MO-9453_0_CA_CLO_20190122_Closure Report

CLOSURE REPORT AND SITE
INVESTIGATION REPORT FOR PERMANENT
CLOSURE OF AN UNDERGROUND STORAGE TANK
Site:
WINDSTREAM COMMUNICATIONS
1813 SARDIS ROAD NORTH
CHARLOTTE, N. C. 28270
MECKLENBURG COUNTY
PREPARED FOR:
WINDSTREAM CORPORATION
4001 NORTH RODNEY PARHAM ROAD
LITTLE ROCK, AR. 72212
PREPARED BY:
CAROLINA ENVIRONMENTAL
RESPONSE TEAM
5648 DAPHNE DRIVE
CHARLOTTE, N. C. 28269
JANUARY, 2019

132 W. Statesville Ave.
Mooresville. NC 28115
January 21, 2019
Professional Engineer Statement
Underground storage tank closure activities were conducted at Windstream
Communications — Sardis Road North site located at 1813 Sardis Road North in
Charlotte, NC by C.E.R.T. PO Box 681016, Charlotte, NC 28216. All
specifications and operating procedures utilized were in accordance with good
engineering practices. Soil sampling was performed by me at appropriate locations
utilizing guidance outlined in Underground Storage Tank Section Guidelines for
Site Checks, Tank Closure. and Initial Response and Abatement, May 2017, and as
shown in the UST Closure Report (UST-12). The laboratory analysis, performed
by a state certified laboratory, indicates NO residual contamination above "State
Action Levels". Based on this and information known of this site, we believe that
the site should be subject to "no further action".
CAF'J0,
1.
p, Jzt 1 Zol9
R. Osborne, PE
Providing Environmental Engineering, Technology and Service

Limitations
These environmental services have been performed for the exclusive use of our client for the
specific application to this project. The specifications and operating procedures utilized in the
performance of these services is in accordance with generally accepted engineering principals.
No other warranty, expressed or implied, is made. Although we cannot be responsible for the
accuracy of the data supplied by others we have no reason to suspect that any of the
information provided is inaccurate unless it has been noted otherwise. Our observations are
based upon conditions visible at the site at the time of our visits. Chemical analyses were
performed on selected soil samples to determine the presence and/or concentrations of
potential contaminants. Selections of specific EPA test methods for chemical analyses were
based upon (1) information supplied by our client (owner) concerning raw materials, products,
and/or wastes which may have been handled or generated within the scope of this project, and
(2) guidelines provided by the North Carolina Department of Environmental Quality.
Conclusions presented in this report are based upon the services described, not on specific
research, tasks, or procedures beyond the scope of described services; nor, beyond the time
and/or budgetary constraints imposed by our client. Carolina Environmental Response Team
by virtue of providing the services described in this report, does not assume the responsibility of
the person(s) in charge of the site.
Windstream Communications -Charlotte, N. C. UST Closure Report-1/19

CLOSURE REPORT AND SITE
INVESTIGATION REPORT FOR PERMANENT
CLOSURE OF AN UNDERGROUND STORAGE TANK
WINDSTREAM COMMUNICATIONS
1813 SARDIS ROAD NORTH
CHARLOTTE, N. C. 28270
TABLE OF CONTENTS
UST Closure Report
Figures:
Figure A Topography Map and Aerial Site Photograph
Figure B Site Plan
Appendices:
Appendix A State Notification Forms-UST-2A, UST-3
Appendix B Analytical/Laboratory Reports and Chain of Custody
Appendix C Disposal Manifests -Tank and Liquid
Appendix D Health and Safety Plan and North Carolina One Call Information
Appendix E City of Charlotte Fire Department Tank Removal Permit
Appendix F Photos of the Activities
Windstream Communications -Charlotte, N. C. UST Closure Report-1119

Underground Storage Tank Closure Report
A. Site Information;
1. Site Identification;
Date of report;
1/22/19
Facility I. D. number;
0-00-000026291
Site name and address;
Windstream Communications
1813 Sardis Road North
Charlotte, N. C. 28270 Mecklenburg County
Description of Geographical Data Point,
Location method: latitude/longitude;
Midpoint of the tank via GPS:
Latitude 35' 08' 32" N Longitude 80' 44' 12" W
2. Information about contacts associated with the UST system;
UST owner;
Windstream Corporation
4001 North Rodney Parham Road
Little Rock, AR 72212 [phone]
UST operator;
See above.
Property owner;
See above.
Property occupant;
The location is a facility for the local telephone company.
Consultant/Contractor;
Carolina Environmental Response Team
5648 Daphne Drive
Charlotte, NC 28269 [phone]
Analytical laboratory;
Pace Analytical
[phone]
3. UST information;
Tank
#
Date
Installed
Date
Removed
Size in
Gal.
Dim.
Tank
Const.
Line
Const.
Product
Release
1
Unk
1/8/19
1,000
4' X 11 .5'
Double Wall
/z inch
Diesel Fuel
No
Fiberglass
Copper
Windstream Communications -Charlotte, N. C. UST Closure Report-1/22

