1 05/05/23 06:25 6200BMSA
<1.00 µg/L 1.002-Hexanone 1 05/05/23 06:25 6200BMSA
<5.00 µg/L 5.00Methyl Ethyl Ketone (MEK)1 05/05/23 06:25 6200BMSA
<2.00 µg/L 2.00Methylene Chloride 1 05/05/23 06:25 6200BMSA
<1.00 µg/L 1.00Methyl tert-butyl ether (MTBE)1 05/05/23 06:25 6200BMSA
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 7 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-1
95102 Matrix:
4/25/2023 11:30
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<1.00 µg/L 1.004-Methyl-2-Pentanone 1 05/05/23 06:25 6200BMSA
<1.00 µg/L 1.00Naphthalene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500n-Propylbenzene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Styrene 1 05/05/23 06:25 6200BMSA
<10.0 µg/L 10.0tert-Amyl Alcohol (TAA)1 05/05/23 06:25 6200BMSA
<10.0 µg/L 10.0tert-Amyl Methyl Ether (TAME)1 05/05/23 06:25 6200BMSA
<10.0 µg/L 10.0tert-Butyl Alcohol (TBA)1 05/05/23 06:25 6200BMSA
<10.0 µg/L 10.0Ethyl Tertiary Butyl Ether (ETBE)1 05/05/23 06:25 6200BMSA
<10.0 µg/L 10.0tert-Butyl formate (TBF)1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,1,1,2-Tetrachloroethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,1,2,2-Tetrachloroethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Tetrachloroethene 1 05/05/23 06:25 6200BMSA
42.2 µg/L 0.500Toluene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,2,3-Trichlorobenzene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,2,4-Trichlorobenzene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,1,1-Trichloroethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,1,2-Trichloroethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Trichloroethene 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.500Trichlorofluoromethane 1 05/05/23 06:25 6200BMSA
<0.500 µg/L 0.5001,2,3-Trichloropropane 1 05/05/23 06:25 6200BMSA
2.27 µg/L 0.5001,2,4-Trimethylbenzene 1 05/05/23 06:25 6200BMSA
1.35 µg/L 0.5001,3,5-Trimethylbenzene 1 05/05/23 06:25 6200BMSA
<5.00 µg/L 5.00Vinyl Acetate 1 05/05/23 06:25 6200BMSA
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 8 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-1
95102 Matrix:
4/25/2023 11:30
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<0.500 µg/L 0.500Vinyl Chloride 1 05/05/23 06:25 6200BMSA
22.9 µg/L 1.00m,p-Xylene 1 05/05/23 06:25 6200BMSA
18.8 µg/L 0.500o-Xylene 1 05/05/23 06:25 6200BMSA
41.7 µg/L 0.500Xylene (Total)1 05/05/23 06:25 6200B
Surrogate: 4-Bromofluorobenzene 101 Limits: 70-130%05/05/23 06:251 MSA V32831
Surrogate: Dibromofluoromethane 101 Limits: 70-130%05/05/23 06:251 MSA V32831
Surrogate: 1,2-Dichloroethane - d4 99.2 Limits: 70-130%05/05/23 06:251 MSA V32831
Surrogate: Toluene-d8 98.2 Limits: 70-130%05/05/23 06:251 MSA V32831
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 9 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-2
95103 Matrix:
4/25/2023 13:10
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<10.0 µg/L 10.0Acetone 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Benzene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Bromobenzene 1 05/05/23 06:52 6200BMSA
<1.00 µg/L 1.00Bromochloromethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Bromodichloromethane 1 05/05/23 06:52 6200BMSA
<5.00 µg/L 5.00Bromoform 1 05/05/23 06:52 6200BMSA
<1.00 µg/L 1.00Bromomethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500n-Butylbenzene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500sec-Butyl benzene 1 05/05/23 06:52 6200BMSA
<2.00 µg/L 2.00tert-Butyl benzene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Carbon Tetrachloride 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Chlorobenzene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Chlorodibromomethane 1 05/05/23 06:52 6200BMSA
<1.00 µg/L 1.00Chloroethane 1 05/05/23 06:52 6200BMSA
0.746 µg/L 0.500Chloroform 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Chloromethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5002-Chlorotoluene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5004-Chlorotoluene 1 05/05/23 06:52 6200BMSA
<2.00 µg/L 2.001,2-Dibromo-3-Chloropropane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,2-Dibromoethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Dibromomethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,2-Dichlorobenzene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,3-Dichlorobenzene 1 05/05/23 06:52 6200BMSA
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 10 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-2
95103 Matrix:
4/25/2023 13:10
