WS-10023_45185_I_O_20190913

General Information:
Date:9/13/2019 Incident No.:45185 Inspector:CGS
Site Name:Speedway #6934 Risk:U
Address:566 Old Hollow Road, Winston-Salem
County:Forsyth Region:WSRO
N W
Site/Facility Information Checklist:
Operating facility?:Yes No Facility No.:00-0-0000015480
Valid UST Permit?:Yes No
Number of USTs:Active UST system
Number of ASTs:None observed
Evidence of a spill or leak (describe):
Evidence of Free Product (describe):
Water Supply Well(s):Yes No ft.
WSW GPS Coordinates:
N W
Remediation System(s) Information:
System Type:No active remediation system.
Fully Installed:
Operating Upon Arriaval:
On-Site Contact:
Name of RP:Company:
Name of Consultant:Company:
Other Representatives:Company:
Distance to source:
GPS Coordinates:
Permit Expiration Date:
North Carolina Deparment of Environmental Quality
Division of Waste Management
UST Section, Corrective Action Branch (CAB)
36.194707 -80.254928
Complaint or Inspection Report (Circle One)
North Carolina Deparment of Environmental Quality
Division of Waste Management
UST Section, Corrective Action Branch (CAB)
Pictures Descriptions:
Photo 1:
Photo 2:
Photo 3:
Photo 4:
Time Spent on site:10 minutes
Comments:
Figure:Figure
6
1 Site is active station.
2
3
4
5