MO-7037_27784_CA_CLO_20041004_Underground Storage Tank Closure Report

MICHAEL F. EASLEY
GOVERNOR
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
October 15, 2004
LYNDo TIPPETT
SECRETARY
Mr. Steve Bograd, LG E $ '
R "
NCDENR, Mooresville Regional Office £;z. Vy
610 East Center Avenue, Suite 301 0 C T 1 9 2004
Mooresville, NC 28115
Subject: TIP: R-2248D AHO
iciF'i.tr�SLLtvi',"€tt €FF€C C
County: Mecklenburg
UST Closure Report, Franklin Blythe Property
NCDOT Parcel 15
8910 Vance Road, Charlotte
Dear Mr. Bograd:
Enclosed for your file is a copy of the UST Closure Report for the above referenced site.
During the construction of the Charlotte Outer Loop, the heating oil UST located on this
property was discovered. The NCDOT currently has a Temporary Construction Easement
on this parcel. After the construction of the Charlotte Outer Loop is complete, control of
the property will revert to the heirs of Franklin Blythe.
Property Owner: Ruth J. Blythe in care of Dorothy B. Canady
4921 South Hill View Drive
Charlotte, NC 28210
704-552-8729
Sincerely,
C kF.Parker, LG
GeoEnvironmental Project Manager
Geotechnical Engineering Unit
Enclosure
cc: William Wilhelm Division 10 Right of Way (w/ Enclosure)
File
MAILING ADDRESS: TELEPHONE: [phone] LOCATION:
NC DEPARTMENT OF TRANSPORTATION FAX: [phone] CENTURY CENTER COMPLEX
GEOTECHNICAL ENGINEERING UNIT BUILDING B
GEOENVIRONMENTAL SECTION WEBSITE: WWW.DOH.DOT.STATE.NC.US 1020 BIRCH RIDGE DRIVE
1589 MAIL SERVICE CENTER RALEIGH NC 27610
RALEIGH NC 27699-1589

PREPARED FOR:
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
1020 BIRCH RIDGE DRIVE
RALEIGH, NORTH CAROLINA 27610
RE C.".E
OCT 1 9 2004
REPORT ON:
UNDERGROUND STORAGE TANK CLOSURE REPORT
FORMER FRANKLIN BLYTHE PROPERTY
(PARCEL # 15)
8910 VANCE ROAD
CHARLOTTE, MECKLENBURG COUNTY, NORTH
CAROLINA
OCTOBER 2004
PREPARED BY:
AMEC EARTH AND ENVIRONMENTAL, INC.
OF NORTH CAROLINA
9800 WEST KINCEY AVE, SUITE 190
HUNTERSVILLE, NORTH CAROLINA 28078
CEodED
OCT 0 6 2004
NCDOT•Geokdrtal Urit

UNDERGROUND STORAGE TANK CLOSURE REPORT
General..I Information°
A. Ownership of UST(s)
1. Name of UST owner:
NA — Abandoned in NCDOT Right -of -Way
2. Owner address and telephone number:
Land owned by:
Ruth J. Blythe In care of Dorothy B. Canady
4921 South Hill View Drive
Charlotte, North Carolina 28210
Telephone: [phone]
B. Facility Information
1. Facility name:
Former Franklin Blythe Property Parcel #15
State DOT Project: (R-2248D)
WBS Element: 34410.3.21
Unknown content, filled with heating fuel & water
2. Facility ID #:
Not Applicable
3. Facility address, telephone number and county:
8910 Vance Road
Charlotte, Mecklenburg County, North Carolina
Telephone — N/A
C. Contacts
Primary contact person:
Mr. Cyrus F. Parker, L.G. - GeoEnvironmental Project Manager
North Carolina Department of Transportation - Geotechnical Engineering Unit
1020 Birch Ridge Drive
Raleigh, NC 27610
Telephone: [phone]
2. Closure contractor:
A & D Environmental and Industrial Services, Inc.
P.O. Box 484
High Point, NC 27261
Telephone: [phone]
3. Primary consultant:
AMEC Earth and Environmental of North Carolina
9800 West Kincey Ave., Suite 190
Huntersville, NC 28078
Telephone: [phone]
NCDOT TIP Number R-2248D)
WBS Element: 34410.3.28
Page I
October 4, 2004

Telephone: [phone]
4. Laboratory:
Prism Laboratories, Inc.
449 Springbrook Road
Charlotte, NC 28224
Telephone: [phone], State Certification # 402
D. UST Information
Tank
No.
Installation
Dates
Size in
Gallons
Liters
Tank Dimensions
Feet (Meters)
Last Contents
Previous Contents
(if any)
550
3.5 ft dia. X 7.5 ft long
1
Unknown
(2,082)
(1.07 m dia. X 2.29 m
Unknown
Heating Fuel
long)
E. Site Characteristics
1. Describe any past releases at this site:
There are no known previous releases of petroleum products that occurred at this site.
When AMEC arrived on -site for the August 5, 2004 UST removal, the UST had been removed
and was placed next to the pit by an unknown party. Petroleum odors were present and staining
was observed in soils beneath the UST. Holes had been made in the UST from unknown party
causing leakage during removal. A flame ionization detector (FID) was used during field
screening of soils.
2. Is the facility active or inactive at this time? If the facility is inactive note the
last time the UST was in operation:
At the time of closure the site was occupied by a former residential structure. The residential
structure is being relocated for the beginning stages of Interstate 485 (1-485). The last active
use of the UST was some time before the clearing of the land for 1-485. The site is shown in
Photographs 3 and 4 in Appendix A. The UST's previous contents were heating fuels.
3. Describe surrounding property use (for example, residential, commercial,
farming, etc.)
In the past, the surrounding properties of the site were all residential. Currently, to the south of
the site is wooded area and north, east, and west of the site is cleared land. Vance Road runs
east to west on the north side of the property.
Figure 1 presents the surrounding site area.
NCDOT TIP Number R-2248D)
WBS Element: 34410.3.28
Page 2
October 4, 2004

4. Describe site geology/hydrogeology
The Former Franklin Blythe property is located in the Charlotte Belt of North Carolina. The
Charlotte Belt consists of metamorphosed quartz diorite. The metamorphosed quartz
diorite consists of intrusive rocks that are strongly foliated to massive. The general age of
the rocks is 350 to 650 million years old.
Soils encountered during excavation consisted of approximately six inches of surface cover
(fine-grained sandy silt topsoil) overlying 2-3 feet of reddish orange, micaceous, dry silt with
minor plasticity. Underlying the silt is saprolite, consisting of yellow and tan sandy silt with
minor clay and black manganese staining. The top of bedrock was not encountered. An
excavation log is included as Appendix B.
Groundwater was not encountered in the excavation. The site is situated very near a local
topographic high. The local topography suggests that ground -water flow is likely toward the
southwest in the site vicinity. The excavation extended to a depth of 15.2 feet (4.63m) below
ground surface (bgs).
A well survey was not undertaken since groundwater was not encountered. See Table 1.
A. Describe preparations for closure including the steps taken to notify
authorities, permits obtained and the steps taken to clean and purge the
tank(s):
On March 22, 2004 AMEC was presented with a Request For Technical and Cost Proposal of a
UST closure at the Blythe property, 8910 Vance Road, Parcel 15, from NCDOT. Notice to
proceed was given on April 9, 2004 by NCDOT to AMEC. The UST had been discovered during
preparation for the Interstate 485 Bypass around Charlotte. It was noted that the UST formerly
contained heating oil and was thus considered unregulated. AMEC performed a site visit on
March 31, 2004 to assess UST conditions. A second site visit was performed on the April 16,
2004 to vacuum fluids within the UST. Fluids were vacuumed by A&D Environmental of High
Point, North Carolina, (A&D). A vacuum hose was inserted into the UST via the fill port
accessible from ground surface above the UST. A total of 389 gallons (1,472.53 liters) of
heating fuel and sludge was removed from the UST for non -hazardous disposal. It was noted
on both visits that the residential structure remained in place. The UST was not to be removed
till the residential structure was relocated. The structure was relocated in late July.
A Notice of Intent: UST Permanent Closure or Change -In -Service form (GW/UST-3) was
completed and faxed to the North Carolina Department of Environment and Natural Resources
(NCDENR) Division of Waste Management (DWM) Mooresville Regional Office. A Construction
NCDOT TIP Number R-2248D)
WBS Element: 34410.3.28
Page 3
October 4, 2004

