19049_Regal_Mfg_UST_Closure_20170327

UNDERGROUND STORAGE TANK
CLOSURE REPORT

PIN: 370312755477 212 12th Avenue Northeast Hickory, Catawba County, North Carolina

March 27, 2017

CVET Project No. 17-308

PREPARED FOR: Mr. Brad Newton
North Carolina Department of Environmental Quality Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115

PREPARED BY:

CATAWBA VALLEY ENGINEERING AND TESTING, P.C.
HICKORY, NORTH CAROLINA

GEOTECHNICAL • CONSTRUCTION MATERIALS • ENVIRONMENTAL • DAMS

CATAWBA VALLEY
ENGINEERING AND TESTING
J. KIRK VIOLA, P.E. JAMES S. TATE, P.E. DAVID M. LEGRAND, JR., P.E.
March 27, 2017
Mr. Brad Newton
North Carolina Department of Environmental Quality
Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Re: Underground Storage Tank Closure
PIN: 370312755477
212 12th Avenue Northeast
Hickory, Catawba County, North Carolina 28601 CVET Project No.: 17-308
Dear Mr. Newton:

Catawba Valley Engineering & Testing (CVET) is pleased to submit this Underground Storage Tank Closure Report for the above referenced property.
CVET appreciates the opportunity to provide our environmental engineering services for this
project. If you have any questions regarding the contents of this report, or if we can provide
additional services, please do not hesitate to contact us. Sincerely,

CATAWBA VALLEY ENGINEERING AND TESTING, P.C.

Nathan S. Simmons, P.G. James H. Carter, Senior Geologist Environmental Professional Environmental Professional

ii

Project Name: PIN: 370312755477
Location: Hickory, Catawba County, North Carolina
Date: March 27, 2017 Project No. 17-308

TABLE OF CONTENTS
1.0 SITE INFORMATION ........................................................................................................ 1
1.1 Site Identification ............................................................................................................. 1
1.2 Contact Information ......................................................................................................... 1
1.3 Tank Information.............................................................................................................. 2
2.0 PROJECT BACKGROUND ............................................................................................... 2
3.0 SITE HISTORY AND CHARACTERIZATION ................................................................ 2
4.0 CLOSURE PROCEDURES AND SITE INVESTIGATION ............................................. 2
5.0 LABORATORY ANALYTICAL RESULTS ..................................................................... 3
6.0 CONCLUSIONS AND RECOMMENDATIONS .............................................................. 4
APPENDIX A – FIGURES
APPENDIX B – PHOTOGRAPHS
APPENDIX C – LABORATORY ANALYTICAL REPORT
APPENDIX D – WASTE DISPOSAL MANIFESTS
iii

Project Name: PIN: 370312755477
Location: Hickory, Catawba County, North Carolina
Date: March 27, 2017 Project No. 17-308

1.0 SITE INFORMATION
1.1 Site Identification
Date of Report: March 27, 2017
Brownfields Project No.: 1049-15-018
Site Name: Former Regal Manufacturing Facility Site Street Address: 212 12th Avenue Northeast
City/Town: Hickory
Zip Code: 28601
County: Catawba
Description of Geographical Data Point: Heating Oil UST Location Method (GPS, topographical map, other): GPS/Google Maps
Latitude (decimal degrees): 35.748395
Longitude (decimal degrees): -81.334287

1.2 Contact Information

UST/AST Owner: Regal Manufacturing (former site operator)
Address: Hickory, NC Tel.: [phone]
Property Owner: Dr. Jerry Pruitt
Address: 245 11th Avenue NE, Hickory, NC 28601
Tel.: [phone] UST Removal/Excavation Contractor: JK Landscaping & Grading
Address: 1902 Highland Avenue NE, Hickory, NC 28601
Tel.: [phone]
Primary Consultant: Catawba Valley Engineering & Testing, P.C. Address: 308 15th Street SE, Hickory, NC 28602
Tel.: [phone]

Analytical Laboratory: Pace Analytical Services, Inc. Address: 9800 Kincey Avenue, Suite #100, Huntersville, NC 28708 Tel.: [phone]

1

Project Name: PIN: 370312755477
Location: Hickory, Catawba County, North Carolina
Date: March 27, 2017 Project No. 17-308

1.3 Tank Information
UST ID
Number
Current/Last
Contents
Capacity
(gallons)
Construction
Details
Status of
UST
Was a release associated with the
UST System?

