MO-9412_40858_G_C_20190327_LSA Emails

Beverly, Trudy
From: Beverly, Trudy
Sent: Monday, April 1, 2019 9:01 AM
To: 'Thomas, Robert 1001'
Cc: Stillwell, Tim 048; Corey Buchanan
Subject: RE: [External] Sysco Charlotte - NORR Response
Rob and Corey,
After reviewing the information that you sent, we do not require preapproval for tasks at new sites for the
LSA. Preapproval will be required for tasks needed after the LSA is completed.
Have a great day,
Trudy
From: Thomas, Robert 1001 [mailto:[e-mail]]
Sent: Friday, March 29, 2019 10:53 AM
To: Beverly, Trudy <[e-mail]>
Cc: Stillwell, Tim 048 <[e-mail]>; Corey Buchanan<[e-mail]>
Subject: RE: [External] Sysco Charlotte - NORR Response
External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
[e-mail]
Good Morning Trudy,
Per your request, attached is the updated electronic Pre -Approval Task Authorization form.
Best Regards,
Robert Thomas I Director, Environmental Compliance
Sysco Corporation
1390 Enclave Pkwy, Houston, TX 77077, USA
0:281-584-5045
C:832-457-8900
thomas. robert2Cabcorp. Sysco. com
S)/
At the heart O#
food and service
CONFIDENTIAL - This e-mail transmission and any documents attached to it may contain information that is confidential or legally
privileged. If you are not the intended recipient, or a person responsible for delivering this transmission to the intended recipient,
you are hereby notified that any discourse, copying, distributions, or use of this transmission is strictly prohibited. If you have
received this transmission in error, please immediately notify the sender and destroy the original transmission, attachments and
destroy any hard copies.