43
C.
V
1.
Fire Permit was also completed as part of UST Closure Activities and is presented as Appendix
1.
Closure activities commenced on August 5, 2004. A permit was obtained from the Mecklenburg
County Fire Marshal, to remove the UST from the site. Upon arrival, AMEC field personnel
noticed that the UST had been removed from its bed and placed on the ground next to the tank
bed (Photograph 1). The bed was left open with strong petroleum odors emanating. The Fire
Marshal was on -site to issue the permit and to witness the removed UST.
Figure 2 presents the site layout depicting the former UST location and excavation.
Note the amount of residual material pumped from the tank(s):
On April 16, 2004 approximately 389 gallons (1,472.53 liters) of liquid classified as non-
hazardous contaminated heating fuel and sludge were removed from the UST by a vacuum
pump truck prior to its excavation. A&D transferred the fluids from the UST to their vacuum
truck. By the time of the August 5, 2004 removal, the UST had filled with approximately 35
gallons (132.49 liters) of liquid classified as non -hazardous contaminated water and sludge that
were removed before disposal.
Describe the storage, sampling and disposal of the residual material:
The heating fuel, water and sludge removed from the UST were temporarily stored in a vacuum
truck until they were transported by A&D for disposal. The heating fuel, water and sludge were
taken to a water separator facility. Appendix C includes the Certificate for Disposal for the
removed liquids.
The UST was removed by A&D and taken to
Carolina. It was removed and disposed of in
includes a copy of the tank disposal certificate.
Excavation
D.H. Griffin Scrap Metals of Greensboro, North
accordance with API 1604, 1987. Appendix D
Describe excavation procedures noting the condition of the soils and the dimensions
of the excavation in relation to the tank, piping and/or pumps:
Since the UST was removed before AMEC personnel arrived on site on August 5, 2004, AMEC
immediately interviewed the NCDOT personnel regarding the UST. They indicated that they
were unaware of the unsupervised removal activities and that it could have been done by one of
the contractors, contracted by NCDOT for the 1-485 project.
The UST had been removed and placed on the ground next to the open bed. Soils excavated
during the removal were stock piled to the east of the bed. AMEC noted petroleum odors and
some staining on the underlying soil. Before the continuation of the excavation, two soil
samples were collected at the bottom of the exposed bed. All AMEC directed excavation
activities were conducted using a backhoe operated by A&D personnel on August 5, 2004. A
total of six confirmatory soil samples were taken from the bottom and the sidewalls of the
excavation. Soils impacted with petroleum hydrocarbons were excavated and stocked piled on
the east side of the bed till the completion of the excavation and then loaded for transport to a
non -hazardous waste disposal landfill. A&D transported petroleum -contaminated soils to
Environmental Soil Inc. located in Shelby, North Carolina. The excavation was then back filled
NCDOT TIP Number R-2248D)
WBS Element: 34410.3.28
Page 4
October 4, 2004

in with clean backfill. The dimensions of the final excavation were approximately 19 feet
(5.79m) long by 11 feet (3.35m) wide by 15.2 (4.63m) feet deep (Photograph 5).
Visual inspection and screening with a field -calibrated FID was performed on soils removed
from the excavation. Soils from directly beneath the UST did indicate the presence of petroleum
hydrocarbons. FID responses and odors were observed in the soils. The excavation was
continued until there were no FID responses.
Upon inspection of the relocated UST numerous holes were observed. It had also been partially
crushed (Photograph 2). Piping and vents had been removed previously.
Before the UST was removed, it was placed on poly and emptied by the vacuum truck. Once
the UST was lifted onto a truck, soil was excavated under where the UST had been relocated in
the event that fluids had seeped out.
2. Note the depth of tank burial(s) (from land surface to top of tank):
The UST was fully removed from the ground prior to AMEC's arrival on site.
3. Quantity of soil removed:
As part of the UST removal, A&D excavated approximately 18.80 tons of apparently impacted
soils. The soils were field screened with a combination of FID readings and visual observations.
Soils deemed impacted through field screening were loaded onto trucks and disposed of at
Environmental Soils, Inc. of Lattimore, NC.
4. Describe soil type(s):
The soil removed for the UST closure consisted of fine-grained sandy clayey silt. The soils were
red brown, semi -plastic, stiff, and dry. The soils are considered to be residual and derived from
chemical weathering of the underlying metamorphic parent rock. Competent bedrock was not
encountered during UST closure.
5. Type and source of backfill used:
The excavation was backfilled with material from the Arart Quarry, in Dobson North Carolina.
The material was fine-grained sandy clayey silt.
E. Contaminated Soil
Soils believed to be impacted were disposed by A&D in a manner approved by the NCDENR.
Appendix E includes the Certificates for Disposal for the removed soils.
Note: Suspected contaminated soil should be segregated from soil that appears to be
uncontaminated and should be treated as contaminated until proven otherwise. It should not be
used as backfill.
NCDOT TIP Number R-2248D)
WBS Element: 34410.3.28
Page S
October 4, 2004

Describe how it was determined to what extent to excavate the soil:
Soils removed from the excavation were screened in the field using a calibrated FID to
determine if the soil had been impacted by petroleum hydrocarbons. The soil was screened
immediately after removal from the excavation while still in the backhoe bucket. Soils indicating
the presence of organic vapors and petroleum odors were encountered. Excavation and field
screening continued until soils were encountered that had no indication of petroleum impact.
Final field screening results are presented in Table 2.
2. Describe method of temporary storage, sampling and treatment/disposal of soil:
Soils believed to be contaminated were field screened then stock piled on site. They were later
loaded onto trucks for disposal and treatment at Environmental Soils Inc. facility. The treatment
methods employed were those needed to eliminate gasoline and diesel range compounds.
III.Site investigation
A. Provide information on field screening and observations, include methods
used to calibrate field screening instrument(s):
Field screening was performed using both FID readings and visual observations during the
removal activities. The FID was used to screen soil samples from excavated areas for
petroleum hydrocarbons. Visual staining was observed within the soils.
The FID was calibrated on -site using calibration gases.
Table 2 in Section VI summarizes the results of the FID field screening for the UST removal.
B. Describe soil sampling points and sampling procedures used:
Note: Refer to the "Groundwater Section Guidelines for the Investigation and Remediation of
Soils and Groundwater" for information about sampling requirements.
Two soil samples were collected from the bottom of the exposed bed, respectively, where
petroleum odors, FID responses and some staining on the soil were noted. At the approximate
depth of 4 feet below grade surface (bgs) (1.22m), soil samples 15-SS-01 and 15-SS-02 were
taken directly beneath the UST's former location.
Excavation was initially performed in all directions to a distance of approximately 2 feet (0.61 m)
from the UST's former location. Continued FID responses were observed. Excavation was
continued until field screening did not indicate the presence of petroleum hydrocarbons in the
sidewalls. Due to restriction of the reach on the backhoe the excavation could only reach a
depth of 15.2 feet (4.63m). The final field screening still indicated slight impact at the floor
bottom.
A total of eight soil samples were taken within the excavation pit. In addition to the two samples
mentioned, six soil samples were taken from the pit floor and sidewalls after additional
excavation was completed. Soil samples. 15-PE-Bl and —132 were taken from the final
excavation floor at 15.2 feet (4.63m) bgs directly beneath the UST centerline. Soil samples 15-
NCDOT TIP Number R-2248D)
WBS Element: 34410.3.28
Page 6
October 4, 2004

PE-N3, -E4, -W5 and —S6 were collected at the approximate depths of 12 feet (3.66m) bgs from
the excavation sidewalls. Sample locations are shown on Figure 3.
All samples collected from the excavation pit were analyzed for total petroleum hydrocarbons
(TPH) gasoline range organics (GRO) and TPH diesel range organics (DRO). All sampling was
performed according to NCDENR's Guidelines for Tank Closure dated September 2003.
Sample depths and analyses are shown in Table 3.
C. Describe groundwater or surface water sampling procedures used:
Note: Refer to the "Groundwater Section Guidelines for the Investigation and Remediation of
Soils and Groundwater" for information about sampling requirements.
The UST excavation extended to a depth of 15.2 feet (4.63m) bgs. Soils in the base of the
excavation were dry. No groundwater or surface water was encountered during UST removal
activities. Consequently, no water samples were collected.
D. Quality control measures
All samples were collected using nitrile-gloved hands to fill sample containers. Samples were
placed into clean, laboratory -supplied, glass sample containers, compacted to minimize
headspace, and immediately placed on ice for preservation. All samples, that were collected,
were hand delivered to Prism Laboratories, Inc. of Charlotte, North Carolina (NC Laboratory
Certification Number 402) within 48 hours of the sampling time. All samples were properly
labeled and recorded on chain -of -custody, which accompanied the samples at all times. A copy
of the chain of custody is included in Appendix F.
Table 3 lists all of the samples collected and the analyses performed on each sample. A copy of
the complete analytical results and laboratory QA/QC data is included in Appendix G.
E. Investigation results
Laboratory analyses of the two UST closure samples, collected directly underneath the UST's
former location, did report TPH/GRO detections of 77 and 14 mg/kg in samples 15-SS-01 and
15-SS-02, respectively. The TPH/DRO detections were measured to be significantly elevated
with 25,000 mg/kg in sample 15-SS-01 and 33,000 mg/kg in 15-SS-02. The initial action levels
for GRO and DRO are 10 mg/kg. All TPH/GRO and DRO results are presented on Figure 3 and
tabulated in Table 4.
The soil from the area of the UST closure samples was removed and further excavation
occurred vertically and horizontally. Results from the two confirmatory post -excavation floor
samples indicated no further measurable release in the gasoline range for both samples or in
the diesel range for one sample. Sample 15-PE-132, however, from the eastern side of the floor
indicated a TPH-DRO of 38 mg/kg.
Confirmatory post -excavation sidewall sample results also indicated some residual impacted soil
remaining. TPH-GRO was measured in just one sidewall sample, the southern, at 53 mg/kg.
The corresponding TPH -DRO in the southern sidewall sample was 26,000 mg/kg. TPH-DRO
was not measurable in the northern or eastern sidewall samples, but minimally reported at 12
mg/kg in the western sidewall.....
Sample locations and analytical results are presented on Figure 3 and compiled in Table 4.
Appendix G presents a copy of the laboratory analytical report.
NCDOT TIP Number R-2248D)
WBS Element: 34410.3.28
Page 7
October 4, 2004

F. Exploration For Additional USTs
The property was surveyed for indication of any other UST and none were found.
Include probable sources of contamination, further investigation or remediation tasks, or whether no
further action is required.
The following conclusions can be drawn based on the field and laboratory data resulting from the
August 5, 2004 UST closure;
• The former heating oil tank caused a release to the subsurface soil;
• Impacted soils with gasoline range impact have been removed vertically;
• Impacted soils with diesel range impact have almost been removed vertically, with the
exception of a detection of 38 mg/kg in one floor sample;
• Excavation has accomplished the removal of gasoline and diesel range impacted soils to
the north and east of the former UST's location;
• Excavation has accomplished the removal of gasoline range impacted soils and most of the
diesel range impacted soils to the west, with a 12 mg/kg of DRO remaining.
• In the direction of the southern sidewall impacted soils remain particularly in the diesel
range where 26,000 mg/kg was measured in the confirmatory sample despite little to no
field indication of contamination;
• The heating oil UST release likely occurred some time ago. The lack of much staining and
the lack of volatile fuel components as noted by the FID during UST closure suggests that
the released petroleum product was already quite weathered by the time of UST removal;
• Based on the lack of ground -water interception and the excavation floor sample results,
impacted ground water is not expected underlying this site;
• It is recommended that further excavation or exploratory drilling and sampling occur in the
direction south of the former UST location; and,
• It is recommended that a type of field test kit or fast turnaround lab analysis is utilized to
improve identification of the weathered petroleum release in soils.
NCDOT TIP Number R-2248D)
WBS Element: 34410.3.28
Page 8
October 4, 2004

