WI-28992_48178_CA_SCH_20211119

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
January 19, 2022

Mr. Clark Wipfield
NCDEQ-UST Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405

Re: Site Check Report
Home Race Mart #1
7824 Seven Springs Highway
Nakina, Columbus County
North Carolina
Facility ID Number: 00-0-0000034121
Incident Number: Pending
GRI Project Number: 5836

Dear Mr. Wipfield,

Please find enclosed the referenced report for the above mentioned site.
If you have any questions, please contact Ethan Rogerson at 704-845-4010.

Sincerely,
Geological Resources, Inc.

Leslie Maxtone-Graham
Administrative Assistant

Enclosure

Cc: Mr. Sanjeev Sethi; K&S, LLC, Inc.

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
Site Check Report
Home Race Mart #1
7824 Seven Springs Highway
Nakina, Columbus County
North Carolina
Facility ID Number: 00-0-0000034121
Incident Number: Pending
GRI Project Number: 5836

Prepared for:

Sanjeev Sethi
K&S, LLC
7824 Seven Creeks Highway
Nakina, North Carolina 28455

November 19, 2021

Ethan Rogerson, G.I.T.
Project Manager
William Regenthal, P.G.
Report Editor

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. Site Check Report
Prepared on: November 19, 2021 Home Race Mart #1
Project Manager: Ethan Rogerson, G.I.T. GRI Project No. 5836
i
EXECUTIVE SUMMARY
The Home Race Mart #1 site is located at 7824 Seven Springs Highway in Nakina, Columbus County, North
Carolina. The property operates as a petroleum retail facility and convenience store. The site is covered
by concrete, asphalt and grass. There are one 12,000-gallon compartmentalized gasoline, one 6,000-
gallon diesel and one 2,000-gallon off-road diesel USTs currently in use at the site with six associated
dispenser islands.

On October 21, 2021, two soil sample (SS-PREM-2' and SS-ORDSL-2’) were collected at the 4,000-gallon
gasoline and 2,000-gallon off-road diesel spill buckets, respectively. Concentrations of TPH-GRO and TPH-
DRO exceeded the RALs that exceeded the RALs were reported in soil sample SS-ORDSL-2’.

Based on this information, a soil quality violation exists and further assessment is warranted at the site.

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. Site Check Report
Prepared on: November 19, 2021 Home Race Mart #1
Project Manager: Ethan Rogerson, G.I.T. GRI Project No. 5836

iii
ACRONYMS
ACM: Asbestos Containing Materials
AFVR: Aggressive Fluid-Vapor Recovery
ARR: Acknowledgement of Report Receipt
AS: Air Sparging
AST: Aboveground Storage Tank
ASTM: American Society for Testing and
Materials
BGS: Below Ground Surface
CAP: Corrective Action Plan
CFR: Code of Federal Regulations
CSA: Comprehensive Site Assessment
DPE: Dual Phase Extraction
DRO: Total Petroleum Hydrocarbons Diesel
Range Organics
DWM: Division of Waste Management
DWR: Department of Water Resources
EPA: Environmental Protection Agency
EPH: Extractible Petroleum Hydrocarbons
ESA: Environmental Site Assessment
GCL: Gross Contamination Level
GRI: Geological Resources, Inc.
GRO: Total Petroleum Hydrocarbons
Gasoline Range Organics
LSA: Limited Site Assessment
MAC: Maximum Allowable Concentration as
specified in T15A NCAC 2L.0202
MADEP: Massachusetts Department of
Environmental Protection
MCC: Maximum Contaminant Concentrations
MMPE: Mobile Multi-Phase Extraction
NAPL: Non-Aqueous Phase Liquid, “Free
Product”
NCDEQ: North Carolina Department of
Environmental Quality
NCDOT: North Carolina Department of
Transportation
NFA: Notice of No Further Action
NORR: Notice of Regulatory Requirements
NOV: Notice of Violation
NPDES: National Pollutant Discharge
Elimination System
NRP: Notice of Residual Petroleum
O&M: Operation and Maintenance
PAHs: Polynuclear Aromatic Hydrocarbons
PCA: Pre-Construction Assessment
RAL: Regulatory Action Level
SCLs: Soil Cleanup Level
SPCC: Spill Prevention Control and
Countermeasures
SVE: Soil Vapor Extraction
SVOCs: Semi-Volatile Organic Compounds
SWPPP: Stormwater Pollution Prevention Plan
TCLP: Toxicity Characteristic Leaching
Procedure (EPA Method SW-846 1311)
TOC: Top of Casing
TPH: Total Petroleum Hydrocarbons
USGS: United States Geological Survey
UST: Underground Storage Tank
UVF: Ultraviolet Fluorescence
VOCs: Volatile Organic Compounds
VPH: Volatile Petroleum Hydrocarbons

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. Site Check Report
Prepared on: November 19, 2021 Home Race Mart #1
Project Manager: Ethan Rogerson, G.I.T. GRI Project No. 5836

TABLE OF CONTENTS

EXECUTIVE SUMMARY ....................................................................................................................... i
SITE INFORMATION ............................................................................................................................ ii
ACRONYMS ................................................................................................................................. iii
A. SITE HISTORY AND CHARACTERIZATION .....................................................................1
B. SITE CHECK PROCEDURES ...........................................................................................2
C. SITE INVESTIGATION ..................................................................................................2
D. SUMMARY AND CONCLUSIONS ..................................................................................3
E. LIMITATIONS .............................................................................................................3

FIGURES
Figure 1: Site Location Map
Figure 2: Site Map
Figure 3: Soil Quality Map

TABLES
Table 1: UST Owner/Operator Information
Table 2: UST System Information
Table 3: Summary of Soil Sample Analytical Results

APPENDICES
Appendix A: State Correspondence
Appendix B: 24-Hour Release and UST Leak Reporting Form (UST-61)
Appendix C: Laboratory Report – Soil Sample

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. Site Check Report
Prepared on: November 19, 2021 Home Race Mart #1
Project Manager: Ethan Rogerson, G.I.T. GRI Project No. 5836
1
A. SITE HISTORY AND CHARACTERIZATION
1. UST Owner and Operator Information:
In accordance with the Site Check Report guidelines, the UST owner and operator information has been
summarized in the attached Table 1.

2. UST System Information:
In accordance with the Site Check Report guidelines, the UST system information has been summarized
in the attached Table 2. There are one 12,000-gallon compartmentalized gasoline, one 6,000-gallon
diesel and one 2,000-gallon off-road diesel USTs currently in use at the site with six associated
dispensers at the site. A copy of the NCDEQ Registered Tank Report is shown below:

3. Non-UST Information:
There are currently no ASTs at the site.

4. Comprehensive Description of the Release:
On August 25, 2021, compliance testing was conducted. The 4,000-gallon compartment of the gasoline
UST and 2,000-gallon off-road diesel spill buckets received non-passing testing results. The non-passing
spill buckets were reportedly repaired and received a passing compliance test. State correspondence is
included as Appendix A.

On October 21, 2021, two soil samples (SS-PREM-2' and SS-ORDSL-2’) were collected approximately 2 feet
bgs, from unlined ATG sumps directly adjacent to the 4,000-gallon gasoline compartment and 2,000-gallon

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. Site Check Report
Prepared on: November 19, 2021 Home Race Mart #1
Project Manager: Ethan Rogerson, G.I.T. GRI Project No. 5836
2
off-road diesel spill buckets, respectively. A release was confirmed upon receipt of the laboratory results
for the soil samples collected in October 2021. A copy of the UST-61 Form has been included as Appendix
B.

5. Description of the Site Characteristics:
The Home Race Mart #1 site is located at 7824 Seven Springs Highway in Nakina, Columbus County, North
Carolina. (Figure 1). The property operates as a petroleum retail facility and convenience store. The site
is covered by concrete, asphalt and grass. There are one 12,000-gallon compartmentalized gasoline, one
6,000-gallon diesel and one 2,000-gallon off-road diesel USTs currently in use at the site. The surrounding
properties are agricultural and residential. A Site Map has been included as Figure 2.

B. SITE CHECK PROCEDURES
1. Results of Tank and Line Tightness Testing:
On October 26, 2020, two non-passing UST spill buckets were reported at the site. The non-passing spill
buckets were reportedly repaired and received passing compliance tests.

2. Summary of Site Check Procedure:
On October 21, 2021, GRI performed a site check that included collecting soil samples from unlined ATG
sumps directly adjacent to the 4,000-gallon gasoline compartment and 2,000-gallon off-road diesel spill
buckets, respectively. Soil samples SS-PREM-2' and SS-ORDSL-2’ were collected approximately 2 feet bgs,
from unlined ATG sumps directly adjacent to the 4,000-gallon gasoline and 2,000-gallon off road diesel
spill buckets, respectively.