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<0.500 µg/L 0.5001,4-Dichlorobenzene 1 05/05/23 06:52 6200BMSA
<5.00 µg/L 5.00Dichlorodifluoromethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,1-Dichloroethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,2-Dichloroethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,1-Dichloroethene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500cis-1,2-Dichloroethene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500trans-1,2-Dichloroethene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,2-Dichloropropane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,3-Dichloropropane 1 05/05/23 06:52 6200BMSA
<2.00 µg/L 2.002,2-Dichloropropane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,1-Dichloropropene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500cis-1,3-Dichloropropene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500trans-1,3-Dichloropropene 1 05/05/23 06:52 6200BMSA
<200 µg/L 200Ethanol 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Ethylbenzene 1 05/05/23 06:52 6200BMSA
<3.00 µg/L 3.00Hexachlorobutadiene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Di-Isopropyl Ether (DIPE)1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Isopropylbenzene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5004-Isopropyl toluene 1 05/05/23 06:52 6200BMSA
<1.00 µg/L 1.002-Hexanone 1 05/05/23 06:52 6200BMSA
<5.00 µg/L 5.00Methyl Ethyl Ketone (MEK)1 05/05/23 06:52 6200BMSA
<2.00 µg/L 2.00Methylene Chloride 1 05/05/23 06:52 6200BMSA
<1.00 µg/L 1.00Methyl tert-butyl ether (MTBE)1 05/05/23 06:52 6200BMSA
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 11 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-2
95103 Matrix:
4/25/2023 13:10
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<1.00 µg/L 1.004-Methyl-2-Pentanone 1 05/05/23 06:52 6200BMSA
<1.00 µg/L 1.00Naphthalene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500n-Propylbenzene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Styrene 1 05/05/23 06:52 6200BMSA
<10.0 µg/L 10.0tert-Amyl Alcohol (TAA)1 05/05/23 06:52 6200BMSA
<10.0 µg/L 10.0tert-Amyl Methyl Ether (TAME)1 05/05/23 06:52 6200BMSA
<10.0 µg/L 10.0tert-Butyl Alcohol (TBA)1 05/05/23 06:52 6200BMSA
<10.0 µg/L 10.0Ethyl Tertiary Butyl Ether (ETBE)1 05/05/23 06:52 6200BMSA
<10.0 µg/L 10.0tert-Butyl formate (TBF)1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,1,1,2-Tetrachloroethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,1,2,2-Tetrachloroethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Tetrachloroethene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Toluene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,2,3-Trichlorobenzene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,2,4-Trichlorobenzene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,1,1-Trichloroethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,1,2-Trichloroethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Trichloroethene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Trichlorofluoromethane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,2,3-Trichloropropane 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,2,4-Trimethylbenzene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.5001,3,5-Trimethylbenzene 1 05/05/23 06:52 6200BMSA
<5.00 µg/L 5.00Vinyl Acetate 1 05/05/23 06:52 6200BMSA
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 12 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-2
95103 Matrix:
4/25/2023 13:10
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<0.500 µg/L 0.500Vinyl Chloride 1 05/05/23 06:52 6200BMSA
<1.00 µg/L 1.00m,p-Xylene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500o-Xylene 1 05/05/23 06:52 6200BMSA
<0.500 µg/L 0.500Xylene (Total)1 05/05/23 06:52 6200B
Surrogate: 4-Bromofluorobenzene 102 Limits: 70-130%05/05/23 06:521 MSA V32831
Surrogate: Dibromofluoromethane 102 Limits: 70-130%05/05/23 06:521 MSA V32831
Surrogate: 1,2-Dichloroethane - d4 100 Limits: 70-130%05/05/23 06:521 MSA V32831
Surrogate: Toluene-d8 98.4 Limits: 70-130%05/05/23 06:521 MSA V32831
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 13 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-3
95104 Matrix:
4/25/2023 12:15
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<100 µg/L 100Acetone 10 05/05/23 10:58 6200BMSA
1060 µg/L 50.0Benzene 100 05/07/23 12:04 6200BMSA
<5.00 µg/L 5.00Bromobenzene 10 05/05/23 10:58 6200BMSA
<10.0 µg/L 10.0Bromochloromethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Bromodichloromethane 10 05/05/23 10:58 6200BMSA