DIRECTED COSTS
ELECTRONIC PREAPPROVAL TASK AUTHORIZATION FORM
Dept of Environmental Quality - Division of Waste Management
Site Name
RP STF ID/Name NIL)
Sysco Charlotte, LLC City / County Concord / Cabarrus Incident # 40858
/ Tim Stillwell Incident Mgr Trudy Beverly Region MOR
RP Type (Owner/Operator/Landowner /Attny-in-fact) Owner/Operator Change Order? No Prev. TA # 0
Consult. ID/Co.Name 2378 / Geological Resources, Inc. (Reserved for Incident Manager)
Phone / Fax Number 704-84S-4010 / 704-845-4012 Task Authorization Number: ChangeOrd:
Email / PM Name (F/L) cnb(cilaeoloaicalresourcesinc.com / Corey N. Buchanan Site Risk/Rank/Abatement: RRA Date:
Proposal# / Scope Dates 18-687 / 4/1/2018 %Commercial (C=100% NC=U% Both=1%-99%)
Has STF Eligibility Been Determined? (T/F) FALSE Site Status (Active or NFA Date)
Note: This Electronic Preapproval Task Authorization (ePATA) shall be used to receive preapproval from the UST Section. A proposal, including maps and figures, must be
attached to elaborate on the costs for the tasks listed below that describes the scope of work and the rationale for the proposed activities. If, following completion of this ePATA,
you discover that unexpected tasks must be performed, incurring costs for tasks not originally included with this form, you must complete and submit a separate ePATA request
designated as a "Change Order" in the provided space above prior to conducting those tasks. Include a copy of the prior ePATA form for confirmation. Please attach this form
to the cover of the corresponding claim when requesting reimbursement. IMPORTANT: Only one claim may be submitted per ePATA and all work on the ePATA must have been
completed within 12 months of the completion date of the FIRST completed task. All ePATAs submitted within a claim are closed with that claim, and may not be re -used in a
separate submittal, even for costs or tasks that were not originally claimed. Final reimbursement of costs associated with the Total Claimed amount below may be affected by the
eligibility status of the site (i.e., deductibles, apportionment, etc.), and the documentary validation of incurred costs as reasonable and necessary expenses per 15A NCAC 2P
.0402 and .0404.
With Claim: [ ] All Main Consultant/Contractor invoices attached? [ ] Proof of payment attached directly to the front of each invoice?
• Important: The date of reimbursement is dependent on the Trust Fund balance. There may be a delay in the reimbursement of claims for work under this ePATA.
PREAPPROVAL / TASK AUTHORIZATION
(See Instructions /RRD for Tasks requiring Preapproval /Task Authorization)
FINAL REIMBURSEMENT
(Must Complete with Claim Submittal)
a
,a
m`
Task #
Lab /
SubCode
Proposed 3
Units / Type ¢
(Consultant) ¢
Proposed �
Rate/Price ¢
(Consultant) Ov
Proposed Task
Subtotal
(Consultant)
Preapproved
Subtotal
(UST Section)
Dates of Work1
(Consultant)
Started /Completed
Claimed
AmountZ
(Consultant)
2.600
1 event
$250.00
$250.00
/
2.600
25 feet
$50.00
$1,250.00
/
2.600
25 feet
$10.00
$250.00
/
2.600
#409
2 sample
$79.00
$158.00
/
2.600
#410
2 sample
$176.00
$352.00
/
2.600
#421
3 sample
$54.00
$162.00
/
2.600
#422
3 sample
$94.00
$282.00
/
2.600
#220
1 1 sample
$37.00
$37.00
/
2.600
#301
1 sample
$196.00
$196.00
/
2.600
#280
1 sample
$42.00
$42.00
/
2.600
#341
1 sample
$52.00
$52.00
/
2.600
#342
1 sample
$94.00
$94.00
/
2.600
1 cooler
$60.00
$60.00
/
2.600
1 LSA
$2,300.00
$2,300.00
/
TOTAL:
Total Standard Costs (Not Third Party)
Total applied as Third Party Deductible/Damage Costs
Process Tracking (Date) (Initials)
Requested
Preapproved
54�5 99
ff
Claimed'
TOTAL:
Total Standard Costs
Total Third Pty Costs
TA Submittal: 3/29/19 by: CNB (PM) (ReservedforRO)
RO Review: by: (IM) Joint UST Preapproval Confirmed By: Date'
CO Review: by: (STF) RP or Designee Receipt Confirmation By: Date a
1- The ePATA expires one year from the Joint UST Preapproval date. Note: Tasks must be claimed within one year of completion.
This one-year activity deadline from the authorization date does not supercede other regulatory deadlines (e.g., NORR's, NOV's, Enforcements, Remissions, etc.)
2 - Only Tasks included on this ePATA may be claimed. Do not include other Tasks or claimed costs (i.e., Claim preparation) that were not preapproved or the claim will be returned.
3 - Preapproval is not valid (i.e., claimable) until receipt is confirmed by the RP or their designee and returned to the Trust Fund within a week of approval. Signature indicates agreement
with the tasks and amounts approved. Any objections/appeals must be submitted via Change Order prior to work proceeding and does not supercede other regulatory
deadlines as described in #1 above.)
DWM/UST ePATA Wr. 1/15/2017

From: Beverly, Trudy [mailto:[e-mail]]
Sent: Friday, March 29, 2019 6:12 AM
To: Thomas, Robert 1001 <[e-mail]>
Cc: Stillwell, Tim 048 <[e-mail]>; Corey Buchanan <[e-mail]>
Subject: RE: [External] Sysco Charlotte - NORR Response
[ External Email ]
Rob,
Each individual task must be broken down on the electronic Pre -Approval Task Authorization form with the
corresponding task code and rate for Trust Fund submittal and approval.
Trudy
DEt QNORTH GAROLINA
Department of Environmental Qua ity
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Email correspondence to and from this address is subiect to the
North Carolina Public Records Law and may be disclosed to third parties.
Office Mailing Address:
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Branch's Underground Storage Tanks Website Address: hlWs:Hdeq.nc.gov/about/divisions/waste-management/ust
Branch's Above Ground Storage Tanks Website Address: hLps:Hdeq.nc.gov/about/divisions/waste-management/ust/ast-program
INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES:
hiips:Hdeq.nc.gov/about/divisions/waste-management/waste-management-rules-data/waste-mane eg ment- isg maps
File Review Procedures:
https:Hdeq.nc. gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office
ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche):
hlt 2s:Hedocs.deq.nc.aov/WasteManagement/Search.aspx
Document Submittal & UST File Names for Laserfiche Policies:
hLps:Hfiles.nc. gov/ncdeq/Waste%20Management/DWM/UST/Corrective%2OAction/Electronic%2ODocument%2OSubmittal%2OMe
mo%20Update.pdf
hLps:Hfiles.nc. gov/ncdeq/Waste%20Management/DWM/UST/Corrective%2OAction/UST%2Ofile%20names%20for%2OLaserfiche.d
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From: Thomas, Robert 1001 [mailto:[e-mail]]
Sent: Wednesday, March 27, 2019 7:09 PM
To: Beverly, Trudy <[e-mail]>
Cc: Stillwell, Tim 048 <[e-mail]>; Corey Buchanan<[e-mail]>
Subject: [External] Sysco Charlotte - NORR Response
qr• cternal email. Do not click links or ope unless you ve ' email as an attachment to
nc. ov
Hello Trudy,