3. Soil Excavation Activities:
No soil excavation activities were conducted.

C. SITE INVESTIGATION
1. Field Screening:
Soil samples were not screened with a PID for VOCs.

2. Soil Sampling Information:
Soil sample SS-PREM-2' and SS-ORDSL-2’ were collected on October 21, 2021 and were submitted for
laboratory analyses of TPH-GRO and/or TPH-DRO. The concentrations of GRO and DRO reported in soil
sample SS-ORDSL-2' exceeded the RALs. No free product was observed at the site. A soil quality map is
presented as Figure 3. A summary of soil sample analytical results is presented in Table 3. The laboratory
report is provided as Appendix C. A summary of the soil sampling data from the October 2021 Site Check
activities is show below:

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. Site Check Report
Prepared on: November 19, 2021 Home Race Mart #1
Project Manager: Ethan Rogerson, G.I.T. GRI Project No. 5836
3 Sample ID Sample Depth (ft-BGS) Gasoline-Range TPH Diesel-Range DRO RAL (mg/kg) 50 100
Soil to Water MCC (mg/kg) NE NE
SS-ORDSL-2 2 176 3,250
SS-PREM-2 2 8.67 NR

3. Ground Water and Surface Water Sampling Information:
A ground water sample was not collected during the October 21, 2021, site check.

4. Quality-Control Measures:
Clean, disposable nitrile gloves were used for the collection of the soil samples. The samples were
collected in laboratory supplied containers and shipped to the laboratory in a cooler following proper
chain-of-custody procedures.
D. SUMMARY AND CONCLUSIONS
 The site is a petroleum retail facility and convenience store. Surrounding properties are
agricultural and residential.
 The spill buckets associated with the 4,000-gallon gasoline compartment and 2,000-gallon off-
road diesel USTs received non-passing testing results and were reportedly repaired.
 A Site Check was conducted on October 21, 2021.
 Two soil samples (SS-PREM-2’ and SS-ORDSL-2') were collected from the unlined ATG sumps
directly adjacent to the non-compliant spill buckets.
 Concentrations of GRO and DRO exceeding the RALs were reported in soil sample SS-ORDSL-2’.
 Based on this information, a soil quality violation exists and further assessment is warranted for
this site.

E. LIMITATIONS
This report has been prepared for the exclusive use of K&S, LLC, Inc. for the specific application to the
referenced site in Columbus County, North Carolina. The assessment was conducted based on the scope
of work and level of effort specified by NCDEQ and with resources adequate only for that scope of work.
Our findings have been developed in accordance with generally accepted standards of geology and
hydrogeology practices in the State of North Carolina, available information, and our professional
judgment. No other warranty is expressed or implied.

The data that are presented in this report are indicative of conditions that existed at the precise locations

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. Site Check Report
Prepared on: November 19, 2021 Home Race Mart #1
Project Manager: Ethan Rogerson, G.I.T. GRI Project No. 5836
4
sampled and at the time the samples were collected. In addition, the data obtained from samples would
be interpreted as being meaningful with respect to parameters indicated in the laboratory report. No
additional information can logically be inferred from these data.

FIGURES
SITE LOCATIONFigure 1 Site Location Home Race Mart #17824 7 Creeks HighwayNakina, North CarolinaColumbus CountyIncident No. N/AGRI Project No. 5836500 M2000 FTDate: 11/20/2021Location: 34.134276° N -78.668266° W Dad

TABLES
UST ID Number 1-3 and 1B Facility ID Number
Owner or Operator?
Owner
UST ID Number 2 and 3 Facility ID Number
Owner or Operator?
Owner
UST ID Number 2 and 3 Facility ID Number
Owner or Operator?
Owner
UST ID Number 1 and 1B Facility ID Number
Owner or Operator?
Owner
Unknown
Telephone Number
Unknown
Address
Home Run Food Mart, Inc.
Unknown Unknown
00-0-0000034121
Dates of Ownership / Operation
08/01/1993 - 10/08/2010
Name of Owner or Operator
Name of Owner or Operator Dates of Ownership / Operation
Home Run Food Mart, Inc.04/03/2002 - 10/08/2010
Address Telephone Number
Address Telephone Number
Unknown Unknown
00-0-0000034121
00-0-0000034121
Name of Owner or Operator Dates of Ownership / Operation
Nikki and Vicky, Inc.10/08/2010 - 01/03/2017
00-0-0000034121
TABLE 1
UST OWNER/OPERATOR INFORMATION
HOME RACE #1 (INCIDENT NO. PENDING)
7824 Seven Creeks Highway, Nakina, NC 28455 910-234-0453
Name of Owner or Operator Dates of Ownership / Operation
K & S, LLC 01/03/2017 - Current
Address Telephone Number
Page 1 of 1
Date: 11/12/21
Was Release
Associated
with UST
System?
(Yes / No)
1B Gasoline 4,000 12/1/1993 Single Wall
Steel/FRP Unknown Single Wall FRP Current No
3 Diesel 2,000 4/3/2002 Single Wall
Steel/FRP Unknown Other Current No
2 Diesel 6,000 4/3/2002 Single Wall
Steel/FRP Unknown Double Wall FRP Current Yes
1 Gasoline 8,000 12/1/1993 Single Wall
Steel/FRP Unknown Single Wall FRP Current No
TABLE 2
UST SYSTEM INFORMATION
HOME RACE #1 (INCIDENT NO. PENDING)
UST
ID
No.
Current
or Most
Recent
Contents
Capacity
(gallons)
Date
Installed
Construction
Details
Tank
Dimensions
Description of
Associated
Product Piping
and
Pumps
Status
of
UST
Facility ID #: 00-0-0000034121
Page 1 of 1
Date: 11/12/21
5030/
8015D
3550/
8015C
Sample IDDate Collected (mm/dd/yy)Sample Depth(ft-BGS)Gasoline-Range TPHDiesel-Range TPH50 100
NE NE
NE NE
SS-ORDSL-2 10/21/2021 2 176 3,250
SS-PREM-2 10/21/2021 2 8.67 NR
Notes:
• Results reported in mg/kg (milligrams per kilograms)
• ft-BGS: feet below ground surface.
• RAL: Regulatory Action Level.
• MCCs: Maximum Contaminant Concentrations (soils).
• SCLs: Soil Cleanup Levels.
• < : Less than the method detection limit specified in the
laboratory report
• Concentrations in bold face type indicate the reported
concentrations exceeded the soil-to-water MCCs.
• Concentrations in italic type indicate the reported
concentrations exceeded the residential SCLs.
• NE: Not Established
• NR: Not Requested.
TABLE 3
SUMMARY OF SOIL SAMPLE ANALYTICAL RESULTS
HOME RACE #1 (INCIDENT NO. PENDING)
RAL (mg/kg)
Soil to Water MCC (mg/kg)
Residential SCLs (mg/kg)
Analytical Method 
Facility ID #: 00-0-0000034121
Page 1 of 1

