MO-9564_40995_CA_MRP_20230315

EXCEL CIVIL & ENVIRONMENTAL ASSOCIATES, PLLC
www.excelengr.com
Excel Civil & Environmental Associates, PLLC
625 Huntsman Court
Gastonia, North Carolina 28054
NC License No. P-0129
Telephone: [phone]
Facsimile: [phone]
Internet: www.excelengr.com
March 15, 2023
Mr. Dan Bowser
NCDEQ / DWM / UST Section
Mooresville Regional Office
610 East Center Ave, Suite 301
Mooresville, North Carolina 28115
Re: Groundwater Monitoring Report
Sam’s Mart 103 (former 715)
3215 Queen City Drive
Charlotte, North Carolina
Land Use: COMMERCIAL
SITE RISK: HIGH
MO-9564_40995_CA_20230315_Groundwater_Monitoring_Report
EXCEL Project No. 2020004
Dear Mr. Bowser:
On behalf of Sam’s Mart LLC, Incorporated, Excel Civil & Environmental Associates,
PLLC (Excel) respectfully submits for your review and approval this Groundwater
Monitoring Report for the above-referenced facility.
If you have any questions, please contact the undersigned.
Sincerely yours,
EXCEL CIVIL & ENVIRONMENTAL ASSOCIATES, PLLC
Aaron C. Long, P.E.
Principal Engineer
p.c. Adnan Jazairi / Sam’s Mart, Inc. / Matthews, NC

GROUNDWATER MONITORING REPORT

SAM’S MART 103 (FORMER 715)
3215 QUEEN CITY DRIVE
CHARLOTTE, MECKLENBURG COUNTY, NORTH CAROLINA
NCDEQ INCIDENT NO. 40995

NCDEQ FACILITY ID NO. 00-0-0000014954
EXCEL PROJECT NO. 2020004

LATITUDE = 35.240161 / LONGITUDE = (-) 80.918470

Date submitted
March 15, 2023

Prepared for
Mr. Adnan Jazairi
Chief Operating Officer
Sam’s Mart, Inc.
7935 Council Place, Suite 200
Matthews, North Carolina 28105

Prepared by
Excel Civil & Environmental Associates, PLLC 625 Huntsman Court
Gastonia, North Carolina 28054
NC License No. P-0129

www.excelengr.com

Aaron C. Long, P.E.
Principal Engineer
Groundwater Monitoring Report NCDEQ No. 00-0-0000014954
Sam’s Mart 103 (Former 715) Excel No. 2020004
Charlotte, North Carolina Page No. i

EXCEL CIVIL & ENVIRONMENTAL ASSOCIATES, PLLC
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TABLE OF CONTENTS

SECTION NO. PAGE NO.

TABLE OF CONTENTS ……………………………………………………………………………………. i

1.0 EXECUTIVE SUMMARY……………………………………………………………………………. 1

2.0 BACKGROUND INFORMATION.……………………………………………………………………. 1
2.1 AREA OF INVESTIGATION.………………………………………………………………….. 1
2.2 RECEPTOR SURVEY.……………………………………………………………………….. 2
2.3 PREVIOUS INVESTIGATIONS.………………………………………………………………. 2

3.0 GEOLOGIC FRAMEWORK.………………………………………………………………………… 2
3.1 REGIONAL GEOLOGY.……………………………………………………………………… 2
3.2 SITE GEOLOGY.…………………………………………………………………………….. 2

4.0 FIELD ACTIVITIES.…………………………………………………………………………………. 3

5.0 LABORATORY ANALYSIS………………………………………………………………………….. 3

6.0 SUMMARY & RECOMMENDATIONS……………………………………………………………….. 3

7.0 LIMITATIONS……………………………………………………………………………………….. 4

8.0 REFERENCES…………………………………………………………………………………….... 4

LIST OF TABLES
TABLE 1 – LIQUID LEVEL DATA
TABLE 2 – GROUNDWATER SUMMARY DATA
TABLE 3 – WATER SUPPLY WELL DATA (B-5)
TABLE 4 – FIELD MEASUREMENTS OF GROUNDWATER SAMPLES

LIST OF FIGURES
FIGURE 1 – TOPOGRAPHICAL MAP
FIGURE 2 – SITE PLAN
FIGURE 3 – WATER TABLE CONTOUR MAP
FIGURE 4 - GROUNDWATER CONSTITUENTS MAP FIGURE 5 – CROSS SECTION B-B’

LIST OF APPENDICES

APPENDIX A – LABORATORY REPORTS & CHAIN OF CUSTODY FORM(S)
APPENDIX B – REPORTING TABLES (B-1, B-2, B-6, B-10)

Groundwater Monitoring Report NCDEQ No. 00-0-0000014954
Sam’s Mart 103 (Former 715) Excel No. 2020004
Charlotte, North Carolina Page No. ii

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PROJECT INFORMATION SUMMARY
Facility Name: Sam’s Mart #103
Facility Address: 3215 Queen City Drive
Charlotte, Mecklenburg County, North Carolina
NCDEQ Incident Number: 40995
Facility UST ID Number: MO-9564628
NCDEQ Incident Manger: Daniel Bowser, MRO, UST Section
Site Risk / Priority Rank: High
Reason for Risk Classification: Drinking water wells within 1,000 feet of the source area
Land Use Category: Commercial / Residential
CONTACT INFORMATION
Responsible Party: Sam’s Mart, Inc.
7935 Council Place, #200
Matthews, North Carolina 28105
Phone: [phone]
Current Property Owner: SAMS INVESTMENTS VI LLC
7935 Council Place, #200
Matthews, North Carolina 28105
Consultant: Excel Civil & Environmental Associates, PLLC
625 Huntsman Court
Gastonia, North Carolina 28054
License No. P-0129
Consultant Contact: Aaron C. Long, P.E.
Principal Engineer
Phone: [phone]
Email: [e-mail]
Analytical Laboratory: PACE - ESC Lab Sciences
12065 Lebanon Road
Mt. Juliet, TN 37122
Phone: [phone]
Certification No. ENV375/DW21704/BIO041
RELEASE INFORMATION
Date Discovered: January 16, 2020
Estimated Quantity of Release: Unknown
Source of Release: Gasoline Underground Storage Tank Lines
UST(s) Size & Contents: (5) 10,000-gal Gasoline and Diesel