2
4. Information about a release;
There are no documented releases at this location.
B. Site history and characterization;
1. UST owner and operator information;
Windstream Corporation
4001 North Rodney Parham Road
Little Rock, AR 72212 [phone]
2. Provide UST information;
See the attached table.
3. Provide non -UST information;
A new generator with a self-contained fuel tank is located on the site.
4. Describe relation of location of current UST system to historical
UST releases, non -UST releases, and off -site releases;
There are no documented releases at this location.
5. Site Characteristics;
This site contains a service facility for Windstream Communications. Soil
encountered consisted of red/brown silty clay. No indication of the depth to
groundwater or bedrock was noted in the excavation as these were not
encountered. The site is served by the City of Charlotte water and sewer system.
C. Closure procedures;
1. Describe preparations for closure including steps taken to notify authorities,
Permits obtained, and steps taken to clean and purge the tank.
Authorities were notified prior to the removal and all necessary permits were
obtained. A UST-3 Notice of Intent -UST Permanent Closure or Change in
Service form was sent to the North Carolina Department of Environmental
Quality on 6/8/18 (see Appendix A). The City of Charlotte fire marshal was
notified and a permit for the removal was obtained (see Appendix E). The fire
marshal was not present for the tank removal project. Approximately 600 gallons
of diesel fuel from the underground tank was removed. A copy of the manifest is
present (see Appendix C).
2. Describe the closure procedures;
The Health and Safety Plan (see Appendix D) was reviewed and signed by all
personnel present. All liquid had been removed from the tank prior to the
removal. A small concrete berm and soil were removed down to the top of the
tank. Soil was removed from both sides and ends of the tank. The fiberglass tank
showed no deterioration and no holes were present in the tank or lines. The tank
was placed on a trailer and removed for disposal. The 1/2 inch copper lines were
removed up to the edge of the new generator area.
Windstream Communications -Charlotte, N. C. UST Closure Report-1/19

Although these lines were encased in PVC, a soil sample was taken from below
them. No petroleum odor was noted at any location around the tank cavity or line
area. Laboratory results also show no contamination present. (see Appendix B).
See the attached map for sample locations (Figures).
3. Note the amount of residual material pumped from the tank and
describe the storage, sampling, and disposal of the residual
material and the disposal of the tank(s), pumps, and piping;
No residual material remained in the tank at the time of the removal.
Approximately 600 gallons of diesel fuel had been removed prior to the digging.
A copy of the liquid manifest is present. The tank was disposed of by the
Carolina Environmental Response Team. A copy of the Certificate of Disposal is
attached (see Appendix Q.
4. Document any soil excavation activities;
The tank was buried to a depth of 4 feet. As the soil was removed, checks were
made to determine the presence of soil contamination. The tank area was 9 feet
by 16 feet. The depth to the bottom of the tank was 8 feet. Approximately 15
tons of soil was removed to access the tank. An additional 15 tons of backfill was
added to complete the removal. Backfill consisted of clean soil from a local
quarry. No groundwater, free product or bedrock was encountered during the
excavation.
D. Site investigation;
1. Field screening activities;
The soil was red/brown silty clay. No petroleum odor of any type was noted in
the soil beneath and beside the UST or product and return lines. The soil samples
were taken in native soil below each end of the tank and from below the copper
lines with a portion of the soil being split into plastic bags for field checks via the
PID. A Mini Rae 2000 Photo -ionization Detector was used to field screen the soil
samples. The PID was calibrated to display concentration in units equal to parts
per million. First, a supply of zero air, which contains no ionizable gases or
vapor, is used to set the zero point. Then, span gas containing a known
concentration of a photo -ionizable gas or vapor is used to set the sensitivity.
Isobutylene at 100 ppm was used as the span. The field screening was done by
holding the PID next to the soil that had been removed and observing the meter
to determine if contaminated soil was present. In addition, soil samples were
placed in plastic bags and allowed to warm and then were read. None of the
checks indicated the presence of soil contamination.
2. Document soil sampling information;
The soil samples were collected from the open excavation by use of the back hoe
digging an area approximately two feet below each end of the tank along the
centerline of the tank. Fresh nitrile gloves then removed soil that had not come
into contact with the track hoe bucket. This soil was placed in new laboratory
provided containers/preparations.
Windstream Communications -Charlotte, N. C. UST Closure Report-1/19