<50.0 µg/L 50.0Bromoform 10 05/05/23 10:58 6200BMSA
<10.0 µg/L 10.0Bromomethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00n-Butylbenzene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00sec-Butyl benzene 10 05/05/23 10:58 6200BMSA
<20.0 µg/L 20.0tert-Butyl benzene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Carbon Tetrachloride 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Chlorobenzene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Chlorodibromomethane 10 05/05/23 10:58 6200BMSA
<10.0 µg/L 10.0Chloroethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Chloroform 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Chloromethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.002-Chlorotoluene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.004-Chlorotoluene 10 05/05/23 10:58 6200BMSA
<20.0 µg/L 20.01,2-Dibromo-3-Chloropropane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,2-Dibromoethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Dibromomethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,2-Dichlorobenzene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,3-Dichlorobenzene 10 05/05/23 10:58 6200BMSA
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 14 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-3
95104 Matrix:
4/25/2023 12:15
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<5.00 µg/L 5.001,4-Dichlorobenzene 10 05/05/23 10:58 6200BMSA
<50.0 µg/L 50.0Dichlorodifluoromethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,1-Dichloroethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,2-Dichloroethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,1-Dichloroethene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00cis-1,2-Dichloroethene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00trans-1,2-Dichloroethene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,2-Dichloropropane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,3-Dichloropropane 10 05/05/23 10:58 6200BMSA
<20.0 µg/L 20.02,2-Dichloropropane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,1-Dichloropropene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00cis-1,3-Dichloropropene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00trans-1,3-Dichloropropene 10 05/05/23 10:58 6200BMSA
3290 µg/L 2000Ethanol 10 05/05/23 10:58 6200BMSA
395 µg/L 5.00Ethylbenzene 10 05/05/23 10:58 6200BMSA
<30.0 µg/L 30.0Hexachlorobutadiene 10 05/05/23 10:58 6200BMSA
20.6 µg/L 5.00Di-Isopropyl Ether (DIPE)10 05/05/23 10:58 6200BMSA
12.8 µg/L 5.00Isopropylbenzene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.004-Isopropyl toluene 10 05/05/23 10:58 6200BMSA
<10.0 µg/L 10.02-Hexanone 10 05/05/23 10:58 6200BMSA
<50.0 µg/L 50.0Methyl Ethyl Ketone (MEK)10 05/05/23 10:58 6200BMSA
<20.0 µg/L 20.0Methylene Chloride 10 05/05/23 10:58 6200BMSA
<10.0 µg/L 10.0Methyl tert-butyl ether (MTBE)10 05/05/23 10:58 6200BMSA
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 15 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-3
95104 Matrix:
4/25/2023 12:15
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<10.0 µg/L 10.04-Methyl-2-Pentanone 10 05/05/23 10:58 6200BMSA
50.4 µg/L 10.0Naphthalene 10 05/05/23 10:58 6200BMSA
37.9 µg/L 5.00n-Propylbenzene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Styrene 10 05/05/23 10:58 6200BMSA
307 µg/L 100tert-Amyl Alcohol (TAA)10 05/05/23 10:58 6200BMSA
<100 µg/L 100tert-Amyl Methyl Ether (TAME)10 05/05/23 10:58 6200BMSA
<100 µg/L 100tert-Butyl Alcohol (TBA)10 05/05/23 10:58 6200BMSA
<100 µg/L 100Ethyl Tertiary Butyl Ether (ETBE)10 05/05/23 10:58 6200BMSA
<100 µg/L 100tert-Butyl formate (TBF)10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,1,1,2-Tetrachloroethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,1,2,2-Tetrachloroethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Tetrachloroethene 10 05/05/23 10:58 6200BMSA
4510 µg/L 50.0Toluene 100 05/07/23 12:04 6200BMSA
<5.00 µg/L 5.001,2,3-Trichlorobenzene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,2,4-Trichlorobenzene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,1,1-Trichloroethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,1,2-Trichloroethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Trichloroethene 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.00Trichlorofluoromethane 10 05/05/23 10:58 6200BMSA
<5.00 µg/L 5.001,2,3-Trichloropropane 10 05/05/23 10:58 6200BMSA
339 µg/L 5.001,2,4-Trimethylbenzene 10 05/05/23 10:58 6200BMSA
