MO-9412_40858_G_C_20181024_Geological Resources Emails Testing Violations

Beverly, Trudy
From: Lisa Hilbish<[e-mail]>
Sent: Wednesday, October 24, 2018 11:21 AM
To: Beverly, Trudy
Subject: Re: [External] FW: Sysco Charlotte - Corrective Action(s) for Response to Notice of
Violation
Thank you. I have the guidelines. I was just confirming because in one of the emails the client sent it looks like Jack Stutts
recommenced getting confirmation from the Mooresville office.
Sent from my iPhone
On Oct 24, 2018, at 10:09 AM, Beverly, Trudy <[e-mail]> wrote:
Hi Lisa,
The UST Site Check Guidelines for Regulated UST Systems can be found in Section 4 of the Guidelines for
Site Checks, Tank Closure and Initial Response (text and figures) 1/9/2018 on the UST website (Pages 5-
8). Soil sampling requirements can be found in Section 4.3 Site Check Requirements (Page 6). The
tables and appendices can also be found at the link below (separate from the text document).
httr)s://dea.nc.gov/about/divisions/waste-management/ust/guidance-documents
Have a wonderful day!
Trudy
<image002.png><i mage003.jpg>
<image004.png>
Branch's Underground Storage Tanks Website Address: https://deg.nc.gov/about/divisions/waste-
management/ust
Branch's Above Ground Storage Tanks Website Address: https://deg.nc.gov/about/divisions/waste-
management/ust/ast-program
INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES:
https://deg.nc.gov/about/divisions/waste-management/waste-management-rules-data/waste-
management-gis-maps
File Review Procedures:
https://deg.nc.gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-
regional-office
ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche):
https://edocs.deg.nc.gov/WasteManagement/Search.aspx
Document Submittal & UST File Names for Laserfiche Policies:
httr)s://files.nc.Rov/ncdea/Waste/20Manaaement/DWM/UST/Corrective%20Action/Electronic%20Doc
ument%20Submittal%20Memo%20UPdate.pdf
https://files.nc.izov/ncdea/Waste%20ManaL-ement/DWM/UST/Corrective%20Action/UST%20file%20na
mes%20f6r%20Laserfiche.docx

From: Taraban, Ron
Sent: Wednesday, October 24, 2018 9:38 AM
To: Beverly, Trudy <[e-mail]>
Subject: FW: [External] FW: Sysco Charlotte - Corrective Action(s) for Response to Notice of Violation
From: Lisa Hilbish<[e-mail]>
Sent: Tuesday, October 23, 2018 8:25 AM
To: Taraban, Ron <[e-mail]>
Subject: [External] FW: Sysco Charlotte - Corrective Action(s) for Response to Notice of Violation
attachment
L-
Hi Ron,
Can you tell me who handles Cabarrus county? We have been contacted by Sysco for assistance with a
site check. We understand from the documentation given to us that 3 samples need to be taken — one
at each dispenser sump and one at the STP sump. I wanted to confirm with this with whomever handles
Cabarrus county. Thanks.
Best Regards,
Lisa Hilbish
Senior Business Development Director
Geological Resources, Inc.
3502 Hayes Road
Monroe, NC 28110
Main [phone] Cell [phone] Fax [phone]
www.geologicalresourcesinc.com
From: Callahan, Josh R. 048 [mailto: [e-mail]]
Sent: Monday, October 22, 2018 5:14 PM
To: Lisa Hilbish
Subject: RE: [External] Sysco Charlotte - Corrective Action(s) for Response to Notice of Violation
Thanks for confirming. The UST 23B is in the Violation 6 attachment.
From: Lisa Hilbish [mailto:llh@geological resourcesinc.com]
Sent: Monday, October 22, 2018 4:57 PM
To: Callahan, Josh R. 048 <[e-mail]>
Subject: RE: [External] Sysco Charlotte - Corrective Action(s) for Response to Notice of Violation
[ External Email ]
Thank you — I have everything. Can you confirm that you have made all the repairs and if so can you
send me the documentation (the UST 23B form).
Best Regards,

Lisa Hilbish
Senior Business Development Director
Geological Resources, Inc.
3502 Hayes Road
Monroe, NC 28110
Main [phone] Cell [phone] Fax [phone]
www.geologicalresourcesinc.com
From: Callahan, Josh R. 048[mailto:Callahan.JoshuaCacha.sysco.com]
Sent: Monday, October 22, 2018 3:59 PM
To: Lisa Hilbish
Subject: FW: [External] Sysco Charlotte - Corrective Action(s) for Response to Notice of Violation
Importance: High
From: Thomas, Robert 1001
Sent: Monday, October 22, 2018 1:20 PM
To: Stillwell, Tim 048 <[e-mail]>; Callahan, Josh R. 048
<[e-mail]>; McIntyre, John 048 <[e-mail]>
Cc: Wills, Corinna 000 <[e-mail]>; Flynn, Barrett 000
<[e-mail]>
Subject: FW: [External] Sysco Charlotte - Corrective Action(s) for Response to Notice of Violation
Importance: High
Tim,
Per our conversation this morning, attached is the Inspectors response to Sysco Charlotte submittal, as
well as, his email below (see highlighted comment by Inspector for your consultant). Specifically,
Violation 4 of the referenced NOV states that "if any containment sump fails the tightness test you must
conduct a site check in accordance with 40 CFR 280.52(b)". Accordingly, both the dispenser sumps and
the STP sump of the diesel UST failed their tightness tests prior to their repair. Therefore, Sysco
Charlotte must complete the appropriate site checks using the sampling protocol and methodology of
the UST Section Guidelines for Site Checks, Tank Closure, and Initial Response and Abatement. Sysco
Charlotte response for Violation 4 is due within 30 days of the attached letter (November 18")
Per our conversation, Jones & Frank or another vendor should re -conduct the tightness test for both the
dispenser sumps and the STP sump, as well as, complete UST-6F/23B Forms on behalf of Sysco
Charlotte.
As you stated, you'll discuss this matter with your team and have the appropriate consult onsite to
rectify this matter with Violation 4.
Let's discuss this matter further.
Regards,
Robert D.F. Thomas
Director, Environmental Compliance
Sysco Corporation
Thomas.Robert2kcorp. sysco. com

O: 281.584.5045
C: 832.457.8900
From: Stutts, Jack L [mailto:[e-mail]]
Sent: Monday, October 22, 2018 11:24 AM
To: Thomas, Robert 1001 <[e-mail]>
Cc: Callahan, Josh R. 048<[e-mail]>; Stillwell, Tim 048
<[e-mail]>
Subject: RE: [External] Sysco Charlotte - Corrective Action(s) for Response to Notice of Violation
[ External Email ]
Robert,
Thank you for the electronic submission. Attached is my response to the information. As you will see in
the letter, there is a requirement for Sysco to perform a site check or checks because of the failure of
the initial tightness test of the STP sump and the dispenser sumps. Your consultant should contact the
Corrective Action Branch Regional Office in Mooresville if they need assistance is determining the
appropriate location(s) and number of sample(s) they will require.
Feel free to contact me with any questions or if you find Sysco needs more than the allotted 30 days to
complete the site check.
Jack
From: Thomas, Robert 1001[mailto:[e-mail]]
Sent: Wednesday, October 3, 2018 2:48 PM
To: Stutts, Jack L <[e-mail]>
Cc: Callahan, Josh R. 048<[e-mail]>; Stillwell, Tim 048
<[e-mail]>
Subject: [External] Sysco Charlotte - Corrective Action(s) for Response to Notice of Violation
External email. Do not click links or open attachments unless verified. Send all suspicious email as an
I attachment to
Hello Jack,
Per our last correspondence, on behalf of Sysco Charlotte attached for your review are the corrective
measures implemented to ensure regulatory compliance with each Notice of Violation (NOV). In
addition to each corrective measure, we've also included the final invoice from our vendor Jones &
Frank that displays (1) every service date; (2) the item/description for each equipment serviced; and (3)
the final expenditure for all work performed at the cost of $24, 990.27.
If you have specific and/or technical inquiries regarding the corrective measures in question, please give
Josh Callahan a call at 704-723-6067 or contact him via email at [e-mail] .
Thank you for your attention with this matter.
Best Regards,
Robert D.F. Thomas
Director, Environmental Compliance

Sysco Corporation
Thomas.Robert2(cr�,corp. sysco.com
O: 281.584.5045
C: 832.457.8900

Violation. Z: 15A NCAC 2N .05D2 LD.1

Application to Install olr.Replace Underground Storage Tank Systems
USTwfiE123D (TANK 1NSTALLATIONR.RIENNIAL TESTING)
A A separate farm should ae used for each facility. If there are more than five (5) tanks at this faoility, make addjttanel copies df us. page.
written guldelines and PEURP.100 "Recommended Practice.
Y. The primary and. Interstitial space of the tank shall be tested In accordance with the marlufactureis
for Installation of Underground Liquid Storage -Systems:
ra The last periodic tightness:test record must be maintalned by the tank owner or operators nd must.be readily available for inspection.
Tanks that are not manitored.com]nuvusly for releases using vacuum, pressure, or. hydrostatic methods. must be rightness tested at.Installation, between 6 and
I months from: lnstallation,:and.every thres years faliowing.installatibn.
The interstitlatspace of the tank shall bo tested using.a 3. ro party certified Interstice tightness test capable of detecting a 0.1 gpll teak from the inner or outer wail
of tha interstice for the tank model that is Installed.
s If tha.tank faits a tightness test; it must ice replaced or repaired. by the man ufactureror.the manufacturer's authorized representative in accordance with the .
manufacturer's socN�cations: Following.any repair, the flank must be re -tested for tfghtness.Also a suspected release report: must be submitted on a USTA 7A
form, tISTSuspecfed Refease.24 NourNolfce. The suspected release must be:€nvestigated, In accordance with 15A NC.AC 2N .0503, and any defective
equipment repairedlreplaced In accordance: with i5A NCAC 2N..04041,0900. Resutlsof the investigation must be submitted on A USTA 78. form,. UST Suspected
Release 7 Day Notice.
ACILITY
Owner 1 Fac. Name Fac. ID#; 00-0-0000035443
Operator Name
Fac. Address Fac. City unty CA6ARRLiS
450o CORPORATE DRIVE; NW CONCORD
o. Name Phone -mail
Superior Services 828=698=6286 [e-mail]
Address city rate zip
P.O. Box 982 Hendersonville NC .28793
Kelly Keller WA t
Print Name. 7 person conducting test Signature of person conducting test.
Identify Tank (Tank Number, etc.) Tank # 1 Tank # Tank# Tank # Tank #
Tank Size 20000
Product Diesel
uST Type
FRP
US7'. es: FRP+ Steel Jacketed, 5tee11CLAD,.Dth,9r
Indicate units for all measurements: inches
I. Pre-frrstallatlon testing
VacuumMressure Gauge Ran w
Test Date
Interstitial space =Liquid Filled or Vacuum.
ITestmethod. Vacuum
Liquid filledlather:
begin EndTest Time (liquid}
Begin. End.Level(liquid)
r
1
1
r
r
I
1
Begin End Test Time
Begin End Pressure/Vacuum
1
E
r
I
I
1
1
1
Test Result
El Pass EFal€
Pass Fall
Pass Fail
Pass Fall
Pass Faii
Liquicivisibis on insldelauteide.
Yes ❑Ida
Yes No
Yes No
Yes No
Yes No
of tank(If applicable)
It. Post-instaMllonitriertnialAesting
Tightness Test Mode (if applicable):
Test. Date, Begin .End
.
'
0312V2018 r 03124120t8
' i
r
i i
F
Interstitial space -Liquid Fif c1lother.
Teat method: QVacuum Liquid fitledlother: Xerxes
Begin .End Test Time (liquid)
11:33 21:33
Begin End Level (liquid)
12.15 ; 12.75
i
Begin End Test Time:
r
I
1
r
Begin End Pressure/Vacuum
Test Result
Pass MFail
Pass Fail
Pass Fail
Pass Fail
Pass Fail
Llquidvlsible on. Inside of tank joyes
NNo I
Yes No
Yes No
Yes No
Yes No
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY, DIVISION OF WASTE MANAGEMENT, UST SECTION 10115.
1646 MAIL sERViCI; CENTER, RALEIGH, NO 27696-16.46. PHONE [phone] FA)C (919) 716A 117bttp:/Avww.wastenotnc.orghveblwm