2
The tank soil samples were collected at a depth of 10 feet below ground level.
The line samples were collected from approximately 2.5 feet deep, below the
PVC encased copper lines. See the attached map for the sample locations.
3. Document groundwater and surface water sampling information;
No groundwater or surface water was encountered during the excavation.
4. Document quality control measure information;
Upon removal, each sample was prepped for GRO via 5035 prep. and DRO.
Laboratory provided containers were used for sampling. The samples were
placed in a chilled cooler and taken to the lab. Fresh disposable gloves were
used to handle each sample. See the attached chain of custody for the date and
time that the samples were submitted to the lab (see Appendix B). As samples
from various points around the area were removed, they were field checked for
soil contamination. These samples were placed in plastic bags, allowed to warm,
and checked.
5. Describe soil and groundwater investigation results;
See the analytical results attached (see Appendix B). All of the sample results
are shown as non -detect. No groundwater or bedrock were encountered during
the excavation. The samples were checked for GRO via 5030 prep and DRO.
PID readings showed no soil contamination present.
E. Conclusions and recommendations;
Upon receipt of the analysis of soil sampling, it was determined that no soil
contamination exists at this site. No groundwater, bedrock, or free product was
encountered during the excavation. On this basis the property should be subject
to "no further action".
Windstream Communications -Charlotte, N. C. UST Closure Report-1/19

FIGURE A
Topography Map and Aerial Site Photograph

FIGURE 1
USGS 7.5 MIN TOPOGRAPHY MAP t
Windstream Communications, Inc.
1813 Sardis Road North
Charlotte, NC
SURFACE WATER SHOWN IN BLUE
u;
y
INENCO, Inc.
132 W. STATESVILLE AVE.
MOORESVILLE,NC 28115

FIGURE 2
AERIAL SITE LOCATION
PHOTOGRAPH
Windstream Communications, Inc.
Charlotte, NC
2018
INENCO, Inc.
132 W. STATESVILLE AVE.
it MOORESVILLE, NC 28115

FIGURE B
Site Plan

r
I
I
See Insets \
/
/ L — y
/
/
/
/
414n /
/ Parking
/ For The
THE Business COLONNADE
ark
Inset°
I /
Approximate /
1000 gallon UST _ �// Boundary /
I
I i T1 #;
T\ Soft Copper Product Lines
I I /
I I
I /
SOIL TEST RESULTS
Test Method
Sample #1 Description
@Depth
GRO
DRO
Tank #1
10'
ND
ND
Tank #2
10'
ND
ND
Line Sample
2.5'
ND
ND
All Results mg/kg
GENERATOR /
I I /
I /
I I /
I T1 = Tank Sample Location
I /
©= Line Sample Location /
I /
y
INENCO Inc.SITE PLAN SCALE: As Shown FIGURE 3
132W Statesville Ave, MWresvitte,NC Windstream 1813 Sardis Road North Charlotte, NC 1/8/2019

