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HomeMy WebLinkAboutMO-7037_27784_CA_CLO_20041004_Underground Storage Tank Closure ReportMICHAEL 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: 919-250-4088 LOCATION: NC DEPARTMENT OF TRANSPORTATION FAX: 919-250-4237 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: 704-552-8729 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: 919-250-4088 2. Closure contractor: A & D Environmental and Industrial Services, Inc. P.O. Box 484 High Point, NC 27261 Telephone: (336) 434-7750 3. Primary consultant: AMEC Earth and Environmental of North Carolina 9800 West Kincey Ave., Suite 190 Huntersville, NC 28078 Telephone: 704-875-3570 NCDOT TIP Number R-2248D) WBS Element: 34410.3.28 Page I October 4, 2004 Telephone: 704-875-3570 4. Laboratory: Prism Laboratories, Inc. 449 Springbrook Road Charlotte, NC 28224 Telephone: 704-529-6364, 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 a-i 82� . ..... W it 7 .0m v .4, Im- Z/ X, < 4, Ak� cs; j v X. BM ,774. , e�, 'Y -V & t 7., 1 :6 i'l 41, Wo v mo X v pc SCALE 0- Y IF R ;P4 100 0 FT 0 7000 FT U W 'ter' DERITA QUADRANGLE Tan Kv - NORTH CAROLINA, 1993 Y I i. f .." - -,, . . I q IL SL x ibilatit Y MAP VICINIT v 1� PARCEL #15 Ilk FORMER FRANKLIN BLYTHE vl CHARLOTTE, NC f ------ - -TDATE-. f%DRAWING NAME: N:\NCD0T\B1yth�\YIG1 10103104 4✓ SCALE: I MCH - 1,000 XXXT I' AMT IOMHPC IU A, - PREPARED FOR: NC Depar•tment of Transportation NCDOT PROJECT # -2248D) GEOTECHNICAL UNIT ! %%"i ;;. ``, £�' `.\\ r--,. �� 1, ':; _{ :1, -: �, WBS ELEMENT. 34410.3.21 PREPARED BY: FIGURE: E jr ERSVILLE, NC 28078 -3570 IM LImcw FIGURE I (7N)875 TEMPORARY CONSTRUCTION EASEMENT 15 FRANKLIN BLYTHE DB 1602 PG 1 X Location of UST upon AMEC's arrival. Xx x x � 0 X X X 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: NC Drpartmwnt of Transportation 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 (704)875-3570 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 (704)875-3570 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 (336) 434-7750 ` 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 (336) 434-7750 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....... .... ............ ............ ........... (336) 434-7750 ........ ..... ................. 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 (336) 434-7750 A8:7:;Jofs:;iVo, HIGH POINT, 6 434 - 75 0 P NC 272 2 FAX 336 434-7752 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 (336) 434-7750 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 (336) 434-7750 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 (336) 434-7750 • FAX (336) 434-7752 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 (704) 434-9533 FAX Job Name: ENVIRONMENTAL SOILS, INC. P.O. BOX,295 LATTIMORE, N.C...28086-0489 704/43470075 (704) 434-9533 FAX Job Name:. ENVIRONMENTAL SOILS, INC. RO. BOX 295: LATTIMORE, N.C. 28086-0489 704/434-0.075 (704) 434-9533 FAX Environmental Soils Inc. PO Box 295 - Lattimore, NC 28089 Phone 704r434-0075 - Fax 704-434-9533 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 (336) 434-7750 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 (336) 434-7750 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 704-434-9533 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 (336) 434-7750 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 Om V � la�.� W m J o`. C1 Q s ' c o Q o a C[L W w L V � V F N m m W Z H / � v H N d cD p m U6 ' OCC >� U N Cv �N {0' L T O O R � _a (D m a W N 0 W d Q d LO L pL amaCL I V y N i o U ` 0 � CD O i 1 1 1 U n • O V y W _v x a 00 m O x N N, ° LL a-,E y t0 ? UJ Ix co Z v y c c ' oars 'a .n C. V 'O Q to E �. ko- cm CL V �o 0 0 c �a m a a U �.