Recommended. Practices for the Testing and Ver tcatlon of So11, Overfill, Leak Detection and Secondary Containment Equipmerft at. UST Fatalities
ZCU I XERXES
making a lasting difference
DIATA LOG
TRUCHEK'
Fill out the site location, tank information and test boxes below..Be sure to [noose the carrerl test box according to the
diameter. of the'tank being tested. Follow t)he test procedures on the. other side of this form. A.sepa►ate test form is needed
for every tank. Fpr additional cap ies.of the form, contact the Customer Service Representative at the.Xerxes manufacturing
facility nearest you. (See back cover for information.)
Site Location: Sysco Food services. of Charlotte Tank Information:
Address: 4500 Corporate Drive. NVV Nominal Gallons: LO 09
Concord,. NC
Diameter: 120"
Phone: [phone]
Contact Name: Josh Callahan.
Test Date: 3-24-2018
95%-S%TEST
1 a. Start level (inthes in standpipe)
2a. End Level after 4 hours
3. D&rem .tsubtract 2a from I a) —
4. Calbration factor - z .20
S. Volume change =
6. Test hours + 4
7.:Gallops-per`hour loss —
(if 0..05 gal bnAaw or. less, tank passed.).
Nate: maximurn allowable dispensing volume during test:
B-foot-diamete► tarok--1.200 gallons maximum
6-foot diameter.tank — 500 gallons maximum
4-foot•diamew rank — 3W gal Ions:rnaximum
95% - 5% TEST
10. Stare level (inches in standpipe)
2a. End level after 6 hours -
3, Difference Witract2a from i a) _
4. Calibration factor x. .30
S. Volume change —
C Test hours + 6
T. Gallons-pervhour lass —
(if 0.05 gallonslhour or less, tank passed.)
Note: Mauknurn allowable. dispensing .volume during test;
10-foot-diameter tank -� 75U gallons: maximum
Approximate. Standpipe Length: 39-25"
Product Type:
17iesel
Person Performing Test' Kelly Keller - Superior Services
C.
999ts -1 % TEST
1b. Start level (indi s in standpipe)
.2b. End level after.I D hours
3. Difference (subpar# 2b from I b)
4. Calbation factor
5. Volume change
6. Test hours
7. Gallons -per -hour loss
(if 0.05 gal.lorslhour or less, tank.passsd:)
Note: No product. dispensing allowed.
99W-1 % TEST
1b. Start level (inches in standpipe)
2b. End level after 10 hours
3: Difference (subtract:20:frartr 1 b)
4, Calibration factor
S..Vokrme change
5, .Test hours
T Gallons -per -hour loss
(if 0.05 gallons]hour or less, tank passecl,)
Note: No. product ftpensing allowed.
x .20
+ 10
12.75"
OZ
x 10.
OA GPH
+ 10
= 0.0 GPH
pei:nrg

TIORI'VIL
JS.: D T.L4P
L
I CENSOR M)Rr Itq.
END
4
L I 'D:1022L
E;FhOOP fV;Pp,j,:,L
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Vioiatlon 3: 15A NCAC 2N .0505 R:CD5

UST-6H/23C Triennial UST Piping Integrity Testing
(for components installed on or after* 11/112007 or when returning
any LIST system to service from temporary closure) "
This form must be used to document pipe integrity testing (far piping not monitored continuously for releases using vacuum, pressure, or
hydrostatic methods) for UST systems installed an or after November 1, 2007 (this includes existing UST systems that have installed or
replaced the piping on or after November 1, 2007) or For any existing UST system conducting interstitial monitoring of the piping
regardless of installation elate prior to returning to service from temporary closure.
If there are more than five (5) piping systems at this facility, make additional copies of this page.
r The primary containment and interstitial space of the piping shall be tested in accordance with the manufacturers written guidelines
and PEIIRP100 "Recommended Practice for Installabon of Underground Liquid Storage Systems."
The last periodic tightness test record must be maintained by the tank owner/operators and must be readily available for inspection.
If any periodic test fails, a suspected release report must be submitted an a UST-17A form, UST Suspected Release 24 Hour Notice,
and investigated in accordance with 15A NCAC 2N .D603, and any defective equipment repaired in accordance with 15A NCAC 2N
.04041.0900. Results of the investigation must be submitted on a UST- 17B form, UST Suspected Release 7 pay NoWe.
If the piping fails a tightness test, it must be replaced or repaired by the manufacturer a the manufacturer's authorized representative
in accordance with the manufacturer's specifications. Foilovving any repair, the piping must be re -tested for tightness.
LIST FACILITY
5ysco
6701 Northpark Blvd Charlatte NC �tato 282 16
1 certify, under penatty or taw, that the testing data provided on this form documents the FIST system equipment was tested in 9Wordanoe vAh the
manufacturer's guidelines and the applicable national industry standards listed In 15A NCAC 2N Opoo
Shawn Bernas
f:
Print Name of person conducting test fgnature
of person conducting test
Identify piping system (By Tank # Tank # Tank �
Tank Number, Stored STP line 1 5TP line 2 Satalite 1
Tank # #
Satalite Tank
Product etc.
Tank Sire 20K 20K Z0 K
20K
Product diesel On Road Diesel On road Diesel On Road
Diesel Can Road
Piping Type(DW FRP, D!►V DW Flex DW flex ❑W Flex
Flex, Other
DW Flex
❑ Gravity ❑ Gravity ❑ Gravity
E3 Gravity ❑ Gravity
Piping Configuration ❑ Manifold ❑ Manifold ❑ Manifold
❑ Manifold ❑ Manifold
0 Pressurized 0 Pressurized 0 Pressurized
© Pressurized ❑ Pressurized
171 Suction D Suction Suction
Suction Suction
Piping Manufacturer I APT X gen 2 APT XP gen 2 APT XP gen 2
APT XP gen 2
Pipe Model (Part No.]
Indicate Test Phase: ■ Triennial Testing Post -Installation Return to Service from Tem ra Closure
Test Date 6/1/2018 6I112018 6111201 B
6/1/2018
A. Primary Pipe Test (Note: Must be a third -pally certified tightness test) (Attach test data sheets to form)
Lino Tightness Test
Results Attached Yes No ❑Yes 0 No Yes No
El IVa ❑Yes ❑ No
B. Secondary Interstice Test (Indicate units for all measurements)
BeginiEnd test time 1200 1300 1415 143U 1530
1545 1645
11315
Begin i End pressure i❑ Psi 110 Psi 10 Psi W Psi 10 Psi 10 Psi
10psi 10 Psi
Secondary Test Result Q Pass ❑ Fail � Pass ❑ Fail [e] Pass ❑ Fail
e❑ Pass ❑ Fail ❑ Pass ❑ Fail
Comments and explanation of railing results and other problems noted firing inspection
Double wail testing boots were deemed bad by Superior Testing Co, Testable boots were replaced and adjusted and tested ok.
NORTH CAROLINA DEPARTMENT OF ENVIRONMr=NTAL QUALITY, DIVISION OF WASTE MANAGEMENT. LIST SECTION
1646 MA)L SERVICE CENTER, RALEIGH, NC 27eW-1640 PH0NC (919) 70T-81_t1 FAX [phone] htlPJMWw wastenotncorghveblwm 1b115

A lication to...Initall ar Re lace Underground Storage. Tank S stems
Pp P Y.
UST,6E/23D {TANK INS fALli4`fI6 &OIEWAL:TESTIHG
0 A separate form should be used for each faciiity..if there are more than five. (5) tanks at this facility. make. additional copies of this page.
`Recommended
0 The primary and Interstitial space of the tank shall be tested in accordance with theme nufacturerswdttan guidelines and PEIlRP100 Prachos
for lnstallalion of Underground Liquid Storage Systems."
0 The last periodic tightness test record must be maintained by the tank owner or operatorand must. be readily available for inspection,.
• Tanks that are not monitored con tinuously .for releases using vacuum, pressure, or. hydrostatic:methods .must.be tightness tested at installatlon, between 6 and
12 months from installation, and every three years fallowing installation.
• The Interstitial space of the tank shall be tested.using a 3: ro party ckfied interstice tightness test capable of detecting a 0.1 gph leak from the:,inner:or outer Well
of the:interstice:for the tank model that. Is: installed.
r If the tank fails a tightness. test, it must be replaced: or repaired by the manufacturer or She. manufacturees.authorized representative in accordance with the
manufac(urets specifications. Following any repair, the tank must be retested for tightness.Also a suspected release report must besuhmitted an a UST-17A
form,. UST Suspected Release 24 Mour Notice.. The suspected release' must be investigated; inaccdrdahoe with 15A:NCAC 2N .0603,. and .any defective
equipment repairedirepiaced in accordance.with 15.A NCAC 2N .04041M00. Results of the investigation mustbei submitted on a UST=17B #orfn. UST Suspected
Release 7 Day NolieaUST
FACILI
Owner l Fac: Name Fac. ID#:
00-0-0000035"3
Operator Name
Fac. Address. Fac. City County.
bRIVE, CONCORD CABARRUS.
4500 CORPORATE NW
Co. Name
Phone -mail
Superior Services
828-698-6286 dave [e-mail]
Address
P.Q. Box 982
City
Hendersonville
State
PVC
Zip
28793
Kelly Keller
Signature of person conducting test
Print Name of person canducting lest
Identify Tank {Tank Numbar, etc.)
Tank #
Tank #
Tank #
Tank.#:
Tank #
Tank Size
217ia00
Diesel
Product
UST Type
FRP
US7 pes`:FRp, Steel.JacikoW,, SteeblQLAD,.Otlier.
Indicate units for all measurements: inches
1.:PreAnstallation:testln9
Vacuum/Pressure Gauge Range:
Test Date.
interstitial :space -Liquid Fillet! cr Vacuum.
ITest method: Vacuum Liquid filledlother:
Begin EndTest Time (liquid)
Begin End Level(liquid)
'.
I
Begin End. Test Time:
Begin End Pressure/Vacuum
Yost Resent
Pass Fail
Pass Fail
Pass Fail
Pass Fail.
Pass Fail
Liquidvisible on Insideloutside
Yes [:]No
Yes No
Yes No
Yes No
Yes No
of tank(If applicablej.
II. PoWnstailationitriennial testing
Tightness Test Modell (if applicable.)'.
Test Date: Begin End
i
63124121118 03124f2018
Interstitial:space.Liquid: Fllled[Other;
Test method: Vacuum .� Liquid filfedlvther: Xerxes.
Begin End Test Tlme (liquid)
11:33 21:33
e
Begin End Level (liquid)
1.2.75 12.7.5
P
; '
Begin End Test Tlme
r
i
Begin End Pressure/Vacuum
Test Result
Pass FjFall
Pass Fall
Pass Fall
Pass Fail
Pass Fail
Liquidvisible: on inside -of tank
Yes KNO
Yes No
Yes Na.
Yes No
Yes. No
ENV! RONuENTAL.CJALITY..WMANAGEMENT
NORTH C:ARQLINA 7EARTMENT .- .M
C01 15
.7F.
1fi46MPiL SERVIGE'CEVTERE�A1 i=fPH, NC..27699.-16 PHQNE%{g19j'74T 8171 FA7C t919] 715-11 17 http:IlwaVw.wasterioi�le.orglweblwm
'.
.:

Recommended Practices for the Testing and Verification of Spill, OVeill, Leak Detection and Secondary Containment Equipment at UST Facilities
U I XERXES`
making a lasting difference
TRUCHEKDATA LOG
Fill out the site location, tank information and test boxes below. Be sure to choose the correct test box according to the
diameter of the tank being tested. Follow the test procedures on the other side of this farm. A separate test form is needed
for every tank. For additional copies of the form, contact the Customer Service Representative at the Xerxes manufacturing
facility nearest you. (See back cover for information,)
SITE LOCATION • ■ TANK INFORMATION
Site Location: Sysco Food Services of Charlotte
Address: 4500 Corporate Drive, NVV
Concord, NC
Phone: [phone]
Contact Name: Josh Callahan
Test Date:
3-24-201 B
95% - 5% TEST
1 a. Start level (inches in standpipe)
2a. End level after 4 hours
3. Difference (subtract 2a from 1 a) -
4. Calibration factor x .20
5. Volume change -
6. Test hours + 4
7. Gallons -per -hour loss =
(If 0.05 ga]Ion slhour or less, tank passed.)
Note: maximum allowable dispensing volume during test:
8-foot-diameter tank - 1,200 gallons maximum
6-foot•diameter tank -- 500 gallons maximum
4-foot-diameter tank - 30D gal Ions maximum
95% - 5% TEST
1 a. Start ievet (inches in standpipe)
2a. End level after 6 hours
3, Difference (subtract 2a from 1 a) -
4. Calloration factor x .30
5. Volume change =
6. Test hours 6
7, Gallons -per -hour loss =
(If 0.05 gallonsihour or less, tank passed.)
Note: Maximum allowable dispensing volume during test:
1D- foot -di ameter tank - 75D gallons maximum
Tank Information:
Nominal Gallons: 20000
❑ia meter:120"
Approximate Standpipe Length: 39.25"
Product Type: Diesel
Person Performing Test: Kelly Keller - Superior Services
C
99% - 1 % TEST
1 b. Start level (inches in standpipe)
2b. End level after 1 D hours
3. Difference (subtract 2b from 1 b) -
4, Calibration factor x .20
5. Volume change =
6. Test hours + 10
7. Gallons -per -hour loss -
(If 0-DS gal Ion ski our or less, tank passed,)
Note. No product dispensing allowed.
99% - 1% TEST
1 b, Start level (inches in standpipe)
12.75"
2b. End level after 10 hours
1215"
3. Difference (subtract 2b from 1b)
= 0A1
4. Calibration factor
x .30
S. Volume change
= 0.0 GPH
6. Test hours
+ 10
7. Gallons -per -hour toss
= 0.0 GPH
(If 0.05 gallonsMour or less, tank passed.)
Note: No product dispensing allowed.
pei.arg 0

it.
12
L I D. I FS'E'L
C3 Ci
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L
SO%8op
END