APPENDICES

Appendix A
State Correspondence
Page 1 of 9 9/14/2021 12:50 PM
North Carolina
Department of Environmental Quality
Underground Storage Tank
UST-10BPrinted:9/14/2021 12:49 PM
Inspection Result:Failed Inspection Date:8/25/2021
Partial Inspection:No Arrive and Depart Times:10:55 AM-11:25 AM
Facility ID:00-0-0000034121 Inspector John Hooks
Facility Name HOME RACE MART #1 Insp.Type Compliance
Facility Address 7824 SEVEN SPRING HIGHWAY
NAKINA,NC 28455
Columbus County
Located facility,USTs onsite
Reason(s)Routine Compliance
Location 34.134353,-78.668531
Permit Exp.12/31/2021
Facility Phone [phone]
CONTACTS
Contact Type Contact Information
Owner
since 1/3/2017
K &S LLC ,7824 SEVEN CREEKS HIGHWAY NAKINA,NC 28455,Phone:(910)
642-7444,Email:[e-mail]
Owner Auth Rep
since 1/3/2017
SANJEEV SETHI,7824 SEVEN CREEKS HIGHWAY NAKINA,NC 28455,Phone:
[phone],Cell Phone:[phone],Email:[e-mail]
Regulatory Operator
since 10/15/2018
SHIVAM LLC ,7824 SEVEN CREEKS HIGHWAY NAKINA,NC 28455,Phone:(910)
922-6795
Operator
since 1/3/2017
SHIVAM LLC ,7824 SEVEN CREEKS HIGHWAY NAKINA,NC 28455,Phone:(910)
922-6795
OWNERSHIP CHANGE
New Owner Change Date Basis Transfer of Ownership Form (UST-15)Submitted
No
EMERGENCY RESPONSE
Emergency response placard with emergency response operator contact information is
posted in the dispensing areas if the dispensers are left on without an attendant present?
N/A
OTHER PARTICIPANTS
Name Organization
INSPECTOR COMMENTS
Type Date Comment
ADDITIONAL INSPECTOR COMMENTS
bf at both dsl.sumps at all.flex pipe at all
TANKS AND PIPING INFORMATION
Tanks Tank #1(1B-
prem)
Tank #2(3-off dsl)Tank #3(dsl)Tank #4(reg-)
Tank ID 1B-prem 3-off dsl dsl reg-
TIMS Tank ID 1B 3 2 1
Is tank registered?Yes Yes Yes Yes
Date tank installed 12/1/1993 4/3/2002 4/3/2002 12/1/1993
Capacity of Tank in
Gallons
4000 2000 6000 8000
Is tank regulated Yes Yes Yes Yes
Diameter (Inches)
Tank /Product use Motor Fuel Motor Fuel Motor Fuel Motor Fuel
UST-10B Facility ID:00-0-0000034121
Page 2 of 9 9/14/2021 12:50 PM
Tanks Tank #1(1B-
prem)
Tank #2(3-off dsl)Tank #3(dsl)Tank #4(reg-)
Product stored in Tank Gasoline,Gas Mix Diesel Diesel Gasoline,Gas Mix
Product Detail Premium BLANK BLANK Regular
If hazardous substance,
CAS#or description
If other,description
Tank status Current Current Current Current
Tank closure report
submitted
Date tank last operated
Inches of product in
Tank
Compartment tank Yes No No Yes
Other compartment(s)#4(reg-)#1(1B-prem)
Base compartment No Yes
Manifolded tank No No No No
Manifolded with tank(s)
Master manifold tank
New Tank System
installed in accordance
with NC or MI
Yes Yes Yes Yes
Tank Construction
Material (DW required
after 11/1/07)
Single Wall
Steel/FRP
Single Wall
Steel/FRP
Single Wall
Steel/FRP
Single Wall
Steel/FRP
If other,description
Tank Manufacturer/Model Unknown Unknown Unknown Unknown
If other,describe
Tank material verified by Invoice Invoice Invoice Invoice
Date Pipe Installed 12/1/1993 12/1/1993 12/1/1993 12/1/1993
Was UST Piping Installed
on or after 11/1/2007?
No No No No
Piping Construction
Material (DW required
after 11/1/07)
Double Wall FRP Double Wall FRP Double Wall FRP Double Wall FRP
If other,description
Pipe Manufacturer/Model Unknown Unknown Unknown Unknown
If other,describe
Pipe material verified by Visual Visual Visual Visual
If E-blend >10%or
Biodiesel Blend >20%;
Was UST-20 completed
and approved?
N/A N/A N/A N/A
CORROSION PROTECTION
Tank Corrosion Protection Tank #1(1B-
prem)
Tank #2(3-
off dsl)
Tank #3(dsl)Tank
#4(reg-)
DWM notified of current CP method Yes Yes Yes Yes
Integrity assessment performed after 3/1/06 No No No No
CP Method 1 Steel/FRP
Composite
Steel/FRP
Composite
Steel/FRP
Composite
Steel/FRP
Composite
if other,Description
CP Installation Date 12/1/1993 4/3/2002 4/3/2002 12/1/1993
CP Method 2
if other,Description
CP Installation Date
Flex Connector ,Piping Extensions,and/or
other metal fittings Present
Other Metal Other Metal Other Metal Other Metal
Flex connector isolated from ground Yes Yes Yes Yes
UST-10B Facility ID:00-0-0000034121
Page 3 of 9 9/14/2021 12:50 PM
Tank Corrosion Protection Tank #1(1B-
prem)
Tank #2(3-
off dsl)
Tank #3(dsl)Tank
#4(reg-)
Source of verification of CP for Flex
Connectors,piping extensions and/or other
metal fittings
Visual Visual Visual Visual
if other,Description
Submersible pump (STP)is isolated from
ground
Yes Yes Yes Yes
Piping extensions and/or other metal fittings
are isolated from ground
Yes Yes Yes Yes
Flex connector,STP and/or other metal
fittings protected from corrosion
N/A N/A N/A N/A
Corrosion protection method
Flex connector ,Piping extensions,and/or
other metal fittings CP Installation Date
Dielectric Coating Installed (If tank installed
after 12/22/88
Yes Yes Yes Yes
Pipe Corrosion Protection Tank #1(1B-
prem)
Tank #2(3-off
dsl)
Tank #3(dsl)Tank #4(reg-)
DWM notified of current CP method Yes Yes Yes Yes
CP method FRP Piping Flexible Flexible FRP Piping
if other,Description
CP Installation Date 12/1/1993 4/3/2002 4/3/2002 12/1/1993
Dielectric Coating Installed (If piping
installed after 12/22/88
N/A N/A N/A N/A
Dispenser Corrosion Protection Dispenser
#1(1)
Dispenser
#2(2)
Dispenser
#3(3)
Dispenser
#4(4)
Flex Connector ,Piping Extensions,
and/or other metal fittings Present
Other Metal Other Metal Other Metal Other Metal
Flex connector isolated from ground Yes Yes Yes Yes
Source of verification of CP for Flex
Connectors,piping extensions and/or
other metal fittings
Visual Visual Visual Visual
if other,Description
Piping extensions and/or other metal
fittings are isolated from ground
Yes Yes Yes Yes
Flex Connectors,Piping extensions
and/or other metal fittings protected
from corrosion
N/A N/A N/A N/A
Corrosion protection method Isolated Isolated Isolated Isolated
Flex connector,Piping extensions,
and/or other metal fittings CP
Installation Date
Source of Information for verification of
corrosion protection for Riser pipe and
other metal piping
Visual Visual Visual Visual
if other,Description
Dispenser Corrosion Protection Dispenser
#5(5)
Flex Connector ,Piping Extensions,
and/or other metal fittings Present
Other Metal
Flex connector isolated from ground Yes
Source of verification of CP for Flex
Connectors,piping extensions and/or
other metal fittings
Visual
UST-10B Facility ID:00-0-0000034121
Page 4 of 9 9/14/2021 12:50 PM
Dispenser Corrosion Protection Dispenser
#5(5)
if other,Description
Piping extensions and/or other metal
fittings are isolated from ground
Yes
Flex Connectors,Piping extensions
and/or other metal fittings protected
from corrosion
N/A
Corrosion protection method Isolated
Flex connector,Piping extensions,
and/or other metal fittings CP
Installation Date
Source of Information for verification of
corrosion protection for Riser pipe and
other metal piping
Visual
if other,Description
CP Conclusions
CP Requirements Met?Yes
Issues
SPILL PREVENTION
Has DWM been notified of spill methods?Yes
Spill/Overfill Details Tank #1(1B-
prem)
Tank #2(3-off
dsl)
Tank #3(dsl)Tank #4(reg-)
Is a drop tube present?Yes Yes Yes Yes
Type of Stage I vapor recovery?Coaxial Not Required Not Required Coaxial
Local Fill Tank #1(1B-
prem)
Tank #2(3-off
dsl)
Tank #3(dsl)Tank #4(reg-)
Does Tank have a Second Fill?No No No No
Spill Protection Catchment
Basin
Catchment
Basin
Catchment
Basin
Catchment
Basin
Is spill prevention equipment provided and
verified?
Yes Yes Yes Yes
Manufacturer/Model Other Other Other Other
If other,describe opw opw opw opw
Spill bucket is double-walled?N/A N/A N/A N/A
Monitoring Type
(UST-6B)
Is spill bucket interstice monitored every
30 days?(If installed before 11/1/07)
Spill bucket is isolated or made of non-
corroding materials?(If installed after
11/1/07)
N/A N/A N/A N/A
Date spill prevention provided 12/1/1993 4/3/2002 4/3/2002 12/1/1993
Last 12 monthly spill bucket checks
completed and all deficiencies corrected
(UST-27)?
Is spill prevention operating properly?No No Yes Yes
If No,select all that apply Hole/Defect Hole/Defect
If other,describe
O&M walkthrough inspection completed in
accordance with national standard (e.g.
PEI RP 900)(UST-27)?
No No No No
UST-10B Facility ID:00-0-0000034121