Groundwater Monitoring Report
Sam’s Mart 103 (Former 715)
Charlotte, North Carolina
NCDEQ No. 00-0-0000014954
Excel No. 2020004
Page No. 1
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1.0 EXECUTIVE SUMMARY
The Sam’s Mart 103 (former 715) facility is located at 3215 Queen City Drive within the
incorporated limits of Charlotte, Mecklenburg County, North Carolina (refer to Figure 1). This
assessment was conducted to complete a groundwater sampling event following completion of
a public water connection for two properties on Mulberry Church Road. Prior activities at the
property include a UST line removal performed by Excel in January 2020, a Limited Site
Assessment Report completed on March 25, 2020 and a Comprehensive Site
Assessment was conducted by Excel during May through December 2020.
2.0 BACKGROUND INFORMATION
2.1 AREA OF INVESTIGATION
The subject property is located on the southeastern corner of the intersection of
Mulberry Church Road and Queen City Drive, located inside the incorporated city limits
of Charlotte, North Carolina (refer to Figure 1). The subject property consists of one
approximately rectangular parcel of land with an area of approximately 0.843-acres. The
property is currently an active gas station and convenience store. The City of Charlotte
has designated this property as zoned B-2 General Business. Queen City Drive bounds
the property to the north and tracks in an approximate east-west direction and Mulberry
Church Road bounds the property to the west and tracks in an approximate north-south
direction. I-85 bounds the property to the south and tracks in an approximate east-west
direction. The surrounding properties consist of commercial properties with Queen City
Drive and a hotel to the north, a restaurant to the east, Interstate 85 to the south and
Mulberry Church Road and a restaurant to the west.
Line closure activities were conducted at the site in early January 2020. During the
closure activities, impacted soils were identified with approximately 235.49 tons removed
and temporarily stockpiled. On January 7 and 13, 2020, Henry Nemargut Engineering
collected soil samples along the former product piping trenches as outlined in the UST
removal guidelines. The lines have since been replaced and backfilled and the property
is currently active at this time (refer to Figure 2).
A Comprehensive Site Assessment was conducted by Excel during May through
December 2020. The assessment included the installation of five soil borings, eight
monitoring wells, soil, groundwater and potable well water sampling, laboratory analysis
and obtaining a right of entry agreement for an offsite monitor well. The areal extent of
benzene, MTBE and naphthalene impacted in groundwater above the NCAC 2L levels
was estimated to be approximately 40,000, 30,000 and 25,000 sf, respectively.
Groundwater samples collected from monitor well MW-4 exceeded the
Gross Contamination Levels (GCLs) for benzene (refer to Table 2).
Groundwater Monitoring Report
Sam’s Mart 103 (Former 715)
Charlotte, North Carolina
NCDEQ No. 00-0-0000014954
Excel No. 2020004
Page No. 2
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The subject site is located in the Piedmont Physiographic Province. Rocks are, for the
most part, metamorphosed and deeply weathered. The 1985 USGS Geologic Map of
North Carolina indicates underlying formations in this area of the Piedmont
Physiographic Province consisting of a biotite gneiss and schists. The majority of the
site is covered by impervious surfaces such as asphalt and concrete. The general
topography of the site is developed to slope to the south with site-specific surface
drainage expected to flow towards a detention pond on the southern side of the property.
2.2 RECEPTOR SURVEY
Based on a receptor survey completed in March 2020, Excel identified one active
potable well within 500 feet of the subject property servicing two residential properties.
The water supply well was utilized at 3109 and 3111 Mulberry Church Road, Charlotte,
North Carolina. The two properties were connected to public water by Plumbing
Connection in October of 2022.
According to the USGS Topographical Map for this area and vehicle reconnaissance,
the nearest surface water body, an unnamed tributary of Taggart Creek, is located
approximately 2,350 feet to the southeast of the subject property. The site is not located
in a designated wellhead protection area.
2.3 PREVIOUS INVESTIGATIONS
Line Closure Assessment, Limited Site Assessment and Comprehensive Site
Assessment.
3.0 GEOLOGIC FRAMEWORK
3.1 REGIONAL GEOLOGY
The subject site is located in the Piedmont Physiographic Province. Rocks are, for the
most part, metamorphosed and deeply weathered. The 1985 USGS Geologic Map of
North Carolina indicates underlying formations in this area of the Piedmont
Physiographic Province consisting of a biotite gneiss and schists.
3.2 SITE GEOLOGY
During previous site assessment activities, a tan silty clay material was observed from
the ground surface to a depth of approximately sixteen feet below ground surface (fbgl)
and a brown sandy clay was located from 16-fbgl to the termination depth of
approximately 35-fbgl.
The type of soils observed at the property appear to be consistent with the surficial
sediments common for this area. During groundwater sampling activities conducted as
part of this assessment, the depth to the groundwater table had significantly increased
from the previously sampling round. Groundwater was measured to be an approximate
depth of 27 feet below grade level at the site.
Groundwater Monitoring Report
Sam’s Mart 103 (Former 715)
Charlotte, North Carolina
NCDEQ No. 00-0-0000014954
Excel No. 2020004
Page No. 3
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4.0 FIELD ACTIVITIES
On January 20, 2023, Excel personnel visited the site to collect groundwater samples from all
available monitoring wells. During the groundwater monitoring event, monitoring wells MW-1
and MW-3 through MW-7 were found to be dry. Monitoring wells MW-2 and MW-8 were not
located and are assumed to be dry based on the elevation of the groundwater table.
Following the measurement of the static groundwater level, a minimum of three well volumes of
water were purged from the well using a disposable polyethylene bailer in wells that were to be
sampled. The samples were stored on ice and transported under chain-of-custody procedures
to Pace Analytical in Mt. Juliet, Tennessee. Each groundwater sample was analyzed for volatile
organic compounds (VOCs) using EPA Method 6200B including MTBE, IPE and EDB.
5.0 LABORATORY ANALYSIS
Groundwater samples were collected from monitoring wells VW-1. The laboratory results for the
groundwater samples collected for VW-1 indicated concentrations to be below NCAC 2L
standards for all constituents analyzed. The groundwater constituent levels in VW-1 appear to
have natural attenuated since the previous sampling round conducted in July of 2020. For a
summary of groundwater analytical results, refer to Table 2 and Figure 4. The areal extent of
benzene, MTBE and naphthalene impact in groundwater is approximately 40,000, 30,000 and
25,000 sf, respectively based on previous assessments. The areal extent of groundwater impact
for benzene exceeding GCLs is approximately 1,100 sf based on previous assessments.
The analytical laboratory report for both soil and groundwater sampling activities and associated
Chain-of-Custody forms are presented in Appendix A.
6.0 SUMMARY & RECOMMENDATIONS
Based on the information in this report Excel concludes the following:
During the groundwater monitoring event, monitoring wells MW-1 and MW-3 through
MW-7 were found to be dry. Monitoring wells MW-2 and MW-8 were not located and are
assumed to be dry based on the elevation of the groundwater table. Based on previous
assessments, the groundwater sample collected from monitor well MW-4 exceeded the
Gross Contamination Levels (GCLs) for benzene (refer to Table 2);
The areal extent of benzene, MTBE and naphthalene impact in groundwater above the
NCAC 2L levels is approximately 40,000, 30,000 and 25,000 sf, respectively;
Based on previous assessments, groundwater samples collected from monitor well MW-
4 exceeded the Gross Contamination Levels (GCLs) for benzene (refer to Table 3). The
areal extent of groundwater impact for benzene exceeding GCLs is approximately 1,100
sf;
Groundwater Monitoring Report NCDEQ No. 00-0-0000014954
Sam’s Mart 103 (Former 715) Excel No. 2020004
Charlotte, North Carolina Page No. vii

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www.excelengr.com
 Based on a receptor survey completed in March 2020, Excel identified one active
potable well within 500 feet of the subject property servicing two residential properties.
The water supply well was utilized at 3109 and 3111 Mulberry Church Road, Charlotte,
North Carolina. The two properties were connected to public water by Plumbing
Connection in October of 2022;

 Excel recommends a reduction in the site risk to intermediate, and;

 Excel recommends reinstallation of MW-4 to determine the current groundwater
constituent levels in the area which previously exceeded the NCDEQ Gross
Contamination Levels (GCLs).