Violation 4: 15A NCAC 2N ..0GU3RLS5

USTA 76 UST Suspected Release 7 Day Notice
queen
This form must be used to report to DEQ, within 7 days of discovery, the investigation results for a Suspected Release from any of the following;
a) Failed or inconclusive leak detection or tightness test results. This includes positive test results, such as "Increase", which indicates the level in the
UST system has increased more than 0.2 gph.
b) Unusual operating conditions which can include, but are not limited to, the erratic behavior of dispensing equipment; the unexplained presence of
water 1n the tank; the presence of fuei in containment sumps or interstitial spaces; or the degradation of any equipment or element of an underground
storage tank system to the point where that equipment or element can not reasonably be expected to perform its intended function.
c) Internal inspection results such as, perforations, corrosion holes, weld failures, or other similar defects that indicate a release could have occurred.
If you have more than four UST systems to report suspected release investigations, then attach additional sheets of the UST-17B form.
Please submit this form along with the supporting documentation to:
NCDEQIDWM, UST Section
1646 Mail Service Center
Raleigh, North Carolina 27699-1646
OR
Fax to [phone] OR UST.Permits ncdenr. ov
I. UST OWNER II. UST FACILITY
Name: Name: Facility ID:
Sysco Charlotte LLC Sysco Charlotte LLC 00-0-0000035443
Address: Address:
4500 Corporate Drive NW 4500 Corporate Drive NW
City: State: Zip: City: County. -
Concord NC 28027 Concord Cabarrus
Person Reporting: Title of Person Reporting: Telephone Number:
Josh Callahan Fleet Manager [phone]
III. INVESTIGATION RESULTS
Tank Number 1 Size: I 1 ! 20,000 Gal 1 1 1
Product Stored:
Reason for Suspected
Release Investigation
(Check all that apply):
You must attach the
supporting documentation
specified in the footnote for
the reason(s) selected.
Diesel
❑ Data entry error'
❑ Dispensing fuel while
test is being conducted
® Faulty equipment'
❑ Incorrect stick or meter
reading'
❑ Incorrect tank chart {
❑ Internal Inspection'
❑ Meter not calibrated c
❑ Other (Attach
explanation)'
® Tank/Dispenser
containment sump
contains liquid'
❑ Tilted tank °
❑ Unknown'
❑ Data entry error'
❑ Dispensing fuel while
test is being conducted t
❑ Faulty equipment 3
❑ Incorrect stick or meter
reading'
❑ Incorrect tank chart'
❑ Internal Inspection s
❑ Meter not calibrated s
❑ Other (Attach
explanation)'
❑ Tank/Dispenser
containment sump
contains liquid'
❑ Tilted tank"
❑ Unknown'
❑ Data entry error'
❑ Dispensing fuel while
test is being conducted 2
❑ Faulty equipment 8
❑ Incorrect stick or meter
reading'
❑ Incorrect tank chart °
❑ Internal Inspection 5
❑ Meter not calibrated e
❑ Other (Attach
explanation)'
❑ Tank/Dispenser
containment sump
contains liquid'
❑ Tilted tank $
❑ Unknown'
❑ Data entry error'
❑ Dispensing fuel while
test is being conducted P
❑ Faulty equipment'
❑ Incorrect stick or meter
reading'
❑ Incorrect tank chart 4
❑ Internal inspection 5
❑ Meter not calibrated $
❑ Other (Attach
explanation)'
❑ Tank/Dispenser
containment sump
contains liquid 7
❑ Tilted tank °
❑ Unknown'
Conduct a tank and/or line tightness test and attach the results, along with all of the supporting data sheets for the test method, to this form for submittal.
The summary page listing the results by itself is not acceptable. If the tightness test results are fail, then you must repair or replace your UST system and
conduct a site check in accordance with 15A NCAC 2N .0603.
s Provide sales receipts or other comparable documentation that shows fuel was being dispensed from the UST during the test.
' Provide invoices (with a description of the work completed) or other documentation that shows the equipment has been repaired.
4 Correct your leak detection results using the correct tank chart and submit copies with this form.
s Repair the UST in accordance with the manufacturer's instructions or a national standard (e.g., PEI API 1631) and conduct a site check in accordance with
15A NCAC 2N .0601 If the UST is not repaired, then it must be permanently closed in accordance with the latest version of the UST Sections Guidelines
for Tank Closure.
° Correct your leak detection results using the amount your meter was adjusted following calibration and submit copies of the meter calibration and leak
detection results with this form.
7 Conduct a tightness test (e.g., hydrostatic test) of the sump and submit the test result along with this form. If the test results are fail, then you must repair
or replace the containment sump and conduct a site check in accordance with 15A NCAC 2N .0603.
s Submit documentation from your UST equipment contractor explaining how they determined the UST was tilted. Correct your Peak detection results using a
tank chart adjusted for the tilt and submit with this form.
Note: Tank, piping, spill bucket and containment sump replacements must be done in accordance with 15A NCAC 2N .0900
UST-17B Revised 1012015 http:llwww.wastenotne.org/web/wm/

Triennia! UST Containment Sump 1
UST-fiF123B UDC Integrity Testing
. If any periodic test fails, a suspected release report must be submitted on a UST-17A form, UST Suspected Release 24 Hour Notice. The suspected
release must be investigated, in accordance with 15A NCAC 2N .0603; and defective equipment repaired or replaced in accordance with 15A NCAC
2N Results of the investigation must be submitted on a UST- 17B form, UST Suspected Release 7 Day Notice.
.0404L0900,
• Containment sumps installed on or after 111112007 that are not monitored cortinuousty for releases using vacuum. pressure, or hydrostatic interstitial
monitoring methods and all other containment sumps Installed prior to 111112D07 that are used for interstitial monitoring shall be tightness tested at
installation and every three j3) years thereafter in amordancc with the manufacturer's written guidelines, PEURP100'Recommend ad Practices far
Installation of Underground Liquid Storage systems" andlor PEllRP1200 "Recommended Practices far the Testing and Verifieatian of Spill, Overfill,
Leak Detection and Secondary Containment Equipment at UST Facilities."
• If a UDC 1 Containment sump fails a periodic tightness test, the sump must be replaced or repaired by the manufacturer, or the manufacturer's
authorized representative in accordance wtth the manufacturer's speciflcatlars.
UST FACILITY
Owner 1 Operator Name Facility Name Facility ID
Sysco Sygco 0040-0D0035443
Facility Street Address Facility City County
45M Corporate Drive Concord Cabarrus
CONTRACTOR/PERSON CONDUCTING INSPECTIONS
Company Name Phone Email address
Jones -Frank 7114 39343542 [e-mail]
I certify, under penalty of law, that the testing data provided on this form documents the UST system equipment was checked in accordance with the
manufacturers guidelines and the applicable national industry standards listed in 'I5A NCAC 2N .406 andlor 15A NCAC 2N .0900,
Shawn Bernas
Signature of p on conducting inspection
5110f2018
Print Name of person conducting inspection
Inspection Date
Identify UDC/sump (By
❑ Dispenser
❑ Dispenser
❑ Dispenser
❑ Dispenser
❑ Dispenser
❑ Dispenser
Dispenser No. or Tank Number,
® Tank #
© Tank #
❑ Tank. #
❑ Tank #
❑ Tank #
❑ Tank #
Tank Size, Storsd Producte.g.
#1 10k Ragular STP, Disp 112,
#, Diesel 20K
#
#
#
#
#
etc.)
Transition sumps should he listed alcove as "TS-XX" (with XX= sump II34)
Sump Manufacturer
Xerxes
® FRP
❑ FRP
❑ FRP
❑ FRP
❑ FRP
❑ FRP
bump Material
❑ Plastic
❑ Plastic
❑ Plastic
❑ Plastic
❑ Plastic
❑ Plastic
® Single Wall
❑ Single Wall
❑ Single Wall
❑ Single Wall
❑ Single Wag
❑ Single Wall
Sump Type
❑ Double Wall
❑ Double Wall
❑ Double Wail
❑ Double Wall
❑ Double Wall
❑ Double Wall
Hydrostatic
❑ Hydrostatic]
Hydrostatic
ElHydrostatic
❑ Hydrostatic
❑ Hydrostatic
Test Type
❑ Vacuum
© Vacuum
❑ Vacuum
❑ Vacuum
❑ Vacuum
❑ Vacuum
Indicate units for ail measurements
Liquid and debris removed from
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
sump?
Visual inspection (No cracks,
loose parts or separation of the
® Pass ❑ Fail
❑ Pass ❑ Fail
❑ Pass ❑ Fail
❑ Pass ❑ Fall
❑ Pass ❑ Fail
❑ Pass ❑ Fail
containment sump)
Sump Depth
46
Height from sump bottom to top
of highest penetration or sump
19.5 Inch
sldewall seam
Waft time between applying
15 mins
vacuum/water and start of test
Begin i End Test Time
1 PM 2 PM
(minimum test time. 1 hour)
Begin I End values
21.5 Inch 21.5 Inch
Pass)Fait criteria: Must pass visual Inspection, Hydrostatitr_ Water level drop of less than 118 inch; Vacuum: No change in vacuum
Test Results
® Pass ❑ Fail
❑ Pass ❑ Fail ❑ Pass ❑ Fail I
© Pass ❑ Fall 10
Pass ❑ Fall
❑ Pass ❑ Fall
Comments and explanation of Tailing results and other problems noted during inspection:
Site Failed hydrostatic, we replaced all boots in STP sump and all tested ok.
Date next Containment Sump/UDC integrity test due (required every 3 years) 5109/2021
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY, DIVISION OF WASTE MANAGEMENT, UST SECTION 512017
1646 MAIL SERVICE CENTER. RALEIGH, NC 27699-1646 PHONE [phone] FAX [phone] hltpJAy.m .wastenotnc Qro!

Remit To:
Junes & Frank
PO Box 531829
ATLANTA. GA 30353-1829
919-838-7555
RILL CUST-0001993
TO: SYSCO
4500 CORP DR
Concord, NC 28027
SERVICE INVOICE:PSER-0349908
SHIP: CUST-0001993
TO: SYSCO
4500 CORP DR
Concord, NC 28027
Page: 1
INVOICEDATE CUSTOMER/ PAYMENTTERMS CALLER NAME
12/21/2017 Josh Callahan Net 30 Days
Date
Serviced Item/Description unit Order Qty Quantity Unit Price Total Price
12114/2017
HOLMES JR., J
JOSEPH HOLMES JR.
Hours
S-25
5.25
87.00
4S6.75
12/14/2017
IT-0000320
FILTER, 400-30 HI CAPACITY 1
Each
4
4
6.61
26.45
12/14/2017
RT TRIP
REG TIME TRIP CHARGE
Each
1
1
150.00
150.00
CD 12/12/2017 SITE NAME: SYSCO SITE ADDRESS- 4500 CARP DR Concord ND 28027 CALLER NAME: Josh Callahan PHONE NUMBER:
704-723-6067 BILL TO: SYSCO CU5T-0001993 was verified as the bill to, PO NUMBER: Josh Callahan HOURS:24 hours
PRIORITY: P2 DESCRIPTION: The customer states there are small leaks in the fuel pumps cabinets on pump#1 and #2.
DATE:12/14/2017 TECH INITIALS: JH EQUIPMENT SERVICED: Gasboy Atlas dispensers ISSUE ENCOUNTERED: Pumps #'s 1 & 2 leaking CAUSE:
Multiple - all filters leaking and several meters and piping bolts Ioase RESOLUTION: Wiped everything down everything as much as possible
- replaced all the filters and went around and checked and tightened every loose bolt - tested and monitor for a while problems did not
reoccur while on site -also had site personnel come out and checked repairs PERSON NOTIFIED: MOD(Josh)
SERIAL,4-KWAT020861 and ]fWAT020862 STATCJS!COMPLETE
Fault Area: GAS BOY DISPENSER Fault Reason: FILTER Resolution: REPLACED
Subtotal: 533.20
Total Sales Tax: 33-82
A FINANCE CHARGE WILL 8E ADDED TO ALL PAST DUE ACCOUNTS Total: 667.02

