The URL can be used to link to this page

Home My WebLink AboutMO-9448_40883_CA_UST-61_20181025_24-Hour Release and UST Leak Reporting FormUST-61 24-Hour Release and UST Leak Reporting Form. For Releases This form should be completed and submitted to the UST Section's regional office following a known or suspected release from an underground storage tank (UST) system. This form is required to be submitted within 24 hours of discovery of a known or in NC suspected release (DWM USE ONLY) Suspected Contamination? (Y/N) Y Facility ID Number None Incident # Risk (H,I,L,U) Confirmed GW Contamination? (Y/N) N Date Leak Discovered 10/19/2018 Received On Received By Confirmed Soil Contamination ?(Y/N) Y Comm/Non-Commercial? Comm Reported by (circle one): Phone, Fax or Report Samples Taken?(Y/N) Y Reg/Non-regulated? Non -regulated Region Free Product? (Y/N) Y If Yes, State Greatest '14" Thickness INCIDENT DESCRIPTION Incident Name: GADO Building Address: 5318 Morris Field Drive County: Mecklenburg Regional Office (circle one): AsheviIl Mooresville ayetteville, City/Town: Charlotte 7ZIPode: 28208 Raleigh, Washington, Wilmington, Winston- em Latitude (decimal degrees): 35.212133 Longitude (decimal degrees) :-80.932548 Obtained by: ❑ GPS Briefly describe suspected or confirmed release: (including but not limited to: nature of release, date of release, amount of release, amount of free product present and recovery efforts, initial responses conducted, impacts to receptors) ❑ Topographic map ❑ GIS Address matching ® Other Google Maps ❑ Unknown Describe location: CLT Airport Tank discovered during demolition of building. Tank removed on 10/19/2018 by Demolition Contractor and corrosion holes observed in tank. The tank was used to store heating oil for a boiler until about 1990, when boiler was converted to natural gas. Soil excavation performed at time of tank removal based on field screening data. Very small amount of heating oil noted on soil beneath tank. HOW RELEASE WAS DISCOVERED (Release code) (Check one) ❑ Release Detection Equipment or Methods ❑ Visual/Odor ❑ Groundwater Contamination ® During UST Closure/Removal ❑ Water in Tank ❑ Surface Water Contamination ❑ Property Transfer ❑ Water Supply Well Contamination ❑ Other (specify) SOURCE OF CONTAMINATION Source of Release Cause of Release Type of Release Product Type Released (Check one to indicate primary (Check one to indicate primary (Check one) (Check one to indicate primary product type source) cause) released) ®Tank ❑ Spill ®Petroleum ❑ Gasoline/ Diesel/ ❑ DieselNeg. Oil ❑ Piping ❑ Overfill ❑ Non -Petroleum Kerosene Blend e Heating Oil ❑ Vegetable Oil 100 /o ❑ Dispenser ®Corrosion ❑ Both ❑ Other Petroleum ❑ E10—E20 ❑ Submersible Turbine Pump ❑ Physical or Mechanical Products ❑ Damage Location ❑ Metals E21 — E84 ❑ Delivery Problem (Check one) ❑ Other Inorganics ❑ E85 — E99 ❑ Install Problem ❑ Other ❑ Other Organics Ethanol 100% ❑Other ® Facility ❑ ❑ Unknown ❑ Unknown ❑ Residence ❑ E01 — E09 Definitions presented on reverse Definitions presented on reverse ❑ Other OWnaLShiD 1 Municipal 2. Military 3. Unknown 4. Private 5. Federal 6. County 7. State Operation Type 1. Public Service 2. Agricultural 3. Residential 4. Education/Relig. 5. Industrial 6. Commercial 7. Mining (ZED UST Form 61 (02/08) Page 1 of 2 IMPACT ON DRINKING WATER SUPPLIES Water Supply Wells Affected? 1. Yes CD 3. Unknown Number of Water Supply Wells Affected Water Supply Wells Contaminated: (Include Users Names, Addresses and Phone Numbers. Attach additional sheet if necessary) 1. 2. 