81.3 µg/L 5.001,3,5-Trimethylbenzene 10 05/05/23 10:58 6200BMSA
<50.0 µg/L 50.0Vinyl Acetate 10 05/05/23 10:58 6200BMSA
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 16 of 26
,
REPORT OF ANALYSISReport Number :
Project
Information :
NC 27511
23-118-0006
01221
Withers & Ravenel
115 Mackenan Dr. BUILDING 117
Matt James
Cary
Received : 04/28/2023
Jimmy's Superette
Report Date : 05/09/2023
Sample ID :
Lab No :
Sampled:MW-3
95104 Matrix:
4/25/2023 12:15
Aqueous
Test Results Units MQL By Analytical
Method
Date / Time
Analyzed
DF
<5.00 µg/L 5.00Vinyl Chloride 10 05/05/23 10:58 6200BMSA
1420 µg/L 10.0m,p-Xylene 10 05/05/23 10:58 6200BMSA
707 µg/L 5.00o-Xylene 10 05/05/23 10:58 6200BMSA
2130 µg/L 5.00Xylene (Total)10 05/05/23 10:58 6200B
Surrogate: 4-Bromofluorobenzene 102 Limits: 70-130%05/05/23 10:5810 MSA V32831
Surrogate: Dibromofluoromethane 104 Limits: 70-130%05/05/23 10:5810 MSA V32831
Surrogate: 1,2-Dichloroethane - d4 101 Limits: 70-130%05/05/23 10:5810 MSA V32831
Surrogate: Toluene-d8 97.8 Limits: 70-130%05/05/23 10:5810 MSA V32831
Surrogate: 4-Bromofluorobenzene 101 Limits: 70-130%05/07/23 12:04100 MSA V32877
Surrogate: Dibromofluoromethane 103 Limits: 70-130%05/07/23 12:04100 MSA V32877
Surrogate: 1,2-Dichloroethane - d4 103 Limits: 70-130%05/07/23 12:04100 MSA V32877
Surrogate: Toluene-d8 96.8 Limits: 70-130%05/07/23 12:04100 MSA V32877
Qualifiers/
Definitions
Method Quantitation LimitMQLDilution FactorDF
Page 17 of 26
Quality Control Data
23-118-0006Report No:
Project Description:
Client ID:Withers & Ravenel
Jimmy's Superette
QC Prep Batch Method:
Volatile Organic Compounds - GC/MS
6200B
V32831QC Analytical Batch(es):
Analysis Method:
Analysis Description:
6200 PT
QC Prep:V32830
Associated Lab Samples: 95102, 95103, 95104
LRB-V32830 Matrix: AQULab Reagent Blank
Parameter
AnalyzedMQLBlank
ResultUnits
%
Recovery
% Rec
Limits
05/05/23 04:0810.0< 10.0µg/LAcetone
05/05/23 04:080.500< 0.500µg/LBenzene
05/05/23 04:080.500< 0.500µg/LBromobenzene
05/05/23 04:081.00< 1.00µg/LBromochloromethane
05/05/23 04:080.500< 0.500µg/LBromodichloromethane
05/05/23 04:085.00< 5.00µg/LBromoform
05/05/23 04:081.00< 1.00µg/LBromomethane
05/05/23 04:080.500< 0.500µg/Ln-Butylbenzene
05/05/23 04:080.500< 0.500µg/Lsec-Butyl benzene
05/05/23 04:082.00< 2.00µg/Ltert-Butyl benzene
05/05/23 04:080.500< 0.500µg/LCarbon Tetrachloride
05/05/23 04:080.500< 0.500µg/LChlorobenzene
05/05/23 04:080.500< 0.500µg/LChlorodibromomethane
05/05/23 04:081.00< 1.00µg/LChloroethane
05/05/23 04:080.500< 0.500µg/LChloroform
05/05/23 04:080.500< 0.500µg/LChloromethane
05/05/23 04:080.500< 0.500µg/L2-Chlorotoluene
05/05/23 04:080.500< 0.500µg/L4-Chlorotoluene
05/05/23 04:082.00< 2.00µg/L1,2-Dibromo-3-Chloropropane
05/05/23 04:080.500< 0.500µg/L1,2-Dibromoethane
05/05/23 04:080.500< 0.500µg/LDibromomethane
05/05/23 04:080.500< 0.500µg/L1,2-Dichlorobenzene
05/05/23 04:080.500< 0.500µg/L1,3-Dichlorobenzene
05/05/23 04:080.500< 0.500µg/L1,4-Dichlorobenzene
05/05/23 04:085.00< 5.00µg/LDichlorodifluoromethane
05/05/23 04:080.500< 0.500µg/L1,1-Dichloroethane
05/05/23 04:080.500< 0.500µg/L1,2-Dichloroethane
Page 1 of 7Date:05/09/2023 11:31 AM
Page 18 of 26
Quality Control Data
23-118-0006Report No:
Project Description:
Client ID:Withers & Ravenel
Jimmy's Superette
QC Prep Batch Method:
Volatile Organic Compounds - GC/MS
6200B
V32831QC Analytical Batch(es):
Analysis Method:
Analysis Description:
6200 PT
QC Prep:V32830
Associated Lab Samples: 95102, 95103, 95104
LRB-V32830 Matrix: AQULab Reagent Blank
Parameter
AnalyzedMQLBlank
ResultUnits
%
Recovery
% Rec
Limits
05/05/23 04:080.500< 0.500µg/L1,1-Dichloroethene
05/05/23 04:080.500< 0.500µg/Lcis-1,2-Dichloroethene
05/05/23 04:080.500< 0.500µg/Ltrans-1,2-Dichloroethene
05/05/23 04:080.500< 0.500µg/L1,2-Dichloropropane
05/05/23 04:080.500< 0.500µg/L1,3-Dichloropropane
05/05/23 04:082.00< 2.00µg/L2,2-Dichloropropane
05/05/23 04:080.500< 0.500µg/L1,1-Dichloropropene
05/05/23 04:080.500< 0.500µg/Lcis-1,3-Dichloropropene
05/05/23 04:080.500< 0.500µg/Ltrans-1,3-Dichloropropene
05/05/23 04:08200< 200µg/LEthanol
05/05/23 04:080.500< 0.500µg/LEthylbenzene
05/05/23 04:083.00< 3.00µg/LHexachlorobutadiene
05/05/23 04:080.500< 0.500µg/LDi-Isopropyl Ether (DIPE)
05/05/23 04:080.500< 0.500µg/LIsopropylbenzene
05/05/23 04:080.500< 0.500µg/L4-Isopropyl toluene
05/05/23 04:081.00< 1.00µg/L2-Hexanone
05/05/23 04:085.00< 5.00µg/LMethyl Ethyl Ketone (MEK)
05/05/23 04:082.00< 2.00µg/LMethylene Chloride
05/05/23 04:081.00< 1.00µg/LMethyl tert-butyl ether (MTBE)