FMI 4
Remit To:
Jones & Frank
PO Box 531829
ATLANTA, GA 30353-1829
919-838-7555
SILL CUST-0001993
TO: SYSCO
4500 CORP DR
Concord, NC 28027
3/5/2018
Date
Serviced Item/Description
SERVICE INVOICE: PSER-0367073
Page: 1
r
i. WR Il�1 {J5 I?00I993
' T YSCD'
4500 CORP DR
---Co"ard, NC 28027
Misty Durham Net 30 Days
unit Order Qty Quantity Unit Price Total Price
2/24/2018 SUBCON SUBCONTRACTOR Each 1 1 312-50 312-50
REQUESTEDSERVICES SITE NAME•SYSCO SITE ADDRESS: 4500 CORP DR Concord NC 28027 CALLER
NAME: Misty Durham PHONE NUMBER: 704-723-6048 BILL TO: CUST-0001993 PO NUMBER: Misty Durham HOURS: 24/7
PRIORITY: P3 DESCRIPTION: They need to have a line tightness test & leak detection test done at the site
SPECIAL INSTRUCTION: They would like a tech on site Man moming in between Sam -gam please contact Misty with ETA 704-723-6048
Precision Test of Line & MLLD
A FINANCE CHARGE WILL BE ADDED TO ALL PAST DUE ACCOUNTS
Subtotal:
312.50
Total Sales Tax:
21-88
Total:
334.38

....SUPERIOR
P.O.- Box 95
Hendersonville, NC 28793
Tel-
Fax-[phone]
www-superiorservices.ua
CUSTOMER
.gaoled 9. Frank = hadoue
sysc.0
00 Corp Dr
Concord, NC 2802
RJUV41NA
DATE INVOICE NO.
4
.21241201B 131977
TERMS P,0- NO,
Net 15 See below
LOCATION
DEscRiPTm QTY RATE AMOUNT
T
7,7
P�t Test of Uns & MLAD 50.00
0,00
. appruclato your W5.iness. Total.
lf)WOS�t Of I-1r2% ;.mr moh to .bo paid pn aH masiercwor uiscovar, Am erlcari xpd
"Where InNgrify a Haber of Record

Service Report
DATE: 3/26118
CUST-0001993 Work Order Number #: WO-00005775
SYSC❑ Location: SYSCO
4500 CORP DR 4500 CORP DR
Concord, NC,28027 Concord, NC,28027
WORK ORDER DETAILS
Caller Name JOSH N/A Product Name
Caller Phone Number 704-723-6067 Product Description
PO Number JOSH Serial/Lot Number K07207439705001
RKIPROBLEM DESCRIPTION
BOOTS NEED TO BE LOOKED AT IN SUMP, ON SECONDARY PUMP MISSING A SHADIER VALVE.. BOOTS UNDER THE
MANHOLE, FOAM NEEDS TO REPLACED. --
installation (improper installation)-940
ATC Probe-1343
Replace Tank Farm Component-2205
WORK PERFORMED
JRP 3-26-18 Surveyed site and took photos. Discussed with .cosh the state NOV and what can be done to fix it. Sent photos to
Shawn Bernas for quote-
er
7Nbe
Product Name
Product
Description
SeriallLot
Number
Fault
Cause
Remedy
Work Order Scope Of Work/Problem Description
Number
Work Order Work Performed
Number

Customer Signature:.
Technician Name: Joshua Pblkey
Work Start: M6118 3:17 PM
Work End' W26/18 4:09 PM
Customer %holu c
Usforner Nzinelosh Callahan

CUST-0001993
SYSC❑
4500 CORP DR
Concord, NC,28027
Service Report
Work Order Number * WO-00005775
Location: SYSCO
4500 CORP DR
Concord,NC,28027
DATE: 4/5l18
Caller Name JOSH N/A
Product Name
848290-122 OEM
Caller Phone Number 704-723-6067
Product Description
TLS-350R BIR CONSOLE
WITH INTEGRAL PRINTER
PO Number JOSH
SeriallLot Number
K07207439705001
BOOTS NEED TO BE LOOKED AT IN SUMP, ON SECONDARY PUMP MISSING A SHAKER VALVE .. BOOTS UNDER THE
MANHOLE, FOAM NEEDS TO REPLACED...
Installation {improper installation}-940
ATC Probe-1343
Replace Tank Farm Component-2205
WORK f
J R P 3.26.18 surveyed site and took photos. ❑iscussed with Josh the state NOV and what can be done to fix it. Sent photos to
Shawn Bernas for quote. JRP, KW, JD 4.5.18. Removed all existing boots from sump. Threaded TCI pipe boots were damaged
and threads were not reusable, this was not determinable from the survey because the boots were heavily covered in sealant.
Removed threads and ordered boot to directly fit to the wall. Installed conduit boots. Cleaned area around sump of excess dirt and
grime. Team will return to install final boots and do under dispenser work.
Work Order Scope Of WorklProblem Description
Number
Work Order Work Performed
Number

Customer Signature:
Technician Name:. Joshua. Pelkey
Work Start: 3126118 1-1-7 PM
Work End: 4/5/18 2:43 PM
Rus Pmer Wn c a
Momer N sh Callahan

Service Report
DATE: 5/16118'
GUST-0001993
Work Order Number #: WO-00005.775
SYSCO
Location: SYSCO
4500 CORP DR
4500 CORP DR
Concord, Id.C,28027
Concord; NC,28027
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Phone Number
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Product Description
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r-,S';fr� � C��"n �� L .z?; �,Ky�4. ���Ys�� v±,�xe� .�x ��r`4��� C,�'�5 �r`.`x �M.'.%�. i r-..� ,�` r�rrci+--�� K- . i- d-: � ���:'s �rk.,c �,xt r�rr�;�K-7s�iwr-L-�,x(;�•�.-n�xr4v"~ dr-'� �d-:� .
ATC. Probe-1343
•:;xns s�., . ;�.s �>. • Y .� ., ram.. . Y vz;.: . Y >ti a� . '�.w . �., c. _�:' . �,-. . � ." .:��_�, . Z, ti i � J � K }- J 1 }-s r � J,� •... ..}� t Y �, J, ° '.1.hy'.f' Y.y 1 `fir ':1}�.f'�'s,r ..'1`-` : 4- }-
�
'[� �._. ,,:y,y, t i ✓e[ l s' t i.�.�"g p kxy- t . i.�..�r o l .A'�)r i � . ��^"a � . � e[ � lT�-.- . 'i"��-r ti •=� =.b�3; 1... 'i"���r�ti •=xi.�zr�->`;
�r' fi `�1,... ?`.2-`�![r�' fi r' `S�rr fi : �:7"3 s. ?r j�75 � . � . ?.�7s-.-` fi �'Irr'3 ? �'��rs-; � �',1rf�r��„•-•3rr`�-r''�fr
���`.k�'ir
w.lfvrs ."rrf3 ...
a..��,� Y y ."rrf31,.� (g : y.
rn''Y,.� � � � � � �^� 3`�� ���`��rix.� �Z ?�r.. r :X
: �.�'$�r.���~ir : �.�K rl��:,_ Ji:`' a�k`'��'��r : �.�'$�'`���'-:`' •k��� r z t..S . ':• 1.� zT.Sya�i t.; .S rfi. �•'- L�zcS..' i�z-�, r.�..i--t' z�k,' .%4 �. �.,� `i. k,' .i �.�'$rr��:, ��:,_ t :-
Replace: Tank Farm Component-2205.
� �r, 42���..�s q'� f �cy7�'y�`� ` l%� '�`�.,.rj'� �>r'1��j-q' 'ic��,rcr-�� t��.���"••y�` ''c�G�`j#� c��z�6''j�?S��' •'��j �Y' Y
3r`i���k d �� � ��7#��>�; `-�� '�c�c�j#� �
k�}'
�.. rc� n
FL,�;.r"�;'j. � s-,.J,=,+...k ;f =.ls. 3 _�C7�"�.-1.N�_, 3 s �rl:a =,,l.N�_�1 s• � �r�.a� �lr-"F� .,=.-1.N�,� 3 3 ���--l.s "�, i•.��r.,'cl .r � _�C7h�.= rxJ.=��'C1�;r �.�' _��iCF�.
a,i .�-:r+r".....5 •s:;- ",.r�.�`.;. �i;.._;•nrry'.,.-L �. ",.r�.x.., ,�-.rzr..,.z- �. ",.ram. ...�:.=..rzr.. .>� �. ,' -... "rzr...
JRP. 3.25A 8 surveyed site and took photos. Discussed .with :Josh the state .NOV'and what can be done to fix it. Sent photos to
Shawn Bernas for quote. JRP, KW;.JD 4.:5.18..:Removed all existing boots from sump.: Threaded TCI pipe boots were. damaged.
and threads were not reusable,: this was not determinable from .the survey because .the boots'Were heavily rove red in sealant:
Removed threads'and,ordeired boot. to d irectly. fitto the.wal1. Installed condpit.boots. Cleaned area around sump of excess dirt and
grime. Team will return to install final boots: and do under dispenser work. 4.10.18 JRP JD and BH Installed pipe (loots and.
showed.Mahager Josh the progress of repairs, STP sump:completed. T-Mobile returnto work .under dispenser. 4117 SB arrived on..
site checked in with Josh; thencleaned dispenser sumps'and STP sump., Hydrostatic tested STP sump found fail but may be due
to conduit ; will check. resuIts in the morh1fig.:Alsd all. UDC boots.are defective will need to change quote and install boots on the
outside. UDCs have 2 lines., 3 electrical and:2.Iines 2 electrical. 4 testable boots. will. need 2 Testablesln STP. sump as well.
4118,18 SB JRP 6H.JD'pumped water out, made repairs,. once repairs.dry will test again. Discussed quote with. Josh for UDC work'
4120118'JD Cut concrete at. dispenser will return nextto bust up and install boots.on outside of the. sump...4125; and'4126 on site
excavation completed buifding side of dispensers.. Installed new entry boots and hydro tested. Filled in excavation with prock.and
made ready for concrete. 4127'5B on4te:instaIled . issue'with test. water.found hoot issue: ,. corrected. Retested both 0DCs.again.
and. shared up boots. Back filled and will install concrete Monday'. tw3 SB on site cleaned up degree from excavation and hauled it
off: Set up compressor and jack hammer for:tomorrow. 5177 518 jack hammered and excavated other.side of dispensers.. 519 SB
installed all electrical boots. and started preps dng.Iine boot instaIlatio..n..5/10 installed line. entry and. tested. UDCs for tightness. 5111
SB,BH,JD and KW on site finished installing and testing sumps today :all passed, .Prepped excavation: for concrete.tomorrow. I will
hav a superior testing out next Wednesday to test double wall lines...5116. SB;JP,. JD and KW on site checked .'in then pulled
l.dispensers and replaced double wall line boots: Superior should be out -on Friday to test':

Work -Order
Number
Produat`Name
Product
Description
Serial/Lot
Number
Fault
Cause
Remedy
Workrder Scope: Of Work►Problem Description
Number
Work Order Work Performed
Number
Customer Signature:
Technician Name: Shawn J Bernas
Work Start. 3/26118 3,1.7 PM
Work End: 5/16/16 4:59 PM
Customer 5itinature
us Omer ame: osh Callahan

Service Report
DATE: 7113/18
CUST-0001993
Work Order Number #: WO-00032904
SYSCO
Location: SYSCO
4500 CORP DR
4500 CORP DR
Concord, NC, 28027
Concord, NC,28027
Caller Name
Mlsty Durham
Product Name
DISP-9840KX DFZ
Caller Phone Number
704-723-6048
Product Description
REMOTE DISP SGL, FRONT
NOZZLE
PO Number
Misty Durham
Serial/Lot Number
AT020862
Replace meter follow up from WO-00017236
Leak (nozzle, hose, and so on)-710
Meter, Other - 0590
Replaced-2200
RVOMERF,- ■
7-12-2018 mt dispenser meter leak. Removed existing leaking meters from dispenser 1 and 2. Replaced with new meters and
meter check valves due to humbug. Calibrated dispensers, purged air out of lines.
Work Order Scope Of Work/Problem Description
Number
Work Order Work Performed
Number