Page 5 of 9 9/14/2021 12:50 PM
Local Fill Tank #1(1B-
prem)
Tank #2(3-off
dsl)
Tank #3(dsl)Tank #4(reg-)
3 Year Tightness Test Date
(UST-6D/23A)
10/26/2020 10/26/2020 10/26/2020 10/26/2020
Primary Tightness Test Result
(UST-6D/23A)
Fail Fail Pass Pass
Secondary Tightness Test Result
(UST-6D/23A)
Tightness Testing done in accordance
with a standard?
Yes Yes Yes Yes
OVERFILL PREVENTION
Has DWM been notified of overfill methods?Yes
Overfill Control Tank #1(1B-
prem)
Tank #2(3-off
dsl)
Tank #3(dsl)Tank #4(reg-)
Is overfill prevention equipment provided
and verified?
Yes Yes Yes Yes
Date overfill control provided 12/1/1993 4/3/2002 4/3/2002 12/1/1993
Type of overfill equipment Auto Shutoff
Device
Ball Float
Valve
Ball Float
Valve
Auto Shutoff
Device
Source of information for overfill control
verification
UST-22A UST-22A UST-22A UST-22A
If other,describe
Manufacturer/Model BLANK BLANK BLANK BLANK
If other,describe
Is overfill control operating properly?No Yes Yes No
If No,select all that apply Incorrect
length/volume
Incorrect
length/volume
If other,describe
Overfill check date (UST-22A)10/26/2020 10/26/2020 10/26/2020 10/26/2020
Overfill check result (UST-22A)Fail Pass Pass Fail
Capacity of Tank in Gallons 4000 2000 6000 8000
Diameter (Inches)
Dispenser Sumps Dispenser
#1(1)
Dispenser
#2(2)
Dispenser
#3(3)
Dispenser
#4(4)
Are containment sumps present?Yes Yes Yes Yes
Installation Date 10/31/2007 10/31/2007 10/31/2007 10/31/2007
Sump Manufacturer Unknown Unknown Unknown Unknown
If Other (Specify)
Sump Construction Type Single Walled Single Walled Single Walled Single Walled
Sump Construction Material Plastic Plastic Plastic Plastic
If Other (Specify)
Are containment sumps monitored?No No No No
Is monitoring required per 2N .0900?No No No No
Piping components and/or STP were
installed/replaced on or after 11/1/07?
No No No No
Are spills or small weeps evident in
sumps?
No No No No
Are single wall piping components located
in containment sump?(If installed after
11/1/07)
UDC Visual Inspection Date
(annually)(UST-22C)
10/26/2020 10/26/2020 10/26/2020 10/26/2020
UDC Visual Inspection Results
(UST-22C)
Pass Pass Pass Pass
UST-10B Facility ID:00-0-0000034121
Page 6 of 9 9/14/2021 12:50 PM
Dispenser Sumps Dispenser
#1(1)
Dispenser
#2(2)
Dispenser
#3(3)
Dispenser
#4(4)
Annual containment sump check
completed in accordance with national
standard (e.g.PEI RP 900)?
Yes Yes Yes Yes
Dispenser Sumps Dispenser
#5(5)
Are containment sumps present?Yes
Installation Date 10/31/2007
Sump Manufacturer Unknown
If Other (Specify)
Sump Construction Type Single Walled
Sump Construction Material Plastic
If Other (Specify)
Are containment sumps monitored?No
Is monitoring required per 2N .0900?No
Piping components and/or STP were
installed/replaced on or after 11/1/07?
No
Are spills or small weeps evident in
sumps?
No
Are single wall piping components located
in containment sump?(If installed after
11/1/07)
UDC Visual Inspection Date
(annually)(UST-22C)
10/26/2020
UDC Visual Inspection Results
(UST-22C)
Pass
Annual containment sump check
completed in accordance with national
standard (e.g.PEI RP 900)?
Yes
Other Sumps Sump#1(offd
slstp)
Sump#2(on
dsl stp)
Sump#3(pre
mstp)
Sump#4(reg
stp)
Are containment sumps present?Yes Yes Yes Yes
Installation Date 10/31/2007 10/31/2007 10/31/2007 10/31/2007
Sump Manufacturer Environ:Tank
Sump
Environ:Tank
Sump
Environ:Tank
Sump
Environ:Tank
Sump
If Other (Specify)
Sump Construction Type Single Walled Single Walled Single Walled Single Walled
Sump Construction Material Plastic Plastic Plastic Plastic
If Other (Specify)
Are containment sumps monitored?No No No No
Is monitoring required per 2N .0900?No No No No
Piping components and/or STP were
installed/replaced on or after 11/1/07?
No No No No
Are spills or small weeps evident in
sumps?
No No No No
Are single wall piping components located
in containment sump?(If installed after
11/1/07)
Sump Visual Inspection Date
(annually)(UST-22C)
10/26/2020 10/26/2020 10/26/2020 10/26/2020
Sump Visual Inspection Results
(UST-22C)
Pass Pass Pass Pass
Annual containment sump check
completed in accordance with national
standard (e.g.PEI RP 900)?
Yes Yes Yes Yes
UST-10B Facility ID:00-0-0000034121
Page 7 of 9 9/14/2021 12:50 PM
SITING AND SECONDARY CONTAINMENT
Siting And Sec.Containment-General Tank #1(1B-
prem)
Tank #2(3-off
dsl)
Tank #3(dsl)Tank #4(reg-
)
UST system upgraded with corrosion
protection,spill and overfill before 1/1/91?
N/A N/A N/A N/A
UST system and/or piping are located
within siting and secondary containment
areas?
No No No No
LEAK DETECTION
General Tank #1(1B-
prem)
Tank #2(3-off
dsl)
Tank #3(dsl)Tank #4(reg-)
DWM notified of leak detection method?Yes Yes Yes Yes
Piping Type
Piping type Pressurized
System
Pressurized
System
Pressurized
System
Pressurized
System
if other,specify
Suction check type
Type LLD present.MLLD MLLD MLLD MLLD
Tank Release Detection
Primary leak detection method Automatic
Tank Gauging
Automatic
Tank Gauging
Automatic
Tank Gauging
Automatic
Tank Gauging
if other,specify
Primary LD install date 4/3/2002 4/3/2002 4/3/2002 4/3/2002
Secondary leak detection method
if other,specify
Piping Release Detection
Primary leak detection method Line Tightness
Testing (LTT)
Line Tightness
Testing (LTT)
Line Tightness
Testing (LTT)
Line Tightness
Testing (LTT)
if other,specify
Primary LD install date 4/3/2002 4/3/2002 4/3/2002 4/3/2002
Secondary leak detection method
if other,specify
Equipment Checks
Last 12 monthly RD equipment checks
completed and all deficiencies corrected
(UST-27)?
if no,select all that apply
Annual RD equipment operability check
result (UST-22B)
Pass Pass Pass Pass
if Fail,select all that apply
Annual RD equipment operability
check date (UST-22B)
10/26/2020 10/26/2020 10/26/2020 10/26/2020
RD equipment checks completed per
national standard (e.g.PEI RP 900/1200)
(UST-22B/27)?
Yes Yes Yes Yes
PIPING LEAK DETECTION
Pressurized Piping Tank #1(1B-
prem)
Tank #2(3-off
dsl)
Tank #3(dsl)Tank #4(reg-)
Last MLLD/ELLD Test Date 10/26/2020 10/26/2020 10/26/2020 10/26/2020
MLLD/ELLD Test Result Pass Pass Pass Pass
Last LTT Test Date 10/26/2020 10/26/2020 10/26/2020 10/26/2020
LTT Test Result Pass Pass Pass Pass
Does test result indicate
suspected release?
No No No No
UST-10B Facility ID:00-0-0000034121
Page 8 of 9 9/14/2021 12:50 PM
Pressurized Piping Tank #1(1B-
prem)
Tank #2(3-off
dsl)
Tank #3(dsl)Tank #4(reg-)
Number of MLLD/ELLD Types 1 1 1 1
MLLD/ELLD Equipment Tank #1(1B-
prem)LLD #1
Tank #2(3-off
dsl)LLD #1
Tank #3(dsl)LLD
#1
Tank #4(reg-)
LLD #1
MLLD/ELLD
Manufacturer/Model
Red Jacket:FX1V V-R/RJ:FX1DV
(M)
V-R/RJ:FX1DV
(M)
Red Jacket:FX1V
If other,describe
MLLD/ELLD Third Party
Certified?
Yes Yes Yes Yes
MLLD/ELLD Testers MLLD/ELLD Tester #1
MLLD/ELLD Tester Name Rodney Ferguson
MLLD/ELLD Testing Company Name NTM
MLLD/ELLD Testing Company Phone Number [phone]
Pressurized Piping LTT LTT #1
LTT Manufacturer/Method AcuRite:Training &Serv
If other,describe
LTT Third Party Certified?Yes
Pressurized Piping LTT Tester LTT Tester #1
LTT Tester Name Rodney Ferguson
LTT Testing Company Name NTM
LTT Testing Company Phone Number [phone]
AUTOMATIC TANK GAUGE
ATG Systems ATG #1
ATG Manufacturer/Model V-R:TLS-350 CSLD
If other,describe
ATG Third Party Certified?Yes
Is ATG console operational?Yes
Tanks #1(1B-prem),#2(3-off dsl),#3(dsl),#4(reg-)
ATG Monthly LD Tank #1(1B-prem)Tank #2(3-off dsl)Tank #3(dsl)Tank #4(reg-)
2021 Aug Pass Pass Pass Pass
2021 Jul Pass Pass Pass Pass
2021 Jun Pass Pass Pass Pass
2021 May Pass Pass Pass Pass
2021 Apr Pass Pass Pass Pass
2021 Mar Pass Pass Pass Pass
2021 Feb Pass Pass Pass Pass
2021 Jan Pass Pass Pass Pass
2020 Dec Pass Pass Pass Pass
2020 Nov Pass Pass Pass Pass
2020 Oct Pass Pass Pass Pass
2020 Sep Pass Pass Pass Pass
ATG Conclusions
Leak Detection Requirements Met?Yes
UST-10B Facility ID:00-0-0000034121
Page 9 of 9 9/14/2021 12:50 PM
ATG Conclusions
Do the results indicate a suspected
release?
Issues
REPAIRS
Repairs
Any Repair Issues?No
Issues
Delivery Information Tank #1(1B-
prem)
Tank #2(3-off
dsl)
Tank #3(dsl)Tank #4(reg-)
All deliveries made to permitted
tanks
Yes Yes Yes Yes
SITE DIAGRAM 1