Unknown

Heating Oil

7,000

Steel, single wall

Removed 2/7/2017

No

2.0 PROJECT BACKGROUND

The subject property is located at 212 12th Avenue NE in Hickory, North Carolina. Formerly, the site was utilized as an industrial manufacturing facility but is currently not operational. In
support of current demolition and site redevelopment efforts at the property, CVET was
contracted by Dr. Jerry Pruitt, the property owner, for the removal and closure of one heating oil
underground storage tank (UST) located at the subject property.
This report describes the investigation, removal, and closure of the heating oil UST.

3.0 SITE HISTORY AND CHARACTERIZATION

The subject property consists of an approximately 2.00 acre parcel of land located at 212 12th
Avenue NE in Hickory, North Carolina. CVET understands that the property has historically been utilized for industrial/manufacturing purposes. Additionally, CVET was informed by Dr.
Pruitt that the site contains impacted soil and groundwater as a result of previous operations and
is currently enrolled in the NC Brownfields Program. The Brownfields Program has reportedly
assisted with site investigation and remediation efforts at the subject property to encourage
redevelopment and reuse of the site.
Currently, the subject property is vacant with all former structures having been demolished.
CVET was contracted by Dr. Pruitt for the removal of one approximately 7,000 gallon heating
oil UST that was discovered at the subject property. CVET performed a site inspection to
confirm the location of the UST and to estimate the size of the tank. The following sections of this report summarize the investigation and removal of the UST.

4.0 CLOSURE PROCEDURES AND SITE INVESTIGATION

Following identification of the tank location and approximate size, a UST removal permit was obtained from the Hickory Fire Department. JK Landscaping & Grading (JKLG) was contracted
for the removal of the heating oil UST on February 7, 2017, and CVET provided oversight, soil
screening, sampling, and closure assessment activities.

During uncovering of the UST, CVET observed the overburden soils for signs of potential impact. Soils were placed in a plastic bag, allowed to off-gas, and were screened with a photo
2

Project Name: PIN: 370312755477
Location: Hickory, Catawba County, North Carolina
Date: March 27, 2017 Project No. 17-308

ionizing detector (PID). The PID approximates the concentration of organic vapors emanating
from the soils. No obvious signs of impact were discovered in the soils above and adjacent to
the tank. Once uncovered, the tank measured approximately 18 feet long, 8 feet in diameter, had
an estimated capacity of 7,000 gallons, and was located approximately 5 feet below the surface. One fill pipe extended to the surface, however, no evidence for product lines was observed
during removal of the tank.

Approximately one foot of remaining heating oil was observed in the bottom of the tank. Stat,
Inc. was contracted for the vacuum removal and proper disposal of the remaining contents. Waste manifest forms are included in Appendix D. Following removal of the residual product,
excavation resumed and the tank was removed from the ground. The tank was inspected and
appeared in good condition with no obvious signs of corrosion, holes, leaks, or damage. The
final excavation measured approximately 25 feet long, by 15 feet wide, by 19 feet deep.
Benching and shoring was completed on the southern side of the excavation to reduce cave-in potential and provide CVET with access to the pit. CVET inspected the bottom of the
excavation for evidence of leaks and potentially impacted soils. Based on visual, olfactory, and
PID screening of the soils directly below and adjacent to the former tank, there does not appear
to be evidence of impacted media in association with the UST. Groundwater or bedrock was not
encountered during the excavation. Based on previous reports, groundwater is expected to be present at a depth of approximately 35 to 40 feet below ground surface (fbgs) at the subject
property. Photographs are included in Appendix B.

Following UST removal activities, two soil samples (designated East and West, Appendix A)
were collected from approximately six inches below the former UST, in accordance with NCDEQ guidelines. Soil samples were immediately place on ice and were submitted to Pace
Laboratories of Huntersville, North Carolina to be analyzed for total petroleum hydrocarbons –
gasoline range organics (TPH-GRO) by EPA Method 8015 and total petroleum hydrocarbons –
diesel range organics (TPH-DRO) by EPA Method 8015. Following collection of soil samples
and inspection of the soils, the open excavation was then backfilled with unaffected overburden soils/surrounding site soils, and was restored to its original condition.