Customer Signature:.
ON
CilStOmef'SI nature
u.s"�vmer Name:.misty durham
Technician Name: Mark Taylor
Work Start: 7113/18 9:12 AM
Work End: 7/13118 3:15 PM

rm�k
Remit To:
Jones & Frank
PO Sax 531829
ATLANTA, GA 30353.1829
919-638-755S
WILL CUST-0001993
TO: SYSCO
450p CORP DR
Concord, NC 28027
7/2/2018
JOSH
3
JUL 12 L..J
SERVICE INVOICE: PSER-0393953
Page: 1
SM Work Order No.; WO-00005775
SHIP CUST-0001993
TO- SYSCO
4500 CORP DR
Concord, NC 28027
Net 30 Days
Data
5ervked
Item/Description
Unit
Order Qty
Quantity
Unit Price
Total Price
5/9/2018
IT-0028003
2-PART 250MIL POLY ADHESIVE
Each
2
2
217.35
43430
4/17/2018
IT-D039286
SPLIT FRP THREAD ON RTFT FITTING FOR
Each
2
2
202.30
404.59
3/4IN TO
411012019
IT-0040206
SPLIT FRP RETROFIT KIT FOR 1.51N FLEX -PIPE
Each
2
2
277.57
5S5.14
W/ 4IN
4/26/2018
IT-0040664
RETROFIT KIT, 8 BOLT REPLACEMENT FOR 2FT
Each
1
1
258.75
258.75
FRP PIPE
4/26/2018
IT-0028003
2-PART 250MiL POLY ADHESIVE
Each
3
3
217.35
652.05
4/26/2018
IT-0036854
RETROFIT KIT, 8 BOLT FRP FOR 1.5IN PIPE
Each
3
3
277.57
832.70
4/26/2019
IT-0028001
SING WAL SPLIT FRP RETRO FITTING
Each
6
$
141.61
1,132.85
4/10/2018
DAVIS, J A
JUSTIN DAVIS
Hours
4.25
4.25
97.00
369.75
4/5/2018
WALTERS, K
KAGE WALTERS
Hours
7
7
87.00
609.00
4/5/2018
RT TRIP
REG TIME TRIP CHARGE
Each
1
1
150.00
150.00
4/17/2018
BERNAS, 5
SHAWN BERNAS
Hours
4.25
4.25
97.00
369.75
4/17/2018
RT TRIP
REG TIME TRIP CHARGE
Each
I
1
150.00
150.00
4/18/2018
PELKEY, J
JOSHUA PELKEY
Hours
3.5
3.5
87.00
304.50
4/18/2018
BERNAS, 5
SHAWN BERNAS
Hours
3.5
3.5
87.00
304.50
4/18/2018
DAVIS, J A
JUSTIN DAVIS
Hours
3.5
3,5
87.00
304.50
3/26/2018
RT TRIP
REG TIME TRIP CHARGE
Each
1
1
150.00
150.00
3/26/2018
PELKEY, J
JOSHUA PELKEY
Hours
1
1
87.00
87.00
4/5/2018
DAVIS, J A
JUSTIN DAVIS
Hours
7
7
87.00
609.00
4/5/2018
SUPPLY
ACETONE AND RAGS FOR SUMP CLEANUP
Each
1
1
100.00
100.00
4/5/2018
RT TRIP
REG TIME TRIP CHARGE
Each
1
1
150.00
150.00
4/5/2018
PELKEY, J
JOSHUA PELKEY
Hours
4.75
4,75
87.00
413.25
4/20/2018
DAVIS, J A
JUSTIN DAVIS
Hours
4
4
87.00
348.00
4/20/2019
WALTERS, K
KAGE WALTERS
Hours
4
4
87.00
348.00
4/26/2018
RT TRIP
REG TIME TRIP CHARGE
Each
1
1
150A0
150.00
4/26/2018
RT TRIP
REG TIME TRIP CHARGE
Each
1
1
150.00
150.00
4/25/2018
BERNAS, S
SHAWN BERNAS
Hours
6
6
87.00
522.00
4/25/2018
DAVIS, J A
JUSTIN DAVIS
Hours
6
6
87.00
522.00
4/26/2018
BERNAS, S
SHAWN BERNAS
Hours
5
5
87.00
435.00
4/26/2018
WALTERS, K
KAGE WALTERS
Hours
2
2
87,00
174.00
4/26/2018
DAVIS, J A
JUSTIN DAVIS
Hours
2
2
87.00
174.00
4/27/2018
RT TRIP
REG TIME TRIP CHARGE
Each
1
1
150.00
150.00
A FINANCE CHARGE WILL BE ADDED TO ALL PAST DUE ACCOUNTS

5ER'VICE' INVOICE: PSER-0399953-
Resn'itTo:
Janes:&,Frank.
Paget
POSOX-531829 Sty Work Order No. W.0-uc 5775
AT.LAPrITA,,"- 30 S3'-�929
919�83&755a�
BILL CUST=6091993 S14IP; CUST CW1993
T4: SYSGO TD SYSCO
4%0 CORP. DR 4500. CORP DR
Cgn�dd, NC -28027 Cantord,.K' 28027
INVOICE
DATE
PC)
PAYMENT -TERMS
CALLER NAME
7j2�201$
JOSH
�et30 pays
4127./2018
RT TRIP
REG TIME TRIP CHARG E
E&h'
1
1.
'150.06
'150:00-
4/27/P018
SERNA5:S:
SHAWN BERNAS
Hours
5n25.
10:2.T
87.4Q
84. '75:
4/27J;.'4I,8
WALTERS, K
KAGE'W4TERS
Hours
8
8
87:0a
`696.00
4127/2418
DAVI5,J A
JUSTIN,bAVI5
Flours
$
8
6;06
OECD
4/30/2018
RT-TRIP
REG TIM E TRIP CHARGE
'Each'
1
1.
150.00
150.00'
4/30j2018
RTTRIp
RFIP:TIMETRIP. CHARGE
Each
1
1
150.00.
1501.40
4l/3bj2018
oRVIS;.! 1E'.
lUSTIN DfIVIS
Hours
6.5
615-
87,00
•565.50
4t36/2018.
WALTERS'K
KAGE WALTERS
Hou rs
6.5
6.5
e700.
565,50:
4/35/2018.
SUPPLY
-MISC. SUPPLIES
Each .
1•
1
225.00
125:00
513/2018;
RTTRIP
REG LIE i`RIP. CHARGE
Each
]
1
150J)0
15010
513120.18-
SERNAS, S-
SHAA N'kkNAS
Hours
5.:
S
87.04.
435.40
3/9/2018
RTTRIP
REGTIME TRIP CHARGE:
Each
>
1
150.00
1SO.Q0,
5/912018
BERNAS, S
SHAWN B]ERNAS
Flau.rs.
175
1.75
87.00
152.25
5/10/2018
REPAIR,
C0NCR£TE„REBAR,'b0VVELlNG
Each
A.
1
350.00
35OAp:
5/10/2RIS
RTTRIP
7REG11ME:FRIP-CHARGE'
Each
1
1
150.Ofl
150.00;
540/2018,
RTTRIP
REG TIME TRIP, .CHARG�-
Each
1.
1
15.6.00
J.SQ,QO,
5/10/2018
BERNA9; 5'
SHAWN HERl�[AS
Hours
8
8
8.7:bD
696,04
511Oj2018
WALTERS, K
KAGE WALTERS
Hours
7.5.:
7:5
87A0
6smb
S1.1012018
DAM J A
)US-gN DAVIS
Hours.
7.51
7.5
87.00
652:50
5/.10/2919
RTTRIP
REG TIiv1E TRIP CHARG E,
EaCh
1
1
7,50:pti
I-50.00.
511W2018.
RTTRIP
RRG'TIME:TRIP CHARGE
'Egh
1
1-.
15p.Ob
150.OQ•
511A/2018
SEiiN S, S
SHAWN 6EkNAS
Flours
8.
8.
, 87.00
696.4fl
5/10ppt g
WALTERS; K
KAGE WALTERS
Hours
7.5
7.5
8T;G0
.652,50
5110/20I8
gRt115: J A
JUSTIN�.R.AVIS:
Hours
7.5`
7.5
L87.09
652.50.
5116/W18'
RTTRIP
REG'iTIMF.TRIP CHARGE
Each
1
1.
JSO.FiO
3S[].DO
5/16/2018
RT TRIP
REGTIM E TRIP CHARGE
Each
1.
.1
157.00
150.00
5115/2010:
'BERNAS, S;
SHAWN SERNAS
Haul's
8
8
87:00
695.00
5]1512018
DAV15, J•A
41J5T 1.17AVi5.
HaurS•.
B
$
57xv
59E.00
5/1613i118-
WALTERS,, K
KAGE"•WALTERS
Hours
8
8,
87.0
W.00
560" NEEb-TO 9E LOOKEDATIN SUMP, ON SECO•NDAKTPLIMP MISSING ASHAUER:VA€ VE... BOOTS UNDER"fiiE:Ju1A¢{F10iE,,FOAM NEEDS TO
REPLACED;..•,
JRP.1: 6.18 5urveyad �sRe and'took.p"ps. Dis-cussed .w ith.lasti'tbe state kbVand ►vhat Gan be done:ta fik it. Sent p6otgs .p, Shawn Bernas
A FINANCE'Ci .RGE WILL, S1 ADDEDlo-ALL PAST DICE ACCDUNT�S

e:in
hetni4 To:.
:lone. & Frank'
P.D Box 531 .29
Ail.ANTA,.GA 30353-Z829
91949.9-7555
BILL CUST�OU01993•
TD;- SYSC(?
450'CORP DR'
Coudrd, NC 28027
SEROM NVOIc�PSER,d393s53
Pace; 3'
SM Wark Order Nbz WO-II0005775
SMp, OUST-GOU1993
TO; SYSICO
45W.ODRP DR -
Concord, NC-:28U27
INVOICE DATE CUSTQUlER PO PA'YMIENT Tl RNIS CALLER NAME
7/212619 JOSH: filet 3tI`bays•
for qutite.- JRP;KW, Jt7'4;5.1&. Removed. eli existing bv�tsiro[ri'slrmp. Threaded TCI pipe boots we:e'da'maged.and lfiiiads Were. not
reusable, tKs.was not detem ina.ble•from the.survey.because the boots were heavily cove md.In; sea lanK Removed threads ar=d ordeimd,boof
todirectlpfitto.& mia31. Installccllconduit bvpts. •Cleaned ,area around. sump of excess dirt and 9rirne. Team w111 t'eturn to install
final boots and do uriderdispeitserwork.. 4.10.18 JRP JD and &N:Installed pipeioaots'and showed mari•ager:Josh ther p'rogreSs of repairs, 5TP
sump toinplited. T-Mofalle return wwork:under dispenser. '447 5B a0vdd on site.checked inivlth. Josh, _than deaned•dlspenser- sumps -and.
STP•sump: Hydrostatic -tested STP sump.found•fal1: but:rrray 6dua to conduit: wilt &et:k results_ in -the .morning, Also al€ 6K.i pots are
Oefec a WIdreed to'change;quote.and install.hoots-oi'i the outside, UD4k leave Zlines, 3`ejectriial and_2.Iines2 electrtcai.4 testable
.bvpts: wit€ heed Z Testables in 5TP stuhp,as well. A:] 8.38 58 lItR:BH: ii]. pun'i'ped. water out trade impairs; once• repo€rs:dry iR�f H test again.
Dlseussed quote with Jost0or.,0Dl Worse 4/20j18 JD. Cut concrete at dlspenser%Al return nest to bust up anti Install boots on outside of•
-the sump. 4/25-and 4/26 an site excavation cgmpfeted #wilding•side of.d1spensers:Installed -new eribyaboots and hydro, t W-. Tilled in
e,xcavafloh with, prock and?mado- re* for concre.te- 4/27 $9 oil -site`install ed•issueWitFs'test:woOr found boat issue, Corrected: Ret6te4
bc.hLJDCs;agairrand shdred up boots. •6ackfilled anal ve"II install aon&ete.MvndEV. 5/3 56 ari site cleaned up degree'from.excavatlorl and
hauiedtt.off: Set• up•compresser and:jackhamner for tomorroia. 5f7'- 5/8jackfidmrtlered an•d extavated other side;of dispet:sers, W.
1ngt6ifed. ail;electrii:al 6apts;and •t#arted prgparing.line boot•instaliation. 5110:instalied NO0ent y:and'#e *s Aj%0 for 00hoess:-
5/1.1.5B, Bli, JD a Md- KW. 6n-site finished installing and.testin9 sumps,today, all passed, Pnipped ext?0vdtion:foreoncrete tamarrow..I will
have superior te0' atlt.next Wednesdayto.test:tfauple wail lines. 5/16.5$, JP J0 and.;KW on site checkedin than pulletf. dlspensers,and
replaced double•vial E line boots. 5u.psriorshould. be: ot#t on Friday'ta test:. AD(3iT1ONAL 1NO]iK 5/31trJ.6/1 Testing and rarriplianCk. Superior
Linable to retuni.to meet N6V daadllne,so!&F•fihiihi3d rampliarrcy poling dispensers'fill€ng with'vrdter rid ecking Hydrostatic 5
cant4inm0nfl houriesis-plus r6o�ing and reclaiming test water. -used origInaI.-tesi dates. againsi.retaairtfrnes. 10.hours occurred y1700 2
meR. Test tioulile waif line boots, had'ta,puII dispenses, adjust Hoots to propertest poi nIs`dn piping, reseal test.Imo[s, instal€'gaucyes,,
test rern6Ve g qugL5, and putdispenser; l,ackorl €.land In working condition, 4 lines 1 noelr test, plus.. physical 18bWof4.men@10h0urs=
$3400. Actual E-is.25K, Add $51,04 ta<Ougte-forihe-actual e> perm of fl r3al
:A&CUTIaNAL INraRMATION
fauItArea;• FaultReasdn: PIPINGITANK/5IPHON Resoldtiort: REPLACE TANK•FARRCOMPO LENT
A F1NANCk. CHAKGE vI1kL BE-ARt7ED.T9 ALL MsT RGE Accou Ts
Sulatota l: -.
23;63Z6s
Total Sales Taxis.
1,458.24
Taw:..
24:994.27