Groundwater Monitoring Report
Sam’s Mart 103 (Former 715)
Charlotte, North Carolina
NCDEQ No. 00-0-0000014954
Excel No. 2020004
Page No. 5
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7.0 LIMITATIONS
This report is based on a limited number of soil and groundwater samples and chemical
analyses. The conclusions presented in this report are based only on the observations made
during this investigation and data provided by others. Subsurface conditions may vary
significantly with time, particularly with respect to groundwater elevations and quality.
Conclusions and recommendations set forth herein are applicable only to the facts and
conditions described at the time of this report.
In performing its professional services, Excel uses that degree of care and skill exercised under
similar circumstances by members of the environmental profession practicing in the same or
similar locality under similar conditions. The standard of care shall be judged exclusively as of
the time these services are rendered and not according to later standards. Excel makes no
express or implied warranty beyond its conformance to this standard. Excel shall not be
responsible for conditions or consequences arising from relevant facts that were concealed,
withheld or not fully disclosed for this report. Excel believes that all information contained in this
report is factual, but no guarantee is made or implied.
8.0 REFERENCES
Driscoll, “Groundwater and Wells”, 2nd edition, (St. Paul, Minnesota, Johnson Division).
R. Perry and C. Chilton, “Chemical Engineer's Handbook”, 5th edition, (New York: McGraw Hill,
Inc. 1973).
“Guidelines for Assessment and Corrective Action for UST Releases” completed by the UST
Section of the NCDEQ, Division of Waste Management dated December 1, 2013 and any
applicable amendments.
“Initial Abatement Action Report” completed by Excel, dated January 27, 2020.
“Limited Site Assessment Report” completed by Excel, dated March 25, 2020.
“Comprehensive Assessment Report” completed by Excel, dated January 6, 2021.

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LIST OF TABLES

TABLE 1 – LIQUID LEVEL DATA

TABLE 2 – GROUNDWATER SUMMARY DATA

TABLE 3 – WATER SUPPLY WELL DATA (B-5)

TABLE 4 – FIELD MEASUREMENTS OF THE GROUNDWATER SAMPLES

Table 1 - Liquid Level DataSam's Mart 103 (Former 715)3215 Queen City Drive, Charlotte, North CarolinaNCDEQ Incident 40995Excel Project No. 2020004WELL NUMBERDATE INSTALLEDWELL DEPTH (ft)SCREEN INTERVAL (ft)TOC (ft)DATE MEASUREDDTW (ft) WTE (ft)MW-126-Feb-20 25 10-25 100.00 20-Jan-23 NM-Dry --MW-229-Jun-20 25 10-25 102.70 20-Jan-23 Not Located --MW-329-Jun-20 25 10-25 98.94 20-Jan-23 NM-Dry --MW-41-Jul-20 25 10-25 100.12 20-Jan-23 NM-Dry --MW-521-Sep-20 25 10-25 96.82 20-Jan-23 NM-Dry --MW-621-Sep-20 25 10-25 96.11 20-Jan-23 NM-Dry --MW-76-Oct-20 25 10-25 100.67 20-Jan-23 NM-Dry --MW-86-Oct-20 25 10-25 100.30 20-Jan-23 Not Located --VW-11-Jul-20 35 30-35 -- 20-Jan-23 26.54 --NOTES:Data provided in feet unless otherwise notedNM- Not MeasuredDTW - Depth to WaterWTE - Water Table Elevation TOC elevation for MW-1 set to datum of 100'
Table 2 - Groundwater Summary DataSam's Mart 103 (Former 715)3215 Queen City Drive, Charlotte, North Carolina NCDEQ Incident 40995Excel Project No. 2020004SAMPLE LOCATIONMW-2 MW-3 MW-4WS-1DATE SAMPLED28-Feb-20 7-Jul-207-Jul-20 20-Jan-23 7-Jul-20EPH C9 - C18 Aliphatics53 B J 81 B J 50 B J < 33.3 11,000 < 33.3 NA NA -- --EPH C19 - C36 Aliphatics< 33.3 40.9 J 47.5 J < 33.3 471 < 33.3 NA NA10,000 --EPH C11 - C22 Aromatics108 132 B 66.5 B J < 33.3 5,360 < 33.3 NA NA -- --VPH C5 - C8 Aliphatics9,510 10,100 3,510 1,390 112,000 488NA NA400 --VPH C9 - C12 Aliphatics2,890 1,870 85.9 J 178 32,900 < 33.3 NA NA -- --VPH C9 - C10 Aromatics1,390 981 < 33.3 < 33.3 8,690 J < 33.3 NA NA -- --TOTAL C9 - C18 Aliphatics2,943 1,951135.9 < 211.343,900BDL NA NA700 --TOTAL C9 - C22 Aromatics1,498 1,113< 99.8 BDL14,050BDL NA NA200 --BENZENE 1,220 1,120 4.97 103 18,100 10.6< 0.0941 < 0.09411 5,000TOLUENE28.3 28.4 2.39 2.3340,5000.359 J < 0.278 < 0.278600 260,000ETHYLBENZENE 845 6830.806 J 15.93,5101.81 < 0.137 < 0.137600 84,500TOTAL XYLENES 747.5358.7 8.99 32.3918,5801.83 J < 0.604 < 0.604500 85,500MTBE 10,900 5,940< 0.101159 18,200 55916.8 < 0.10120 20,000NAPHTHALENE 15.9 J 533.62 J < 1918 J< 1< 1< 16 6,000N-PROPYLBENZENE 93.7 J 86.70.547 J 3.53290.18 J < 0.0993 < 0.099370 30,0001,2,4-TRIMETHYLBENZENE261 75.9 4.32 9.293,0900.48 J < 0.322 < 0.322400 28,5001,3,5-TRIMETHYLBENZENE< 3.87 9.38 1.29 0.625 J688< 0.104 < 0.104 < 0.104400 25,000DI-ISOPROPYL ETHER 174 J 192< 0.105 6.551,76047.3 3.08 < 0.10570 70,000sec-BUTYLBENZENE7.04 J 5.22 0.466 J 0.652 J < 31.3 < 0.125 < 0.125 < 0.12570 8,500ISOPROPYLBENZENE38.6 29.7 0.591 J 4.88121 J0.188 J < 0.105 < 0.10570 25,000p-ISOPROPYLTOLUENE5.91 J 4.84 0.339 J 0.381 J44.5 J< 0.12 < 0.12 < 0.1225 11,700NAPHTHALENE 11 19.51.81 0.209 J439< 0.162 NA NA6 