On February 7, 2017, Stat, Inc. provided transportation and proper disposal of the tank. Waste
manifest forms are included in Appendix D.
No abatement actions were performed in association with this release.

5.0 LABORATORY ANALYTICAL RESULTS
Based on the laboratory analytical results, no constituents were detected in either of the soil
samples collected from beneath the UST. Laboratory analytical results are included in
Appendix C.

3

Project Name: PIN: 370312755477
Location: Hickory, Catawba County, North Carolina
Date: March 27, 2017 Project No. 17-308

6.0 CONCLUSIONS AND RECOMMENDATIONS
Laboratory analytical results indicate that soil concentrations are below the applicable NCDEQ
action levels. Based on the results of this investigation and the closure of this UST, there does not appear to be impacted soils in association with the UST described in this report.

CVET does not recommend additional cleanup and/or assessment activities at this time and
requests the NCDEQ to issue a Notice of No Further Action for this property.

4

Project Name: PIN: 370312755477
Location: Hickory, Catawba County, North Carolina
Date: March 27, 2017 Project No. 17-308

APPENDIX A – FIGURES

P.O.B. 2616 HICKORY NORTH CAROLINA
WWW . CVET . CO
TELE: 828-578-9972 FAX: [phone]
NSS 17-308
March 1, 2017 FIGURE 1
UST Closure Sample Locations
212 12th Avenue NE
Hickory, Catawba County, NC
West
East
Project Name: PIN: 370312755477
Location: Hickory, Catawba County, North Carolina
Date: March 27, 2017 Project No. 17-308

APPENDIX B – PHOTOGRAPHS

Photograph 1: General layout of site and approximate location of tank
on western perimeter of property. From the west looking east.

Photograph 2: View of tank being uncovered. No odors or staining
present around fill pipe and no evidence of product lines.

Photograph 3: View of tank being uncovered. No odors, staining,
elevated PID readings, or evidence of impacted soil.

Photograph 4: View of tank being removed from excavation following
removal/pumping of remaining product.

Photograph 5: General view of removed tank. No corrosion, pitting,
holes, or evidence of leaks.

Photograph 6: Other side of tank. No evidence of corrosion, pitting,
holes, or leaks.

Photograph 7: View of final exaction following tank removal.
Benching and shoring on the south end for access.

Photograph 8: View of bottom of excavation. No odors, staining,
elevated PID readings, or evidence of leaks.

Photograph 9: View of backfilled and restored excavation area.

Project Name: PIN: 370312755477
Location: Hickory, Catawba County, North Carolina
Date: March 27, 2017 Project No. 17-308