APPENDIX A
State Notification Forms
UST-2A, UST-3

U`ST-2A.
Site Investigatllpn Report for 'Permanent Closure or Change -in- .
Service' of
REGISTEREDVST:
Return completed forth to:
STATE USE ONLY:
NC DEQ / DWM / UST SECTION
Facility ID #
1646 MAIL SERVICE CENTER
RALEIGH, NC 27699-1646
ATTN: REGISTRATION & PERMITTING
Date Received
phone [phone] fax [phone] http://www.wastenotnc.orci
INSTRUCTIONS READ THIS FIRST)
1. UST permanent closure or change in service must be completed in accordance with the latest version of the Guidelines for Site Checks, Tank
Closure and Initial Response and Abatement. The guidelines can be obtained at http://deg.nc.gov/about/divisions/waste-management/waste-
m a n agement-permit-Guidance/underground-storage-tan ks-section.
2. Permanent closure: Complete all sections of this form.
3. Chanae-in-service: Where a UST system will be converted from storing a regulated substance to a non -regulated substance, complete sections I, II,
III, IV, and VI
4. For more than 5 registered UST systems, attach additional forms as needed
6. Tank Fee Refund: An annual tank fee may be refunded for a tank for which a tank fee was not required. An owner or operator must submit
a written request and include: (1) contact information, (2) federal identification # or SSN, and (3) a copy of UST-2 form. The annual tank
fee will be prorated based on the date of permanent closure.
6. UNREGISTERED USTs use Form UST 26
1.OWNERSHIP 'OF TANKS '
II. LOCATION OF TANKS
Owner Name (Corporation, Individual, Public Agency, or Other Entity)
Facility Name or Company
Windstream Services, LLC
Windstream Communications, N. C.
Street Address
Facility ID # (if known)
4001 North Rodney Parham Road
00-0-0000026291
City County
Street Address
Little Rock Pulaski
1813 Sardis Road North
State Zip Code
City County Zip Code
Ar 72212
Charlotte Mecklenburg 28211
Phone Number
Phone Number
501-748-4612
III. CONTACT PERSONNEL
Contact for Facility:
Job Title:
Phone #:
Closure Contractor Name:
Closure Contractor Company:
Address:
Phone #
Larry Boone
CERT
Charlotte, N. C.
877-505-6799
Primary Consultant Name:
Primary Consultant Company:
Address:
Phone #
Ryan Osborne
Inenco, Inc.
I Mooresville, N. C.
704-662-8192
IV UBT:INFORMAT70N; FOR REGISTERED UST SYSTEMS ..
�..EXGAVATION CONDITION
UNREGISTERED USTs.ase Fonn,UST 26.
Tank ID
Size in
Last
Last
Permanent
Method of Permanent Closure:
Change -in-
Notable
No.
Gallons
Contents
Use
Close Date
Indicate REMOVED or enter fill
Service
water in
Free product
odor or
visible soil
Date
material, such as foam!
Date
excavation
contaminatio
concrete/ sand
n
Yes
I No
Yes
No
Yes
I No
j
1000
Dielsel, Di
8/18
1/8/19
Removed
❑
®
❑
®
❑
El
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
A. CERTIFICATION `` =
I certify under penalty of law that 1 have personally examined and am familiar with the information submitted in this and all attached documents and that
based on my inquiry of those individuals immediately responsible for obtaining the information, 1 believe that the submitted information is true accurate
and complete.
Print name and official title of owner or owner's authorized representative
Larry Boone
Signature �.,;f
Date Signed
NORTH CAROLING DEPARTMENT OF ENVIRONMENTAL QUALITY, DIVISION OF ASTE MANAGEMENT, UST SECTION
1646 MAIL SERVICE CENTER, RALEIGH, NG 27699-1646 PHONE' 919 707-8171 FAX [phone] - sl/www.wastenotr cor 1. 112016.