05/05/23 04:081.00< 1.00µg/L4-Methyl-2-Pentanone
05/05/23 04:081.00< 1.00µg/LNaphthalene
05/05/23 04:080.500< 0.500µg/Ln-Propylbenzene
05/05/23 04:080.500< 0.500µg/LStyrene
05/05/23 04:0810.0< 10.0µg/Ltert-Amyl Alcohol (TAA)
05/05/23 04:0810.0< 10.0µg/Ltert-Amyl Methyl Ether (TAME)
05/05/23 04:0810.0< 10.0µg/Ltert-Butyl Alcohol (TBA)
05/05/23 04:0810.0< 10.0µg/LEthyl Tertiary Butyl Ether (ETBE)
Page 2 of 7Date:05/09/2023 11:31 AM
Page 19 of 26
Quality Control Data
23-118-0006Report No:
Project Description:
Client ID:Withers & Ravenel
Jimmy's Superette
QC Prep Batch Method:
Volatile Organic Compounds - GC/MS
6200B
V32831QC Analytical Batch(es):
Analysis Method:
Analysis Description:
6200 PT
QC Prep:V32830
Associated Lab Samples: 95102, 95103, 95104
LRB-V32830 Matrix: AQULab Reagent Blank
Parameter
AnalyzedMQLBlank
ResultUnits
%
Recovery
% Rec
Limits
05/05/23 04:0810.0< 10.0µg/Ltert-Butyl formate (TBF)
05/05/23 04:080.500< 0.500µg/L1,1,1,2-Tetrachloroethane
05/05/23 04:080.500< 0.500µg/L1,1,2,2-Tetrachloroethane
05/05/23 04:080.500< 0.500µg/LTetrachloroethene
05/05/23 04:080.500< 0.500µg/LToluene
05/05/23 04:080.500< 0.500µg/L1,2,3-Trichlorobenzene
05/05/23 04:080.500< 0.500µg/L1,2,4-Trichlorobenzene
05/05/23 04:080.500< 0.500µg/L1,1,1-Trichloroethane
05/05/23 04:080.500< 0.500µg/L1,1,2-Trichloroethane
05/05/23 04:080.500< 0.500µg/LTrichloroethene
05/05/23 04:080.500< 0.500µg/LTrichlorofluoromethane
05/05/23 04:080.500< 0.500µg/L1,2,3-Trichloropropane
05/05/23 04:080.500< 0.500µg/L1,2,4-Trimethylbenzene
05/05/23 04:080.500< 0.500µg/L1,3,5-Trimethylbenzene
05/05/23 04:085.00< 5.00µg/LVinyl Acetate
05/05/23 04:080.500< 0.500µg/LVinyl Chloride
05/05/23 04:081.00< 1.00µg/Lm,p-Xylene
05/05/23 04:080.500< 0.500µg/Lo-Xylene
05/05/23 04:084-Bromofluorobenzene (S)103 70-130
05/05/23 04:08Dibromofluoromethane (S)101 70-130
05/05/23 04:081,2-Dichloroethane - d4 (S)99.0 70-130
05/05/23 04:08Toluene-d8 (S)100 70-130
Page 3 of 7Date:05/09/2023 11:31 AM
Page 20 of 26
Quality Control Data
23-118-0006Report No:
Project Description:
Client ID:Withers & Ravenel
Jimmy's Superette
QC Prep Batch Method:
Volatile Organic Compounds - GC/MS
6200B
V32831QC Analytical Batch(es):
Analysis Method:
Analysis Description:
6200 PT
QC Prep:V32830
LCS-V32830 LCSD-V32830Laboratory Control Sample & LCSD
LCSD
ResultParameter Max
RPD
LCSD
% Rec
LCS
%Rec
LCS
Result
Spike
Conc.Units
% Rec
Limits RPD
33.1 82.785.034.040.0µg/LAcetone 40-160 2.6 20.0
19.9 99.596.519.320.0µg/LBenzene 70-130 3.0 20.0
20.3 10299.019.820.0µg/LBromobenzene 70-130 2.4 20.0
19.8 99.010320.520.0µg/LBromochloromethane 70-130 3.4 20.0
20.0 10010120.120.0µg/LBromodichloromethane 70-130 0.4 20.0
18.7 93.596.519.320.0µg/LBromoform 70-130 3.1 20.0
19.9 99.589.517.920.0µg/LBromomethane 60-140 10.5 20.0
19.3 96.592.018.420.0µg/Ln-Butylbenzene 70-130 4.7 20.0
19.6 98.097.019.420.0µg/Lsec-Butyl benzene 70-130 1.0 20.0
20.0 10099.019.820.0µg/Ltert-Butyl benzene 70-130 1.0 20.0
22.4 11210220.320.0µg/LCarbon Tetrachloride 70-130 9.8 20.0
19.3 96.597.019.420.0µg/LChlorobenzene 70-130 0.5 20.0
20.8 10410220.420.0µg/LChlorodibromomethane 70-130 1.9 20.0
21.5 10810220.420.0µg/LChloroethane 60-140 5.2 20.0
20.5 10310020.020.0µg/LChloroform 70-130 2.4 20.0
19.1 95.593.018.620.0µg/LChloromethane 60-140 2.6 20.0
19.2 96.097.519.520.0µg/L2-Chlorotoluene 70-130 1.5 20.0
20.3 10299.019.820.0µg/L4-Chlorotoluene 70-130 2.4 20.0
20.6 10310420.720.0µg/L1,2-Dibromo-3-Chloropropane 70-130 0.4 20.0
20.0 10010120.120.0µg/L1,2-Dibromoethane 70-130 0.4 20.0
19.7 98.599.519.920.0µg/LDibromomethane 70-130 1.0 20.0
19.4 97.095.019.020.0µg/L1,2-Dichlorobenzene 70-130 2.0 20.0
20.3 10210120.120.0µg/L1,3-Dichlorobenzene 70-130 0.9 20.0
19.4 97.096.519.320.0µg/L1,4-Dichlorobenzene 70-130 0.5 20.0
20.5 10397.019.420.0µg/LDichlorodifluoromethane 60-140 5.5 20.0
21.2 10610320.620.0µg/L1,1-Dichloroethane 70-130 2.8 20.0
Page 4 of 7Date:05/09/2023 11:31 AM
Page 21 of 26
Quality Control Data
23-118-0006Report No:
Project Description:
Client ID:Withers & Ravenel
Jimmy's Superette
QC Prep Batch Method:
Volatile Organic Compounds - GC/MS
6200B
V32831QC Analytical Batch(es):
Analysis Method:
Analysis Description:
6200 PT
QC Prep:V32830
LCS-V32830 LCSD-V32830Laboratory Control Sample & LCSD
LCSD
ResultParameter Max
RPD
LCSD
% Rec
LCS
%Rec
LCS
Result
Spike
Conc.Units
% Rec
Limits RPD
19.9 99.596.019.220.0µg/L1,2-Dichloroethane 70-130 3.5 20.0
22.7 11410320.620.0µg/L1,1-Dichloroethene 70-130 9.6 20.0
20.1 10198.519.720.0µg/Lcis-1,2-Dichloroethene 70-130 2.0 20.0
21.5 10810521.020.0µg/Ltrans-1,2-Dichloroethene 70-130 2.3 20.0