NORTH CAROLINA
Environmental Quality

North Carolina Department of Environmental Quality | Division of Waste Management
217 West Jones Street | 1646 Mail Service Center | Raleigh, North Carolina 27699-1646
919.707.8171
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
MICHAEL SCOTT
Director
September 14, 2021

CERTIFIED MAIL 70182290000182956365
RETURN RECEIPT REQUESTED

Sanjeev Sethi, Registered Agent
K & S LLC
7824 Seven Creeks Highway
Nakina, NC 28455

Re: NOTICE OF VIOLATION OF 15A NCAC 2N .0301(UPG2, UPG3), .0407(MT8, RCD6), .0603(RLS7)
Home Race Mart #1
7824 Seven Spring Highway, Nakina, NC 28455
Columbus County
Facility ID#: 00-0-0000034121

Dear Sanjeev Sethi:

On August 25, 2021, I conducted a compliance inspection at the above-referenced facility. I observed that
underground storage tanks (USTs) at Home Race Mart #1 are not in compliance with North Carolina UST regulations
(North Carolina Administrative Code [NCAC] 2N "Criteria and Standards Applicable to Underground Storage Tanks).
According to those rules (15A NCAC 2N .0203) K & S LLC is identified as the owner and/or operator of UST(s) at
Home Race Mart #1.

The following violations of the state rules (15A NCAC 2N) were observed on August 25, 2021 at Home Race Mart
#1. Following each violation are the actions required to correct the violations:

Violation 1: 15A NCAC 2N .0301 UPG2; Failure to meet the spill prevention requirements of a 'new tank system' as
required by federal regulation 40 CFR 280.20(c) (as incorporated by 15A NCAC 2N .0301).
Corrective Action(s):
All UST systems installed after December 22, 1988 are defined as 'new tank systems.' All "new tank systems" that
are filled by transfers of more than 25 gallons at one time are required to have spill prevention equipment. Please
complete the following actions:
1) Repair or empty your spill prevention equipment. If the spill prevention equipment is replaced as part of the repair
then the spill prevention equipment must meet the secondary containment requirements of 15A NCAC 2N .0900 and
must have an integrity test conducted after installation that is documented on a UST-23A form, Triennial UST Spill
Bucket Integrity Testing.
Submit a copy of invoices, designs or other documentation of the completed work within 30 days of receipt of this
NOV to the inspector at the address provided. In addition, if spill prevention is added, please submit a UST-8 form,
Notification for Activities Involving USTs, identifying methods (i.e., catchment basin) used along with a UST-23A
form, Triennial UST Spill Bucket Integrity Testing.
Comment: Tank #1B-prem: Spill Bucket Failed the most recent test
Tank #3-off dsl: Spill Bucket Failed the most recent test

Violation 2: 15A NCAC 2N .0301 UPG3; Failure to meet the overfill control requirements of a 'new tank system' as
required by federal regulation 40 CFR 280.20(c) (as incorporated by 15A NCAC 2N .0301).
Corrective Action(s):
All UST systems installed after December 22, 1988 are defined as 'new tank systems.' All "new tank systems" that
are filled by transfers of more than 25 gallons at one time are required to have overfill control equipment. Please

North Carolina Department of Environmental Quality | Division of Waste Management
217 West Jones Street | 1646 Mail Service Center | Raleigh, North Carolina 27699-1646
919.707.8171
complete one of the following actions:
1) The overfill prevention equipment was inspected however the equipment is not installed at the correct height in the
tank or it needs repairing and does not meet the performance standards of 15A NCAC 2N .0301. Provide
documentation, on a UST-22A form, Overfill Prevention Equipment Operability Check, of an operability check
conducted in accordance with the manufacturer's written guidelines, PEI RP 1200 “Recommended Practice for the
Testing and Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities”
and the instructions on the UST-22A form.
Submit a copy of invoices, designs or other documentation, such as a letter signed by the installer or a report from an
equipment contractor, of the completed work within 30 days of receipt of this notice to the inspector at the address
provided. In addition, if overfill control is added, please submit a UST-8 form Notification for Activities Involving
USTs identifying methods (i.e., automatic shut-off device or overfill alarm) used and provide documentation of an
operability check on a UST-22A form, Overfill Prevention Equipment Operability Check.
Comment: This Violation and Corrective Action Applies to the Overfill Equipment Associated with:
Tank #1B-prem: ,
Tank #reg-:

Violation 3: 15A NCAC 2N .0407 MT8; Failure to perform periodic operation and maintenance walkthrough
inspections as required by federal regulation 40 CFR 280.36 (as incorporated by 15A NCAC 2N .0407)
Corrective Action(s):
Periodic operation and maintenance walkthrough inspections must be conducted for the following:
1) Conduct a monthly spill bucket inspection in accordance with PEI RP 900, "Recommended Practices for the
Inspection and Maintenance of UST Systems" and document the results on form UST-27, "Monthly Walkthrough
Inspections".
2) Conduct a monthly inspection of your leak detection equipment (e.g. ATG console operation and leak detection
records) in accordance with PEI RP 900, "Recommended Practices for the Inspection and Maintenance of UST
Systems" and document the results on form UST-27, "Monthly Walkthrough Inspections".
3) The periodic operation and maintenance walkthrough inspections were not done in accordance with a national
standard. Conduct the periodic inspections in accordance with PEI RP 900, "Recommended Practices for the
Inspection and Maintenance of UST Systems" and submit the results on the applicable UST form.
Within 30 days of receipt of this notice, please submit the inspection results on one of the following applicable
forms: UST-22B, Annual Leak Detection Equipment Operability Check; UST-22C, Annual Sump Visual Inspections;
and/or UST-27, Monthly Walkthrough Inspections, to the inspector at the address provided.
Comment: Tank #1B-prem: ,
Tank #1B-prem: ,
Tank #1B-prem: ,
Tank #3-off dsl: ,
Tank #3-off dsl: ,
Tank #3-off dsl: ,
Tank #dsl: ,
Tank #dsl: ,
Tank #dsl: ,
Tank #reg-: ,
Tank #reg-: ,
Tank #reg-:

Violation 4: 15A NCAC 2N .0407 RCD6; Failure to provide records demonstrating operation and maintenance
walkthrough inspections have been completed as required by federal regulation 40 CFR 280.36 (as incorporated
by 15A NCAC 2N .0407)
Corrective Action(s):

1) Provide records demonstrating that the operation and maintenance walkthrough inspections have been completed.
Within 14 days of receipt of this notice, please submit the operation and maintenance walkthrough inspection results
on one of the following applicable forms: UST-22B, Annual Leak Detection Equipment Operability Check; UST-

North Carolina Department of Environmental Quality | Division of Waste Management
217 West Jones Street | 1646 Mail Service Center | Raleigh, North Carolina 27699-1646
919.707.8171
22C, Annual Containment Sump Visual Inspections; and/or UST-27, Monthly Walkthrough Inspections, to the
inspector at the address provided.
Comment: Tank #1B-prem: ,
Tank #3-off dsl: ,
Tank #dsl: ,
Tank #dsl: ,
Tank #reg-: ,
Tank #reg-:

Violation 5: 15A NCAC 2N .0603 RLS7; Failure to investigate a suspected release in accordance with federal
regulation 40 CFR 280.52 (as incorporated by 15A NCAC 2N .0603) after a failing tightness test of the spill
containment, the presence of fuel in spill containment buckets or the degradation of the spill containment
equipment to the point where that equipment can not reasonably be expected to perform its intended function was
observed.
Corrective Action(s):
Tank owners or operators must investigate a suspected release as directed below.
1) The spill containment bucket failed a tightness test or the condition of the spill containment bucket has deteriorated
such that it may need repairing or replacing. All replaced spill buckets must meet the secondary containment
requirements of 15A NCAC 2N .0900. You must complete the actions listed below.
Conduct a tightness test (if one has not already been completed) of the existing spill containment bucket(s) integrity
(prior to repair/replacement) in accordance with the manufacturer's recommendations* or a code of practice developed
by a nationally recognized association. If a testing standard is not available then you must fill the spill containment
bucket(s) with clean water to within 1.5 inches of the top of the spill bucket; mark the water level; wait a minimum of
1 hour and re-check the level. A spill containment bucket fails the tightness test if there has been any change in level.
Submit a copy of the test results to the inspector at the address provided. If any spill containment bucket fails the
tightness test, you must complete all of the following tasks: (a) Conduct a site check around the spill containment
bucket for the tanks listed above in accordance with 40 CFR 280.52(b) (as incorporated by 15A NCAC 2N .0603)
using the sampling protocol and methodology of the most recent version of the UST Section Guidelines for Site
Checks, Tank Closure, and Initial Response and Abatement and submit, within 30 days of receipt of this notice, a site
check report or initial abatement report (whichever is applicable) to the inspector at the address provided; AND (b)
Repair or replace the spill containment bucket and test the tightness of the spill containment bucket in accordance with
the manufacturer's recommendations, a code of practice developed by a nationally recognized association, or the
alternate instructions listed above if no standard is available. All replaced spill buckets must meet the secondary
containment requirements of 15A NCAC 2N .0900. Within 30 days of receipt of this notice, unless noted differently
above, submit a UST-17B, UST Suspected Release 7 Day Notice, with the results and any supporting information for
all equipment repairs, equipment replacements, tightness test(s), and site check as required in the above sections to
the inspector at the address provided. * Proper disposal of liquids in accordance with State and Federal requirements
is required. See the attached document Recommended ways to dispose of small quantities of petroleum and
petroleum/water mixtures for some suggested methods.
Comment: Tank #1B-prem: ,
Tank #3-off dsl:

Notice of Deficiency:
Deficiency 1: NCGS 143-215.94NN-SS OPTR4; Failure to maintain compliance with UST regulations which requires
Primary Operator retraining as required by NCGS 143-215.94NN - 143.215.94SS.
Corrective Action(s):
Please perform the following corrective action:
1) Within 30 days of receipt of this notice, the Primary Operator designated for this facility must go to the following
website http://tankschool.nc.gov and take the NC DEQ on-line course for retraining. Retraining as a Primary
Operator must be completed and a Primary Operator training certificate achieved within 30 days of receipt of this
notice.

North Carolina Department of Environmental Quality | Division of Waste Management
217 West Jones Street | 1646 Mail Service Center | Raleigh, North Carolina 27699-1646
919.707.8171
Corrective actions must be completed and reported to the inspector at the address provided within 30 days of receipt
of this notice, unless otherwise noted in one of the corrective actions listed above. Assessment of civil penalties may
be recommended for violations described in this NOV, as well as, operating permit revocation/denial unless the
violations are corrected. If K & S LLC believes that the inspection findings are in error, or if K & S LLC has any
questions pertaining to this NOV and/or corrective actions please have it contact me at [phone] or
[e-mail].

Sincerely,
John Hooks, Environmental Specialist
Division of Waste Management, NC DEQ
D

Enclosures

cc: Michael Phelps w/ Enclosures (electronic)
Files (electronic)

Appendix B
24-Hour Release and UST Leak Reporting Form (UST-61)

UST-61 24-Hour Release and UST Leak Reporting Form.
For Releases
in NC
This form should be completed and submitted to the UST Section’s regional office following a known or suspected release from an underground storage tank (UST) system. This form is required to be submitted within 24 hours of discovery of a known or
suspected release
(DWM USE ONLY) Incident # ________ Risk (H,I,L,U)_______ Received On ________ Received By ________ Reported by (circle one): Phone, Fax or Report Region _______
Suspected Contamination? (Y/N) ________ Confirmed GW Contamination? (Y/N) ______ Confirmed Soil Contamination ?(Y/N) ______
Samples Taken?(Y/N) ______ Free Product? (Y/N) _____ If Yes, State Greatest Thickness ______________
Facility ID Number ______________ Date Leak Discovered ___________ Comm/Non-Commercial? ________
Reg/Non-regulated? _____________
INCIDENT DESCRIPTION
Incident Name:
Address: County:
City/Town: Zip Code: Regional Office (circle one): Asheville, Mooresville, Fayetteville, Raleigh, Washington, Wilmington, Winston-Salem
Latitude (decimal degrees): Longitude (decimal degrees) : Obtained by:
Briefly describe suspected or confirmed release: (including but not limited to: nature of release, date of release, amount
of release, amount of free product present and recovery efforts, initial responses conducted, impacts to receptors)  GPS
 Topographic map
 GIS Address matching
 Other
 Unknown
Describe location:

HOW RELEASE WAS DISCOVERED (Release Code)
(Check one)
 Release Detection Equipment or Methods
 During UST Closure/Removal
 Property Transfer
 Visual/Odor
 Water in Tank
 Water Supply Well Contamination
 Groundwater Contamination
 Surface Water Contamination
 Other (specify) _______________

SOURCE OF CONTAMINATION
Source of Release (Check primary source) Cause of Release (Check primary cause) Type of Release (Check one) Product Type Released (Check primary product type released)

 Tank
 Piping
 Dispenser
 Submersible Turbine Pump
 Delivery Problem
 Spill Bucket
 Other
 Unknown
Definitions presented on reverse

 Spill
 Overfill
 Corrosion
 Physical/Mechanical
Damage
 Install Problem
 Other
 Unknown
Definitions presented on reverse

 Petroleum
 Non-Petroleum
 Both
Location
(Check one)
 Facility
 Residence
 Other

 Gasoline/ Diesel/
Kerosene
 Heating Oil
 Other Petroleum
Products
 Metals
 Other Inorganics
 Other Organics

 Diesel/Veg. Oil
Blend
 Vegetable Oil 100%
 E10 – E20
 E21 – E84
 E85 – E99
 Ethanol 100%
 E01 – E09
Ownership
1. Municipal 2. Military 3. Unknown 4. Private 5. Federal 6. County 7. State Operation Type 1. Public Service 2. Agricultural 3. Residential 4. Education/Relig. 5. Industrial 6. Commercial 7. Mining
UST Form 61 (02/19) Page 1 of 2

Y
Y
Y
N 11/4/21
Comm.
Reg.
28412
X Google maps
X
X
X
X
X
00-0-0000034121
Home Race Mart #1
7824 Seven Springs Highway
Nakina
Columbus
confirmed a petroleum release.
During site check activites, the soil sample collected at the off-road diesel spill bucket
Petroleum Retail Facility
34.134353 -78.668531
X site check

IMPACT ON DRINKING WATER SUPPLIES
Water Supply Wells Affected? 1. Yes 2. No 3. Unknown Number of Water Supply Wells Affected __________________
Water Supply Wells Contaminated: (Include Users Names, Addresses and Phone Numbers. Attach additional sheet if necessary) 1. 2. 3.
UST SYSTEM OWNER UST Owner/Company
Point of Contact Address
City State Zip Code Telephone Number
UST SYSTEM OPERATOR
UST Operator/Company Address
City State Zip Code Telephone Number
LANDOWNER AT LOCATION OF UST INCIDENT
Landowner Address
City State Zip Code Telephone Number
Draw Sketch of Area (showing two major road intersections) or Attach Map
Person Reporting Incident Company Telephone Number
Title Address Date
UST Form 61 (02/19) Page 2 of 2
Definitions of Sources Tank: means the tank that stores the product and is part of the underground storage tank system Piping: means the piping and connectors running from the tank or submersible turbine pump to the dispenser or other end-use equipment (Vent, vapor recovery, or fill lines are excluded.) Dispenser: includes the dispenser and the equipment used to connect the dispenser to the piping (e.g., a release from a suction pump or from components located above the shear valve) Submersible Turbine Pump (STP) Area includes the submersible turbine pump head (typically located in the tank sump), the line leak detector, and the piping that connects the submersible turbine pump to the tank Delivery Problem: identifies releases that occurred during product delivery to the tank. (Typical causes associated with this source are spills and overfills.)
Other: serves as the option to use when the release source is known but does not fit into one of the preceding categories (e.g., for releases from vent lines, vapor recovery lines, and fill lines) Unknown: identifies releases for which the source has not been determined Definitions of Causes
Spill: use this cause when a spill occurs (e.g., when the delivery hose is disconnected from the tank fill pipe or when the nozzle is removed from the dispenser) Overfill: use when an overfill occurs (e.g., overfills may occur from the fill pipe at the tank or when the nozzle fails to shut off at the dispenser) Physical or Mechanical Damage: use for all types of physical or mechanical damage, except corrosion (e.g., puncture of tank or piping, loose fittings, broken components, and components that have changed dimension) Corrosion: use when a metal tank, piping, or other component has a release due to corrosion (e.g., for steel, corrosion takes the form of rust) Installation Problem: use when the problem is determined to have occurred specifically because the UST system was not installed properly Other: use this option when the cause is known but does not fit into one of the preceding categories (e.g., putting regulated substances into monitoring wells) Unknown: use when the cause has not been determined
NC
See attached Map
Ethan Rogerson, GIT
11/4/2021
704-845-4010
3502 Hayes Road, Monroe, NC 28110 Agent
Geological Resources Inc.
Sanjeev Sethi 7824 Seven Creeks Highway
Nakina 28455 910-642-744
K & S LLC
Shivam LLC 7824 Seven Creeks Highway
Nakina NC 28455 910-642-7444
7824 Seven Creeks Highway K&S Foodmart LLC
Nakina NC 28455 910-642-7444