6,000DI-N-BUTYL PHTHALATE2.68 J < 0.453 < 0.453 < 0.453 < 0.453 < 0.462 NA NA700 --DIETHYL PHTHALATE14.3 < 0.287 < 0.287 < 0.287 < 0.287 < 0.293 NA NA6,000 --MetalsLEAD91.115.64.38 J23.4NA< 2.95NANA1515,000NOTES:Data in ug/l MTBE - Methyl Tert Butyl EtherMADEP - Massachusetts Dept. of Environmental Protection J - Reported value is an estimateEPH - Extractable Petroleum Hydrocarbons B - The same analyte was found in the associated blankVPH - Volatile Petroleum Hydrocarbons NA - Not AnalyzedVOC - Volatile Organic Compound Bold data represents constituents above NCAC 2L Standards SVOC - Semi-Volatile Organic Compound Highlighted data represent constituents above GCL Standards Additional Results from July 2020 Sampling Event: Data in ug/lMW-1: 4.58 n-Butylbenzene, 327 TAA, 1,990 TBA, 113 TAME, 0.525 J Acenaphthene, 0.276 J Fluorene, 0.306 J Phenanthrene, 5.65 J PhenolMW-2: 0.687 J Tetrachloroethene, 377 TAA, 33.3 TBAMW-3: 139 TAA, 38.4 TBA, 2.66 TAMEMW-4: 10,300 J TAA, 1,170 J TBA, 600 TAME, 0.521 J Acenaphthene, 0.351 J Anthracene, 0.183 J Fluoranthene, 0.707 J Fluorene, 1.01 Phenanthrene, 0.229 J Pyrene, 9.74 J PhenolVW-1: 10.6 Chloroform, 0.589 J Methylene Chloride, 95.9 TAA, 257 TBA, 18.6 TAMEVOCsMADEPSVOCsNCAC 2L GCLMW-17-Jul-20VW-1
Table 2 - Groundwater Summary Data Cont'd Sam's Mart 103 (Former 715)3215 Queen City Drive, Charlotte, North Carolina NCDEQ Incident 40995Excel Project No. 2020004SAMPLE LOCATIONMW-5 MW-6 MW-7 MW-8DATE SAMPLEDEPH C9 - C18 Aliphatics71.8 B J 182 B 78.3 B J 152 B -- --EPH C19 - C36 Aliphatics< 33.3 < 37.3 < 33.3 < 33.310,000 --EPH C11 - C22 Aromatics38.4 B J 47.2 B J 45.8 B J 40.3 B J -- --VPH C5 - C8 Aliphatics< 33.3509 1,400 3,420 400 --VPH C9 - C12 Aliphatics< 33.3 55.2 J 39.4 J 226 -- --VPH C9 - C10 Aromatics< 33.3 50.8 J < 33.3 151 -- --TOTAL C9 - C18 Aliphatics71.8 B J 237.2 B J 117.7 B J 378 B700 --TOTAL C9 - C22 Aromatics38.4 B J 98 B J 45.8 B J 191.3 B J200 --BENZENE0.361 J9.43 10.1 73.6 1 5,000TOLUENE< 0.278 4.45 < 0.278 149600 260,000ETHYLBENZENE< 0.137 1.19 0.543 J 30.8600 84,500TOTAL XYLENES1.006 J 45.3 2.814 J 166500 85,500MTBE7.78851< 0.101 < 0.10120 20,000NAPHTHALENE1.11 J6.82< 110.7 6 6,000N-PROPYLBENZENE0.282 J 0.348 J 0.222 J 3.5870 30,0001,2,4-TRIMETHYLBENZENE1.56 8.14 < 0.322 30.8400 28,5001,3,5-TRIMETHYLBENZENE0.425 J 0.344 J < 0.104 1.91400 25,000DI-ISOPROPYL ETHER< 0.105 < 0.105 < 0.105 < 0.10570 70,000sec-BUTYLBENZENE< 0.125 0.426 J < 0.125 1.1970 8,500ISOPROPYLBENZENE0.124 J 2.92 0.547 J 3.3270 25,000p-ISOPROPYLTOLUENE< 0.12 0.322 J 0.609 J 0.505 B J25 11,700NAPHTHALENE0.329 J 0.298 J < 0.1598.466 6,000DI-N-BUTYL PHTHALATE< 0.453 < 0.453 < 0.453 < 0.453700 --DIETHYL PHTHALATE< 0.287 < 0.287 0.428 J < 0.2876,000 --MetalsLEAD< 14.8 < 2.9554.1 23.8 1515,000NOTES:Data in ug/lMTBE - Methyl Tert Butyl EtherMADEP - Massachusetts Dept. of Environmental ProtectionJ - Reported value is an estimateEPH - Extractable Petroleum HydrocarbonsB - The same analyte was found in the associated blankVPH - Volatile Petroleum HydrocarbonsNA - Not AnalyzedVOC - Volatile Organic CompoundBold data represents constituents above NCAC 2L Standards SVOC - Semi-Volatile Organic CompoundHighlighted data represent constituents above GCL Standards Additional Results from October 2020 Sampling Event: Data in ug/lMW-5: 0.248 J n-Butylbenzene, MW-6: 0.261 J n-Butylbenzene, 7.05 J TAA, 6.88 TAME, 0.308 J Benzo(a)anthracene, 0.327 J Benzo(b)fluoranthene, 0.124 J Benzo(k)fluoranthene, 0.153 J Benzo(g,h,i)perylene, 0.276 J Benzo(a)pyrene, 0.192 J Chrysene, 0.132 J Fluoranthene, 0.188 J PyreneMW-7: 10.9 MEK, 73 TAA, 7.48 TBAVOCsSVOCs12-Oct-20NCAC 2L GCLMADEP
TABLE 3 (B‐5):  PUBLIC and PRIVATE WATER SUPPLY WELL and OTHER RECEPTOR 
INFORMATION SAM’S MART 103/715 
3215 QUEEN CITY DRIVE, CHARLOTTE, NORTH CAROLINA 
NCDEQ Incident No. 40995 
Excel Project No. 2020004 
Well ID #  Well Depth Property Owner Property Address Well Status 
WS‐1* Unknown Roy John  
RJN Holdings, LLC 
3109 Mulberry Church Road 
3111 Mulberry Church Road Inactive 
Notes: 
* ‐ Denotes status obtained from well questionnaires dated February 2020 and response received on March 24,20203109 & 3111 Connected to municipal water in October 2022. Bids are being obtained to abandon the WSW
Electrical
Conductivity ORP
(µS/cm)
MW-1
MW-2
MW-3
MW-4
MW-5
MW-6
MW-7
MW-8
VW-1 6.65 0.903 187 5.11 19.19
Notes:SU Standard units
µS/cm Microsiemens per centimeter
ppm Parts per million
0C Degrees Celsius
NS Not sampled, (Dry, Not Located, Destroyed, etc…)
MW Monitoring Well
TABLE 4
FIELD MEASUREMENTS OF THE GROUNDWATER SAMPLES
Sam's Mart No. 103
3215 Queen City Drive, Charlotte North Carolina
Excel Project No. 2020004
Well
Identification
Sampling
Date
pH
(su)
Temperature
(0C)
Disolved
Oxygen
(ppm)
1/20/23
Not Sampled - Dry
Not Sampled - Not Located
Not Sampled - Dry
Not Sampled - Dry
Not Sampled - Dry
Not Sampled - Dry
Not Sampled - Dry
Not Sampled - Not Located