3. UST SYSTEM OWNER UST Owner/Company UNKNOWN Point of Contact Address City State Zip Code Telephone Number UST SYSTEM OPERATOR UNKNOWN UST Operator/Company Address City State Zip Code Telephone Number LANDOWNER AT LOCATION Or UST INCIDENT Landowner Address CITY OF CHARLOTTE 600 East 4th Street City State Zip Code Telephone Number Charlotte NC 28202 704-359-4789 Draw Sketch of Area (showing two major road intersections) or Attach Map Person Reporting Incident rr�,y Company C' lrt2 L av �q�rtrJ �4,�»�2.T Telephone Number tic 560-9dtF�- Titlentvi I Address 9(.c)1 [ilC/�Ct,LrffL- NC, 3236Q Date 10a� dotg UST Form 61 (02/08) Page 2 of z Definitions of Sources Tank: means the tank that stores the product and is part of the underground storage tank system Piping: means the piping and connectors running from the tank or submersible turbine pump to the dispenser or other end -use equipment (Vent, vapor recovery, or fill lines are excluded.) Dispenser: includes the dispenser and the equipment used to connect the dispenser to the piping (e.g., a release from a suction pump or from components located above the shear valve) Submersible Turbine Pump (STP) Area includes the submersible turbine pump head (typically located in the tank sump), the line leak detector, and the piping that connects the submersible turbine pump to the tank Delivery Problem: identifies releases that occurred during product delivery to the tank. (Typical causes associated with this source are spills and overfills.) Other: serves as the option to use when the release source is known but does not fit into one of the preceding categories (e.g., for releases from vent lines, vapor recovery lines, and fill lines) Unknown: identifies releases for which the source has not been determined Definitions of Causes Spill: use this cause when a spill occurs (e.g., when the delivery hose is disconnected from the tank fill pipe or when the nozzle is removed from the dispenser) Overfill: use when an overfill occurs (e.g., overfills may occur from the fill pipe at the tank or when the nozzle fails to shut off at the dispenser) Physical or Mechanical Damage: use for all types of physical or mechanical damage, except corrosion (e.g., puncture of tank or piping, loose fittings, broken components, and components that have changed dimension) Corrosion: use when a metal tank, piping, or other component has a release due to corrosion (e.g., for steel, corrosion takes the form of rust) Installation Problem: use when the problem is determined to have occurred specifically because the UST system was not installed properly Other: use this option when the cause is known but does not fit into one of the preceding categories (e.g., putting regulated substances into monitoring wells) Unknown: use when the cause has not been determined i m= mk - O;L� bb u O Rrndd ftoBd x as Cd /C ol � a CD -1r=.Y W Z O 00 � _ �Al x ya co i-r 7 �E CL �A� U VIOA �i a {. c'xi*x< _ - B+M c✓dran Wr.y _ a &"d,h Pwv •. E g Y j � i 00 el 4 ,t (� ,ow OO,Y Fl}iyA yv Zl:=x BaR].�r%ter �a b N O CO 6 o d a c O a E � � W �L c p S_ a E O 00 M J , O 0 LO U C7 t iL U V w � •S~-1 ' � LYalia<e Neel Rd W:v'M.e tle�ftd }-I O 0 YloHaro Nexl Pd _- ldln0S8C'1 - - O25ylyfzeNeA� D Beverly, Trudy From: McDorman, James <James.McDorman@cltairport.com> Sent: Monday, October 29, 2018 9:28 AM To: Beverly, Trudy Cc: Jordan, Jimmy Subject: RE: [EXT] RE: [External] CLT-Former GADO Building Hello Beverly, Yes, we will submit an IAAR upon completion. Thank you, JAMES P MCDORMAN P.G. I ENVIRONMENTAL COMPLIANCE COORDINATOR CHARLOTTE DOUGLAS INTERNATIONAL AIRPORT m 704-560-9242 cltairport.com From: Beverly, Trudy [mailto:trudy.beverly@ncdenr.gov] Sent: Monday, October 29, 2018 9:23 AM To: McDorman, James; Bowser, Daniel P Subject: RE: [EXT] RE: [External] CLT-Former GADO Building EXTERNAL EMAIL: This email originated from the Internet. Do not click any images, links or open any attachments unless you recognize and trust the sender and know the content is safe. Please forward all suspicious email to bad.mail@charlottenc.gov. Hi James, I did get the forwarded UST-61 from Dan. When completed, the Initial Action Abatement Report should be submitted per the policies below. Let me know if you have any questions. Document Submittal & UST File Names for Laserfiche Policies: httos://files.nc.Rov/ncdea/Waste%20Manaeement/DWM/UST/Corrective%2OAction/Electronic%2ODocument%2OSubmi ttal%20Memo%2OUpdate.pdf httns://files.nc. tiov/ncdea/Waste%20ManaLyement/D WM/UST/Corrective%2OAction/UST%20file%20names%20for%20 Laserfiche.docx Have a wonderful day, Trudy Trudy Beverly, L.G. Hydrogeologist, Division of Waste Management North Carolina Department of Environment Quality Underground Storage Tanks Section Corrective Action Branch Mooresville Regional Office (704) 235-2182 (Office) Trudy.Beve rlyPncdenr.eov +.:' :+. 'X 4 w, Fw : L ' .1, 11 4 .. 'J....1rh &1 ti p■ . %1 •' :: " % 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: https://files.nc.gov/ncdeq/Waste%2OManagement/DWM/UST/Corrective%2OAction/Electronic%2ODocument%2OSubmi ttal%20Memo%20UPdate.pdf https:Hfiles.nc. izov/ncdeq/Waste%2OManaizement/DWM/UST/Corrective%2OAction/UST%20file%20names%20for%20 Laserfiche.docx From: McDorman, James [mailto:James.McDorman@cltairport.com] Sent: Monday, October 29, 2018 9:03 AM To: Bowser, Daniel P <dan.bowser@ncdenr.gov> Cc: Beverly, Trudy <trudy.beverly@ncdenr.gov> Subject: RE: [EXT] RE: [External] CLT-Former GADO Building Thank you Dan. JAMES P MCDORMAN P.G. I ENVIRONMENTAL COMPLIANCE COORDINATOR CHARLOTTE DOUGLAS INTERNATIONAL AIRPORT m 704-560-9242 cltairport.com From: Bowser, Daniel P [mailto:dan.bowser@ncdenr.gov] Sent: Monday, October 29, 2018 8:59 AM To: McDorman, James Subject: [EXT] RE: [External] CLT-Former GADO Building EXTERNAL EMAIL: This email originated from the Internet. Do not click any images, links or open any attachments unless you recognize and trust the sender and know the content is safe. Please forward all suspicious email to bad.mail(c_r�charlottenc.gov. James, I forwarded this to Trudy Beverly, she handles non -regulated UST releases in Mecklenburg County. Trudy Beverly, LG - Trudy. Beverly@ncdenr.gov Hydrogeologist NCDEQ- Division of Waste Management Underground Storage Tanks Section — Corrective Action Branch Mooresville Regional Office 610 East Center Ave., Suite 301 Mooresville, NC 28115 Phone: (704) 235-2182 Fax: (704) 663-6040 Thank you, Daniel P. Bowser, PG Hydrogeologist North Carolina Department of Environmental Quality Underground Storage Tank Section - Corrective Action Branch (704) 235-2172 dan.bowser anncdenr.aov 610 East Center Ave Suite 301 Mooresville, North Carolina 28115 Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. From: McDorman, James <James.McDorman@cltairport.com> Sent: Thursday, October 25, 2018 2:35 PM To: Bowser, Daniel P <dan.bowser@ncdenr.gov> Subject: [External] CLT-Former GADO Building � , . • • . ernal email. Do not click links or open attachments unless verified. Send all suspicious email as an attachment to 0 Good afternoon Dan, Attached please find a completed UST-61 Form for the subject facility. We have removed the tank and are currently conducting Initial Abatement Actions. Please contact me should you have questions or require additional information. Thank you, JAMES P MCDORMAN P.G. I ENVIRONMENTAL COMPLIANCE COORDINATOR CHARLOTTE DOUGLAS INTERNATIONAL AIRPORT m 704-560-9242 cltairport.com