APPENDIX C – LABORATORY ANALYTICAL REPORT

#=CL#
February 17, 2017
LIMS USE: FR - JAMES CARTER
LIMS OBJECT ID: 92329321
92329321
Project:
Pace Project No.:
RE:
James Carter
Catawba Valley Engineering & Testing
PO Box 2616
Hickory, NC 28603
UST 17-308east
Dear James Carter:
Enclosed are the analytical results for sample(s) received by the laboratory on February 09, 2017.
The results relate only to the samples included in this report. Results reported herein conform to the
most current, applicable TNI/NELAC standards and the laboratory's Quality Assurance Manual,
where applicable, unless otherwise noted in the body of the report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Taylor Ezell
[e-mail]
Project Manager
Enclosures
cc:Nathan Simmons, Catawba Valley Engineering & Testing
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 1 of 13
#=CP#
CERTIFICATIONS
Pace Project No.:
Project:
92329321
UST 17-308east
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Virginia/VELAP Certification #: 460221
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 2 of 13
#=SA#
SAMPLE ANALYTE COUNT
Pace Project No.:
Project:
92329321
UST 17-308east
Lab ID Sample ID Method
Analytes
Reported LaboratoryAnalysts
92329321001 EAST EPA 8015 Modified 2 PASI-CPKS
EPA 8015 Modified 2 PASI-CZDO
ASTM D2974-87 1 PASI-CCLW
92329321002 WEST EPA 8015 Modified 2 PASI-CPKS
EPA 8015 Modified 2 PASI-CZDO
ASTM D2974-87 1 PASI-CCLW
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 3 of 13
#=AR#
ANALYTICAL RESULTS
Pace Project No.:
Project:
92329321
UST 17-308east
Sample:EAST Lab ID:92329321001 Collected:02/07/17 13:10 Received:02/09/17 11:19 Matrix:Solid
Results reported on a "dry weight" basis and are adjusted for percent moisture, sample size and any dilutions.
Parameters Results Units DF Prepared Analyzed CAS No.QualReport Limit
Analytical Method: EPA 8015 Modified Preparation Method: EPA 35468015 GCS THC-Diesel
Diesel Range Organics(C10-C28)ND mg/kg 02/09/17 22:0802/09/17 15:306.4 1
Surrogates
n-Pentacosane (S)63 %02/09/17 22:08 629-99-202/09/17 15:3041-119 1
Analytical Method: EPA 8015 Modified Preparation Method: EPA 5035A/5030BGasoline Range Organics
Gas Range Organics (C6-C10)ND mg/kg 02/16/17 16:3602/16/17 14:287.1 1
Surrogates
4-Bromofluorobenzene (S)94 %02/16/17 16:36 460-00-402/16/17 14:2870-167 1
Analytical Method: ASTM D2974-87Percent Moisture
Percent Moisture 21.3 %02/10/17 09:300.10 1
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.Date: 02/17/2017 02:45 PM
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 4 of 13
#=AR#
ANALYTICAL RESULTS
Pace Project No.:
Project:
92329321
UST 17-308east
Sample:WEST Lab ID:92329321002 Collected:02/07/17 13:15 Received:02/09/17 11:19 Matrix:Solid
Results reported on a "dry weight" basis and are adjusted for percent moisture, sample size and any dilutions.
Parameters Results Units DF Prepared Analyzed CAS No.QualReport Limit
Analytical Method: EPA 8015 Modified Preparation Method: EPA 35468015 GCS THC-Diesel
Diesel Range Organics(C10-C28)ND mg/kg 02/09/17 22:0802/09/17 15:306.6 1
Surrogates
n-Pentacosane (S)87 %02/09/17 22:08 629-99-202/09/17 15:3041-119 1
Analytical Method: EPA 8015 Modified Preparation Method: EPA 5035A/5030BGasoline Range Organics
Gas Range Organics (C6-C10)ND mg/kg 02/16/17 17:4902/16/17 14:286.7 1
Surrogates
4-Bromofluorobenzene (S)98 %02/16/17 17:49 460-00-402/16/17 14:2870-167 1
Analytical Method: ASTM D2974-87Percent Moisture
Percent Moisture 23.7 %02/10/17 09:300.10 1
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.Date: 02/17/2017 02:45 PM