Appendix C
Laboratory Report – Soil Sample
11/03/21
Technical Report for
GRI (Geological Resources Inc.)
Home Race 1; Nakina, NC
SGS Job Number: FA90187
Sampling Date: 10/21/21
Report to:
GRI
3502 Hayes Rd
Monroe, NC 28110
[e-mail]; [e-mail];
[e-mail]; [e-mail]
ATTN: Ethan Rogerson
Total number of pages in report:
Certifications: FL(E83510), LA(03051), KS(E-10327), NC(573), NJ(FL002), NY(12022), SC(96038001)
DoD ELAP(ANAB L2229), AZ(AZ0806), CA(2937), TX(T104704404), PA(68-03573), VA(460177),
AL, AK, AR, CT, IA, KY, MA, MI. MS, ND, NH, NV, OK, OR, UT, VT, WA, WV
This report shall not be reproduced, except in its entirety, without the written approval of SGS.
Test results relate only to samples analyzed.
SGS North America Inc. • 4405 Vineland Road • Suite C-15 • Orlando, FL 32811 • tel: [phone] • fax: [phone]
Test results contained within this data package meet the requirements
of the National Environmental Laboratory Accreditation Program
and/or state specific certification programs as applicable.
Client Service contact: Muna Mohammed 407-425-6700
Norm Farmer
Technical Director
Orlando, FL 11/03/21
e-Hardcopy 2.0
Automated Report
21
SGS is the sole authority for authorizing edits or modifications to this document.
Unauthorized modification of this report is strictly prohibited.
Review standard terms at: http://www.sgs.com/en/terms-and-conditions
The results set forth herein are provided by SGS North America Inc.
Please share your ideas about
how we can serve you better at:
[e-mail]
1 of 21
FA90187
Table of Contents
-1-
Sections:
Section 1: Sample Summary ...................................................................................................3
Section 2: Summary of Hits ....................................................................................................4
Section 3: Sample Results ........................................................................................................5
3.1: FA90187-1: SS-ORDSL-2 ............................................................................................6
3.2: FA90187-2: SS-PREM-2 ..............................................................................................8
Section 4: Misc. Forms ............................................................................................................9
4.1: Chain of Custody ...........................................................................................................10
Section 5: GC Volatiles - QC Data Summaries .....................................................................12
5.1: Method Blank Summary ................................................................................................13
5.2: Blank Spike Summary ...................................................................................................15
5.3: Matrix Spike/Matrix Spike Duplicate Summary ...........................................................17
Section 6: GC/LC Semi-volatiles - QC Data Summaries .....................................................18
6.1: Method Blank Summary ................................................................................................19
6.2: Blank Spike Summary ...................................................................................................20
6.3: Matrix Spike/Matrix Spike Duplicate Summary ...........................................................21 1234562 of 21
FA90187
SGS North America Inc.
Sample Summary
GRI (Geological Resources Inc.)
Job No:FA90187
Home Race 1; Nakina, NC
Sample Collected Matrix Client
Number Date Time By Received Code Type Sample ID
FA90187-1 10/21/21 14:45 JR 10/26/21 SO Soil SS-ORDSL-2
FA90187-2 10/21/21 15:00 JR 10/26/21 SO Soil SS-PREM-2
Soil samples reported on a dry weight basis unless otherwise indicated on result page.
3 of 21
FA901871
Summary of Hits Page 1 of 1
Job Number:FA90187
Account:GRI (Geological Resources Inc.)
Project:Home Race 1; Nakina, NC
Collected:10/21/21
Lab Sample ID Client Sample ID Result/
Analyte Qual RL MDL Units Method
FA90187-1 SS-ORDSL-2
TPH-GRO (C6-C10)176 32 16 mg/kg SW846 8015C
TPH (C10-C28)3250 1200 600 mg/kg SW846 8015C
FA90187-2 SS-PREM-2
TPH-GRO (C6-C10)8.67 8.1 4.0 mg/kg SW846 8015C
4 of 21
FA901872
SGS North America Inc.
Sample Results
Report of Analysis
Orlando, FL
Section 3
5 of 21
FA901873
SGS North America Inc.
Report of Analysis Page 1 of 1
Client Sample ID:SS-ORDSL-2
Lab Sample ID:FA90187-1 Date Sampled:10/21/21
Matrix:SO - Soil Date Received:10/26/21
Method:SW846 8015C Percent Solids:83.5
Project:Home Race 1; Nakina, NC
File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
Run #1 1U70083.D 1 11/01/21 19:19 KB n/a n/a G1U309
Run #2 a 1U70044.D 1 10/31/21 12:52 KB n/a n/a G1U308
Initial Weight Final Volume Methanol Aliquot
Run #1 5.49 g 5.0 ml 20.0 ul
Run #2 5.49 g 5.0 ml 25.0 ul
CAS No.Compound Result RL MDL Units Q
TPH-GRO (C6-C10)176 32 16 mg/kg
CAS No.Surrogate Recoveries Run# 1 Run# 2 Limits
460-00-4 4-Bromofluorobenzene 150% b 159% b 56-149%
98-08-8 aaa-Trifluorotoluene 105%99%66-132%
(a) Confirmation run.
(b) Outside control limits.
ND = Not detected MDL = Method Detection Limit J = Indicates an estimated value
RL = Reporting Limit B = Indicates analyte found in associated method blank
E = Indicates value exceeds calibration range N = Indicates presumptive evidence of a compound
6 of 21
FA9018733.1
SGS North America Inc.
Report of Analysis Page 1 of 1
Client Sample ID:SS-ORDSL-2
Lab Sample ID:FA90187-1 Date Sampled:10/21/21
Matrix:SO - Soil Date Received:10/26/21
Method:SW846 8015C SW846 3546 Percent Solids:83.5
Project:Home Race 1; Nakina, NC
File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
Run #1 WW31225.D 200 10/28/21 13:00 KA 10/27/21 09:15 OP88031 GWW1252
Run #2
Initial Weight Final Volume
Run #1 20.0 g 1.0 ml
Run #2
CAS No.Compound Result RL MDL Units Q
TPH (C10-C28)3250 1200 600 mg/kg
CAS No.Surrogate Recoveries Run# 1 Run# 2 Limits
84-15-1 o-Terphenyl 0% a 56-122%
(a) Outside control limits due to dilution.
ND = Not detected MDL = Method Detection Limit J = Indicates an estimated value
RL = Reporting Limit B = Indicates analyte found in associated method blank
E = Indicates value exceeds calibration range N = Indicates presumptive evidence of a compound
7 of 21
FA9018733.1
SGS North America Inc.
Report of Analysis Page 1 of 1
Client Sample ID:SS-PREM-2
Lab Sample ID:FA90187-2 Date Sampled:10/21/21
Matrix:SO - Soil Date Received:10/26/21
Method:SW846 8015C Percent Solids:86.6
Project:Home Race 1; Nakina, NC
File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
Run #1 1U70045.D 1 10/31/21 13:18 KB n/a n/a G1U308
Run #2
Initial Weight Final Volume Methanol Aliquot
Run #1 3.96 g 5.0 ml 100 ul
Run #2
CAS No.Compound Result RL MDL Units Q
TPH-GRO (C6-C10)8.67 8.1 4.0 mg/kg
CAS No.Surrogate Recoveries Run# 1 Run# 2 Limits
460-00-4 4-Bromofluorobenzene 109%56-149%
98-08-8 aaa-Trifluorotoluene 107%66-132%
ND = Not detected MDL = Method Detection Limit J = Indicates an estimated value
RL = Reporting Limit B = Indicates analyte found in associated method blank
E = Indicates value exceeds calibration range N = Indicates presumptive evidence of a compound