V. Signature of Professional Engineer or Licensed Geologist
❑Licensed Geologist Li
Im4Fm"jI,,w,w,4- 10
mh M40
Helen Corley, LG
ttlyy®10/111/®/0j,,
f A,90
IV
SEAL
1485
� CL®G\c��®o�
�Qo,qprwa�AapY@ a� � ®®
®eaaeesoa®®
North Carolina License # 1485
Anna Turlik
Engineering Technician
NCDOT TIP Number R-2248D)
WBS Element: 34410.3.28
Page 9
October 4, 2004

VI Enclosures
A. Figures
Area Map(s) (can be USGS Topographic Quadrangle) showing:
• Adjacent streets, roads, highways with names and numbers
• Buildings
• Surface water bodies
• Groundwater flow direction (if available)
• Scale
• North arrow
2. Site map of UST excavation area drawn to scale, showing:
• Buildings
• Underground utilities such as sewer lines and other conduits
• Orientation of UST(s), pumps, and product lines
• Sample locations for GRO and DRO (identified by letter or number)
• Final limits of excavation
• North arrow
• Scale
• Sample locations and identifications
• Analytical results
• Final limits of excavation(s)
3. Site map of UST excavation area drawn to scale, showing:
• Sample locations for 8260, 8270, EPH & VPH
• Along with items noted in map 2
4. Site map of UST excavation area drawn to scale, showing:
• Estimated area of contamination remaining
• Along with items noted in map 2
B. Tables
1. Water Supply Wells within a 1500' (457.2m) radius
2. Field screening results
3. Sample identifications, depths and analyses
4. Sample identifications with results and dates that samples were taken
C. Appendices
Appendix A: Photographs
Appendix B: Geologic Log for Excavation
Appendix C: Fluid Disposal Certificate
Appendix D: Certificate of Tank Disposal
Appendix E: Soil Disposal Certificates Complete
Appendix F: Chain -of -Custody Records
Appendix G: Copy of All Laboratory Analytical Records
Appendix H: UST-2 Form, Site Investigation Report for Permanent Closure or Change -in -Service of UST
Appendix I: Construction Fire Permit

TABLES

Table 1
Water Supply Wells
Within 1,500-Foot (457.2Meter) Radius
Distance/Direction and
Address Active? Depth
Topographic Relation
No ground water was encountered; soils were dry at 15.2 feet (3.50m) below ground surface; No well survey necessary

Table
Field Screening Results
Field`Observations/ _
Date
Sample Location"
FID Measurements in
arts per million
August 5, 2004
North end, midline of 550 gallon UST, -4 feet
978
1.22m bgs
August 5, 2004
South end, midline of 550 gallon UST, -4 feet
259
1.22m bgs
August 5, 2004
South end, midline of 550 gallon UST, -15.2 feet
4.63m bgs
0.0
August 5, 2004
North end, midline of 550 gallon UST, -15.2 feet
0.8
4.63m bgs
August 5, 2004
North sidewall, -12 feet (3.66m) bgs
2.1
August 5, 2004
East sidewall, -12 feet (3.66m) bgs
0.8
August 5, 2004
West sidewall, -12 feet (3.66m) bgs
1.2
August 5, 2004
South sidewall, -12 feet (3.66m) bgs
0.0

Table 3
Sample Information
Sample Identification
Depth of Sample (bgs)
Analyses Performed
15-SS-01
-4 feet (1.22m) bgs
EPA Method 8015MOD/5030
15-SS-02
-4 feet (1.22m) bgs
EPA Method 8015MOD/5030
15-PE-B1
-15.2 feet (4.63m) bgs
EPA Method 8015MOD/5030
15-PE-62
-15.2 feet (4.63m) bgs
EPA Method 8015MOD/5030
15-PE-N3
-12 feet (3.66m)bgs
EPA Method 8015MOD/5030
15-PE-E4
-12 feet (3.66m)bgs
EPA Method 8015MOD/5030
15-PE-W5
-12 feet (3.66m)bgs
EPA Method 8015MOD/5030
15-PE-S6
-12 feet (3.66m)bgs
EPA Method 8015MOD/5030

Table 4
Analytical Detections
Sample Identification
Initial Action Level for
`TFH
Analytical Results (mg/kg)
15-SS-01
GRO 10
77
DRO 10
25,000
15-SS-02
GRO 10
14
DRO 10
33,000
15-PE-B1
GRO 10
ND
DRO 10
ND
15-PE-B2
GRO 10
ND
DRO 10
38
15-PE-N3
GRO 10
ND
DRO 10
ND
15-PE-E4
GRO 10
ND
DRO 10
ND
15-PE-W5
GRO 10
ND
DRO 10
12
15-PE-S6
GRO 10
53
DRO 10
26,000

FIGURES

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FIGURE I
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TEMPORARY
CONSTRUCTION
EASEMENT
15
FRANKLIN BLYTHE
DB 1602 PG 1 X
Location of UST upon
AMEC's arrival.
Xx
x
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X
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Legend
® Soil Sample Location Beneath UST
♦ Post Excavation Soil Sample Location
1:::3 Limits of Excavation
ID Former Location of House
Site Map
8910 Vance Rd (Parcel 15)
Former Franklin Blythe Property
Auaust 2004
rDRAWING NAME: J;\NCDOT\Yanoa I DATE: 1014104
I SCALE: 1 Snoh a 30 fact '"T I a,HpC I ,
PREPARED FOR:
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NCDOT PROJECT / (R-2240D)
GEOTEC9NICIL UNIT
LIDS ELEMENT: 34410.3.21
PREPARED BY: I FIGURE:
9800 T KINCEY AVE
SUITE iWES90 FIGURE 2
HUNTERSVILLE, NC 28078
[phone]

15-PE-WS
75-PE-W5 (12.0' bgs)
GRO I ND
DRO 1 12
15-PE-B1,
15-PE-B1 (15.1' bgs)
GRO I ND
DRO I ND
1 S-PF-S
15-PE-S6 (12.0' bgs)
GRO
53
DRO
26,000
15-SS-02------
15-SS-02 (4.25' bgs)
GRO 1 14
DRO 1 33,000
15-PE-E4
15-PE-E4 (12.0' bgs)
GRO
ND
DRO
ND
,15-PE-B2
15-PE-B2 (15.1' bgs)]
GRO I ND
D RO 1 38
j
15-SS-01
I
15-SS-01 (4.25' bgs)
GRO 77
DRO 25,000
15-PE-N3
15-PE-N3 (12.0' bgs)
GRO
ND
DRO
ND
Note:
To Vance Rd.
11
GRO
Lime]
bgs
/,36)/
KD
ActionLeveQare��igchlig�itededin boldespective
Soil Sample Location Beneath UST
Post Excavation Soil Sample Location
Limits of Excavation
Former Location of House
Gasoline Range Organics
Diesel Range Organics
below grade surface
Parcel 15
Former Franklin Blythe
Property Sample Locations
August 2004
DRAWING NAME: LCDOT Yanot DATE: 8/76/04
SCALE: Iftnoh - f0 1�ot °RIMY "RPC '
PREPARED FOR:
NC Department of 71�tton
NCDOT PRO✓6CT # (R-8848D)
GBOTSCD'NICAL UNIT
1BS RLMENT: 34410.3.21
PREPARED BY: FIGURE:
9800 WEST KINCEY AVE
SUITE 190 FIGURE 3
HUNTERSVILLE, NC 28078
[phone]

Appendix A
Photographs

ameO
Photograph 1: Location of UST upon AMEC's Arrival on August 5, 2004.
Photograph 2: Crushed UST

Photograph 3: Looking North and East towards adjacent properties.
Photograph 4: Looking East towards stock pile.

•
-111 M-Q
Photograph 5: Looking North into the bottom of Excavation Pit.
Photograph 6: Beginning Stages of Clean Up.

W
--
i_
g-n
P
AM

Photograph 9: UST being loaded for transport.
Photograph 10: Partially hackfilled pit with clean dirt.

Photograph 11: Site restored to original condition.