19.6 98.096.019.220.0µg/L1,2-Dichloropropane 70-130 2.0 20.0
18.6 93.093.018.620.0µg/L1,3-Dichloropropane 70-130 0.0 20.0
17.7 88.586.017.220.0µg/L2,2-Dichloropropane 70-130 2.8 20.0
21.5 10810220.420.0µg/L1,1-Dichloropropene 70-130 5.2 20.0
19.4 97.094.518.920.0µg/Lcis-1,3-Dichloropropene 70-130 2.6 20.0
18.7 93.593.518.720.0µg/Ltrans-1,3-Dichloropropene 70-130 0.0 20.0
437 87.490.6453500µg/LEthanol 60-140 3.5 20.0
19.6 98.097.019.420.0µg/LEthylbenzene 70-130 1.0 20.0
19.6 98.099.019.820.0µg/LHexachlorobutadiene 70-130 1.0 20.0
19.2 96.093.518.720.0µg/LDi-Isopropyl Ether (DIPE)70-130 2.6 20.0
20.6 10399.019.820.0µg/LIsopropylbenzene 70-130 3.9 20.0
20.7 10499.519.920.0µg/L4-Isopropyl toluene 70-130 3.9 20.0
16.6 83.085.517.120.0µg/L2-Hexanone 60-140 2.9 20.0
17.3 86.585.517.120.0µg/LMethyl Ethyl Ketone (MEK)60-140 1.1 20.0
20.1 10110320.620.0µg/LMethylene Chloride 70-130 2.4 20.0
19.8 99.094.018.820.0µg/LMethyl tert-butyl ether (MTBE)70-130 5.1 20.0
17.5 87.589.017.820.0µg/L4-Methyl-2-Pentanone 60-140 1.6 20.0
15.9 79.579.515.920.0µg/LNaphthalene 70-130 0.0 20.0
19.7 98.595.519.120.0µg/Ln-Propylbenzene 70-130 3.0 20.0
19.2 96.094.518.920.0µg/LStyrene 70-130 1.5 20.0
17.7 88.511122.120.0µg/Ltert-Amyl Alcohol (TAA)40-140 22.1*20.0
39.7 99.297.739.140.0µg/Ltert-Amyl Methyl Ether (TAME)40-140 1.5 20.0
Page 5 of 7* QC Fail Date:05/09/2023 11:31 AM
Page 22 of 26
Quality Control Data
23-118-0006Report No:
Project Description:
Client ID:Withers & Ravenel
Jimmy's Superette
QC Prep Batch Method:
Volatile Organic Compounds - GC/MS
6200B
V32831QC Analytical Batch(es):
Analysis Method:
Analysis Description:
6200 PT
QC Prep:V32830
LCS-V32830 LCSD-V32830Laboratory Control Sample & LCSD
LCSD
ResultParameter Max
RPD
LCSD
% Rec
LCS
%Rec
LCS
Result
Spike
Conc.Units
% Rec
Limits RPD
33.4 83.586.534.640.0µg/Ltert-Butyl Alcohol (TBA)40-140 3.5 20.0
40.6 10210140.540.0µg/LEthyl Tertiary Butyl Ether (ETBE)70-130 0.2 20.0
37.4 93.594.037.640.0µg/Ltert-Butyl formate (TBF)40-140 0.5 20.0
19.6 98.010120.220.0µg/L1,1,1,2-Tetrachloroethane 70-130 3.0 20.0
19.2 96.098.019.620.0µg/L1,1,2,2-Tetrachloroethane 70-130 2.0 20.0
20.2 10199.519.920.0µg/LTetrachloroethene 70-130 1.4 20.0
20.0 10096.519.320.0µg/LToluene 70-130 3.5 20.0
20.0 10099.519.920.0µg/L1,2,3-Trichlorobenzene 70-130 0.5 20.0
19.0 95.096.519.320.0µg/L1,2,4-Trichlorobenzene 70-130 1.5 20.0
20.3 10299.019.820.0µg/L1,1,1-Trichloroethane 70-130 2.4 20.0
19.6 98.010220.320.0µg/L1,1,2-Trichloroethane 70-130 3.5 20.0
20.7 10410020.020.0µg/LTrichloroethene 70-130 3.4 20.0
20.5 10310020.020.0µg/LTrichlorofluoromethane 60-140 2.4 20.0
19.3 96.599.019.820.0µg/L1,2,3-Trichloropropane 70-130 2.5 20.0
19.9 99.599.019.820.0µg/L1,2,4-Trimethylbenzene 70-130 0.5 20.0
20.6 10310020.020.0µg/L1,3,5-Trimethylbenzene 70-130 2.9 20.0
19.5 97.596.519.320.0µg/LVinyl Acetate 60-140 1.0 20.0
21.3 10710120.220.0µg/LVinyl Chloride 60-140 5.3 20.0
39.6 99.098.239.340.0µg/Lm,p-Xylene 70-130 0.7 20.0
19.7 98.596.019.220.0µg/Lo-Xylene 70-130 2.5 20.0
1001004-Bromofluorobenzene (S)70-130
100100Dibromofluoromethane (S)70-130
99.298.61,2-Dichloroethane - d4 (S)70-130
97.897.6Toluene-d8 (S)70-130
Page 6 of 7Date:05/09/2023 11:31 AM
Page 23 of 26
Quality Control Data
23-118-0006Report No:
Project Description:
Client ID:Withers & Ravenel
Jimmy's Superette
QC Prep Batch Method:
Volatile Organic Compounds - GC/MS
6200B
V32877QC Analytical Batch(es):
Analysis Method:
Analysis Description:
6200 PT
QC Prep:V32876
Associated Lab Samples: 95104
LRB-V32876 Matrix: AQULab Reagent Blank
Parameter
AnalyzedMQLBlank
ResultUnits
%
Recovery
% Rec
Limits
05/07/23 05:140.500< 0.500µg/LBenzene
05/07/23 05:140.500< 0.500µg/LToluene
05/07/23 05:144-Bromofluorobenzene (S)100 70-130
05/07/23 05:14Dibromofluoromethane (S)103 70-130
05/07/23 05:141,2-Dichloroethane - d4 (S)106 70-130
05/07/23 05:14Toluene-d8 (S)95.6 70-130
LCS-V32876 LCSD-V32876Laboratory Control Sample & LCSD
LCSD
ResultParameter Max
RPD
LCSD
% Rec
LCS
%Rec
LCS
Result
Spike
Conc.Units
% Rec
Limits RPD
19.6 98.098.019.620.0µg/LBenzene 70-130 0.0 20.0
19.9 99.510220.320.0µg/LToluene 70-130 1.9 20.0
99.898.04-Bromofluorobenzene (S)70-130
100103Dibromofluoromethane (S)70-130
1041071,2-Dichloroethane - d4 (S)70-130
96.297.8Toluene-d8 (S)70-130
Page 7 of 7Date:05/09/2023 11:31 AM
Page 24 of 26
Fed Ex
UPS
US Postal
Client
Lab
Courier
Other :
Shipment Receipt Form
Customer Number:
Customer Name:
Report Number:23-118-0006
Withers & Ravenel
01221
Shipping Method
Shipping container/cooler uncompromised?