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LIST OF FIGURES

FIGURE 1 – TOPOGRAPHICAL MAP

FIGURE 2 – SITE PLAN

FIGURE 3 – WATER TABLE CONTOUR MAP

FIGURE 4 - GROUNDWATER CONSTITUENTS MAP

PREPARED FOR:
PROJ. MGR: DATE:
DRAWN BY: PROJ. #:
Image Provided By EDR USGS Topographic Maps
Boundaries are approximate
FIGURE 1 - TOPOGRAPHICAL MAP
SAM'S MART 1073215 QUEEN CITY DRIVE, CHARLOTTE, NC
Sam's Mart
Mike Stanforth 1/23/2020
Mike Stanforth 2020004

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LIST OF APPENDICES

APPENDIX A – LABORATORY REPORTS & CHAIN OF CUSTODY FORM(S)

APPENDIX B – REPORTING TABLES (B-1, B-2, B-6, B-10)

EXCEL CIVIL & ENVIRONMENTAL ASSOCIATES, PLLC
www.excelengr.com

APPENDIX A

LABORATORY REPORTS & CHAIN OF CUSTODY FORM(S)

ANALYTICAL REPORT
January 25, 2023
Excel Civil & Environmental Associates
Sample Delivery Group:L1578130
Samples Received:01/21/2023
Project Number:2020004
Description:Sam's Mart 103
Report To:Aaron Long
625 Huntsman Court
Gastonia, NC 28054
Entire Report Reviewed By:
January 25, 2023
[Preliminary Report]
Heather J Wagner
Project Manager
Results relate only to the items tested or calibrated and are reported as rounded values. This test report shall not be reproduced, except in full, without written approval of the laboratory. Where applicable, sampling conducted by Pace Analytical National is performed per guidance provided in laboratory standard operating procedures ENV-SOP-MTJL-0067 and ENV-SOP-MTJL-0068. Where sampling conducted by the customer, results relate to the accuracy of the information provided, and as the samples are received.
Pace Analytical National
12065 Lebanon Rd Mount Juliet, TN 37122 615-758-5858 800-767-5859 www.pacenational.com
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
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January 25, 2023
Heather J Wagner
Project Manager
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TABLE OF CONTENTS
Cp: Cover Page 1
Tc: Table of Contents 2
Ss: Sample Summary 3
Cn: Case Narrative 4
Sr: Sample Results 5
VW-1 L1578130-01 5
Qc: Quality Control Summary 7
Volatile Organic Compounds (GC/MS) by Method 6200B-2011 7
Gl: Glossary of Terms 11
Al: Accreditations & Locations 12
Sc: Sample Chain of Custody 13
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
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SAMPLE SUMMARY
Collected by Collected date/time Received date/time
VW-1 L1578130-01 GW C DeVane 01/20/23 14:00 01/21/23 08:45
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Volatile Organic Compounds (GC/MS) by Method 6200B-2011 WG1992912 1 01/22/23 23:26 01/22/23 23:26 GH Mt. Juliet, TN
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
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CASE NARRATIVE
All sample aliquots were received at the correct temperature, in the proper containers, with the
appropriate preservatives, and within method specified holding times, unless qualified or notated within
the report. Where applicable, all MDL (LOD) and RDL (LOQ) values reported for environmental samples
have been corrected for the dilution factor used in the analysis. All Method and Batch Quality Control
are within established criteria except where addressed in this case narrative, a non-conformance form
or properly qualified within the sample results. By my digital signature below, I affirm to the best of my
knowledge, all problems/anomalies observed by the laboratory as having the potential to affect the
quality of the data have been identified by the laboratory, and no information or data have been
knowingly withheld that would affect the quality of the data.
[Preliminary Report]
Heather J Wagner
Project Manager
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
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Heather J Wagner
Project Manager
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SAMPLE RESULTS - 01
L1578130
VW-1
Collected date/time: 01/20/23 14:00
Volatile Organic Compounds (GC/MS) by Method 6200B-2011
Result Qualifier MDL RDL Dilution Analysis Batch
Analyte ug/l ug/l ug/l date / time
Acetone U 11.3 50.0 1 01/22/2023 23:26 WG1992912
Acrolein U 2.54 50.0 1 01/22/2023 23:26 WG1992912
Acrylonitrile U 0.671 10.0 1 01/22/2023 23:26 WG1992912
Benzene U 0.0941 1.00 1 01/22/2023 23:26 WG1992912
Bromobenzene U 0.118 1.00 1 01/22/2023 23:26 WG1992912
Bromodichloromethane U 0.136 1.00 1 01/22/2023 23:26 WG1992912
Bromoform U 0.129 1.00 1 01/22/2023 23:26 WG1992912
Bromomethane U 0.605 5.00 1 01/22/2023 23:26 WG1992912
n-Butylbenzene U 0.157 1.00 1 01/22/2023 23:26 WG1992912
sec-Butylbenzene U 0.125 1.00 1 01/22/2023 23:26 WG1992912
tert-Butylbenzene U 0.127 1.00 1 01/22/2023 23:26 WG1992912
Carbon tetrachloride U 0.128 1.00 1 01/22/2023 23:26 WG1992912
Chlorobenzene U 0.116 1.00 1 01/22/2023 23:26 WG1992912
Chlorodibromomethane U 0.140 1.00 1 01/22/2023 23:26 WG1992912
Chloroethane U 0.192 5.00 1 01/22/2023 23:26 WG1992912
Chloroform U 0.111 5.00 1 01/22/2023 23:26 WG1992912
Chloromethane U 0.960 2.50 1 01/22/2023 23:26 WG1992912
2-Chlorotoluene U 0.106 1.00 1 01/22/2023 23:26 WG1992912
4-Chlorotoluene U 0.114 1.00 1 01/22/2023 23:26 WG1992912
1,2-Dibromo-3-Chloropropane U 0.276 5.00 1 01/22/2023 23:26 WG1992912
1,2-Dibromoethane U 0.126 1.00 1 01/22/2023 23:26 WG1992912
Dibromomethane U 0.122 1.00 1 01/22/2023 23:26 WG1992912
1,2-Dichlorobenzene U 0.107 1.00 1 01/22/2023 23:26 WG1992912
1,3-Dichlorobenzene U 0.110 1.00 1 01/22/2023 23:26 WG1992912
1,4-Dichlorobenzene U 0.120 1.00 1 01/22/2023 23:26 WG1992912
Dichlorodifluoromethane U 0.374 5.00 1 01/22/2023 23:26 WG1992912
1,1-Dichloroethane U 0.100 1.00 1 01/22/2023 23:26 WG1992912
1,2-Dichloroethane U 0.0819 1.00 1 01/22/2023 23:26 WG1992912
1,1-Dichloroethene U 0.188 1.00 1 01/22/2023 23:26 WG1992912
cis-1,2-Dichloroethene U 0.126 1.00 1 01/22/2023 23:26 WG1992912
trans-1,2-Dichloroethene U 0.149 1.00 1 01/22/2023 23:26 WG1992912
1,2-Dichloropropane U 0.149 1.00 1 01/22/2023 23:26 WG1992912
1,1-Dichloropropene U 0.142 1.00 1 01/22/2023 23:26 WG1992912
1,3-Dichloropropane U 0.110 1.00 1 01/22/2023 23:26 WG1992912
2,2-Dichloropropane U 0.161 1.00 1 01/22/2023 23:26 WG1992912
Di-isopropyl ether 3.08 0.105 1.00 1 01/22/2023 23:26 WG1992912
Ethylbenzene U 0.137 1.00 1 01/22/2023 23:26 WG1992912
Hexachloro-1,3-butadiene U 0.337 1.00 1 01/22/2023 23:26 WG1992912
Isopropylbenzene U 0.105 1.00 1 01/22/2023 23:26 WG1992912
p-Isopropyltoluene U 0.120 1.00 1 01/22/2023 23:26 WG1992912
2-Butanone (MEK)U 1.19 10.0 1 01/22/2023 23:26 WG1992912
Methylene Chloride U 0.430 5.00 1 01/22/2023 23:26 WG1992912
4-Methyl-2-pentanone (MIBK)U 0.478 10.0 1 01/22/2023 23:26 WG1992912
Methyl tert-butyl ether 16.8 0.101 1.00 1 01/22/2023 23:26 WG1992912
Naphthalene U 1.00 5.00 1 01/22/2023 23:26 WG1992912
n-Propylbenzene U 0.0993 1.00 1 01/22/2023 23:26 WG1992912
Styrene U 0.118 1.00 1 01/22/2023 23:26 WG1992912
1,1,1,2-Tetrachloroethane U 0.147 1.00 1 01/22/2023 23:26 WG1992912