.1140iMmso'l lof4iK] us -sfp�'. , I I ftqj; ixi"I,"141

Appendix B
Geologic Log for Excavation

PROJECT NAME: NCDOT — UST Permanent Closure and Soil Excavation — 8910
Vance Rd., Charlotte, Mecklenburg County, North Carolina, 28216
PROJECT NUMBER: 2-7763-R248
EXCAVATION COMPANY: A&D Environmental
OPERATOR:
PAGE 1 OF 1
DATE: August 5, 2004
COMPLETION DEPTH: 15.2 ft
WATER LEVEL: N/A
II EXCAVATION EQUIPMENT: Backhoe II LOGGED BY: Anna M. Turlik II
NOTES: Logged directly beneath UST
0.0
(0.0)
0.3
(0.09)
Red Orange, micaceous silt, dry w/ minor clay,
minor plasticity, saprolite with yellow -tan mottling
ML
Petroleum Odor;
FID = 978
0.3
9.0
Orange, micaceous silt, dry and brittle non -plastic,
ML
Petroleum Odor;
(0.09)
(2.74)
saprolite with yellow -tan mottling
FID = 510 to 658
9.0
15.2
Orange, micaceous silt, dry and brittle non -plastic,
ML
Light Petroleum
Odor; FID = 45.8
(2.74)
(4.63)
saprolite with yellow -tan mottling
to 105.2

Appendix C
Fluid Disposal Certificate

GENERATOR INFORMATION :«::::<:::>::«::>:::::::>:>�:::»:::<>::<:::::<>:_�.:::<.:<:>�::::;•:::»::<::::>:<>:>::>::»»>:>;::;:>:::::;:><:;::::>::::»:::::.
Name
US EPA ID No.
Street Address
Mailing Address
Phone No.
Contact
DESCRIPTION OF MATERIALS
USDOT Proper Shipping Name
Hazard
UN / NA
Packing
Containers
Total
Unit
HM (Complete All Items for Hazardous Materials
Class or Div.
ID No.
Group
Qty. Type
Quantity
Wt./ Vol.
a.
b.
C.
ADDITIONAL INFORMATION
ERG No.
A;&.D:Prnflle:Code
, : t aCilfty ilse
a.
,..
......:::_:;..:
.;
•w:::..:.: �:
:.: v.:...
b
c.
..
GENERATOR'S CERTIFICATION
This is to certify that the above -described materials are properly classified, described, packaged, marked and labeled, and are in
proper condition for transportation according to the applicable regulations of the Department of Transportation. I further certify
that none of the materials described above are a hazardous waste as defined by EPA 40 CFR Part 261 or any applicable state law,
and unless specifically identified above, the materials contain less than 1,000 ppm total halogens and do not contain quantifiable
levels 2 m of PCBs as defined by EPA 40 CFR Parts 279 and 761.
Printed I Typed Name
Signature -'"
Mo. / Day I Yr.
TRANSPORTER INFORMATION
Transporter
i hereby acknowledge receipt of the above -described materials for transport
A & D ENVIRONMENTAL AND INDUSTRIAL SERVICES
from the generator site listed above.
Address
2718 UWHARRIE ROAD
J
ARCHDALE, NC 27263
Signature Shipment Date
I hereby acknowledge that the above described materials were received
from the generator site and were transported to the facility listed below.
Transporter or
Unit No.
EPA ID No. NCD986232221
Phone [phone]
`
Signature - Delivery Date
INFORMATION
:::.::.:..`::;:.;::':."...::.`.::.::':::.:::::;`.::.;;;:;:>:><::::
::..........FACILITY
.....:..:
Facility
l hereby acknowledge receipt of the materials covered by this manifest
A & D ENVIRONMENTAL AND INDUSTRIAL SERVICES
except for any discrepancy noted below.
Address
2718 UWHARRIE ROAD
ORMUNAI - Facility Rafninr r1PY 7 - Roturn to r:onarntnr (-r)PY 3 - Tranennr Pr Retain COPY d - riPnFrntnr Retain

Name
✓Mailing
Street Addiess
Address
Phone No.
J,
Contact
DESCRIPTION OF MATERIALS
USDOT Proper Shipping Name
Hazard
UN/NA
Packing
Containers
Total
Unit
HMI (Complete All Items for Hazardous Materials)
Class or Div.
ID No.
Group
at . Type
Quantity
WtJ Vol.
a.
B
10:
ADDITIONAL INFORMATION ERG No. ::A:& 0 Profile:Code,
. . .. ......
.. ...............
a. ...... .. . . ........... ...... ...
... .. .... ....
.................................. ....................................
...........
...............
b. ........ . ..........
......... .......
........ .. .......... .... . . . ... ...
.......... . ........... ......... ... ..... .........
. . ........ .......... ......... .... ......... ..... 11 .....
................. ....
... .. .... ... .........
C-1 ....... ....... ...... ......... ... .........................
. ............. ............ .
GENERATOR'S CERTIFICATION
This is to certify that the above -described materials are properly classified, described, packaged, marked and labeled, and are in
proper condition for transportation according to the applicable regulations of the Department of Transportation. / further certify
that none of the materials described above are a hazardous waste as defined by EPA 40 CFR Part 261 or any applicable state law,
and unless specifically identified above, the materials contain less than 1,000 ppm total halogens and do not contain quantifiable
levels (2 ppm) of PCBs as defined by EPA 40 CFR Parts 279 and 761.
Printed Typed Name Signature Mo. l Day I Yr.
..........
..................
TRANSPORTER INFORMATION .. ..
Transporter I hereby acknowledge receipt of the above -described materials for transport
A & D ENVIRONMENTAL AND INDUSTRIAL SERVICES from the generator site listed above.
Address
2718 UWHARRIE ROAD
Signature Shipment Date
ARCHDALE, NC 27263
1 hereby acknowledge that the above -described materials were received
Transporter or
Unit Np.,-
from the generatorsite and were transported to the facility listed below.
EPA ID No, NCD986232221
Phone [phone]
Signature Delivery Date
.... . ..... . .... FACILITY
INFORMATION•.
. . . . .....
... . . . . ....
Facility
/hereby acknowledge receipt of the materials covered by this —manifest
A & D ENVIRONMENTAL AND INDUSTRIAL SERVICES
except for any discrepancy noted below.
Address
?-'S LTWHARRIE ROAD
Signature Receipt Date
NC 27263-
Q' a cjes I.Rouflnc� Codes I P,,ihd
... .............
..........
Phone.......
.... ............ ............ ...........
[phone]
........ ..... .................
Contact
...... j
............ ...................
ERIC McMANUS
.. ......... .. . .... .. .. ....
.... . .................. ... . ....
....... ...... . ........ ...................
fnDv (.r)PV 3 - Tr!2ncnnr4Pr Retain CnPY 4 - Generator Retain

A&D 10125
AManifest Document No.
MATERIAL & Environmental and -
MANIFEST D Industrial Services, Inc. Pige7 of ,.
EMERGENCY PHONE NO. POST OFFICE BOX 484 TEL [phone] A8:7:;Jofs:;iVo,
HIGH
POINT, 6
434 - 75 0
P NC 272 2 FAX [phone]
800 7
>;>r
GENERATOR O INFORMATION
I F
Name US EPA ID No.
j
Stf6et Address "` ez Mailing Address Phone No.
Contact
DESCRIPTION OF MATERIALS
USDOT Proper Shipping Name Hazard UN I NA Packing Containers Total Unit
HM (Complete All Items for Hazardous Materials Class or Div. ID No. Group Qty. Type Quantit Wtj vol.
a.
ram:
b.
C.
ADDITIONAL INFORMATION' ERG No. :A rs:,q,Proflle:Code _aclllty iJse
a
,
s-�
::::::
b.
c
GENERATOR'S CERTIFICATION
This is to certify that the above -described materials are properly classified, described, packaged, marked and labeled, and are in
proper condition for transportation according to the applicable regulations of the Department of Transportation. I further certify
that none of the materials described above are a hazardous waste as defined by EPA 40 CFR Part 261 or any applicable state law,
and unless specifically identified above, the materials contain less than 1,000 ppm total halogens and do not contain quantifiable
levels 2 m of PCBs as defined by EPA 40 CFR Parts 279 and 761.
Printed ! Typed Name Signature Mo. I Day! Yr.
TRANSPORTER INFORMATI
ON
R R I
Transporter ! hereby acknowledge receipt of the above -described materials for transport
A & D ENVIRONMENTAL AND INDUSTRIAL SERVICES from the generator site listed above.
Address
2718 UWHARRIE ROAD Signature Shipment Date
ARCHDALE, NC 27263 I hereby acknowledge that the above -described materials were received
Transporter or Unit No.,. from the generator site and were transported to the facility listed below.
EPA ID No, NCD986232221,
Phone [phone] Signr
ature Delivery Date
C INFORMATION
...............................................................................:.........:::......................
Facility i hereby acknowledge receipt of the materials covered by this manifest
A & D ENVIRONMENTAL AND INDUSTRIAL SERVICES except for any discrepancy noted below.
Address
2718 UWHARRIE ROAD
Signature ."- Receipt Date
�CF-iD.�?.E, NC 2?2�3 � �,;s�i-eba�cres i.=ccautinc Codes i 'r?�rsdTirib'fi�efho.��_:: ,
l-. '.
Nc.
`'none
[phone]
Contact C
ERIC MCMANUS -
ORIGINAL - Farility Potnin rOPY 7 _ Potnrn to r Amorntnr rr)PY 3 _ Trnnennrtor Potnin COPY d - r;onorntnr Pptain

Appendix D
Certificate of Tank Disposal

A
& Environmental and Industrial Services
DP.O. Box 484 • High Point, NC • Phone [phone] • FAX [phone]
TANK DISPOSAL MANIFEST
1) Tank Owner/Authorized Representative:., Name and Mailing. Addressl"
�s
{
2) Tank Owner/Authorized Representative: Contact
Phone#: ' t, , a.
3) Description Of Tanks:
Tank No. Capacity Previous Contents Comments
OTIM-10 MR?
4) Tank Owner/Authorized
'- Representative Certification: The undersigned certifies that the above listed storage
tanks have been removed from the premises of the tank owner.
r.;
f
F ,tin _
PrintedlTyped Name Signature Month/DaylYear
5) Transporter: The undersigned certifies that the above listed storage tanks have been transported to A&D
Environmental' and Indtrstnal_vServides, 2748, Uwhame Road;"Archdale, N C:-.27263.'
PrintedlTyped Name Signature Month/DaylYear
6) Disposal Certification: The undersigned certifies that the above -named storage tank(s) have been cut
into scrap pieces and accepted by the metal recycling facility.
Recycling Facility:
Printed/Typed Name Signature MfontME) ay!Yea r

Appendix E
Soil Disposal Certificates Complete

.:...DRIVER IN TRUCK UNLESS -.CHECKED HERE —
Jdrgs and phone number to
GEf2TiFIED WR1�F1'� :.
(IF RAW) iQHj
998 SAT Scale CgMpany 04K