Violation 5: 15A NCAC 2N .0603 IILS3

UST-17B UST Suspected Release 7 Day Notice E�y
This form must be used to report to DEQ, within 7 days of discovery, the investigation results for a Suspected Release from any of the following:
a) Failed or inoonclusive leak detection or tightness test results. This includes positive test results, such as "Increase", which indicates the level in the
UST system has increased more than 0.2 gph.
b) Unusual operating conditions which can include, but are not limited to, the erratic behavior of dispensing equipment; the unexplained presence of
water in the tank; the presence of fuel in containment sumps or interstitial spaces; or the degradation of any equipment or element of an underground
storage tank system to the point where that equipment or element can not reasonably be expected to perform its intended function.
c) Internal inspection results such as, perforations, corrosion holes, weld failures, or other similar defects that indicate a release could have occurred.
If you have more than four UST systems to report suspected release investigations, then attach additional sheets of the UST-17B form.
Y Please submit this form along with the supporting documentation to:
NCDEO/DWM, UST Section
1646 Mail Service Center
Raleigh, North Carolina 27699-1646
OR
Fax to [phone] OR UST.Permits(ancdenr.gov
I. UST OWNER
II. UST FACILITY
Name:
Name:
Facility 0:
Sysco Charlotte LLC
Sysoo Charlotte LLC
00-0-0000035443
Address:
Address:
4500 Corporate Drive NW
4500 Corporate Drive NW
City:
State:
Zip:
City:
County:
Concord
INC
28027
Concord
Cabarrus
Person Reporting:
Title of Person Reporting:
Telephone Number:
Josh Callahan
Fleet Manager
[phone]
III. INVESTIGATION RESULTS
Tank Number/ Size:
1 / 20,000 Gal
!
1
1
Product Stored:
Diesel
Reason for Suspected
❑ Data entry error'
❑ Data entry error
❑ Data entry error'
❑ Data entry error'
Release Investigation
❑ Dispensing fuel while
❑ Dispensing fuel while
❑ Dispensing fuel while
❑ Dispensing fuel while
(Check all that apply):
test is being conducted z
test is being conducted s
test is being conducted 2
test is being conducted
® Faulty equipment 3
❑ Faulty equipment'
❑ Faulty equipment'
I[ Faulty equipment'
You must attach the
❑ Incorrect stick or meter
❑ Incorrect stick or meter
❑ Incorrect stick a meter
❑ Incorrect stick or meter
supporting documentation
reading'
reading'
reading'
reading'
specified in the footnote for
the reason(s) selected.
El Incorrect tank chart a
❑ Incorrect tank than: s
❑ Incorrect tank chart
❑ Incorrect tank chart
Internal Inspection 5
❑ internal Inspection 5
❑ Internal Inspection 5
❑ Internal Inspection 5
❑ Meter not calibrated g
❑ Meter not calibrated c
❑ Meter not calibrated e
❑ Meter not calibrated e
❑ Other (Attach
❑ Other (Attach
❑ Other (Attach
❑ Other (Attach
explanation)'
explanation)'
explanation)'
explanation)'
® TankfDispenser
❑ Tank/Dispenser
❑ Tank/Dispenser
❑ TanklDispenser
containment sump
containment sump
containment sump
containment sump
contains liquid'
contains liquid'
contains liquid 7
contains liquid'
❑ Tilted tank a
❑ Tilted tanks
❑ Tilted tank a
❑ Tilted tank s
❑ Unknown'
❑ Unknown'
❑ Unknown'
❑ Unknown'
' Conduct a tank and/or line tightness test and attach the results, along with all of the supporting data sheets for the test method, to this form for submittal.
The summary page listing the results by itself is not acceptable. If the tightness test results are fail, then you must repair or replace your UST system and
conduct a site check in accordance with 15A NCAC 2N .0603.
z Provide sales receipts or other comparable documentation that shows fuel was being dispensed from the UST during the test.
3 Provide invoices (with a description of the work completed) or other documentation that shows the equipment has been repaired.
{ Correct your leak detection results using the correct tank chart and submit copies with this fort.
5 Repair the UST in accordance with the manufacturer's instructions or a national standard (e.g., PE API 1631) and conduct a site check in accordance with
15A NCAC 2N .0603. If the UST is not repaired, then it must be permanently closed in accordance with the latest version of the UST Sections Guidelines
for Tank Closure-
" Correct your leak detection results using the amount your meter was adjusted following calibration and submit copies of the meter calibration and leak
detection results with this form.
7 Conduct a tightness test (e.g., hydrostatic test) of the sump and submit the test result along with this form. If the test results are fail, then you must repair
or replace the containment sump and conduct a site check in accordance with 15A NCAC 2N 0603.
s Submit documentation from your UST equipment contractor explaining how they determined the UST was tilted. Correct your leak detection results using a
tank chart adjusted for the tilt and submit with this form.
Note: Tank, piping, spill bucket and containment sump replacements must be done in accordance with 15A NCAC 2N .0900
UST-17B Revised 1012015 http:ifwww.wastenotnc.org/web/wrn/

Rarnit To:
Jones & Frank
PO Box 531829
ATLANTA, GA 30353.1829
919-838-7555
BILL CUST-0001943
TO: SYSCO
4500 CORP DR
Concord, NC 28027
SERVICE INVOICE: PSER-0349908
SHIP: CUST-0001993
TO.- SYSCO
4500 CORP DR
Concord, INC 25027
Page: 1
DATE
CUSTOMERINVOICE •s
PAYMENT TERMS
CALLER
NAME
12/21/2017
Josh Callahan
Net 30 Days
Date
Serviced Item/Description
Unit
Order City
Quantity
Unit Price
Total Price
12!'4,2017 HOLMES )R., J
JOSEPH HOLMES JR.
Hours
S.25
5.25
87.00
456.75
12/14/2017 IT-0000320
FILTER, 400-30 HI CAPACiTY 1
Each
4
4
6,61
26A5
1211412017 RT TRIP
REG TIME TRIP CHARGE
Each
1
1
150.00
150.00
SERVICES REQUESTFE)
CD 12/12/2017 SITE NAME; SYSCO SITE ADDRESS: 4500 CORP OR Concord NO 28027 CALLER NAME Josh Callahan PHONE NUmBER:
704.723-6067 BILL TO: SYSCO CUST-00D1993 was verified as the bill to. PO NUMBER: Josh Callahan HOURS: 24 hours
PRIORITY: P2 DESCRIPTION: The customer states there are smal? leaks in the fuel pumps cabinets an pump#1 and Q.
'SERVICES PER�ORMED
DATE:12/14/2017 TECH INITIALS-JH FOU;PMENT SERVICED: Gasboy Atlas dispensers ISSUE ENCOUNTERED: Pumps #'s 1 & 2lea king CAUSE'
Multiple - ail filters Ieakin 9 and save rai meterS and piping bolts loose AESOLUT10N: Wiped everything down everything as much as possible
- replaced all the filters and went around and chetked and Iightened every loose bolt - tested and rnon1tor for a while problems did not
reoccur while on site also had site personnel come out and checked repairs PERSON NOTIFIED: MOD(Josh)
SER1ALd*,1CWAT02nM51 anti VWAT020862 STATUS:COMPI E7E
ADDITIONAL INFORNIANON
Fault Area: GASBOY DISPENSER Fault Reason FILTER Resolution: REPLACED
Subtotal: 633.20
Total Sales Tdx: 33.82
A FINANCE CHARGE WILL BE ADDED TO ALL PAST DUE ACCOUNTS Total; 667.02

rim
Remit TO:
Jones & Frank
PO Box 531829
ATLANTA, GA 30353-1829
919-838-7555
BILL CUST-0001993
TO: 5Y5CO
4500 CORP DR
Concord, NC 28027
SERVICE INVOICE:PSER•0386066
Page: 1
SM Work Order No.: WO-00017236
SHIP: COST-0001993
- _ TO' 5YSCO
4500 CORP DR
Concord, NC 28027
5/30/2018
Misty Durham
Net 30 Days
Date
Serviced
Item/Description
unit
Order Qty
Quantity
Unit Price
Total Price
5/25/2018
IT-0008088
A55Y CFT METER
Each
1
1
307.92
307.92
5/4/2018
RTTRIP
REG TIME TRIP CHARGE
Each
1
1
150.00
150.00
5/4/2018
TAYLOR, M
MARK TAYLOR
Hours
1
1
87.00
87.00
5/25/2018
RTTRIP
REG T1ME TRIP CHARGE
Each
1
1
150.00
150.00
239.25
5/25/2018
VELASQUEZ, A
AMILCAR VELASQUEZ
Hours
2.75
2.75
87.00
REQUESTEDSERVICES
They need to have two GiIbarco meters replaced they have a small leak
PERFORMEDSERVICES
5/4/2018: Mt lea icing meter. Checked meter for leaks. Meter is leaking, need to order 2 meters (T20150-G5). Will return when parts arrive.
5/25/2018 AV - Replaced meter on dispenser 1 and calibrated. Work order complete.
ADDITIONAL
Fault Area: Fault Reason: METER, OTHER Resoiutlan: PART REQUIRED
+ ► k.
TO R ky
I NO,
S-ALI'S 'I'.11
Subtotal: 934.17
Total Sales Tax: 44.39
A FINANCE CHARGE WILL BE ADDED TO ALL PAST DUE ACCOUNTS Total: 979.56