Geological Resources, Inc.
March 25, 2019
Ms. Trudy Beverly
North Carolina Department of Environmental Quality
Underground Storage Tank Section, Division of Waste Management
610 East Center Avenue, Suite 301
Mooresville, Iredell County, North Carolina 28115
Re: GRI Proposal No. 18-687
Limited Site Assessment
Sysco Charlotte, LLC.
4500 Corporate Drive NW
Concord, Cabarrus County, North Carolina 28027
Facility ID # 00-0-0000035443
Incident No. 40858
GRI Project No. 4958
Dear Ms. Beverly:
During a site check conducted in November 2018, a soil sample collected from a soil boring installed
adjacent to the dispenser island # 1/2 sump had a contaminant concentration that exceeded the
Regulatory Action Level (RAL) for TPH-DRO. A petroleum release was discovered and reported to North
Carolina Department of Environment Quality (NCDEQ).
Geological Resources, Inc. (GRI) presents this proposal for cost associated with Limited Site Assessment
(LSA) activities at the above referenced site. The purpose of the project is to determine the risk
classification for the site in accordance with the December 1, 2013, NCDEQ Guidelines for Site Checks,
Tank Closure and Initial Response and Abatement for UST Releases.
This proposal is based upon the scope of work, assumptions and responsibilities listed below.
SCOPE OF WORK
GRI personnel will conduct a receptor survey in order to locate and identify any potential receptors,
such as water supply wells, unconfined or semi -confined aquifers and/or wellhead protection areas
within 1,500 feet of the source area. GRI will obtain all property owner information, zoning information
and land usage.
GRI will install one Type II monitoring well at the site adjacent to the dispenser island # 1/2 sump. Due
to the presence of an active UST system and overhead canopy the well will have to be moved out from
under the canopy to allow access for the drill rig. The monitoring well will be installed to an estimated
depth of 25 feet below grade surface and will be completed with a 15-foot screened interval set to
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] [phone] 9 Fax [phone]

Proposal #18-687
Phase I LSA
Sysco Charlotte, LLC.
Concord, North Carolina
GRI Project NO.4958
Page 2 of 3
bracket the water table at the time of installation. If the water table is not reached within 25 feet below
grade surface then the well will be drilled deeper until the water table is encountered.
During the borehole advancement, three soil samples will be collected at 5-foot intervals if ground
water at the site is less than 25 feet; if ground water at the site is greater than 25 feet then additional
soil samples will be collected at 10-foot intervals. Because the UST system contains diesel product, the
first and last soil samples collected will be submitted for laboratory analysis by EPA Methods 8260E and
8270D and MADEP Methods VPH/EPH. The middle samples will only be submitted for MADEP Methods
VPH/EPH.
One ground water sample will be collected from the completed monitoring well and submitted for
laboratory analysis by EPA Methods 602 with xylenes, 625 base/neutrals and acids plus 10 Tentatively
Identifiable Compounds (TICS), MADEP Methods VPH/EPH and EDB by 504.1.
GRI will prepare a Phase I LSA report that will include a required summation of the results of the soil and
ground water sampling activities in conjunction with the data that is collected while conducting the
receptor survey. The Phase I LSA report will include all appropriate maps, tables, data, conclusions and
recommendations. This report will be sealed by a North Carolina licensed geologist or engineer and will
be suitable for submittal to the NCDEQ.
ESTIMATED COSTS
Task
Description
Number
Unit
Rate
Total
Drill Rig Mobilization
1
event
$250.00
$250.00
2-Inch Well Installation
25
feet
$50.00
$1,250.00
Field Supervision of Well Installation
25
feet
$10.00
$250.00
Soil Sample Laboratory Analysis
2
sample
$79.00
$158.00
Code #409 VOCs by EPA Method 8260B
Soil Sample Laboratory Analysis
2
sample
$176.00
$356.00
Code #410 SVOCs by EPA Method 8270D
Soil Sample Laboratory Analysis
3
sample
$54.00
$162.00
Code #421 VPH by MADEP Method
2.600
Soil Sample Laboratory Analysis
3
sample
$94.00
$282.00
Code #422 EPH by MADEP Method
Water Sample Laboratory Analysis
1
sample
$37.00
$37.00
Code #220 SVOC by EPA Method 602
Water Sample Laboratory Analysis
1
sample
$196.00
$196.00
Code #301 625 +10 TICs by EPA Method 602
Water Sample Laboratory Analysis
1
sample
$42.00
$42.00
Code #280 EDB by EPA Method 504.1
Water Sample Laboratory Analysis
1
sample
$52.00
$52.00
Code #341 VPH by MADEP Method
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