ENVIRONMENTAL SOILS, INC.
APPROVAL#
LOCATION OF SOIL
TRANSPORTER
P.O. BOX 295
LATTIMORE, N.C. 28089
704-434-0075
NON -HAZARDOUS PETROLEUM CONTAMINATED SOIL
MANIFEST#
F'L-.
l
TIME, g E
TRUCK #
GROSS WT.
'`.tBS.
DATE:
LICENSE #
TARE WT.
- :LBS.
DRIVER SIGNATURE
TIME:.
TRUCK#
GROSS WT.
LBS:
DATE:
LICENSE #
TARE WT.
LBS.
DRIVER
I ER SIGT A U RE
NATURE
TIME:
TRUCK #
GROSS WT.
LBS.
i
DATE:
LICENSE #
TARE WT.
LBS.
DRIVER SIGN
IGN AT UR E
ATURE
TIME:
'i.
TRUCK #
GROSS WT.
LBS.
DATE:
LICENSE #
TARE WT.
LBS.
DR V I ER SI GN ATU R E
TOTAL NET WT
.t I
TOTAL EQUIV-TONS
INSPECTED & ACCEPTED BY ENVIRONMENTAL SOILS, INC.
i
SUPERVISOR'S SIGN.^,TURE

ENVIRONMENTAL SOILS, INC.
P.O. BOX 295
LATTIMORE, N.C. 28086-0489
,704/434-0075
[phone] FAX
Job Name:
ENVIRONMENTAL SOILS, INC.
P.O. BOX,295
LATTIMORE, N.C...28086-0489
704/43470075
[phone] FAX
Job Name:.
ENVIRONMENTAL SOILS, INC.
RO. BOX 295:
LATTIMORE, N.C. 28086-0489
704/434-0.075
[phone] FAX

Environmental Soils Inc.
PO Box 295 - Lattimore, NC 28089
Phone 704r434-0075 - Fax [phone]
Non -Hazardous Waste Manifest # 116, F
Date Load Number
.(numbered sequentially as trucks are dispatched)
EArVIRONMENTAL CONS ULT,4NT-
Contact: -77 : 7
Phone: Fax:
GENERATOR:
Address: x5-- County:
Contact: Phone:
WASTE ORIGIN,4T]ONPOINT- Complete Address:
..,Class &Type of Contaminate in soil
SOURCE OF CONE431INATION.• (ex. UST or other source)
GENERATORS CERTIFICATION OF WASTE CONSTITUENTS.- In lieu ofsubmitting analytical data (metbods
8240 and.82 70). verjoing that the waste in question does not contain organic tonstituents other than those which would
normally ap n'analysisofvirgin pearipetroleumproduct residue, I am submitting this Certificate of Waste
i Constituents. I cert� that I anifamiliar with the source of contamination of the soil and furtber cert� the source, to
the best o that listed above. my hnowledge, contains no contaminants other than t
f i
TP,4NSPORTER-
Contact:
Phone:
As the carrier, I certify that the materials described above being shipped under this non -hazardous materials
manifest are properly classified, packaged, labeled, secured, and are in proper condition for transport in commerce
under the applicable regulations governing transportation, and I hereby receive this material for delivery to the
IV
facility designate.
Carrier Signature: Date:
TRUCK#: TAG #: VOLUME:
TRUCK DRIVER SIGNATURE: DATE:
DESTINATION.- Environmental Soils Inc.._,910 Crowdy Rd, Shelby, NC 28150 Dedicated Land Application
Site Permit #SR0300038'
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this material
for treatment and/or disposal in a manner that has been authorized by the Sate of North Carolina.
FP ",ty Signature
Name
,_ N L , i. d- -,:
Date:
White/Facility Canary/Invoice Pink/Carrier Goldenrod/Generator

?r
O GENERATOR INFORM
ATION
N
Name US EPA ID No.
F r �...:
Street Addr-ess Mailing Address Phone No.
f
Contact
DESCRIPTION OF MATERIALS
USDOT Proper Shipping Name Hazard UN / NA Packing Containers Total Unit
HM ____(Complete All Items for Hazardous Materials Class or Div. ID No. Group Qty. Type Quantity Wt./ Vol.
a. F
b.
C.
ADDITIONAL INFORMATION ERG No. A.&D:ProtileCode ;acillryIlse`
a.
b .'>;.»>
.:::......:..:..
GENERATOR'S CERTIFICATION
This is to certify that the above -described materials are properly classified, described, packaged, marked and labeled, and are in
proper condition for transportation according to the applicable regulations of the Department of Transportation. I further certify
that none of the materials described above are a hazardous waste as defined by EPA 40 CFR Part 261 or any applicable state law,
and unless specifically identified above, the materials contain less than 1,000 ppm total halogens and do not contain quantifiable
levels 2 m of PCBs as defined by EPA 40 CFR Parts 279 and 761.
Printed / Typed Name Signature v - Mo. i Day I Yr.
�., ;i
TRANSPORTER AT Transporter I hereby acknowledge receipt of the above -described materials for transport
A & D ENVIRONMENTAL AND INDUSTRIAL SERVICES from the generator site listed above. F
Address
2718 UWHARRIE ROAD
ARCHDALE, NC 27263 Signature r' „ Shipment Date
I hereby acknowledge jh*' the above -described materials were received
Transporter or Unit No. from the generatorsite`and weredransported'to the facility listed below.
EPA ID No. NCD986232221
Phone [phone] Signature ���' ;'' ` Delivery Date
..::..::....::.::.:.:.:.::..::.::.FAC
:ILIINFORMATION
:::.::: .
Facility, l hereby acknowledge receipt' of the materials covered by this manifest
A-'& DENVIRONMENTAL AND'R- DUSTRIAL,SERVICES` except for any discrepancy noted below.
Address
2718" UWHARRIE ROAD
Signature Receipt Date_
ARCHDAILE, NC 27263o ail lQ COdes- F ^ S I d l i nC. Msth CfS
hcnc l
[phone] k
CantactERIC McMANUSc
ORIGINAI - Facility Patain COPY 7 - RPtttrn fn GPnarafnr COPY 3 - Transnorter Retain COPY 4 - Generator Retain

Environmental Soils Inc.
PO Box 295 • Lattimore, NC 28089
Phone 704r434-0075• Fax [phone]
Non -Hazardous Waste Manifest #1 1 1P
Date Load Number e
(numbered sequentially as trucks are dispatched)
EAWRONMENT4L CONSULT4NT _ B
Contact: F r - f� Phone: TM 7 ax:
Address:
Contact:'
WASTE ORIGINATIONPOINT.•.Complete Address:
Class &Type of Contaminate in soil
SOURCE OF CONT4MINATION.• (ex. UST or other source)
f
County` �.
-Phone:
GENERATORS CERTIFICfITION OF WASTE CONSTITUENTS. In lieu ofsubmitting analytical data (metbods
8240 and.8270). tiering that the waste in question does not contain organic constituents other than those wbicb would
normally appear in analysis of virgi.npetroleunaproduct residue, Iam submitting this Certificate of Waste.
Constituents. I cert�o that I am familiar with the source of contamination ofthe soil and furtber certio the source, to
the best of my knowledge, contains no contaminants other than that listed above.
TRANSPORTER:
Contact: t'
Phone:
As the carrier, I certify that the materials described above being shipped under this non -hazardous materials
manifest are properly classified, packaged, labeled, secured, and are in proper condition for transport in commerce
under the applicable regulations governing transportation, and I hereby receive this material for delivery to the
facility designate.
Carrier Signature: Date:
TRUCK #: `� F
TAG #: �` VOLUME
t
TRUCK DRIVER SIGNATURE. DATE = " F
DESTINATION.- Environmental Soils Inc. 910 Crowdy Rd, Shelby, NC 28150 Dedicated Land Application
Site Permit #SR0300038
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this material
for treatment and/or disposal in a manner that has been authorized by the Sate of North Carolina.
cility Signature: Date:
Company Name
Title:
White/Facility Canary/Invoice Pink/Carrier Goldenrod/Generator

A&D 1019,5
Manifest Document No.
Page of
Name US EPA ID No.
Street Address Mailing Add riss Phone No,
AD
Contact
DESCRIPTION OF MATERIALS
USDOT Proper Shipping Name Hazard UN/NA Packing Containers Total Unit
HM (Complete All Items for Hazardous Materials) Class or Div. ID No. Group Qty. Type Quantity Wt./ Vol.
a.
b.
C.
L
ADDITIONAL INFORMATION ERG No. :,A:.& 0-Profile Code.-.
....... ... ..
a. .... ..
. . . ........ ...... .. .. ............ . ............
.... .... . .....
............ ................ ..... ................
b . ... ...... .........
.............................
......... .... .. ... .... ..
............... . ......
...........
............
. ........... . ..............
.......... ................... ...........
C.
..................
...................
GENERATOR'S CERTIFICATION
This is to certify that the above -described materials are properly classified, described, packaged, marked and labeled, and are in
proper condition for transportation according to the applicable regulations of the Department of Transportation. / further certify
that none of the materials described above are a hazardous waste as defined by EPA 40 CFR Part 261 or any applicable state law,
and unless specifically identified above, the materials contain less than 1,000 ppm total halogens and do not contain quantifiable
levels (2 ppm) of PCBs as defined by EPA 40 CFR Parts 279 and 761.
Printed Typed Name Signature Mo. Day Yr.
....................
.. ... .....
TRANPORTER INFORMATION
Transporter I hereby acknowledge receipt of the above -described materials for transport
A & D ENVIRONMENTAL AND INDUSTRIAL SERVICES from the generator site listed above.
Address
2718 LTWHARRIE ROAD Sig I nature Shipment Date
ARCHDALE, NC 27263 / hereby acknowledge that the above -described materials were received
Transporter or Unit No. from the generator site and were transported to the facility listed below.
EPA ID No. NCD986232221
Phone [phone] Slgnaft_iidDelivery Date
. .. ..... ........ .
................. ......
........... i . .... . ..........
..... .. .
.................. FACILITY INFORMATION
....................
....... .
. . ... .....................
................. ............... . ..........................................
Facility 1hereby acknowledge receipt of the materials covered by this manifest
A,& D ENVIRONMENTALLAND�`IiITDUSTki ERVICES=' except for any discrepancy noted below.
Address
2718 ' LJWHARRrE ROAD Slanature Receipt Date
ARCIFIDALE, NC 27263 'ino �'O_ andflint Vietho-_� t e S scre:�Snciee [Rou
................... .......... ..............
...........
..... ..... ..........
............ ....... .................. ............ - ............... ............
... ................. ............ - ........ .. .............................. ......
(33 16) 434-7750 ......
..... .............. ............. ........ ..... ........... ... ..... .....
............. ........
contact . .....
..........
.. ......... .... -:-`;:......' ..............
.......... . . ....
. ....... .. ................
ERIC McMANUS .......
.......... I ........ . .... ..
ORIGINAL - Facility Retain COPY 2 Ppfitrn to (',PnPr=fnr (C)PY.'1 - Trnn-tnnr-ter Retain rr)PY A (-,e-ns-r:2tr)r Retain