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 5 of 13
#=QC#
QUALITY CONTROL DATA
Pace Project No.:
Project:
92329321
UST 17-308east
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
QC Batch:
QC Batch Method:
Analysis Method:
Analysis Description:
348602
EPA 5035A/5030B
EPA 8015 Modified
Gasoline Range Organics
Associated Lab Samples:92329321001, 92329321002
Parameter Units
Blank
Result
Reporting
Limit Qualifiers
METHOD BLANK:1934170
Associated Lab Samples:92329321001, 92329321002
Matrix:Solid
Analyzed
Gas Range Organics (C6-C10)mg/kg ND 6.0 02/16/17 19:49
4-Bromofluorobenzene (S)%96 70-167 02/16/17 19:49
Parameter Units
LCS
Result
% Rec
Limits Qualifiers% RecConc.
1934171LABORATORY CONTROL SAMPLE:
LCSSpike
Gas Range Organics (C6-C10)mg/kg 58.850 118 70-165
4-Bromofluorobenzene (S)%105 70-167
Parameter Units
MS
Result
% Rec
Limits Qualifiers% RecConc.
1934172MATRIX SPIKE SAMPLE:
MSSpike
Result
92329321001
Gas Range Organics (C6-C10)mg/kg 63.958.8 108 47-187ND
4-Bromofluorobenzene (S)%91 70-167
Parameter Units
Dup
Result QualifiersRPDResult
92329321002
1934173SAMPLE DUPLICATE:
Gas Range Organics (C6-C10)mg/kg NDND
4-Bromofluorobenzene (S)%104 698
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.Date: 02/17/2017 02:45 PM
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 6 of 13
#=QC#
QUALITY CONTROL DATA
Pace Project No.:
Project:
92329321
UST 17-308east
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
QC Batch:
QC Batch Method:
Analysis Method:
Analysis Description:
347583
EPA 3546
EPA 8015 Modified
8015 Solid GCSV
Associated Lab Samples:92329321001, 92329321002
Parameter Units
Blank
Result
Reporting
Limit Qualifiers
METHOD BLANK:1928244
Associated Lab Samples:92329321001, 92329321002
Matrix:Solid
Analyzed
Diesel Range Organics(C10-C28)mg/kg ND 5.0 02/09/17 13:16
n-Pentacosane (S)%80 41-119 02/09/17 13:16
Parameter Units
LCS
Result
% Rec
Limits Qualifiers% RecConc.
1928245LABORATORY CONTROL SAMPLE:
LCSSpike
Diesel Range Organics(C10-C28)mg/kg 48.866.7 73 49-113
n-Pentacosane (S)%78 41-119
Parameter Units
MS
Result
% Rec
Limits Qualifiers% RecConc.
1928246MATRIX SPIKE SAMPLE:
MSSpike
Result
92329214005
Diesel Range Organics(C10-C28)mg/kg 45.284.8 52 10-146ND
n-Pentacosane (S)%49 41-119
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.Date: 02/17/2017 02:45 PM
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 7 of 13
#=QC#
QUALITY CONTROL DATA
Pace Project No.:
Project:
92329321
UST 17-308east
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
QC Batch:
QC Batch Method:
Analysis Method:
Analysis Description:
347616
ASTM D2974-87
ASTM D2974-87
Dry Weight/Percent Moisture
Associated Lab Samples:92329321001, 92329321002
Parameter Units
Dup
Result QualifiersRPDResult
92329269001
1928495SAMPLE DUPLICATE:
Percent Moisture %87.1 087.1
Parameter Units
Dup
Result QualifiersRPDResult
92329125003
1928496SAMPLE DUPLICATE:
Percent Moisture %87.0 087.0
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.Date: 02/17/2017 02:45 PM
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 8 of 13
#=QL#
QUALIFIERS
Pace Project No.:
Project:
92329321
UST 17-308east
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND - Not Detected at or above adjusted reporting limit.
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL - Adjusted Method Detection Limit.
PQL - Practical Quantitation Limit.
RL - Reporting Limit.
S - Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is
a combined concentration.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean-Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI - The NELAC Institute.