1,1,2,2-Tetrachloroethane U 0.133 1.00 1 01/22/2023 23:26 WG1992912
Tetrachloroethene U 0.300 1.00 1 01/22/2023 23:26 WG1992912
Toluene U 0.278 1.00 1 01/22/2023 23:26 WG1992912
1,2,3-Trichlorobenzene U 0.230 1.00 1 01/22/2023 23:26 WG1992912
1,2,4-Trichlorobenzene U 0.481 1.00 1 01/22/2023 23:26 WG1992912
1,1,1-Trichloroethane U 0.149 1.00 1 01/22/2023 23:26 WG1992912
1,1,2-Trichloroethane U 0.158 1.00 1 01/22/2023 23:26 WG1992912
Trichloroethene U 0.190 1.00 1 01/22/2023 23:26 WG1992912
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
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SAMPLE RESULTS - 01
L1578130
VW-1
Collected date/time: 01/20/23 14:00
Volatile Organic Compounds (GC/MS) by Method 6200B-2011
Result Qualifier MDL RDL Dilution Analysis Batch
Analyte ug/l ug/l ug/l date / time
Trichlorofluoromethane U 0.160 5.00 1 01/22/2023 23:26 WG1992912
1,2,3-Trichloropropane U 0.237 2.50 1 01/22/2023 23:26 WG1992912
1,2,4-Trimethylbenzene U 0.322 1.00 1 01/22/2023 23:26 WG1992912
1,3,5-Trimethylbenzene U 0.104 1.00 1 01/22/2023 23:26 WG1992912
Vinyl chloride U 0.234 1.00 1 01/22/2023 23:26 WG1992912
o-Xylene U 0.174 1.00 1 01/22/2023 23:26 WG1992912
m&p-Xylenes U 0.430 2.00 1 01/22/2023 23:26 WG1992912
(S) Toluene-d8 93.1 80.0-120 01/22/2023 23:26 WG1992912
(S) 4-Bromofluorobenzene 90.8 77.0-126 01/22/2023 23:26 WG1992912
(S) 1,2-Dichloroethane-d4 107 70.0-130 01/22/2023 23:26 WG1992912
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
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QUALITY CONTROL SUMMARYWG1992912
Volatile Organic Compounds (GC/MS) by Method 6200B-2011 L1578130-01
Method Blank (MB)
(MB) R3884399-2 01/22/23 19:32
MB Result MB Qualifier MB MDL MB RDL
Analyte ug/l ug/l ug/l
Acetone U 11.3 50.0
Acrolein U 2.54 50.0
Acrylonitrile U 0.671 10.0
Benzene U 0.0941 1.00
Bromobenzene U 0.118 1.00
Bromodichloromethane U 0.136 1.00
Bromoform U 0.129 1.00
Bromomethane U 0.605 5.00
n-Butylbenzene U 0.157 1.00
sec-Butylbenzene U 0.125 1.00
tert-Butylbenzene U 0.127 1.00
Carbon tetrachloride U 0.128 1.00
Chlorobenzene U 0.116 1.00
Chlorodibromomethane U 0.140 1.00
Chloroethane U 0.192 5.00
Chloroform U 0.111 5.00
Chloromethane U 0.960 2.50
2-Chlorotoluene U 0.106 1.00
4-Chlorotoluene U 0.114 1.00
1,2-Dibromo-3-Chloropropane U 0.276 5.00
1,2-Dibromoethane U 0.126 1.00
Dibromomethane U 0.122 1.00
1,2-Dichlorobenzene U 0.107 1.00
1,3-Dichlorobenzene U 0.110 1.00
1,4-Dichlorobenzene U 0.120 1.00
Dichlorodifluoromethane U 0.374 5.00
1,1-Dichloroethane U 0.100 1.00
1,2-Dichloroethane U 0.0819 1.00
1,1-Dichloroethene U 0.188 1.00
cis-1,2-Dichloroethene U 0.126 1.00
trans-1,2-Dichloroethene U 0.149 1.00
1,2-Dichloropropane U 0.149 1.00
1,1-Dichloropropene U 0.142 1.00
1,3-Dichloropropane U 0.110 1.00
2,2-Dichloropropane U 0.161 1.00
Di-isopropyl ether U 0.105 1.00
Ethylbenzene U 0.137 1.00
Hexachloro-1,3-butadiene U 0.337 1.00
Isopropylbenzene U 0.105 1.00
p-Isopropyltoluene U 0.120 1.00
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
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QUALITY CONTROL SUMMARYWG1992912
Volatile Organic Compounds (GC/MS) by Method 6200B-2011 L1578130-01
Method Blank (MB)
(MB) R3884399-2 01/22/23 19:32
MB Result MB Qualifier MB MDL MB RDL
Analyte ug/l ug/l ug/l
2-Butanone (MEK)U 1.19 10.0
Methylene Chloride U 0.430 5.00
4-Methyl-2-pentanone (MIBK)U 0.478 10.0
Methyl tert-butyl ether U 0.101 1.00
Naphthalene U 1.00 5.00
n-Propylbenzene U 0.0993 1.00
Styrene U 0.118 1.00
1,1,1,2-Tetrachloroethane U 0.147 1.00
1,1,2,2-Tetrachloroethane U 0.133 1.00
Tetrachloroethene U 0.300 1.00
Toluene U 0.278 1.00
1,2,3-Trichlorobenzene U 0.230 1.00
1,2,4-Trichlorobenzene U 0.481 1.00
1,1,1-Trichloroethane U 0.149 1.00
1,1,2-Trichloroethane U 0.158 1.00
Trichloroethene U 0.190 1.00
Trichlorofluoromethane U 0.160 5.00
1,2,3-Trichloropropane U 0.237 2.50
1,2,4-Trimethylbenzene U 0.322 1.00
1,3,5-Trimethylbenzene U 0.104 1.00
Vinyl chloride U 0.234 1.00
o-Xylene U 0.174 1.00
m&p-Xylenes U 0.430 2.00
(S) Toluene-d8 94.5 80.0-120
(S) 4-Bromofluorobenzene 89.8 77.0-126
(S) 1,2-Dichloroethane-d4 107 70.0-130
Laboratory Control Sample (LCS)
(LCS) R3884399-1 01/22/23 18:51
Spike Amount LCS Result LCS Rec.Rec. Limits LCS Qualifier
Analyte ug/l ug/l %%
Acetone 25.0 26.3 105 19.0-160
Acrolein 25.0 15.0 60.0 10.0-160
Acrylonitrile 25.0 28.2 113 55.0-149
Benzene 5.00 4.86 97.2 70.0-123
Bromobenzene 5.00 4.38 87.6 73.0-121
Bromodichloromethane 5.00 5.33 107 75.0-120
Bromoform 5.00 4.94 98.8 68.0-132
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
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QUALITY CONTROL SUMMARYWG1992912
Volatile Organic Compounds (GC/MS) by Method 6200B-2011 L1578130-01
Laboratory Control Sample (LCS)
(LCS) R3884399-1 01/22/23 18:51
Spike Amount LCS Result LCS Rec.Rec. Limits LCS Qualifier
Analyte ug/l ug/l %%
Bromomethane 5.00 5.04 101 10.0-160
n-Butylbenzene 5.00 4.22 84.4 73.0-125
sec-Butylbenzene 5.00 4.20 84.0 75.0-125
tert-Butylbenzene 5.00 4.21 84.2 76.0-124
Carbon tetrachloride 5.00 4.42 88.4 68.0-126
Chlorobenzene 5.00 4.67 93.4 80.0-121
Chlorodibromomethane 5.00 4.96 99.2 77.0-125
Chloroethane 5.00 5.53 111 47.0-150
Chloroform 5.00 5.44 109 73.0-120
Chloromethane 5.00 4.02 80.4 41.0-142
2-Chlorotoluene 5.00 4.23 84.6 76.0-123
4-Chlorotoluene 5.00 4.20 84.0 75.0-122
1,2-Dibromo-3-Chloropropane 5.00 4.40 88.0 58.0-134
1,2-Dibromoethane 5.00 4.85 97.0 80.0-122
Dibromomethane 5.00 5.22 104 80.0-120
1,2-Dichlorobenzene 5.00 4.76 95.2 79.0-121
1,3-Dichlorobenzene 5.00 4.85 97.0 79.0-120
1,4-Dichlorobenzene 5.00 4.96 99.2 79.0-120
Dichlorodifluoromethane 5.00 4.83 96.6 51.0-149
1,1-Dichloroethane 5.00 5.37 107 70.0-126
1,2-Dichloroethane 5.00 5.67 113 70.0-128
1,1-Dichloroethene 5.00 4.83 96.6 71.0-124
cis-1,2-Dichloroethene 5.00 5.12 102 73.0-120
trans-1,2-Dichloroethene 5.00 4.94 98.8 73.0-120
1,2-Dichloropropane 5.00 5.26 105 77.0-125
1,1-Dichloropropene 5.00 4.71 94.2 74.0-126
1,3-Dichloropropane 5.00 4.81 96.2 80.0-120
2,2-Dichloropropane 5.00 5.56 111 58.0-130
Di-isopropyl ether 5.00 5.06 101 58.0-138
Ethylbenzene 5.00 4.57 91.4 79.0-123
Hexachloro-1,3-butadiene 5.00 5.35 107 54.0-138
Isopropylbenzene 5.00 4.21 84.2 76.0-127
p-Isopropyltoluene 5.00 4.22 84.4 76.0-125
2-Butanone (MEK)25.0 28.1 112 44.0-160
Methylene Chloride 5.00 5.17 103 67.0-120
4-Methyl-2-pentanone (MIBK)25.0 24.9 99.6 68.0-142
Methyl tert-butyl ether 5.00 5.26 105 68.0-125
Naphthalene 5.00 4.04 80.8 54.0-135
n-Propylbenzene 5.00 4.01 80.2 77.0-124
Styrene 5.00 4.24 84.8 73.0-130
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
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QUALITY CONTROL SUMMARYWG1992912
Volatile Organic Compounds (GC/MS) by Method 6200B-2011 L1578130-01
Laboratory Control Sample (LCS)
(LCS) R3884399-1 01/22/23 18:51
Spike Amount LCS Result LCS Rec.Rec. Limits LCS Qualifier
Analyte ug/l ug/l %%
1,1,1,2-Tetrachloroethane 5.00 4.73 94.6 75.0-125
1,1,2,2-Tetrachloroethane 5.00 4.77 95.4 65.0-130