Appendix F
Chain -of -Custody Records

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Appendix G
Copy of All Laboratory Analytical Records

Case Narrative
Date: 8/18/04
Company: AMEC Earth & Environmental
Contact: Helen Corley
Address: 9800 West Kincey Ave. Ste 190
Huntersville, NC 28078
The attached Laboratory Report contains the analytical results for the project identified above and includes Quality Control Data and a
Chain -of -Custody copy.
Data qualifiers are flagged individually on each sample. A Key Reference for the data qualifiers appears at the bottom of this page.
Quality control statements and/or sample specific remarks are included in the sample comments section of the
laboratory report for each sample affected.
Please call if you have any questions relating to this analytical report.
Data Reviewed by: Paula A. Gilleland Project Manager: An ela D vercash
Signature: " A' , � �Q 6 d Signature:
Review Date: 8/18/04 Approval Date: 8/18/04
Data Qualifier Key Reference:
#.
Result outside of QC Limits
B:
Compound also detected in the method blank
DO:
Compound diluted out.
E:
Estimated concentration, calibration range exceeded
J:
The analyte was positively identified but the value is estimated below the reporting limit
JH:
Estimated concentration with a high bias
JL:
Estimated concentration with a low bias
M:
A matrix effect is present
T:
Tentatively identified compound. The concentration is estimated.
Note: This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road, P. 0. Box 240543, Charlotte, NC, 28224-0403
Phone: 7,04/529-6364 Toll Free: 800/529-6364 Fax: [phone]
F:lcommonlcasenarrative Revised 4/20/04

Lab Report
8/18/04
AMEC Earth & Environmental
Attn: Helen Corley
9800 West Kincey Ave. Ste 190
Huntersville, NC 28078
R.ISM
LA86RAT04IES, INC.
Full Service Analytical And Environmental Solution
Page 1 of 10
Customer Project ID: Parcel 15, Former Franklin Blyth
Customer Sample ID: 15-SS-01
Prism Sample ID: AD25359 Matrix: soil
Login Group: 2359M9
Sample Collection Date/Time: 8/5/04 09:30
Lab Submittal Date/Time: 8/5/04 15:01
The following analytical results have been obtained for the indicated sample which was submitted to this laboratory
TEST
PARAMETER
TEST
RESULT
UNITS
REPORTING
LIMIT
METHOD DATE/TIME
REFERENCE STARTED
ANALYST
GASOLINE RANGE ORGANICS (GRO)
77
mg/kg
10
5035/5030/8015B 8/16/04 13:16
JYS
SURR: GRO
37 # M
%
55-129
5035/5030/8015B 8/16/04 13:16
JYS
DILUTION FACTOR
1
mg/kg
5035/5030/8015B 8/16/04 13:16
JYS
CALCULATIONS BASED ON DRY WT.
73.2
% DRY WT.
0.01 SM 2540 G
8/6/04 09:55
DMO
PREP. METHOD 3545 FOR DIESEL
25.05g-1mL
SW846-3545
8/13/04 09:00
CWC
DIESEL RANGE ORGANICS (DRO)
25000
mg/kg
5000 SW846-8015B
8/16/04 13:29
JMV
SURR: o-TERPHENYL
DO
%
49-124 SW846-8015B
8/16/04 13:29
JMV
DILUTION FACTOR
500
mg/kg
SW846-8015B
8/16/04 13:29
JMV
Sample Comments:
Analysis note for GR: # M - One surrogate recovery was below the control limit. The sample was re-
analyzed at a 500 x dilution with no improvement in recovery. Matrix interference is suspected.
Angela D. Overcash, V.P. Laboratory Services
NC Certification No. 402 - SC Certification No. 99012 - NC Drinking Water Cert. No. 37735 - FL Certification No. E87519
449 Springbrook Road - PO Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800-529-6364 - Fax: [phone]

Lab Report
8/18/04
AMEC Earth & Environmental
Attn: Helen Corley
9800 West Kincey Ave. Ste 190
Huntersville, NC 28078
LASORATORIE§, WC :,
s
Full Service Analytical And Environmental Solution
Page 2 of 10
Customer Project ID:
Parcel 15, Former Franklin Blyth
Customer Sample ID:
15-SS-02
Prism Sample ID:
AD25360
Matrix: soil
Login Group:
2359M9
Sample Collection Date/Time:
8/5/04
09:35
Lab Submittal Date/Time:
8/5/04
15:01
The following analytical results have been obtained for the indicated sample which was submitted to this laboratory
TEST
PARAMETER
TEST
RESULT
UNITS
REPORTING
LIMIT
METHOD DATEmME
REFERENCE STARTED
ANALYST
GASOLINE RANGE ORGANICS (GRO)
14
mg/kg
10
5035/5030/8015B 8/13/04 16:49
JYS
SURR: GRO
88
%
55-129
5035/5030/8015B 8/13/04 16:49
JYS
DILUTION FACTOR
1
mg/kg
5035/5030/8015B 8/13/04 16:49
JYS
CALCULATIONS BASED ON DRY WT.
75.3
% DRY WT.
0.01 SM 2540 G
8/6/04 09:55
DMO
PREP. METHOD 3545 FOR DIESEL
25.01g-1mL
SW846-3545
8/13/04 09:00
CWC
DIESEL RANGE ORGANICS (DRO)
33000
mg/kg
5000 SW846-8015B
8/16/04 14:43
JMV
SURR: o-TERPHENYL
DO
%
49-124 SW846-8015B
8/16/04 14:43
JMV
DILUTION FACTOR
500
mg/kg
SW846-8015B
8/16/04 14:43
JMV
Sample Comments:
Angela D. Overcash, V.P. Laboratory Services
NC Certification No. 402 - SC Certification No. 99012 - NC Drinking Water Cert. No. 37735 - FL Certification No. E87519
449 Springbrook Road - PO Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800-529-6364 - Fax: [phone]

Lab Report
,
"_LABORA gRlEB IP�C`. `;
Full Service Analytical And Environmental Solution
8/18/04
Page 3 of 10
AMEC Earth & Environmental
Customer Project ID:
Parcel 15, Former Franklin Blyth
Attn: Helen Corley
Customer Sample ID:
15-PE-B1
9800 West Kincey Ave. Ste 190
Prism Sample ID:
AD25361 Matrix: soil
Huntersville, NC 28078
Login Group:
2359M9
Sample Collection Date/Time:
8/5/04 11:10
Lab Submittal Date/Time:
8/5/04 15:01
The following analytical results have been
obtained for the indicated sample which was submitted to this laboratory
TEST
PARAMETER
TEST
RESULT
UNITS
REPORTING
LIMIT
METHOD DATElrIME
REFERENCE STARTED
ANALYST
GASOLINE RANGE ORGANICS (GRO)
Not Detected
mg/kg
10
5035/5030/8015B 8/13/04 17:25
JYS
SURR: GRO
70
%
55-129
5035/5030/8015B 8/13/04 17:25
JYS
DILUTION FACTOR
1
mg/kg
5035/5030/8015B 8/13/04 17:25
JYS
CALCULATIONS BASED ON DRY WT.
66.2
% DRY WT.
0.01 SM 2540 G
8/6/04 09:55
DMO
PREP. METHOD 3545 FOR DIESEL
25.25g-1mL
SW846-3545
8/13/04 09:00
CWC
DIESEL RANGE ORGANICS (DRO)
Not Detected
mg/kg
10 SW846-8015B
8/13/04 17:32
JMV
SURR: o-TERPHENYL
75
%
49-124 SW846-8015B
8/13/04 17:32
JMV
DILUTION FACTOR
1
mg/kg
SW846-8015B ,
8/13/04 17:32
JMV
Sample Comments:
Angela D. Overcash, V.P. Laboratory Services
NC Certification No. 402 - SC Certification No. 99012 - NC Drinking Water Cert. No. 37735 - FL Certification No. E87519
449 Springbrook Road - PO Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800-529-6364 - Fax: [phone] ,