LABORATORIES
Pace Analytical Services - CharlottePASI-C
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.Date: 02/17/2017 02:45 PM
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 9 of 13
#=CR#
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Pace Project No.:
Project:
92329321
UST 17-308east
Lab ID Sample ID QC Batch Method QC Batch Analytical Method
Analytical
Batch
92329321001 347583 347622EASTEPA 3546 EPA 8015 Modified
92329321002 347583 347622WESTEPA 3546 EPA 8015 Modified
92329321001 348602 348715EASTEPA 5035A/5030B EPA 8015 Modified
92329321002 348602 348715WESTEPA 5035A/5030B EPA 8015 Modified
92329321001 347616EASTASTM D2974-87
92329321002 347616WESTASTM D2974-87
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.Date: 02/17/2017 02:45 PM
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 10 of 13
Page 11 of 13
peAna/ytica(
Laboratory receiving samples:
Asheville D EdenD
Sample Condition Upon
Receipt
Courier:
D Commercial
Custody Seal Present?
Packing Material:
Thermometer·
Oves ~o
0 Bubble Wrap
Document Name: Document Revised: Sept. 21, 2016
Sample Condition Upon Receipt(SCUR) Page 1 of 2
Document No.: Issuing Authority:
F-CAR·CS-033-Rev.01 Pace Quality Office
Greenwood D Huntersville'C© Raleigh0 MechanicsvilleO
Seals Intact? Oves
~ubble Bags 0 None
Project I
· nt
~o
lJ0#'92329321
111 111 11111 111 1 I I I I Ill
92329321
Date/lnltlals Person Examining Contents:_--'-+-~~
O other: __
lliGun ID: "T\ lQC)'.2)
Correction F~r: Cooler Temp Corrected {0C):
\rt0.'et
Type of :'.6: ,9 ~v
0 Blue D ~on~· ~amples on ice, cooling process has begun
Biological.Tissue Frozen? Oves qo O N/A
Temp should be above(~~ing to 6°C
USDA Regulated Soil l'1,.ylN/A, water sample)
Did samr~riginate in a quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (intf]n~onally,
0 Yes o · including Hawaii and Puerto Rico)? O ves Ne
Chain of Custody Present?
Samples Arrived within Hold Time?
Short Hold Time Analysis (<72 hr.)?
Rush Turn Around Time Requested?
Sufficient Volume?
Correct Containers Used?
-Pace Containers Used?
Containers Intact?
Samples Field Filtered?
Sample Labels Match COC? SL -Includes Date/Time/ID/Analysis Matrix:
Headspace in VOA Vials (>5-6mm)?
Trip Blank Present?
Trip Blank Custody Seals Present?
CLIENT NOTIFICATION/RESOLUTION
Person Contacted:
Comments/Sample
Discrepancy:
Project Manager SCURF Review:
Project M anager SRF Review:
'-€Jves
qg.les
O ves
Oves
~s
~Yes
&es
071\tes -
Oves
~es
Oves
O ves
I Oves
Comments/Discrepancy:
0 No O N/A 1.
0 No O N/A 2.
'f3No O N/A 3.
({Z}No ON/A 4.
[)No O N/A 5.
0No O N/A 6.
0No ON/A
0No ON/A 7. ~
0No ~A 8. Note if sediment is visible in the dissolved container
0No ON/A 9. ...
0No tziN)A 10.
0No ~ 11.
0 No
'---" Field Data Required? 0Yes 0 No
Date/Time:
p~t~: 1 _____ '/_r,__ ____ _
Date: 0
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office (i.e.
Out of hold, incorrect preservative, out of temp, incorrect containers)
Page 12 of 13
&eAnalytica!"
Document Name: Document Revised: Sept. 21, 2016
Sample Condition Upon Receipt(SCUR} Page 2 of 2
Document No.: Issuing Authority:
I F-CAR-CS-033-Rev.01 ~ -,.
*Check mark top half of box if pH and/or dechlorination Projecl •
is verified and within the acceptance range for Due Oat.e: 02/16/17
PM: PTE
preservatiori samples. CLIENT : 92-Cat.awba V
wo#·9z3z9321
**Bottom half of box is to list number of bottles
I
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Project Name: PIN: 370312755477
Location: Hickory, Catawba County, North Carolina
Date: March 27, 2017 Project No. 17-308