Violation 6: 15A. NCAC 2N .0901 SECD3

Triennial UST Containment Sump J
UST-fiFI238 UDC Integrity Testing _...�
• If any periodic test fails, a suspected release report must be submitted on a UST-17A form, USTSuspected Release 24 Flour Notice. The suspected
release must he investigated, in accordance With 15A NCAC 2N .0603, and defective equipment repaired or replaced 1n accordance with 15A NCAC
2N Results of the investigation must be submitted on a UST-17B form, UST Suspected Release 7 Day Notice.
.04041.0900.
• Containment sumps installed on or after 1111I2007 that are not monitored continuously for releases using vacuum, pressure, or hydrostatic interstitial
monitoring methods and all other containment sumps installed prior to 11MQD07 that are used for interstitial monitonng shall be tightness tested at
installation and every three (3) years thereafter in accordance rn+ith the manufacturer's written guidelines, PEURp100'Recommandad Practices for
Installation of Underground Liquid Storage Systems" andlor PEIIRP1200'Recommendad Practices for the Testing and Verification of Spill, Overfill,
Leak Detection and Secondary Containment Equipment at UST Faculties.°
• If a UDC 1 containment sump fails a periodic tightness test, the sump must be Teplaced or repaired by the manuTacturer, or the mane#acturees
authorized representative in accordance with the manufacturer's specifications.
UST FACILITY
Owner 1 operator Name Facility Name Facility ID
Sysco gym 00-a-0000035443
Facility Street Address Facility City County
4600 Corporate Drive Concord Cabarrus
CONTRACTOR/PERSON CONDUCTING INSPECTIONS
Company Name Phone Email address
Jones -Frank [7041 393 8542 St�ernas�¢jones-crank com
I certify, under penalty of law, that the testing data provided on this form documents the UST system equipment was checked in accordance with the
manufacturer's guidelines and the applicable national industry standards fisted in 15A NC AC 2N .406 andlor 15A NCAC 2N .0900,
Shawn Bernas
Signature of son conducting inspection
May 10 2018
Print Name of person conducting inspection
Inspection Date
Identify UDGlsump (By
® Dispenser
® Dispenser
❑ Dispenser
❑ Dispenser
❑ Dispenser
❑ Dispenser
Dispenser No. or Tank 1Numhef;
❑ Tank #
❑ Tank;
❑ Tank#
❑ Tank #
❑ Tank #
❑ Tank#
Tank Size, Stored Product; e. g.
01 1Ok Regular 5TP. Disp Ia.
� Dispenser 1 UDC
# Dispenser 2 UDC
#
#
#
#
etc.)
iTransition sumps should be listed above as "TS-XX" (with XX= sump IDS)
Sump Manufacturer
APT
APT
❑ FRP
❑ FRP
❑ FRP
❑ FRP
❑ FRP
❑ FRP
Sump Material
® Plastic
® Plastic
❑ Plastic
❑ Plastic
❑ Plastic
❑ Plastic
Single Wall
® Single Wall
El single Wail
❑ Single Wall
ElSingle Wall
❑ Single Wail
Sump Type
❑ Double Wall
❑ Double Wall
❑ Double Wall
❑ Double Wall
❑ Daublc Wali
❑ Double Wall
® Hydrostatic
® Hydrostatic
❑ Hydrostatic
❑ Hydrostatic
❑ Hydrostatic
❑ Hydrostatic
Test Type
Vacuum
❑ Vacuum
❑ Vacuum
❑ Vacuum
❑ Vacuum
❑ Vacuum
Indicate units for all measurements
Liquid and debris removed from
® Yes ❑ No
Z Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
sump?
Visual inspection (No cracks,
loose parts or separation of the
Pass ❑ Fail
X Pass ❑ Fail
❑ Pass ❑ Fail
❑ Pass ❑ Fail
❑ Pass ❑ Fail
❑ Pass ❑ Fail
containment sump]
Sump Depth
36 inches
36 inches
Height from sump bottom to top
of highest penetration or sump
16 inches
8 inches
sidewall seam
Wait time between applying
15 mins
15 mins
vacUurnm ater and start of test
Begin j End Test Time
2:30 PM 3:30 PM
3:45 .4:45
=
(minimum test time: 1 hour)
Begin I End values
18 inch 18 inch
10 inch 10 inch
=
Pass/Fail criteria: Must pass v4suat inspection. Hydrostatic: Water level drop of less theft 118 inch; Vacuum: No change in vacuum
Test Results
® Pass ❑ Feil
n Pass ❑ Fail
❑ Pass ❑ Fall
❑ Pass ❑ Fall
❑ Pass ❑IF
❑ Paaa ❑ Fail
Comments and explanation of failing results and other problems noted during inspection.
Site failed Hydrostatic testing, replaced Entry boots and re tested with passing specs.
Date next Containment Sump/UDC integrity test due (required every 3 years)
NORTH CAROLINA DEPARTMENT OF ENMRCNMENTAL QUALITY, DIVISION OF WASTE MANAGEMENT. UST SECTION 9MO17
IM MAIL SERVICE CENTER, RALEIGH, NG 27699-1645 PHONE [phone] FAX [phone] h {pllyn�u_vsest l2G pLt;L

Triennial UST Containment Sump !
UST-fiF,f23B UDC Integrity Testing
• If any periodic test fails, a suspected release report must be submitted on a USTA7A form, UST suspected Release 24 Hour Notice. The suspected
release must be investigated, in accordance with 1SA NCAC 2N .0603, and defective equipment repaired a replaced in accordance with 15A NCAC
2N 134G41.0 900. Results of the investigation must be submitted on a UST-178 form, UST Suspected Release 7 Day Notice,
.
• Containment sumps installed an or after 1111r2007 that are not monitored continuously for releases using vacuum, pressure, or hydrostatic interstitial
manitonng methods and all other containment sumps installed prior to 11A=07 that are used for interstitial monitoring shall be tightness tested at
installation and every three (31 years thereafter In accordance with the man utacture r's written guidelines, PEI1RP100 -Recommended Practices for
installation of Underground Liquid Storage Systems andlor PE11RP1200 "Recommended Practices for the Tasting and Verification of Spill, Overllll,
Leak Detection and Secondary Containment Equipment at UST Facilities.'
• if a UDC I contalnment sump fails a periodictightness test, the sump must be replaced or repaired by the manufacturer, or the manufacturer's
authorized representatve In accordancewith the manufacturer's specifications.
LIST FACILITY
Owner 1 operator Name Facility Name Facility 1D
Sysoa Sys 00-D-000035443
Facility Street Address Facility City County
45DO Corporate Drive Concord Cabwrus
CONTRACTOR/PERSON CONDUCTING INSPECTIONS
Company Name Phone Email address
Jones --Frank 704 393-8S42 Sbarnas@jones-t►ank.com
I certify, under penalty of IaW, that the testing data provided on this form documents the UST system equipment was checked in accordance with the
manufacturer's guidelines and the applicable national industry standards listed in 15A NCAC 2N .406 andlor 1SA NCAC 2N .0900.
Shawn Bernal 5110f2018
Print Name of person conducting inspection Sign�ra��esp�Wion Inspection Date
identify UDClsump (By ❑ Dispenser ❑ Dispenser ❑ Dispenser ❑ Dispenser ❑Dispenser ❑ dispenser
Dispenser No. or Tank Number. ® Tank # # ❑ Tank # ❑ Tank # ❑ Tank # ❑ Tank # ❑ Tank #
Tank Sire, Stored Product; e.g.
W 10k Regular STP. Disp 1J2. #. Diesel 20K # # # # #
etc.)
Transition sumps should be listed above as "TS-XX" lrNth XX= sump ID#j
Sump Manufacturer
Xerxex
® FRP
❑ FRP
❑ FRP
❑ FRP
❑ FRP
❑ FRP
Sump Material
[] Plastic
❑ Plastic
Cl Plastic
❑ Plastic
❑ Plastic
❑ Plastic
® Single Wall
❑ Single Wail
❑ Single Wall
❑ Single Wall
❑ Single Wag
❑ Single Wag
Sump Type
❑ Double Wall
❑ Double Wall
❑ Double Wall
❑ double Wall
❑ Qoubte Wall
❑ double Wag
Hydrostatic
❑ Hydrostatic
❑ Hydrostatic
0 Hydrostatic
❑ Hydrostatic
❑ Hydrostatic
Test Type
❑ Vacuum
❑ Vacuum
❑ Vacuum
1E) Vacuum
❑ Vacuum
❑ Vacuum
Indicate units for ail measurements
Liquid and debris removed from
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
sump?
Visual inspection (No cracks,
lapse parts or separation Of the
E5 Pass ❑ Fail
❑ Pass ❑ Fail
❑ Pass ❑ Fall
❑ Pass ❑ Fail
❑ Pass ❑ Fail
j] Pass ❑ Fail
containment aurn p}
Sump Depth
46
Height from sump bottom to top
of highest penetration or sump
19.5 Inch
sidewail seam
Wait time between applying
15 mins
vacuumlwater and start of test
Begin I End Test Time
1 PM 2 PM
(minimum testtime: 1 hour)
Begin i End values
21.5 Inch 21.5 Inch
PasslFail criteria: Must pass visual inspection. Hydrostatic: Water level drop of less than 118 inch; Vacuum: No change in vacuum
Test Results IS
Pass ❑ Fall I
❑ Pass ❑ Fail ❑ Pass ❑ Fail
❑ Pass ❑ Fag
❑ Pass ❑ Fall
❑ Pass ❑ Fall
Comments and explanation of falling results and other problems noted during inspection:
Site Failed hydrostatic, we replaced all boots in STP sump and all tested ok,
Date next Containment Sump/UDC Integrity test due (required every 3 year's) 5109/2021
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY, DIVISION OF WASTE MANAGEMENT, LIST SECTION 912017
1646 ]NAIL SERVICE CENTER, RALEIGH, NC 27699-1546 PHONE [phone] FAX [phone] http-/tV yW- %0Stenetnc."

UST-6H123C Triennial UST Piping Integrity Testing
(for components installed on or after 111112007 or when returning NZ
any UST system to service from temporary closure)
This form must be used to document pipe integrity testing (for piping not monitored continuously for releases using vacuum, pressure, or
hydrostatic methods) for UST systems installed on or after November 1, 2007 (this includes existing UST systems that have installed or
replaced the piping on or after November 1, 2007) or for any existing UST system conducting interstitial monitoring of the piping
regardless of Installation date prior to returning to service from temporary closure,
if there are more than five (5) piping systems at this facility, make additional copies of this page.
The primary containment and interstitial space of the piping shall be tested in accordance with the manufacturers written guidelines
and PEI1RP100 "Recommended Practice for Installation of Underground Liquid Storage Systems_"
e The fast periodic tightness test record must be maintained by the tank ownerloperators and must be readily available for inspection.
o If any periodic lest fails, a suspected release report must be submitted on a UST- 17A form, UST Suspected Release 24 Hour Notice,
and investigated in accordance with 15A NCAC 2N .0603, and any defective equipment repaired in accordance with 15A NCAC 2N
.0404/.0900 Results of the investigation must be submitted on a UST -178 form. UST Suspected Release 7 Day Notice.
if the piping fails a tightness test, it must be replaced or repaired by the manufacturer or the manufacturer's authorized representative
in accordance with the manufacturers specifications. Following any repair, the piping most be re -tested for tightness.
UST FACILITY
QwrierlDperator Name
Sysco Charlotte LLC
FacilityName
Sysco
Qo-o-00 035443
Facility Street Address
4500 Corporate Dri
Facility Crty
Gaurve
Concord
Cabarrus
TESTING CONTRACTOR INFORMATION
Company Name
(ones -Frank
U—,,.,.. n.., ___
Phone
7043938542
E-mail Address
[e-mail]
101 Northpark Blvd ` ty State Zip
Charlotte NC 28216
1 certify, under penalty of law, that the testing data provided on this form documents She UST system equipment was tested rn accordance With the
manufacturer s guidelines and the applicable national industry standards listed in 15A NCAC 2N 0900
Shawn Bernas
1_
Print Name of person conducting test ignature of person conducting test
fdentify piping system (By Tank Number, Stored Tank # STP line 1 Tank 0 STP line 2 TankSatalite 1 Tank # 5atalite 2 Tank #
Tank Size
20K
2OK
roduct
Diesel On Road
Diesel On road
Piping Type(, DW
E
DW Flex
DW flex
Flex, Other
❑ Gravity
❑ Gravity
Piping Configuration
❑ Manifold
❑ Manifold
0 Pressurized
0 Pressurized
Piping Manufacturer APT XP gen 2 APT XP gen 2
Pipe Model (Part No,)
Indicate Test Phase: ■ Triennial Testing ❑ Post -Install
Test Date 6/1/2018 � 6/1/2018
A. Primary Pipe Test (Note: Must be a third -party certified
Line Tightness Test
20 K
Diesel On Road
DW Flex
20K
Qiesei On Road
DW Flex
❑ Gravity
❑ Manifold
❑ Gravity
❑Manifold
❑ Gravity
❑Manifold
Pressurized
© Pressurized
❑ Pressurized
177 Suction
Suction
Suction
APT XP gen;2
APT XP gen 2
Return to
Service from Temporary
Closure
61112018
6I112018
ness test] (Attach test data sheets to farm]
Results Attached ❑Yes 0 No ❑ Yes❑ No ❑ Yes❑
No
❑Yes Q Nv ❑Yes ❑ No
B. Secondary Interstice Test (indicate units for all measurements)
Begin i End test time 1200 11300 1315 , 1415 1430
.1530
1545 j 1645
Begin I End pressure 10 Psi 10 Psi 10 Psi 10 Psi i 0 Psi
]0 PsI
] OPsi 10 Psi
Secondary Test Result 0 Pass ❑ Fail f Pass ❑ Fail Pass
❑ Fail
e❑ Pass ❑ Fail ❑ Pass ❑ Fail
Comments and explanation of falling results and Other problems noted during inspection
Double wall testing boots were deemed bad by Superior Testing Co. Testable boots were replaced
and adjusted and tested ok.
NORTH CAROr_INA DEPARTMENT OF ENVIRONMENTAL QUALITY. DIVISION OF WASTE MANAGEMENT, UST SECTION
1646 MAIL SERVICE CENTER, RALEIGH. NC 27690-1646 PHONE [phone] FAX [phone] http llwwwwastenotnc or9Meb/wrn 10115