Lab Report
8/18/04
AMEC Earth & Environmental
Attn: Helen Corley
9800 West Kincey Ave. Ste 190
Hunte.rsville, NC 28078
PRISM
LABOIRATORIES; INC.
Full Service Analytical And Environmental Solution
Page 4 of 10
Customer Project ID:
Parcel 15,
Former Franklin Blyth
Customer Sample ID:
15-PE-132
Prism Sample ID:
AD25362
Matrix: soil
Login Group:
2359M9
Sample Collection Date/Time:
8/5/04
11:15
Lab Submittal Date/Time:
8/5/04
15:01
The following analytical results have been obtained for the indicated sample which was submitted to this laboratory
TEST
PARAMETER
TEST
RESULT
UNITS
REPORTING
LIMIT
METHOD DATE/TIME
REFERENCE STARTED
ANALYST
GASOLINE RANGE ORGANICS (GRO)
Not Detected
mg/kg
10
5035/5030/8015B 8/13/04 18:02
JYS
SURR: GRO
101
%
55-129
5035/5030/8015B 8/13/04 18:02
JYS
DILUTION FACTOR
1
mg/kg
5035/5030/8015B 8/13/04 18:02
JYS
CALCULATIONS BASED ON DRY WT.
69.5
% DRY WT.
0.01 SM 2540 G
8/6/04 09:55
DMO
PREP. METHOD 3545 FOR DIESEL
25.04g-1mL
SW846-3545
8/13/04 09:00
CWC
DIESEL RANGE ORGANICS (DRO)
38
mg/kg
10 SW846-8015B
8/13/04 18:15
JMV
SURR: o-TERPHENYL
118
%
49-124 SW846-8015B
8/13/04 18:15
JMV
DILUTION FACTOR
1
mg/kg
SW846-8015B
8/13/04 18:15
JMV
Sample Comments:
Angela D. Overcash, V.P. Laboratory Services
NC Certification No. 402 - SC Certification No. 99012 - NC Drinking Water Cert. No. 37735 - FL Certification No. E87519
449 Springbrook Road - PO Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800-529-6364 - Fax: [phone]

Lab Report
8/18/04
AMEC Earth & Environmental
Attn: Helen Corley
9800 West Kincey Ave. Ste 190
Huntersville NC 28078
PRISM
LA6044TORIES, INC.
Full Service Analytical And Environmental Solution
Page 5 of 10
Customer Project ID:
Parcel 15,
Former Franklin Blyth
Customer Sample ID:
15-PE-N3
Prism Sample ID:
AD25363
Matrix: soil
Login Group:
2359M9
Sample Collection Date/Time: 8/5/04 11:30
Lab Submittal Date/Time: 8/5/04 15:01
The following analytical results have been obtained for the indicated sample which was submitted to this laboratory
TEST
TEST
REPORTING METHOD DATElrIME
PARAMETER
RESULT
UNITS LIMIT REFERENCE STARTED
ANALYST
GASOLINE RANGE ORGANICS (GRO)
Not Detected
mg/kg 10 5035/5030/8015B 8/13/04 18:38
JYS
SURR: GRO
83
% 55-129 5035/5030/8015B 8/13/04 18:38
JYS
DILUTION FACTOR.
1
mg/kg 5035/5030/8015B 8/13/04 18:38
JYS
CALCULATIONS BASED ON DRY WT.
68.2
% DRY WT.
0.01 SM 2540 G
8/6/04 09:55
DMO
PREP. METHOD 3545 FOR DIESEL
25.20g-1mL
SW846-3545
8/13/04 09:00
CWC
DIESEL RANGE ORGANICS (DRO)
Not Detected
mg/kg
10 SW846-8015B
8/13/04 18:57
JMV
SURR: o-TERPHENYL
74
%
49-124 SW846-8015B
8/13/04 18:57
JMV
DILUTION FACTOR
1
mg/kg
SW846-8015B
8/13/04 18:57
JMV
Sample Comments:
Angela D. Overcash, V.P. Laboratory Services
NC Certification No. 402 - SC Certification No. 99012 - NC Drinking Water Cert. No. 37735 - FL Certification No. E87519
449 Springbrook Road - PO Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800-529-6364 - Fax: [phone]

• • •
8/18/04
AMEC Earth & Environmental
Attn: Helen Corley
9800 West Kincey Ave. Ste 190
Huntersville, NC 28078
The following analytical results have been obtained for the indicated sample which was submitted to this laboratory
TEST
PARAMETER
TEST
RESULT
UNITS
REPORTING
LIMIT
METHOD DATE/TIME
REFERENCE STARTED
ANALYST
GASOLINE RANGE ORGANICS (GRO)
Not Detected
mg/kg
10
5035/5030/8015B 8/13/04 19:14
JYS
SURR: GRO
63
%
55-129
5035/5030/8015B 8/13/04 19:14
JYS
DILUTION FACTOR
1
mg/kg
5035/5030/8015B 8/13/04 19:14
JYS
CALCULATIONS BASED ON DRY WT.
67.9
% DRY WT.
0.01 SM 2540 G
8/6/04 09:55
DMO
PREP. METHOD 3545 FOR DIESEL
25.09g-imL
SW846-3545
8/13/04 09:00
cWC
DIESEL RANGE ORGANICS (DRO)
Not Detected
mg/kg
10 SW846-8015B
8/13/04 19:39
JMV
SURR: o-TERPHENYL
57
%
49-124 SW846-8015B
8/13/04 19:39
JMV
DILUTION FACTOR
1
mg/kg
SW846-8015B
8/13/04 19:39
JMV
Sample Comments:
Angela D. Overcash, V.P. Laboratory Services
NC Certification No. 402 - SC Certification No. 99012 - NC Drinking Water Cert. No. 37735 - FL Certification No. E87519
449 Spdngbrook Road - PO Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800-529-6364 - Fax: [phone]

Lab Report
.
PRISM
LABORATORIES INC;,
s�-
Full Service Analytical And Environmental Solution
8/18/04
Page 7 of 10
AMEC Earth & Environmental
Customer Project ID: Parcel 15, Former Franklin Blyth
Attn: Helen Corley
Customer Sample ID: 15-PE-W5
9800 West Kincey Ave. Ste 190
Prism Sample ID: AD25365 Matrix: soil
Huntersville, NC 28078
Login Group: 2359M9
Sample Collection Date/Time: 8/5/04 11:50
Lab Submittal Date/Time: 8/5/04 15:01
The following analytical results have
been obtained for the indicated sample which was submitted to this laboratory
TEST
TEST REPORTING METHOD DATE/TIME
PARAMETER
RESULT UNITS LIMIT REFERENCE STARTED ANALYST
GASOLINE RANGE ORGANICS (GRO)
Not Detected mg/kg 10 5035/5030/8015B 8/13/04 19:51 JYS
SURR: GRO
99 % 55-129 5035/5030/8015B 8/13/04 19:51 JYS
DILUTION FACTOR
1 mg/kg 5035/5030/8015B 8/13/04 19:51 JYS
CALCULATIONS BASED ON DRY WT.
71.3
% DRY WT.
0.01 SM 2540 G
8/6/04 09:55
DMO
PREP. METHOD 3545 FOR DIESEL
25.18g-1mL
SW846-3545
8/13/04 09:00
CWC
DIESEL RANGE ORGANICS (DRO)
12
mg/kg
10 SW846-8015B
8/13/04 20:21
JMV
SURR: o-TERPHENYL
91
%
49-124 SW846-8015B
8/13/04 20:21
JMV
DILUTION FACTOR
1
mg/kg
SW846-8015B
8/13/04 20:21
JMV
Sample Comments:
Angela D. Overcash, V.P. Laboratory Services
NC Certification No. 402 - SC Certification No. 99012 - NC Drinking Water Cert. No. 37735 - FL Certification No. E87519
449 Springbrook Road - PO Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800-529-6364 - Fax: [phone]

r p M
8/18/04
AMEC Earth & Environmental
Attn: Helen Corley
9800 West Kincey Ave. Ste 190
Huntersville, NC 28078
LABORAT4RWS; IN6>,t
Full Service Analytical And Environmental Solution
Page 8 of 10
Customer Project ID:
Parcel 15,
Former Franklin Blyth
Customer Sample ID:
15-PE-SS
Prism Sample ID:
AD25366
Matrix: soil
Login Group:
2359M9
Sample Collection Date/Time:
8/5/04
11:55
Lab Submittal Date/Time:
8/5/04
15:01
The following analytical results have been obtained for the indicated sample which was submitted to this laboratory
TEST
PARAMETER
TEST
RESULT
UNITS
REPORTING
LIMIT
METHOD DATE/TIME
REFERENCE STARTED
ANALYST
GASOLINE RANGE ORGANICS (GRO)
53
mg/kg
10
5035/5030/8015B 8113/04 21:40
JYS
SURR: GRO
66
%
55-129
5035/5030/8015B 8/13/04 21:40
JYS
DILUTION FACTOR
1
mg/kg
5035/5030/8015B 8/13/04 21:40
JYS
CALCULATIONS BASED ON DRY WT.
75.2
% DRY WT.
0.01 SM 2540 G
8/6/04 09:55
DMO
PREP. METHOD 3545 FOR DIESEL
25.03g-1mL
SW846-3545
8113/04 09:00
CWC
DIESEL RANGE ORGANICS (DRO)
2600Q—
mg/kg
4000 SW846-8015B
8/16/04 14:01
JMV
SURR: o-TERPHENYL
DO
%
49-124 SW846-8015B
8/16/04 14:01
JMV
DILUTION FACTOR
400
mg/kg
SW846-8015B
8/16/04 14:01
JMV
Sample Comments:
Angela D. Overcash, V.P. Laboratory Services
NC Certification No. 402 - SC Certification No. 99012 - NC Drinking Water Celt. No. 37735 - FL Certification No. E87519
449 Springbrook Road - PO Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800-529-6364 - Fax: [phone]