APPENDIX D – WASTE DISPOSAL MANIFESTS

STAT Incorporated
Date
2/10/2017
Bill To Ship To
J & K Landscaping and Grading
PO Box 937
Hickory, NC 28603
P.O. Number Terms Rep Ship Manifest#
Net 30 217/2017 02072017
Quantity Item Code Description Price Each
1 315.0002 2/07/2017 -J& Landscaping - clean up fuel, water & 1,335.00
sludge; disposal of material and disposal of a 7,000 gallon
used fuel tank
Service charge of 1.8% on all accounts past 30 days.
Phone # [phone] Fax# [phone]
Total
Payments/Credits
Balance Due
www.statenvironu11:ntais1::rvic1::s.cum
Invoice#
85631
Items Attached
Amount
1,335.00
$1 ,335.00
$0.00
$1 ,335.00
STAT, INC. DAILY WORK SUMMARY
P.O. BOX 1443 LENOIR, NC 28645 ----Phone [phone]
Location Hickory, NC P.O. Date 217/2017
Customer Name JK Landscaping Job Name
Description of Work clean up of fuel, water & sludge
* * * * E UIPMENT 1t * * *
Description Hours Rate Total Description Hours Rate Total
Vac truck 3 $ 65 $ 195.00 $ $
lowbo 2 $ 60 $ 120.00 $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ TOTAL EQUIPMENT COST $ 315.00
* * Re ular Time * * LABOR * * Premium Time * *
Employee Name Class Hours Rate Total Employee Name Class Hours Rate Total
Gary Triplett SUP 3 $ 65.00 $ 195.00 $
Stan Ford ORI 2 $ 65.00 $ 130.00 $
Brandon Neal TC 3 $ 45.00 $ 135.00 $
$ $
$ $
$ $
$
$
$ $
$ $
$ $
$ $
$ $
$ $
$ Total Premium Time Cost $
Total Regular Time Cost $ 460.00 TOTAL LABOR COST $ 460.00
* * * * MATERIAL & MlSC. COSTS * * * *
Description Qty Units Rate Total Description Qty Units Rate Total
DYS $ non haz water/sludge 200 gal $ 0.30 $ 60.00
$ used 3k fuel tank 1 gal $ 500.00 $ 500.00
$ $.
$ $
$ $
$ $
$ $
$ $
$ s ·
$ $
$ $
$ $
$ $
$ $
$ TOTAL MATERIAL & MISCELLANEOUS COSTS $ 560.00
VERIAED & ACCEPTED BY DATE CERTIAED CORRECT BY DATE
CUSTOMER REPRESENTATIVE
3ES ARE PREPAID ON ~L OF LADING UNLESS MARKED COLLECT. '<l 5 ~ 0 \
.IGHT Bill OF LADING
ORIGINAL -NOT NEGOTIABLE Shipper No. ------'----
Carrier No. --~~-----
Date _2.~\1--l l1L...___ T
(Name of carrier) (SCAC)
~rwlse prcw)ded In hem 430, Sec.1. FROM: -5}(. L tl.i\J ~ L l\ (.) ; ()::;) -r Gr,wl ,;9 I Shipper I •1 I .
Street ~1 -L i 2 1~ 1-\~t Nf
L
City ) \ . L . H-· v <...; r-i State ,A) L Zip Code 7Y&,ot
>Code 2fS&,3 8 24 hr. Emergency Contact Tel. No. I Vehicle
Number
DESCRIPTION TOTAL QUANTITY WEIGHT CHARGES
)r UN or NA Number, Proper Shipping Name, (Weight, Volume, (Subject to RATE (For Carrier Hazard Class, Packing Group Gallons, etc.) Correction) Use Only)
; i ..... <l ti(.J £.5'f. -in O f"r
,J
)
oco
e. Y'\. ,.Q 1,$4 q~
', .... ·\t:.. t 0 \-sQO>S.q_ \' '{QC,\-\<..
:) l!1 ....,
I
:::::J NOD
· dedare that the contents of this
rient .,. tully and accurately
d above by lhe proper shtpplng name
classlfied, packed, rnarked and
placarded. and a,e In all respects In
:ondltion for lranspon according to
,le ln1ernat1ona1 and n11tlona.l
ental regulations.
;//}/;{/ Signature .. ,
J
REMIT
C.0.D. TO:
ADDRESS
COD
C.O.D. FEE:
PREPAID O
Amt:$ COLLECT O $
Subject to Sectlon 7 of the concfiUOnG, if this shipment is \0 be TOTAL delivered lo the consignee without re-course on the consignof, the
consignor shall sign the foMOWM'lg statement CHARGES $ The c:arrie.-shall not make delivery °' this ~elll without FREIGHT CHARGES payll'le01 of freight and all other lawful ch&f'lleS.
FREIGITT PREPAID Check bo• w d>a,ges ~=~xat o ar~
(Sionatuteo1Comlgn()r>
de5tJnation ana as to~ party at an, rime inter~ In alt or 8ff'f said prop81"t)'. that every seMce to be par10ffT?G(l , heretJllOe,r ,nai be 1-lJbi&et ro all the bl ol tadlng klrms and condi11oos In the govemlng Classification on lhe date of
&hipnu1rrt. Shipper hereby cert!Nes that he is lamflar whh al the latfn~ terms and conditions In lhe goven-ing olB.Ssilication and the uld terms and conciUons are hereby agreed to~ the &hipper and accap!ed for t'frnsatf and Ms as,)gns.