MO-6615_27296_G_RRA_20121116

NCDEQ UNDERGROUND STORAGE TANK SECTION
RISK, RANK, AND ABATEMENT RATING FORM
Incident Name: Region:
Incident Number: County:
Date: //./�,». Ranked By:
SCORE III % S_
Note: a new ranking form must be completed whenever site conditions may have changed, or at least once every 5 years
SECTION I. Initial Risk Classification (Check all that apply)
1. High Risk
All UST and Non -UST Petroleum Releases
A. An existing water supply well, including one used for non -drinking purposes, has been contaminated by any UST release or
any non -UST petroleum release;
B. There exists a serious threat of explosion due to the accumulation of vapors in a confined space, as a result of the release;
C. Vapors from the discharge or release pose a serious exposure risk through vapor intrusion into inhabited structures; or
D, There exists an imminent danger to public health, public safety or the environment, as a result of the release.
Commercial UST, Noncommercial Motor Fuel UST, and Non -UST Petroleum Releases Only
E. A water supply well used for drinking water is located within 1,000 feet of the source area of a confirmed release;
F. A water supply well not used for drinking water is located within 250 feet of the source area of a confirmed release; or
G. The groundwater within 500 feet of the source area of a confirmed release has the potential for future use in that there is
no source of water supply other than the groundwater;
Noncommercial UST Releases OnIV (including Noncommercial Farm or Residential Motor Fuel USTs)
H. A water supply well, including one used for non -drinking purposes, is located within 150 feet of the source area of a
confirmed release;
I. Unassessed free product has been found within 30 feet of a property boundary with a landowner other than the
responsible party for the release; or
J. An unabated surface exposure of free product remains present at a confirmed release from a noncommercial UST
2. Intermediate Risk (Commercial UST and Non -UST Releases Only)
A. Surface water is located within 500 feet of the source area of a confirmed release and the maximum groundwater
contaminant concentration exceeds the applicable surface water quality standard and criteria found in 15A NCAC 213 .0200
by a factor of 10;
B. In the Coastal Plain Physiographic Province (as designated on a map entitled Geologic Map of North Carolina published by
the Department in 1985), the source area of a confirmed release is located where there is recharge to an unconfined or
semi -confined deeper aquifer which the Department determines is being used or may be used as a source of drinking
water;
C. The source area of a confirmed release is located within a designated wellhead protection area, per 42 USC 300h-7(e);
D. The levels of groundwater contamination associated with a confirmed release for any contaminant (except ethylene
dibromide, benzene and the aliphatic and aromatic carbon fraction classes) exceed 50 percent of the solubility of the
contaminant at 25 degrees Celsius or 1,000 times the groundwater quality standard or interim standard established in 15A
NCAC 2L .0202, whichever is lower (these levels have been termed "gross contamination levels"); or
E. The levels of groundwater contamination associated with a confirmed release for ethylene dibromide or benzene exceed
1,000 times the federal drinking water standard set out in 40 CFR 141(these levels have also been termed "gross
contamination levels').
3. Low Risk
A. A low risk classification means that the risk posed by a release does not meet any of the high or intermediate risk
criteria or, based on site -specific information received by the Department, the release does not pose a significant risk.
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SECTION I. Risk Classification
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Section 11.2: Surface Water (cons.)
A.LanclUse (Choose soil cleanup level. Apply points only if soil contamination exceeds requirement.) Q
No Risk Data Soil to GW Residential Ind/Comm z H
❑ ❑ ❑ ❑ 0.a O
1. Maximum soil contaminant concentration exceeds "Soil to Groundwater" but below "Residential" exposure
concentration. 5 pts total. 5
OR
2. Maximum soil contaminant concentration exceeds "Residential" but below "Industrial Commercial"
exposure concentration. 10 pts total. 10
OR
3. Maximum soil contaminant concentration exceeds the "Industrial/Commercial" exposure concentration or
no risk -based data is available. 15 pts total. 15
Air Quality
A. Vapor Phase Exposure
1. Contaminant vapors detected in inhabitable building(s), but levels are below 20%of the lower explosive
limit and health concern levels. 20 pts total. - - 20
2. Contaminant vapors detected in other confined areas (uninhabited buildings, sewer lines, utility vaults, etc.)
but levels are below 20% of the lower explosive limit. 5 pts total. 5
3. HYDROGEOLOGY and LITHOLOGY
A. Bedrock
Contamination is located in, on, or within five (5) feet of bedrock. 20 pts total.
20
B. Vertical Contaminant Migration -
Literature or well logs indicate that no confining layer is present above bedrock or within 20 feet of land
surface. 10 pts total.
10
C. Horizontal Contaminant Migration
Data or observations indicate that no discharge points or aquifer discontinuities exist between the discharge,
release, or known extent of contamination and the nearest down -gradient drinking water supply. 5 pts total.
%
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4. ENVIRONMENTAL VULNERABILITY ASSESSMENT
A. Existing Groundwater Quality - Worst -Case Monitor or Supply Well (assign only one)
1. Concentrations at less than 10 times the 2L groundwater standards. 5 pts total.
5
OR
2. Concentrations between 10 and 100 times the 2L groundwater standards. 20 pts total.
20
OR
3. Concentrations greater than 100 times the 2L groundwater standards. 40 pts total.
40
OR
4. Free product is present. 80 pts total.
80
B. Predominant Contamination Type
1. Low boiling -point petroleum productes (gasoline, aviation fuel). 20 pts total. 20
2. High boiling -point petroleum products (fuel oil, kerosene, diesel fuel, etc). 0 pts. 0 .
S. CONTAMINANT SOURCE ABATEMENT (from section in)
A. Rank Contributions from Section III: Source Abatement Assignment (automated)
1. Abatement letter "A" assigned due to an active UST system present onsite. 100 pts total. 100 :
2. Abatement letter "D" assigned due to a contaminated soil source remaining. 50 pts total. 50
SECTION II. Release Ranking
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Incident # 0
SECTION III. Source Abatement Assignment (Assign Letter)
1. Abated or Unabated Contaminant Source
A. Emergency Situation
An Emergency condition must be immediately abated. Assign letter "E" (and see Section 11.1).
OR
B. Active UST System
UST Systems remain in operation and continue to discharge into the environment.
Assign Letter "A". (+100 points added to Rank.)
OR
C. Residual Soil Contamination
The UST release has been abated; however, contaminated soil continues to release product or contaminants
into the environment. Assign Letter "D". (+50 points added to Rank in Section 11.5.)
OR
D. Contaminant Sources Abated
The UST release has been abated and contaminated soil has been removed or remediated.
Assign Letter "R". (No points added to Rank in Section 11.5.)
SECTION III. Source Abatement Assignment
SECTION IV. Risk, Rank, and Abatement Score
Total: Risk, Rank, and Abatement Score
0
FM
(Use Risk letter from Section I, total of all Rank points from Section II, and Abatement letter from Section Ill. Transfer final score to Page 1)
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