Tetrachloroethene 5.00 4.82 96.4 72.0-132
Toluene 5.00 4.41 88.2 79.0-120
1,2,3-Trichlorobenzene 5.00 4.85 97.0 50.0-138
1,2,4-Trichlorobenzene 5.00 4.60 92.0 57.0-137
1,1,1-Trichloroethane 5.00 5.24 105 73.0-124
1,1,2-Trichloroethane 5.00 4.88 97.6 80.0-120
Trichloroethene 5.00 5.19 104 78.0-124
Trichlorofluoromethane 5.00 5.24 105 59.0-147
1,2,3-Trichloropropane 5.00 4.97 99.4 73.0-130
1,2,4-Trimethylbenzene 5.00 4.20 84.0 76.0-121
1,3,5-Trimethylbenzene 5.00 4.34 86.8 76.0-122
Vinyl chloride 5.00 4.61 92.2 67.0-131
o-Xylene 5.00 4.42 88.4 80.0-122
m&p-Xylenes 10.0 9.20 92.0 80.0-122
(S) Toluene-d8 92.4 80.0-120
(S) 4-Bromofluorobenzene 92.4 77.0-126
(S) 1,2-Dichloroethane-d4 110 70.0-130
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
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GLOSSARY OF TERMS
Guide to Reading and Understanding Your Laboratory Report
The information below is designed to better explain the various terms used in your report of analytical results from the Laboratory. This is not
intended as a comprehensive explanation, and if you have additional questions please contact your project representative.
Results Disclaimer - Information that may be provided by the customer, and contained within this report, include Permit Limits, Project Name,
Sample ID, Sample Matrix, Sample Preservation, Field Blanks, Field Spikes, Field Duplicates, On-Site Data, Sampling Collection Dates/Times, and
Sampling Location. Results relate to the accuracy of this information provided, and as the samples are received.
Abbreviations and Definitions
MDL Method Detection Limit.
RDL Reported Detection Limit.
Rec.Recovery.
RPD Relative Percent Difference.
SDG Sample Delivery Group.
(S)
Surrogate (Surrogate Standard) - Analytes added to every blank, sample, Laboratory Control Sample/Duplicate and
Matrix Spike/Duplicate; used to evaluate analytical efficiency by measuring recovery. Surrogates are not expected to be
detected in all environmental media.
U Not detected at the Reporting Limit (or MDL where applicable).
Analyte The name of the particular compound or analysis performed. Some Analyses and Methods will have multiple analytes
reported.
Dilution
If the sample matrix contains an interfering material, the sample preparation volume or weight values differ from the
standard, or if concentrations of analytes in the sample are higher than the highest limit of concentration that the
laboratory can accurately report, the sample may be diluted for analysis. If a value different than 1 is used in this field, the
result reported has already been corrected for this factor.
Limits
These are the target % recovery ranges or % difference value that the laboratory has historically determined as normal
for the method and analyte being reported. Successful QC Sample analysis will target all analytes recovered or
duplicated within these ranges.
Qualifier
This column provides a letter and/or number designation that corresponds to additional information concerning the result
reported. If a Qualifier is present, a definition per Qualifier is provided within the Glossary and Definitions page and
potentially a discussion of possible implications of the Qualifier in the Case Narrative if applicable.
Result
The actual analytical final result (corrected for any sample specific characteristics) reported for your sample. If there was
no measurable result returned for a specific analyte, the result in this column may state “ND” (Not Detected) or “BDL”
(Below Detectable Levels). The information in the results column should always be accompanied by either an MDL
(Method Detection Limit) or RDL (Reporting Detection Limit) that defines the lowest value that the laboratory could detect
or report for this analyte.
Uncertainty
(Radiochemistry)Confidence level of 2 sigma.
Case Narrative (Cn)
A brief discussion about the included sample results, including a discussion of any non-conformances to protocol
observed either at sample receipt by the laboratory from the field or during the analytical process. If present, there will
be a section in the Case Narrative to discuss the meaning of any data qualifiers used in the report.
Quality Control
Summary (Qc)
This section of the report includes the results of the laboratory quality control analyses required by procedure or
analytical methods to assist in evaluating the validity of the results reported for your samples. These analyses are not
being performed on your samples typically, but on laboratory generated material.
Sample Chain of
Custody (Sc)
This is the document created in the field when your samples were initially collected. This is used to verify the time and
date of collection, the person collecting the samples, and the analyses that the laboratory is requested to perform. This
chain of custody also documents all persons (excluding commercial shippers) that have had control or possession of the
samples from the time of collection until delivery to the laboratory for analysis.
Sample Results (Sr)
This section of your report will provide the results of all testing performed on your samples. These results are provided
by sample ID and are separated by the analyses performed on each sample. The header line of each analysis section for
each sample will provide the name and method number for the analysis reported.
Sample Summary (Ss)This section of the Analytical Report defines the specific analyses performed for each sample ID, including the dates and
times of preparation and/or analysis.
Qualifier Description
The remainder of this page intentionally left blank, there are no qualifiers applied to this SDG.
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
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8Al
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Pace Analytical National 12065 Lebanon Rd Mount Juliet, TN 37122
Alabama 40660 Nebraska NE-OS-15-05
Alaska 17-026 Nevada TN000032021-1
Arizona AZ0612 New Hampshire 2975
Arkansas 88-0469 New Jersey–NELAP TN002
California 2932 New Mexico ¹TN00003
Colorado TN00003 New York 11742
Connecticut PH-0197 North Carolina Env375
Florida E87487 North Carolina ¹DW21704
Georgia NELAP North Carolina ³41
Georgia ¹923 North Dakota R-140
Idaho TN00003 Ohio–VAP CL0069
Illinois 200008 Oklahoma 9915
Indiana C-TN-01 Oregon TN200002
Iowa 364 Pennsylvania 68-02979
Kansas E-10277 Rhode Island LAO00356
Kentucky ¹ ⁶KY90010 South Carolina 84004002
Kentucky ²16 South Dakota n/a
Louisiana AI30792 Tennessee ¹ ⁴2006
Louisiana LA018 Texas T104704245-20-18
Maine TN00003 Texas ⁵LAB0152
Maryland 324 Utah TN000032021-11
Massachusetts M-TN003 Vermont VT2006
Michigan 9958 Virginia 110033
Minnesota 047-999-395 Washington C847
Mississippi TN00003 West Virginia 233
Missouri 340 Wisconsin 998093910
Montana CERT0086 Wyoming A2LA
A2LA – ISO 17025 1461.01 AIHA-LAP,LLC EMLAP 100789
A2LA – ISO 17025 ⁵1461.02 DOD 1461.01
Canada 1461.01 USDA P330-15-00234
EPA–Crypto TN00003
ACCREDITATIONS & LOCATIONS