8 of 21
FA9018733.2
SGS North America Inc.
Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
Orlando, FL
Section 4
9 of 21
FA901874
FA90187: Chain of Custody
Page 1 of 2
10 of 21
FA9018744.1
Job Number:FA90187 Client:GRI
Date / Time Received:10/26/2021 2:45:00 PM Delivery Method:FX
Project:HOME RACE #1
Airbill #'s:923153843474
Cooler Information
1. Custody Seals Present
2. Custody Seals Intact
4. Cooler temp verification
3. Temp criteria achieved
5. Cooler media
IR Gun
Ice (Bag)
Trip Blank Information
1. Trip Blank present / cooler
2. Trip Blank listed on COC
2. Samples preserved properly
Sample Information
1. Sample labels present on bottles
5. Sample recvd within HT
4. Condition of sample
3. Sufficient volume/containers recvd for analysis:
Intact
Comments FROZEN @ 15:38 - 10/26/21
SM001Rev. Date 05/24/17
SGS Sample Receipt Summary
Cooler Temps (Raw Measured) °C:
Cooler Temps (Corrected) °C:
Cooler 1: (2.6);
Cooler 1: (2.8);
3. Type Of TB Received
W or S N/A
6. Dates/Times/IDs on COC match Sample Label
7. VOCs have headspace
8. Bottles received for unspecified tests
9. Compositing instructions clear
10. Voa Soil Kits/Jars received past 48hrs?
11. % Solids Jar received?
Misc. Information
25-Gram 5-GramNumber of Encores:Number of 5035 Field Kits:Number of Lab Filtered Metals:
Test Strip Lot #s:pH 0-3 230315 pH 10-12 219813A Other: (Specify)
Y or N N/A
Y or N
Therm ID:IR 1; Therm CF:0.2; # of Coolers:1
Y or N N/A
12. Residual Chlorine Present?
Residual Chlorine Test Strip Lot #:
Technician:Reviewer:NATHANS Date:Date:10/26/2021 2:45:00 P
FA90187: Chain of Custody
Page 2 of 2
11 of 21
FA9018744.1
SGS North America Inc.
GC Volatiles
QC Data Summaries
Includes the following where applicable:
• Method Blank Summaries
• Blank Spike Summaries
• Matrix Spike and Duplicate Summaries
Orlando, FL
Section 5
12 of 21
FA901875
Method Blank Summary Page 1 of 1
Job Number:FA90187
Account:GRINCC GRI (Geological Resources Inc.)
Project:Home Race 1; Nakina, NC
Sample File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
G1U308-MB 1U70042.D 1 10/31/21 KB n/a n/a G1U308
The QC reported here applies to the following samples:Method: SW846 8015C
FA90187-2
CAS No.Compound Result RL MDL Units Q
TPH-GRO (C6-C10)ND 5.0 2.5 mg/kg
CAS No.Surrogate Recoveries Limits
460-00-4 4-Bromofluorobenzene 108%56-149%
98-08-8 aaa-Trifluorotoluene 106%66-132%
13 of 21
FA9018755.1.1
Method Blank Summary Page 1 of 1
Job Number:FA90187
Account:GRINCC GRI (Geological Resources Inc.)
Project:Home Race 1; Nakina, NC
Sample File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
G1U309-MB 1U70069.D 1 11/01/21 KB n/a n/a G1U309
The QC reported here applies to the following samples:Method: SW846 8015C
FA90187-1
CAS No.Compound Result RL MDL Units Q
TPH-GRO (C6-C10)ND 5.0 2.5 mg/kg
CAS No.Surrogate Recoveries Limits
460-00-4 4-Bromofluorobenzene 110%56-149%
98-08-8 aaa-Trifluorotoluene 108%66-132%
14 of 21
FA9018755.1.2
Blank Spike Summary Page 1 of 1
Job Number:FA90187
Account:GRINCC GRI (Geological Resources Inc.)
Project:Home Race 1; Nakina, NC
Sample File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
G1U308-BS 1U70041.D 1 10/31/21 KB n/a n/a G1U308
The QC reported here applies to the following samples:Method: SW846 8015C
FA90187-2
Spike BSP BSP
CAS No.Compound mg/kg mg/kg %Limits
TPH-GRO (C6-C10)20 23.3 117 74-128
CAS No.Surrogate Recoveries BSP Limits
460-00-4 4-Bromofluorobenzene 110%56-149%
98-08-8 aaa-Trifluorotoluene 109%66-132%
* = Outside of Control Limits.
15 of 21
FA9018755.2.1
Blank Spike Summary Page 1 of 1
Job Number:FA90187
Account:GRINCC GRI (Geological Resources Inc.)
Project:Home Race 1; Nakina, NC
Sample File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
G1U309-BS 1U70068.D 1 11/01/21 KB n/a n/a G1U309
The QC reported here applies to the following samples:Method: SW846 8015C
FA90187-1
Spike BSP BSP
CAS No.Compound mg/kg mg/kg %Limits
TPH-GRO (C6-C10)20 19.2 96 74-128
CAS No.Surrogate Recoveries BSP Limits
460-00-4 4-Bromofluorobenzene 112%56-149%
98-08-8 aaa-Trifluorotoluene 110%66-132%
* = Outside of Control Limits.
16 of 21
FA9018755.2.2
Matrix Spike/Matrix Spike Duplicate Summary Page 1 of 1
Job Number:FA90187
Account:GRINCC GRI (Geological Resources Inc.)
Project:Home Race 1; Nakina, NC
Sample File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
FA90215-1MS 1U70048.D 1 10/31/21 KB n/a n/a G1U308
FA90215-1MSD 1U70049.D 1 10/31/21 KB n/a n/a G1U308
FA90215-1 a 1U70047.D 1 10/31/21 KB n/a n/a G1U308
The QC reported here applies to the following samples:Method: SW846 8015C
FA90187-2
FA90215-1 Spike MS MS Spike MSD MSD Limits
CAS No.Compound mg/kg Q mg/kg mg/kg %mg/kg mg/kg %RPD Rec/RPD
TPH-GRO (C6-C10)ND 19.4 19.0 98 19.4 21.3 110 11 74-128/17
CAS No.Surrogate Recoveries MS MSD FA90215-1 Limits
460-00-4 4-Bromofluorobenzene 102%103%103%56-149%
98-08-8 aaa-Trifluorotoluene 102%106%103%66-132%
(a) Pre-weighed vials were altered in the field; sample weights are estimated.
* = Outside of Control Limits.
17 of 21
FA9018755.3.1
SGS North America Inc.
GC/LC Semi-volatiles
QC Data Summaries
Includes the following where applicable:
• Method Blank Summaries
• Blank Spike Summaries
• Matrix Spike and Duplicate Summaries
Orlando, FL
Section 6
18 of 21
FA901876
Method Blank Summary Page 1 of 1
Job Number:FA90187
Account:GRINCC GRI (Geological Resources Inc.)
Project:Home Race 1; Nakina, NC
Sample File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
OP88031-MB WW31195.D 1 10/27/21 KA 10/27/21 OP88031 GWW1251
The QC reported here applies to the following samples:Method: SW846 8015C
FA90187-1
CAS No.Compound Result RL MDL Units Q
TPH (C10-C28)ND 5.0 2.5 mg/kg
CAS No.Surrogate Recoveries Limits
84-15-1 o-Terphenyl 67%56-122%
19 of 21
FA9018766.1.1
Blank Spike Summary Page 1 of 1
Job Number:FA90187
Account:GRINCC GRI (Geological Resources Inc.)
Project:Home Race 1; Nakina, NC
Sample File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
OP88031-BS WW31196.D 1 10/27/21 KA 10/27/21 OP88031 GWW1251
The QC reported here applies to the following samples:Method: SW846 8015C
FA90187-1
Spike BSP BSP
CAS No.Compound mg/kg mg/kg %Limits
TPH (C10-C28)50 42.3 85 62-116
CAS No.Surrogate Recoveries BSP Limits
84-15-1 o-Terphenyl 82%56-122%
* = Outside of Control Limits.
20 of 21
FA9018766.2.1
Matrix Spike/Matrix Spike Duplicate Summary Page 1 of 1
Job Number:FA90187
Account:GRINCC GRI (Geological Resources Inc.)
Project:Home Race 1; Nakina, NC
Sample File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
OP88031-MS WW31199.D 5 10/27/21 KA 10/27/21 OP88031 GWW1251
OP88031-MSD WW31200.D 5 10/27/21 KA 10/27/21 OP88031 GWW1251
FA90171-1 a WW31198.D 5 10/27/21 KA 10/27/21 OP88031 GWW1251
The QC reported here applies to the following samples:Method: SW846 8015C
FA90187-1
FA90171-1 Spike MS MS Spike MSD MSD Limits
CAS No.Compound mg/kg Q mg/kg mg/kg %mg/kg mg/kg %RPD Rec/RPD
TPH (C10-C28)20.3 J 53.3 52.2 60*53.5 53.6 62 3 62-116/35
CAS No.Surrogate Recoveries MS MSD FA90171-1 Limits
84-15-1 o-Terphenyl 72%77%59%56-122%
(a) Dilution required due to matrix interference; extract was viscous.
* = Outside of Control Limits.
21 of 21
FA9018766.3.1