� W ¢ z Z U a -r o Z Z . O IW O LJ- Z O I� I s� LU w GC O } oC W Z I I O O *' U I m aVa w 'LL U Z Z d O .w:. a o c C o m UF) J t V LU IL cu O :i w mY= � Ca' OC t f0 G W lco W co❑ CLO WN NY LU D 0.zzm Q W❑ oc.¢Wa x U U❑ N y I Z? a c m C N>� y V T, O N ;0:W wN. ❑ nyZO m N d U Q W \ O -d0 co N c ❑ m w N ❑ m LU rnocZ y` r co �ai F _ O m. g Fr z O z �mWm U Z 3.LU m. y j O w w J O o m 5•Eww 2 3 m ,II G y'O c0 Q W y rn c w z U) . d w. a' cc U) in c� �LU 3 r x ..Ow C7 1- O lu � = a (n �--.3N V � ¢ w 6 2 LU ui S \ ~ J J O m V.� O 1� LUU, I y F V y- UJ W � 0 0 Q Q V W U Z E LL N 'y O W a mm ,t a_ o z Z c C Z N a U J � 1 Ea.°= y L4 W. W U) to rr .0 er 1 _ .4 . .� . . OE F'C La Um V1 1 I 1 1 Y w. CO CD Qc. N ,c mm . ., .,.., . U) D N y 15 E 0 U tea.' L i W OC z ITT- 2 2 ' M J f!J � ILLJac O z U ga cc U J ❑ of U z O U ❑ W U 2 Cf) F ❑ O a� o Z V H o cc oIL wo W CO m LU = Q ❑ LL, n N< G -+ W =) z e �' (n ❑ L �� L Ir uj ;� 6c UZ W H 0 3 coy 0 =y z ❑ N= m Y LLI O w z U a< ❑ 2 Z raG ❑ a W M: pj m 2jr OZ n W 2 Q v f- N W LL 3 LU iL y 0 H 4 VQ a ? ❑ t jF Z �. a-z m O❑❑ Nw m v, 'C > a U LU Cl) a' � ❑ O N }- z a � Ia.❑ 0 O U) `o w N ❑ 0 m o� LL aZ i O z❑❑ 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: 704/525-0409 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: 704-529-6364 - Toll Free Number: 1-800-529-6364 - Fax: 704-525-0409 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: 704-529-6364 - Toll Free Number: 1-800-529-6364 - Fax: 704-525-0409 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: 704-529-6364 - Toll Free Number: 1-800-529-6364 - Fax: 704-525-0409 , 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: 704-529-6364 - Toll Free Number: 1-800-529-6364 - Fax: 704-525-0409 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: 704-529-6364 - Toll Free Number: 1-800-529-6364 - Fax: 704-525-0409 • • • 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: 704-529-6364 - Toll Free Number: 1-800-529-6364 - Fax: 704-525-0409 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: 704-529-6364 - Toll Free Number: 1-800-529-6364 - Fax: 704-525-0409 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: 704-529-6364 - Toll Free Number: 1-800-529-6364 - Fax: 704-525-0409 • • • 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: 704-529-6364 - Toll Free Number: 1-800-529-6364 - Fax: 704-525-0409 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: 704-529-6364 - Toll Free Number: 1-800-529-6364 - Fax: 704-525-0409 o� Sy to 0 �.d � 3 3 P. 0 CO) .(Amm a tl1 a m o v 3 0 vd rrV- (�` M Nm O3o Z ^ z0-1 m Z c z A m a a Lk o v D C O two -n -f 13 r° 0 r O m Qh CO) w v � r CpmOD �mFR m 0- x y w i2 C m w v M O M. O0 m- rm N zin o m � Zm N O y r- .D v1.yac a 0 m m N y Q ~B°. . !� N. 0 70 p_ O n m o A)0� m 0 Z yO.y O 9 ❑❑� i N j 3m.co W O CD v C)O m N r a tm0 R?.�ym N c'; No°�wozi co -w w❑eN mto f O)Ny f1 V x na () X . mN mm OOaaw 70 Q � N in" to N N D Z2� ❑ i C - A C, O <CL , W m o a ❑ yUl o v CL r — � m 18 m CID) y ;� W A 0 = :M S � tm p n rt O O o r m v CL 7 m c 7 v y o Cl) Z Z = a o w o n ` m n Its I = Z z m c -� rn m ° D n I ca > �� m; S S n 3 Yu o o o n a o 0 0 a t4 a o d roo 4� . o O VW 0 �. x y N .la Go zn n 3 ID � 7 1 co c Z n o co N C � d. a F)' N � m m p m m S O N p, 0 ).. o a 1 7aO n- for Z o S y n 5 y C O C tD (D O C Im A � O to 1 W v S IS o, r tD . z m m ,� o v v to ZLo 1 J m N u Z Z A, n, z n m ��� k o 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 --j col cn O Cm tz� m OF m -n m > m-: yC� cn� ra SZ 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 ­ C E i O CO • C U) y CP a) a) C) v U3 V E Q: M co it OA rnO N �. co rn0) U' 40< Z C t a: ai mY N�rn C ,U CEO �� yU �NQ iti L M 0 Z LL Q. 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