¹ Drinking Water ² Underground Storage Tanks ³ Aquatic Toxicity ⁴ Chemical/Microbiological ⁵ Mold ⁶ Wastewater n/a Accreditation not applicable
* Not all certifications held by the laboratory are applicable to the results reported in the attached report.
* Accreditation is only applicable to the test methods specified on each scope of accreditation held by Pace Analytical.
1 Cp
2Tc
3Ss
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5Sr
6Qc
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EXCEL CIVIL & ENVIRONMENTAL ASSOCIATES, PLLC
www.excelengr.com

APPENDIX B

REPORTING TABLES (B-1, B-2, B-6, B-10)

1Table B‐1: SITE HISTORY – UST/AST SYSTEM and OTHER RELEASE INFORMATION SAM’S MART 103 (former 715) 3215 QUEEN CITY DRIVE, CHARLOTTE, NORTH CAROLINA NCDEQ Incident No. 40995 Excel Project No. 2020004  UST ID Number Current / Most‐Recent Contents* Previous Contents* Capacity (in gallons) Construction Details** Tank Dimensions Description of Piping and Pumps  Date Tank Installed Status of UST*** Release associated with this UST System? 1 Gasoline  12,000       5/1/85  Current See Below 2 Kerosene  4,000      3 Gasoline  8,200      4 Gasoline  8,200      5 Diesel  8,200                                                                            Add additional records as necessary AST ID Number Current / Most‐Recent Contents* Previous Contents* Capacity (in gallons) Construction Details** Tank Dimensions Description of Piping and Pumps  Date Tank Installed Status of AST*** Release associated with this AST System?                         Add additional records as necessary Incident Number Material Released Date of Release Description of Release 40995   Line closure activities were conducted at the site in early January 2020.  During the closure activities, impacted soils were identified with approximately 235.49 tons removed and temporarily stockpiled.  On January 7 and 13, 2020, Henry Nemargut Engineering collected soil samples along the former product piping trenches as outlined in the UST removal guidelines.              Add additional records as necessary *    Gasoline (unleaded or leaded), diesel, used oil, waste oil, aviation fuel, etc., or pesticides, non‐halogenated or halogenated solvents, etc. ** Fiberglass (single‐ or double‐walled), steel (single‐ or double‐walled), steel with FRP (single‐ or double‐walled), steel with liner, other, unknown. *** Currently operational, not in use or temporarily closed (specify date), permanently closed in place (specify date), permanently closed by removal (specify date)
TABLE B‐2: SITE HISTORY ‐ UST/AST OWNER/OPERATOR and OTHER RESPONSIBLE PARTY 
INFORMATION 
SAM’S MART 103 (former 715) 
3215 QUEEN CITY DRIVE, CHARLOTTE, NORTH CAROLINA 
NCDEQ Incident No. 40995 
Excel Project No. 2020004 

UST ID Number MO‐9564 

Facility ID Number 00‐0‐0000014954 

Owner Name (and Contact) Dates of Operation 
(mm/dd/yy to mm/dd/yy) 
Sam’s Investments VI, LLC (Adnan Jazairi) Nov 1997 ‐ Present 
Street Address 
7935 Council Place, Suite 200 
City State Zip Telephone Number 
Matthews NC 28105 704‐563‐3988 
Operator Name (and Contact) Dates of Operation 
(mm/dd/yy to mm/dd/yy) 
Sam’s Investments VI, LLC (Adnan Jazairi) Nov 1997 ‐ Present 
Street Address 
7935 Council Place, Suite 200 
City State Zip Telephone Number 
Matthews NC 28105 704‐563‐3988 
Other Incidents Onsite or Commingled/In Close Proximity 
Incident Number  Date Incident 
Occurred  
Name of Responsible Party  
for Other Incident  
Date Incident 
Reported  
 Date Incident Closed 
(i/a)  
Street Address 

City State Zip Telephone Number 

Table 6: Adjacent Property Owner Information
Incident No. 40995 Name: Sam’s Mart No. 103 (715) Facility ID#: 14954

Tax Parcel
Number/
Map ID
Owner/ Occupant Name
(Last, First MI) Mailing Address / Physical Address
06122301 SME Investments LLC 3309 Queen City Drive, Charlotte NC, 28208
06122503
( SITE ) Sam’s Investments LLC 7935 Council Place, Matthews, NC 28105 /
3215 Queen City Drive, Charlotte NC, 28208
06122218 Jiayuan LLC 218 Saint Andrews Ln, Chapel Hill, NC 27517 /
3302 Queen City Drive, Charlotte NC, 28208
06122107 Maruti Hospitality LLC P.O. Box 1415 Cornelius, NC 28031 /
3200 Queen City Drive, Charlotte, NC 28208
06122505 Cracker Barrel Old Country
Store Inc.
P.O. Box 787 Lebanon, TN 37088 /
3203 Queen City Drive, Charlotte, NC 28208
Notes:
Revision Date: 3/25/2020

Appendix B
Reporting Tables
192 Change 2
Table B-10: Land Use
Revision Date: 1/5/2021 Incident Number and Name: 40995 Facility ID#: 14954
Map ID # Date
Determined
Land Use Feature
(include zoning)
Location
(complete street address if applicable)
Distance and
Direction from
Source Area
06122301 1/5/21 Commercial 3309 Queen City Drive, Charlotte NC, 28208 Adjacent to west
06122503
( SITE )
1/5/21 Commercial 7935 Council Place, Matthews, NC 28105 /
3215 Queen City Drive, Charlotte NC, 28208
SITE
06122218 1/5/21 Commercial 218 Saint Andrews Ln, Chapel Hill, NC 27517 /
3302 Queen City Drive, Charlotte NC, 28208
Adjacent to northwest
06122107 1/5/21 Commercial P.O. Box 1415 Cornelius, NC 28031 /
3200 Queen City Drive, Charlotte, NC 28208
Adjacent to north
06122505 1/5/21 Commercial P.O. Box 787 Lebanon, TN 37088 /
3203 Queen City Drive, Charlotte, NC 28208
Adjacent to east