UST-6F/23B Triennial LIST Containment Sump / UDC integrity NC
Testing r-; 1
If any periodic test fails, a suspected release report must be submitted on a UST- 17A form, UST Suspected Release 24 Hour Notice The suspected
release must be investigated, in accordance with 15A NC AC 2N .0603, and detective equipment repaired or replaced in accordance with 15A NCAC
2N .04041.D900. Results of the investigation must be submitted on a LIST-179 form, V S T Suspected Release 7 pay Noboe
o Containment sumps installed on or after 11/112007 that are not monitored continuousty for releases using vacuum, pressure, or hydrostatic �nterst bal
monitoring methods and all other containment sumps installed prior to t 11112G07 that are used for interstitial monitoring shall be tightness tested at
installation and every three (3) years thereafter in accordance with the manufacturer's written guidelines, PEIIRP10o "Recommended practices for
InstaIlatinn of Underground Liquid Storage Systems" and/or FEI1RP1200'Recornmended Practices for the Testing and Verification of Spill, ❑verfi#I.
Leak Detection and Secondary Containment Equipment at UST Facilities."
i If a UDC ! containment sump fails a periodic tightness test, the sump must be replaced or repaired by the manufacturer, or the manufacturer's
authorized representative in accordance with the manufacturer's specifications.
Sysco Charlotte LLC sy'
Facility Street Address Facility C
4500 Corporate Dr. Concord
WV111por1Y nau'e Phone
Jones 3 Frank_ 704393-88i8
I certrfy, under penalty of law, that the testing data provided on this form documents the
manufacturer's guidelines and the applicable national industry standards listed in 15A N
stage Wafters
Print Name of person oonduoting teat Sionaw a o
Identify UDC/sump (By ®Dispenser ®Dispenser ❑Dis enser
Dispenser No. or Tank Number, P
Tank Srza, Shored Product e.g. ❑Tank ❑Tank ❑Tank
#4 1Ok Regular STp, prop 1/2. #: FP1 #: FP2 #:
etc_) Satalite UDC Satalite UDC
Transition sumps should be nstad above as "TS-Xx" (with XX- sump 01111)
Sump Manufacturer APT APT
Sump Material
❑ FRP
❑ FRP
❑ FRP
® Plastic
®Plastic
❑Plastic
Sump Type
® Single Wall
® Single Wan
❑ Single Wall
❑ Double Wall
❑ Double Wak
❑ Double Wall
Test Type
®Hydrostatic
0 Hydrostatic
❑ hydrostatic
❑ Vacuum
❑ Vacuum
❑ Vacuum
cabanus
charionegroup(gjones-Na nk.com
system equipment was tested to accordance with the
2N .0408 and/or 15A NCAC 2N .0900.
5-31-18
o acting test Test Date
❑Dispenser ❑L 8panser ❑piSpenser
❑Tank ©Tank ❑Tank
❑ FRP
❑ Plastic
❑ Single Wall
❑ Double Wan
❑ Hydrostatic
Cl Vacuum
❑ FRP
❑ Plastic
❑ Single Wall
❑ Double Wan
❑ Hydrostatic
❑ Vacuum
❑ FRP J
+ Cl Plastic
❑ Single Wall
❑ Double Wall
❑ Hydrostatic
❑ Vacuum
Liquid and debris removed from ®Yes ❑ No ❑ ❑ No sump? ® Yes ❑ No Yes ❑ Yes ❑ No ❑ Yes ❑No ❑Yes El No
loose parts or separation of the ®Pass [I Fail containment sumo/ + ® Peas ❑ Fail ❑ Pass ❑ Fail I ElPass El FBI ElPass [IFail I IDPass ❑ Fail
I
Sump Depth 131" 13V
Height from sump bottom to top
of highest penetration or sump 7" 8"
sidewali seam
Wart time between applying 1
vacuumlwatei and start of test hour 1 hour
Begin i End Test Time 13:Q0 j 14:at7 15:00 j 15:00
(minimum test time: 1 hour) 1 I I i
Begin i End values 9' j W I to, i 10,
PasslFaII criteria: Must pass visual inspection. Hydrostatic: Water level drop of less than 118 inch; Vacuum: No change in vacuum
Test Result ® Pass ❑ Fail ® Pass ❑ Fail ❑Pass ❑Fait ❑Pass ❑Fail ❑ Pass ❑ Fail
❑ Pass ❑Fail
Comments— {include MfOrmation an repairs made prior to testing, and recommended follow-up for failed tests)
Date next Containment SumplUDC integrity test due (required every 3
5-31-2021
NORTH CAROUNA DEPARTMENT OF ENVIRONMENTAL QUALITY, DIVISION OF WASTE MANAGEMENT. LIST SECTION
1646 MAIL SERVICE CEI+iTER, RALEIGH, Nl; 27699-f646 PRONE (9i9) 707-al71 FAX [phone]
9Q017

ttiorRplc�ndegui�a,Trikaems;°Rcon'taUST-E�3] .
AIgK INSTALL:A"ilt]NiFRiEHilAi::7�S%IC�Gy
A separat�f6nr shodki he used:foc each facfllly, If tigers ark mare than tKe tsj tun4eu at #ris faclNiy, raatie adanlanal copies al:rhls }7age.
Vw p irnaryand iiuera"tilial.sliace.oft f tank;s}rall ae tasted'fn ac mdarke islith•11i�:marruf� viers miueie pdrdnlirca� grid PEURPIgvHspammended:Prselice
for fnsiallslfan of9Jnd%grouod i:igt,fd Slorage tg terAs.'
The lasl peHod cd'ightnsss.tast record most ha. mail hdhed•.bi ttre Wa owner or open tbmod must li�feadlly AirailebletGr tss§pectlar! .
o . Tanks. dial -are pet rnori#tnred eont nuously-faf releases usfr�,vacuum; pressur�,.arhydrastaticmetliads inilst'fee-�grlhrless te6ted at.lristallat�re,'hethesst Band
72rn mths frota irlsfallatioil, tsnd.eVery rYlrea years foUapvTng instatlatlon.
a The Interstitial. space.of Jh'�q turik.shO be tested itsllig g a id'party ceru iat! interstice tiphtnsss fslcapabla.cf detecting a o_i gph leak tram the inner or ornerrvaat#
4ritip infersSiCefar ills lank•rnt#fal.lhat:7s lnstsl�d.. •
p tf rise tanklail's a tlghtness•IOE4it. t lie replaced oi repalredbj the rn@nuf ti rer prthe n a ul&lumes aWhcH6d-mp*66%W ve.€rl•aeearddnce Q5 O the
rrwu
manuracturer's speclflcatipm. Following any ropalr, fife tank must be re4ested foc fiohtnessAlso-a'suspected j614r3 r6part must $s..5ilbMkte' on a UStLVA
form,-USrSLwOded Relaasa,24 f tottrNafiog. Tha suspected relcow must•ba•inve'alyated, irl arcordan.ce Wih .I EA WO2N`.17608, and zany defectivs
equ iced in:acaxrdence With I$A.NCAC2N.og041.090i1: Reza fts'af the.'Irpres3 stlan must beisu6nNtied on a-u 3T-:17B %rm.115T 8uspeeied'
prneht rfipdtfedlrap
Release 7day NoOpe,
Wner Fab_ Name tic: 1p#:-{iif100(?i}35443
Opertgtar Mania
ao... rase Fac:'cw ounty.
454g COi FOfiATE f]RjVE, NW 'CONCORD CABARRUS
Co. Namo.
Su sl-lar'seivjtiss
Phaittl .... l
,828�698�t3288 daveti�auperigrserirraes:u�'
dress.
RQ stax-862
city
Kendersonvilte-.
rate NCh
lis 28793
.Kell iGellior
-
S rspturt3 a person ca urn rag test
nG amepf.peraq. can uct rag.
Wen* Tank.(Tank,NumGer, etc.)
Tank
Unit #
Tank i
Tank#•
Tank.Sixe
20000
Nasal
piurluct
UST Type
FRP
UST` w,MR Wed J,ache&d,SfeelfCl.RA,.Ofher.
IndicatV units for atoll-measur6merils: inches
L Pre4nstallatlim testl lyacuurnipressure
Gauge ne.
Test Date
lbterstitial.spa o-Liquld'FRlWd:arY;i um..
Tostmothar#,, Var_uum :
f.iqu�d t ledl4 er:
Begirt End bm- Time'giquid)
Sdki End Levet(fiquld)------------
I !
!
I
t
Begin Ertl Test l arts.
Begin End
d.
+ i.
r
,
I
TalikReautt
Pass • ail.
Pala- Fall
i>ass Fag
Pass Fart
Pass Fall
Liqutdvisible on ittsldelouLsid
QYsa ad.
Yes•NO
-Yes No
Yes ;hip
Yes No
df ttrnk(lf e6pOlWabjq)
tl: isdat�iriatntleticrtPrlcrinl sf tes�liag
Tfghtrress�Tesi Made] (if apigicable),
lest bate• Be in . End
a3i?r37�0 B IM9218
thter: #hilal spac4.4.fgWd•F016&Dlher:
Test inetho'd.. E]Ve ppm XLlquki.fi$editstltar:;
...Xerxes
Begin UndT'est7iMR, Ofquldj
1!.33 233
F
;
;. �.
In E= d.Leyef.uid
�s i . � �
7�.75 ; 12:T5
;
Begin. End Teat Tars
Bcqin End, Press ure111acqum
i.
r
Test'>Zesellt
Pass all
Pass: Fail
Pass rail-
P.6ss Fail
:1PA s Fall
lJoluidVisible on ihatido of tank
Yes
Yes, No
Yes -No
Yes No:
Yes No:
NORTH CAROLINA DEPAi3TM�T C3F;ENVIP3(}N)Ar2r4 QUALITY; DJVlSiOKf rIUASWIMMAGEMENT, li5T`5EC,TION [4115
;fYt6 llilPllL$i FtCIICE Ei+[71=F2, FfA1.EEGH, NC 2]699.18dB. PF7tJ1+lE {$19y.7f7T-$�7,1' F.AX 619) 7950117 trttg IhYoVw;Waslerrptriv;w�j( �fYrrri;

Recoin men&d,PrKtlCe5 40f IM TeAn 94n d Vietfflcatjwof Spll I Ovdi I k. Leak -Mection and Secaqdafy-tunjain OiOt EOlpme rit at UST Wl 11fies
L; I XERXES Pil
making lasting difference
TRUCHEK'
DATA LIOG,
F M a %A- the site 14r.9 . tion, . tank i4dernallon.and jest boxes W19ft #eq-.,b4x -Wprding tp-tbe
-d'ameter Otlhe. p.rtk bel hg to-ittd , Follow Tht'lest p rqcedu rm on the.plh er side,of III is. f a rm., Xsepartle test'fqrM Is nee6p ' d-
for every tank. Fb r ad chtlonal. capies of -the fogn, cont . acr thaA . Zustomer Servke Repfesen*ive at ihe)(erxes martubkturing
hack
Cover fpt 'Warm
R F: Q C- AT 0 N AND TANK fNF(-)RlNll!`J�C)N
Ske Location: syew Fo-od. ser*m of ch aiioaq. mink lnfo.q*Ww-.
Addfe,Z- 4606 CorOomte Drive..NW Nominal !Ga"Hons:
Phone.,: 7047234W7 Ap Length.- 394
progim-ate Standpipe
-CaMahan Diesel
Contact Name% Pfqductlype-
3-2 . 42018 KPHY Keiser- 5uPilQr,0Grvke3r
lbst.DM6.: Piaimbh Performlhg Test Mnwmur�k mc:
95% - 5% TEST
la. Stamlevel Omhesin:standpipe?
U But.. kwl bftwr 4 hows
(%vbtra -qtbkom lo)
A. tlllxaWh fador X. .10
5. Volume dipw
6. lekthom 4
71 6al6SVAMX loss
Of 0.05 gat khskrmK cwless, tw--Pasw d)
WC.m3ximum Amable dispning volume deriog test:
fi4aM-dipmeter.twtk:— 500 9iidk=&.m&xk-nurn
4-ImAldiameter taM � 30t1 aalbm maiHmn
95% - 5% TEST
2W.. End kwi after 6 hGUTS
I Dfti0w-(subbaa2 6 framl a)
4, Calbafi6n facw' k .30
51 Vbbme ChaNe 6..
C lesihm. +
7; Gailans-perbmw Ion
(it 0A..qpk]DnskwW Orkl% tank pome&)
Raw MeAknum a I lowable.. cRspertOng. vp$me, dWW9 mt;
99% -1% TEO
1 a. ,Start kyO 900,ies in #zrWp4m)
2b, End,"fafter-10him r - s
3. Dftrerfa�(2b fiam 1 b) At
A Calbatkm fadw 'x .20
5. Wume change
,6.. Tek, hours +
7. GAmimphoyr- loss
op-05 galm wflaw or L-51, WA: pafisw
Note'No pindlUddispensing -Aywed
99% - I.'%-- TtST-
ib, Start level W*s in maridpipe)
Zb. Fnd Wal Out I fl Mors
12.75'
1 WlffawKq.jiObVact2b fmm'lhl
Off
A-, 61PmaWnlatft
x 10
1; irtlhlrne change
DA GPH.
6. TLsthckrl
+ It
7, GMWr&W-hoW km
= 0.9 'GPH
(if 0.05galbaslhi3w. or �A, tank, passedj
Norte; No. pm*q Ol spmimg all"p
PeLarg.

4600 q)R.
d6 N
4LIN -IJ, ylblR f.'20 Pill
T ll-hf�tL
-
'41 QP63
0 tJME -
7 306
HF I -
46-. 4
L3RT VOL =
obf;Ls,
TEIIIP
HES
77.0 DEG F
END,