Proposal #18-687
Phase I LSA
Sysco Charlotte, LLC.
Concord, North Carolina
GRI Project NO.4958
Page 3 of 3
Task
Description
Number
Unit
Rate
Total
Water Sample Laboratory Analysis
Code #342 EPH by MADEP Method
1
sample
$94.00
$94.00
Sample Shipping Costs 40 lb cooler
1
shipping
$60.00
$60.00
Base Rate for Phase I LSA
1
site
$2,300.00
$2,300.00
Total
$5,485.00
Please contact me at 704-845-4010 with any questions or comments.
Sincerely,
Geological Resources, Inc.
M. and
Corey N. Buchanan, P.G.
enclosures
3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]

LEGEND
-------------------UNDERGROUND STORAGE TANK
O FILL PORT
f SOIL SAMPLE LOCADON
�ASPHAL T�
Sysco Food
Services of
Charlotte LLC ONCRETE
�ASPHAL TD �ASPHAL TD
Satellite SS-2
Dispensers Ou® 0 O i o I 20K—Gallon
I Diesel UST
I O I
SS-3 I I
O
O I I
L—O—J
0 15 30 60 SOIL SAMPLE LOCA0MAP
00 Corporate DrIve 1VW
4500 Corporate Drive NW
Incident No. N/A Concord, Coboirus County,
( IN FEET) GRl Project No. 4958 NO
Geological Resources Inc. 1 inch = 30 ft Dote: 11113116 1 Drown by. DTN I Figure: 3