• • •
8/18/04
AMEC Earth & Environmental
Attn: Helen Corley
9800 West Kincey Ave. Ste 190
Huntersville, NC 28078
Lab Submittal Date/Time: .8/5/04 15:01
The following analytical results have been obtained for the indicated sample which was submitted to this laboratory
TEST TEST REPORTING METHOD DATElrIME
PARAMETER RESULT UNITS LIMIT REFERENCE STARTED ANALYST
DRO QC REPORT xDRO-8015/MOD 8/13/04 10:29 JMv
QC DATA FOR DRO-3545/8015B
Batch ID: SDRO-081304
Spiked Sample: AD26346
True Value Observed % Recovery Acceptance Range
mg/kg mg/kg
Method Blank N/A
< 10
N/A
< 10
Blank Spike 80.0
58.5
73
55-109%
Spiked Sample Result N/A
< 10
N/A
Matrix Spike 89.5
73.1
82
50-117%
MS Duplicate 89.2
77.9
87
50-117%
RPD
6
< 24
GRO QC REPORT - 5035
xGRO/8015MOD 8/13/04 14:40
QC DATA FOR 8015/5035 GRO
Batch ID: VGC-E-081304
Spiked sample: AD25140
True Value Observed % Recovery Acceptance Range
mg/kg
----------
mg/kg
------------------
Method Blank
N/A
< 10
N/A
----------------
< 10
LCS
50
47.5
95
67-116%
Spiked Sample
< 10
N/A
Matrix Spike
46.5
35.51
76
57-113%
MS Duplicate
46.5
35.88
77
57-113%
RPD
1.0
< 23
JYS
NC Certification No. 402 - SC Certification No. 99012 - NC Drinking Water Cert. No. 37735 - FL Certification No. E87519
449 Springbrook Road - PO Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800-529-6364 - Fax: [phone]

Lab Report
8/18/04
AMEC Earth & Environmental
Attn: Helen Corley
9800 West Kincey Ave. Ste 190
Huntersville, NC 28078
'RIsm,"
'LABORATORIES, jNC.:
Full Service Analytical And Environmental Solution
Page 10 of 10
Customer Project ID: Parcel 15, Former Franklin Blyth
Customer Sample ID: QC
Prism Sample ID: AD25367 Matrix: n/a
Login Group: 2359M9
Sample Collection Date/Time: 8/5/04
Lab Submittal Date/Time: 8/5/04 15:01
The following analytical results have been obtained for the indicated sample which was submitted to this laboratory
I LST TEST REPORTING METHOD DATE/TIME
PARAMETER RESULT UNITS LIMIT REFERENCE STARTED ANALYST
Sample Comments:
Angela D. Overcash, V.P. Laboratory Services
NC Certification No. 402 - SC Certification No. 99012 - NC Drinking Water Cert. No. 37735 - FL Certification No. E87519
449 Springbrook Road - PO Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800-529-6364 - Fax: [phone]

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Appendix H
UST-2 Form, Site Investigation Report for Permanent
Closure of UST

CHARLOTTE FIRE DEPARTMENT
REQUIREMENT FOR TANK
INSTALLATIONS AND REMOVALS/ABANDONMENTS
THIS IS TO CERTIFY THAT THE TANK(S) LOCATED AT fl#
f'c%- HAVE BEEN INSTALLED OR REMOVED ACCORDING'TO NFPA
CODES, VOLUME 5 OF THE N.C. STATE FIRE CODE, MANUFACTURER'S STANDARDS AND
THE FOLLOWING REQUIREMENTS.
UL# TANK PERMIT CAPACITY CATAGORY CONTENTS
TYPE (GALS) ABOVE/BELOW
TANK #1- •,fit 'r- ,r_;� ;;� `T- %..j,; �� , ;,,��., nLQ
TANK #2 V --�
TANK #3
TANK
COMPLETE FOR TANK INSTALLATIONS
INITIAL APPROPRIATE SECTION
LB. PSI TEST ON EACH TANK FOR HOURS. FOUND FREE OF LEAKS.
CORROSION PROTECTION BY CATHODIC PROTECTION BY INSTALLATION
OF ANODE(S) (IF REQUIRED)
ALL PIPING CHECKED FOR LEAKS
COMPLETE FOR TANK REMOVALS/ABANDONMENTS
ALL FLAMMABLE OR COMBUSTIBLE LIQUIDS REMOVED FROM THE TANK
AND CONNECTING LINES.
U as TANKS WERE PURGED AT SCENE
SUCTION, VENT, INLET, GAGE DISCONNECTED AND REMOVED
TANK INLETS AND OUTLETS CAPPED
IF TANK(S) REMAIN IN PLACE, TANK AND STUBS WILL BE FILLED
COMPLETELY WITH CONCRETE, SAND, OR OTHER APPROVED MATERIALS
DATE REMOVED/INSTALLED
r
FIRE INSPECTORIEMPLOYEE NO.
COMPANY NAME
COMPANY ADDRESS
STATE ZIP CODE
PHONE NO. Z"
f,
ORIGINAL-INPECTOR
SIGNATURE OF REMOVER
CANARY -OCCUPANT

CHARLOTTE FIRE DEPARTMENT
441 BEAUMONT AVENUE
CHARLOTTE, NC 28204
ON SITE PERMIT
APPLICANT OR MAIL TO:
Name
Cl -
Address Apt.Blde. No.
r%.1'l1t i / -e- , ;/� C_
City
State
OCCUPANT AND LOCATION FOR WHICH PERMIT IS VALID:
Name
0 '7�)
ZIP Code
Address Apt.Bldg. No.
City State ZIP Code
USE OF BUILDING, STRUCTURE OR PREMISES
PERMIT FOR: �..
b Va-
CODE I (n FEE $ a' 0 iCHECK NO. c it
PERMIT GUIDELINES
1. THIS PERMIT SHALL BE POSTED ON PREMISES FOR WHICH ISSUED.
2. ANY CHANGE IN THIS PERMIT SHALL REQUIRE PRIOR APPROVAL OF THE FIRE MARSHAL.
3. THE ISSUANCE OF A PERMIT OR APPROVAL OF PLANS SHALL NOT BE DEEMED OR
CONSTRUED TO BE A PERMIT FOR AN APPROVAL OF ANY VIOLATION OF ANY OF THE
PROVISIONS OF THE BUILDING AND FIRE CODES.
VALID FROM: / s / Cl I � 1.+� `� , 1?_! , L
l REPRESENT TIVE/EMERGENCY CONTACT (PRINT NAME)
VALID /
THROUGH: 4 / G REPRESENTATIVE/EMERGENCY CONTACT (SIGNATURE)
PHONE NUMBER r'•C�_�=7;_�r--�, �•
FIRE INSPECTORIEMPL OYEE NO.
ORIGINAL -INSPECTOR CANARY -OCCUPANT

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Appendix I
Construction Fire Permit

UST-2 Site Investigation Report for Permanent
Closure or Change -in -Service of UST
FOR TANKS Return completed form to:
STATE USE ONLY:
The DWM Regional office in the area the facility is located. SEE MAP ON THE BACK OF THIS
IN FORM FOR REGIONAL OFFICE ADDRESSES.
Return the yellow copy to the Central Office in l.D. #
NCRaleigh so that the status of the tank may be changed to "PERMANENTLY CLOSED"' Date Received
1. OWNERSHIP OF +NKS
III. LOCATIONOF +
Abandoned in DOT Riaht-of-Way. Franklin Blythe
Parcel 15 Former Franklin Blythe Property
Owner Name (Corporation, Individual, Public Agency, or Other Entity)
Facility Name or Company
Vance Road
NA
_8910
Street Address
Facility ID # (If known)
Charlotte Mecklenburg
8910 Vance Road
City County
Street Address
Carolina 28216
Charlotte Mecklenburg 28216
_North
State Zip Code
City County Zip Code
A
Area Code Phone Number
NA
Area Code Phone Number
CONTACT
PERSONNEL
Name Cyrus E. Parker LG Job Title NCDOT Project
Manager Tel. No. 919.250.4088
Closure Contractor A&D Environmental Address P n So, 484 High
Point Nc. 27262 Tel. No. 336.434,7750
Primary Consultant AMEC E & E Address emn WP t Kinrey
Ave Siira ten HuntP sviila NC 9m7A Tel. No. 704.875.3570
Lab Prism Laboratory Address P.O. Box240543,
Charlotte, NC28224 Tel. No. _1,800,529,6364
IV. LIST INFORMATION EXCAVATION
CONDITION VI. ADDITIONAL INFORMATION
Tank Size in Tank Last Water inFFree
Notable odor or visible See reverse side of pink copy (owners
No. Gallons Dimensions Contents excavatbnuct soil contaminationcopy) for additional information required by
Yes No No Yes No
NC DWM in the written report and sketch.
1 550 Heating Oil
NOTE: If a release from the tank(s) has
occurred, the site assessment portion of the
tank closure must be conducted under the
supervision of a P.E. or L.G., with all closure
site assessment reports bearing the
signature and seal of the P.E. or L.G.
CHECKLIST (CHECK
THE ACTIVITIES
COMPLETED)VII.
PERMANENT CLOSURE
ABANDONMENT IN PLACE
(For Removal or Abandonment4n-Place)
❑• Fill tank until material overflows tank opening
0- Contact local fire marshal
❑- Plug or cap all openings
0- Notify DWM Regional Office before abandonment
❑- Disconnect and cap or remove vent line
0- Drain and flush piping into tank
❑- Solid inert material used —specify
& Remove all product and residuals from tank
®• Excavate down to tank
REMOVAL
®- Clean and inspect tank
❑• Remove drop tube, fill pipe, gauge pipe, vapor recovery tank
U- Create vent hole
connections, submersible pumps, and all other tank fixtures
U- Label tank
❑- Cap or plug all lines except the vent and fill lines
❑- Dispose of tank in approved manner. Final tank destination:
❑- Purge the tank of all product and flammable vapors
❑- Cut one or more large holes in the tank
0- Backfill the area
Date tank(s) Permanently Closed: 08-05-04
Date of Change in-service:
I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents and that
based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true
accurate and complete
Print name and official title of owner or owner's authorized representative
Signature
Date Signed
Helen P. Corley, LG, NCDOT Program Manager
10-04-04
UST-2 Rev 02/2001 vvnite copy — Regional umce TeuoW wpy — i.anudi vnwe rn m Py - _v ­

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