Thermometer ID:IRT15 3.5C
Chain of Custody (COC) present?Yes No
Yes No Not Present
Yes No Not Present
Yes No
COC agrees with sample label(s)? Yes No
COC properly completed
Samples in proper containers?
Sample containers intact?
Sufficient sample volume for indicated test(s)?
All samples received within holding time?
Cooler temperature in compliance?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes NoCooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
Yes No
Yes No N/A
Yes No N/A
Yes No N/ASoil VOA method 5035 – compliance criteria met
Water - Sample containers properly preserved
Water - VOA vials free of headspace Yes No N/A
Trip Blanks received with VOAs
Low concentration EnCore samplers (48 hr)
High concentration pre-weighed (methanol -14 d) Low conc pre-weighed vials (Sod Bis -14 d)
High concentration container (48 hr)
Custody seals intact on shipping container/cooler?
Custody seals intact on sample bottles?
Number of coolers/boxes received
Yes No
1
Signature:Angelo Norvell Date & Time:04/28/2023 13:55:23
Special precautions or instructions included?
Comments:
Page 25 of 26
Page 26 of 26
WithersRavenel
Our People. Your Success.

APPENDIX D GENERAL STANDARD OPERATING PROCEDURES

Generalized Standard Operating Procedures (Not All Inclusive)

WithersRavenel
Our People. Your Success.
Soil Sampling, Soil Boring and Monitor Well Installation, Well Development Soil borings are installed utilizing a stainless-steel hand auger, direct-push hydraulic drill or auger rotary
drill using either a macro core™ sampler, hollow stem augers, or air rotary roller cone bit. Soil borings are
typically sampled at discrete intervals from the bucket of a clean stainless steel hand auger, direct push stainless steel sampler with acetate sleeve, or a split barrel sampler. When appropriate, soil samples may be collected from drill cuttings associated with the boring or well installation. Monitor wells are constructed within select soil borings of one, two, or four-inch inside diameter PVC
casing and machine slotted screen in accordance with NCAC Title 15A, Subchapter 02C (Well Construction Standards, Criteria and Standards Applicable to Water Supply and Certain Other Wells). Clean-washed “#2 Torpedo Sand” is typically utilized to fill the boring annulus surrounding the well screen, extending to a minimum of 1-foot above the well screen. A minimum 1-foot thick bentonite clay seal is emplaced above the sand pack and hydrated. Neat cement grout is placed in the remaining annulus
space from the upper portion of the bentonite seal to within 1-foot of surface grade. In coastal plain areas where shallow groundwater is encountered, a variance to construction standards may be employed to ensure the upper portion of the well screen intersects the upper aquifer surface. Wellheads may be completed with either concrete-set flush mounted traffic-bearing steel skirted manholes with bolt down covers or steel above-ground “stick-up” well protectors set in a concrete pad. The monitoring wells are
secured with locking caps. Temporary wells or piezometers may be completed with the PVC riser cut at or above grade, and are abandoned within 24-hours of their installation. Wells may be developed using a bailer, electric submersible pump, pneumatic pump, or peristaltic pump, dependent upon site conditions. When wells are developed by the driller, they may be developed with
any of the methods outlined above, in addition to air or water injection. Soil boring logs and well construction details are typically prepared for presentation in a report appendix. Borings completed in bedrock may be drilled using air rotary, coring, or sonic drilling methods. Groundwater Depth to Water Measurements

Groundwater level measurements are typically obtained using an electronic water level indicator which registers a tone and/or illuminated light when the probe contacts groundwater. Depth to groundwater measurements are obtained by lowering the probe attached to a cable usually marked in 0.01 foot intervals into the well until the probe of the meter intersects the water surface. The measurement from
the top of the riser pipe or top of casing (TOC) to the water level is recorded to the nearest 0.01 foot. The
electronic water level indicator probe and exposed probe cable is decontaminated between measurement locations.

Generalized Standard Operating Procedures (Not All Inclusive)

WithersRavenel
Our People. Your Success.