DIRECTED COSTS
ELECTRONIC PREAPPROVAL TASK AUTHORIZATION FORM
Dept of Environmental Quality - Division of Waste Management
Site Name Sysco Charlotte, LLC. City / County Concord / Cabarrus Incident # 40858
RP STF ID/Name (F/L) / Tim Stillwell Incident Mgr Trudy Beverly Region MOR
RP Type (Owner/Operator/Landowner/Attny-in fact) Owner/Operator Change Order? No Prev. TA # NA
Consult. ID/Co.Name 2378 / Geological Resources, Inc (Reserved for incident Manager)
Phone / Fax Number 704-845-4010 / 704-845-4012 Task Authorization Number: ChongeOrd:
Email / PM Name (F/L) cnb(a)ueoluocialresourcesinc.com / Corey N. Buchanan Site Risk/Rank/Abatement: RRA Date:
Proposal# / Scope Dates 18-687 / March 2018 %Commercial (C=1001, NC=O% Both=1%-99%)
Has STF Eligibility Been Determined? (T/F) TRUE Site Status (Active or NFA Date)
Note: This Electronic Preapproval Task Authorization (ePATA) shall be used to receive preapproval from the UST Section. A proposal, including maps and figures, must be
attached to elaborate on the costs for the tasks listed below that describes the scope of work and the rationale for the proposed activities. If, following completion of this ePATA,
you discover that unexpected tasks must be performed, incurring costs for tasks not originally included with this form, you must complete and submit a separate ePATA request
designated as a "Change Order" in the provided space above prior to conducting those tasks. Include a copy of the prior ePATA form for confirmation. Please attach this form to
the cover of the corresponding claim when requesting reimbursement. IMPORTANT: Only one claim may be submitted per ePATA and all work on the ePATA must have been
completed within 12 months of the completion date of the FIRST completed task. All ePATAs submitted within a claim are closed with that claim, and may not be re -used in a
separate submittal, even for costs or tasks that were not originally claimed. Final reimbursement of costs associated with the Total Claimed amount below may be affected by the
eligibility status of the site (i.e., deductibles, apportionment, etc.), and the documentary validation of incurred costs as reasonable and necessary expenses per 15A NCAC 2P
.0402 and .0404.
With Claim: [ ] All Main Consultant/Contractor invoices attached? [ ] Proof of payment attached directly to the front of each invoice?
• Important: The date of reimbursement is dependent on the Trust Fund balance. There may be a delay in the reimbursement of claims for work under this ePATA.
PREAPPROVAL / TASK AUTHORIZATION
(See Instructions /RRD for Tasks requiring Preapproval /Task Authorization)
FINAL REIMBURSEMENT
(Must Complete with Claim Submittal)
r
Task #
Lab /
SubCode
Proposed
Units / Type
(Consultant) )
a
Proposed
Rate/Price a
(Consultant)
Proposed Task
Subtotal
(Consultant)
Preapproved
Subtotal
IUSTSectionJ
Dates of Workl
(Consultant)
Started Completed
Claimed
Amountz
(Consultant)
2.600
1 site
$5,485.00
$5,485.00
/
Requested Preapproved
Claimed`
TOTAL: 0.00
TOTAL: 0.00
Total Standard Coss (Not Third Party) �5-4506 0.00
Total Standard Cos $
s $0.00
Total applied as Third Party Deductible/Damage Costs $0.00 $0.00
Total Third Pty Costs $0.00
Process Tracking (Date) (Initials)
TASubmittal: 3/25/19 by: CNB (PM) (Reservedfor RO)
RO Review: by: (IM) Joint UST Preapproval Confirmed By: Date'
CO Review: by: (STF) RP or Designee Receipt Confirmation By: Date s
1 -The ePATA expires one year from the Joint UST Preapproval date. Note: Tasks must be claimed within one year of completion.
This one-year activity deadline from the authorization date does not supercede other regulatory deadlines (e.g., NORR's, NOV's, Enforcements, Remissions, etc.)
2 -Only Tasks included on this ePATA maybe claimed. Do not include other Tasks or claimed costs (i.e., Claim preparation) that were not preapproved or the claim will be returned.
3 - Preapproval is not valid (i.e., claimable) until receipt is confirmed by the RP or their designee and returned to the Trust Fund within a week of approval. Signature indicates agreement
with the tasks and amounts approved. Any objections/appeals must be submitted via Change Order prior to work proceeding and does not supercede other regulatory
deadlines as described in #1 above.)
4 - Once siged the ePATA is not to be modified without written consent of all signatories.
S. Directed - CAB Only ePATAs that violate any RRD scope of work, rule or statute will not be reimbursed as approved.
D W M/UST ePATA Ver.1/10/2019

Per our conversation, please see the attached items in regards to the Notice of Regulatory Requirements (NORR)
notification from the North Carolina DEQ.
As discussed, Sysco Charlotte will be implementing the following measures to ensure compliance with Title 15A NCAC 2L
.0405:
- Phase I Limited Site Assessment (LSA)
- Proposed Well locations
- Electronic Preapproval Task Authorization (ePATA)
- Sysco Charlotte Extension Request
Moving forward, if you have any questions or concerns; please respond back to this email as I have copied Sysco
Charlotte's Vice President of Operations Tim Stillwell and our consultant Corey Buchanan of Geological Resources, Inc.
Thank you for your attention with this matter.
Best Regards,
Robert Thomas I Director, Environmental Compliance
Sysco Corporation
1390 Enclave Pkwy, Houston, TX 77077, USA
0:281-584-5045
C:832-457-8900
thomas. robert2Cabcorp. sysco.com
S)/the heart of
food and service
CONFIDENTIAL - This e-mail transmission and any documents attached to it may contain information that is confidential or legally
privileged. If you are not the intended recipient, or a person responsible for delivering this transmission to the intended recipient,
you are hereby notified that any discourse, copying, distributions, or use of this transmission is strictly prohibited. If you have
received this transmission in error, please immediately notify the sender and destroy the original transmission, attachments and
destroy any hard copies.