Free Product Level Measurements Light Non-Aqueous Phase Liquid (LNAPL) or “free product” present on the water table is measured using
an electronic oil/water interface probe. The interface probe has both an audible and illuminating light
that indicate when a liquid level is encountered. The oil/water interface probe registers a solid tone and solidly lit light when LNAPL petroleum product is encountered and a beeping tone flashing light when groundwater is encountered. Depth to LNAPL measurements are obtained by lowering the probe attached to a cable marked in 0.01 foot intervals into the well until the probe of the meter intersects the product or groundwater. The measurements from the top of the riser pipe or TOC to the liquid level are
recorded to the nearest 0.01 foot. The thickness of LNAPL is calculated by subtracting the depth to LNAPL measurement from the depth to groundwater measurement. The electronic interface probe is decontaminated between measurement locations. Soil Sampling and Field Screening
Soil sampling is performed in general accordance with ASTM: 1586-84 where applicable. Sampling procedures are followed to protect the chemical integrity of the soil samples and minimize the potential for cross contamination between sample locations, including discarding of the exterior of the sample which contacts the auger bucket, acetate sleeve, or split barrel sampler, the use of stainless steel sampling
equipment, and the thorough decontamination of sampling apparatus prior to use and between sample locations. Soil samples retained as a part of excavation or other intrusive “digging” activities may be collected from the bucket of excavation equipment or using a hand shovel, if appropriate. Care to collect soil samples
from excavation equipment includes retrieving native soil from material that has not made contact with the excavating equipment. Samples are collected in sealable bags or by directly filling sample containers as described above. Sampling is performed using new, disposable nitrile gloves for each sample location to ensure sample
integrity and minimize the potential for cross contamination or field personnel exposure to contaminants.
Sampling equipment such as hand auger extensions and buckets, direct push samplers, split spoons or shovels, are decontaminated prior to their use in the collection of samples. Samples are placed within laboratory grade sample containers provided by the laboratory to which the
samples are submitted, labeled, sealed, and placed in an ice filled cooler. An aliquot of the sample is
typically placed in a clean sealable bag and allowed to reach ambient air temperature for future screening of volatile vapor content with a photoionization detector (PID), flame-ionization detector (FID) or other portable screening device.
Screening of samples with a PID, FID or other field screening device is performed in accordance with
device manufacturer specifications for screening, following calibration of the instrument based on manufacturer recommended procedures.

Generalized Standard Operating Procedures (Not All Inclusive)

WithersRavenel
Our People. Your Success.
Groundwater Sampling Groundwater samples are generally collected using one of three standard methods – through the use of a
dedicated, disposable bailer, a peristaltic pump or submersible electric pump.
When sampling with a bailer, a minimum of three well volumes of groundwater are extracted from the well as a means of purging, unless the well is purged to a “dry” state prior to the removal of three volumes of water. Prior to collection of the groundwater sample with the bailer, the water level is allowed to recover to within 80% of the original level measured prior to purging.
When sampling with a peristaltic or submersible electric pump, polyethylene (PE) tubing (or equivalent) is emplaced into the screened section of the monitoring well, and the pump is used to extract water through the tubing. When using the either of these methods, general water quality measurements including but not limited to pH, temperature, dissolved oxygen (DO), oxygen reductive potential (ORP), specific
conductivity and turbidity may be used as methods for determining when an adequate purge of the well has been conducted. When water quality parameters are measured, the resulting data are included in well purge forms or field notes specific to each site and sampling point. Following the purging of three well volumes of groundwater (in the case of the bailed well) or stability of
monitored measurements (in the case of the peristaltic or submersible electric pump), the groundwater sample(s) are introduced directly into sample containers provided by the laboratory to which samples are ultimately submitted for analysis. Any samples requiring chemical preservation are contained in pre-preserved container(s) provided by the laboratory.
Sampling is performed using new, disposable nitrile gloves for each sample location to ensure sample integrity and minimize the potential for cross contamination of samples or field personnel exposure to contaminants. Water Supply Well Sampling

Sampling of water supply wells is accomplished through the collection of a representative sample from an in-line water tap or other point accessible for sampling. Where possible, the sample is collected from a point prior to any filtration or point of entry (POE) system which might be installed on a well. In some cases, samples will be collected from both pre and post-POE locations. Prior to the collection of samples
through an in-place sampling point, the tap or sampling port is cleaned with an Alconox® and deionized
water solution, rinsed with deionized water, and again with an isopropyl alcohol (IPA) rinse. In the case of active supply wells (e.g., a well with a useable well pump with an active power supply), the well pump is energized and allowed to run for a minimum of ten (10) minutes time, after which a sample is
contained in laboratory grade sample containers as described in the previous section. Water quality
parameters may be (but are not necessarily) measured in association with the well purging. Supply wells without active power supplies are not generally sampled, as the well seal cannot be compromised by individuals not certified as a well contractor. However, in the case of a well with no
power supply or pump installed, samples could be obtained through the use of a bailer, peristaltic pump or
electric submersible pump.
Generalized Standard Operating Procedures (Not All Inclusive)

WithersRavenel
Our People. Your Success.
Decontamination Procedures Decontamination procedures employed in the performance of field activities will vary dependent upon
the method(s) of sampling performed at any site, but will generally include the following:
• Remove excess soil/sludge from any sampling equipment as needed, • Wash and scrub the equipment with a phosphate-free detergent such as Alconox® or Liquinox® in a contaminant-free tap water solution. Use a brush to remove particulate matter and surface films as necessary,
• Rinse thoroughly with tap water, • Rinse thoroughly with analyte-free water (deionized water),
 Rinse thoroughly with isopropyl alcohol, • Allow the equipment to air dry,
• Prevent inadvertent contamination during storage and transport (accomplished through storage of equipment in foil or plastic bags/sheeting). In the case of disposable bailers and tubing utilized for the purging and sampling of wells, these items may be decontaminated prior to their disposal. In general, no decontamination of these items is necessary
prior to their use in sampling.