U*-,-) 1 -S NOUCe 0t Intent: U5 I Permanent Closure or Change -in -Service
Retum completed forth to:
STATE USE ONLY
The DWM Regional Office located in the area where the facility is located. Send a copy to the Central Office in Raleigh so that
I.D. #
the status of the tank may be changed to "PERMANENTLY CLOSED" and your tank fee account can be closed out.
SEE MAP ON THE BACK OF THIS FORM FOR THE CENTRAL AND REGIONAL OFFICE ADDRESSES.
Date Received
INSTRUCTIONS (READ THIS FIRST)
Complete and return at least thirty (30) days prior to closure or change -in-service activities. If a Professional Engineer (P.E.) or a Licensed Geologist (L.G.)
provides supervision for closure or change -in-service site assessment activities and signs and seals all closure reports then at least a five (5) working
days notice is acceptable.
Completed UST closure or change -in-service site assessment reports, along with a copy of the UST-2 form, should be submitted to the appropriate Division
of Waste Management (DWM) Regional Office within thirty (30) days following closure activities. The UST-2 form should also be submitted to the Central
Office in Raleigh so that the status of the tanks may be changed to permanently closed and your tank fee account can be closed out.
UST closure and change -in-service site assessments must be completed in accordance with the latest version of the Guidelines for Site Checks, Tank
Closure and Initial Response. The guidelines can be obtained at htto://www.wastenotnc.org/web/wm/. Note: To close tanks in place you must obtain prior
approval from the DWM Regional office located in the region where the facility is located.
You must make sure that USTs removed from your property are disposed of properly. When choosing a closure contractor, ask where the tank(s) will be
taken for disposal. Usually, USTs are cleaned and cut up for scrap metal. This is dangerous work and must be performed by a qualified company. Tanks
disposed of illegally in fields or other dumpsites can leak petroleum products and sludge into the environment. If your tanks are disposed of improperly, you
could be held responsible for the cleanup of any environmental damage that occurs.
I. OWNERSHIP OF TANKS
II. LOCATION
Owner Name (Corporation, Individual, Public Agency, or Other Entity)
Facility Name or Company
Windstream Services, LLC
Windstream Communications N. C.
Street Address
Facility ID # (If known)
4001 Rodney Parham Road
00-0-0000026291
City County
Street Address
Little Rock Pulaski
1813 Sardis Road North
State Zip Code
City County Zip Code
Ar 72212
Charlotte Mecklenburg 28211
Phone Number
Phone Number
501 748-4612
III. CONTACT PERSONNEL
Name:
Company Name:
Job Title:
Phone Number.
Kris Ramon
Windstream Services, LLC
Project Manager -Env. Corn liance
See Abov
IV. TANK REMOVAL CLOSURE IN PLACE, CHANGE -IN SERVICE
1. Contact local fire marshal. 5. Provide a sketch locating piping, tanks and a P.E. or L.G., with ail closure site
2. Plan entire closure event soil sampling locations. assessment reports bearing the signature
3. Conduct Site Soil Assessment. 6. Submit a closure report in the format of and seal of the P.E. or L.G. If a release has
UST-12 (including the form UST-2) within not occurred, the supervision, signature or
4. If removing tanks or closing in place, refer to thirty (30) days following the site seal of a P.E. or L.G. is not required_
API Publication 2015 Cleaning Petroleum investigation. 8. Keep closure records for three (3) years.
Storage Tanks and 1604 Removal and 7 If a release from the tanks has occurred, the
Disposal of Used Underground Petroleum
Storage Tanks. site assessment portion of the tank closure
must be conducted under the supervision of
V. WORK TO BE PERFORMED BY
Contractor Name:
Contractor Company Name:
Larry Boone
C.E.R.T.
Address:
State:
Zip Code:
Phone No:
5648 Daphne Drive -Charlotte
NC
28269
877-505-6799
Primary Consultant Name:
Primary Consultant Company Name:
Consultant Phone No:
Ryan Osborne
Inenco, Inc.
704-662-8194
VI. TANKS SCHEDULED FOR CLOSURE
OR CHANGE -IN-SERVICE
Proposed ctivilly
Closure
Change -In -Service
Tank ID No_
Size in Gallons
Last Contents
Removal
Abandonment in Place
New Contents Stored
1
550
Dielsel, Dielsei Mix
®
❑
❑
❑
' Prior written approval to abandon a tank in place must be received from a DWM Regional Office.
VII. OWNER OR OWNER'S AUTHORIZED REPRESENTATIVE
I understand that I can be held responsible for ironmental damage resulting from the improper disposal of my USTs.
Print nee,, and official title: f HIV
Sig t
Dao Signed
SCHEDULED REMOVAL DATE
Notify your DWM Regional Office
48 hours before this date if
scheduled removal date changes

APPENDIX B
Analytical/Laboratory Reports and
Chain of Custody

aceAnalytical
—pacelabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
January 12, 2019
Lee Shank
Carolina Environmental Respons
5648 Daphne Drive
Charlotte, NC 28269
RE: Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
Dear Lee Shank:
Enclosed are the analytical results for sample(s) received by the laboratory on January 08, 2019.
The results relate only to the samples included in this report. Results reported herein conform to the
most current, applicable TNI/NELAC standards and the laboratory's Quality Assurance Manual,
where applicable, unless otherwise noted in the body of the report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
f&ro- l
Amanda Payne
[e-mail]
[phone]
Project Manager
Enclosures
cc: Steve Hamilton, Carolina Environmental Response Team
Cassandra Kisiah, Carolina Environmental Response
Team
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 17

aceAnalytical
—pacelabs.com
i
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
CERTIFICATIONS
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
South Carolina Certification #: 99006001
Louisiana/NELAP Certification # LA170028
Florida/NELAP Certification #: E87627
North Carolina Drinking Water Certification #: 37706
Kentucky UST Certification #: 84
North Carolina Field Services Certification #: 5342
Virginia/VELAP Certification #: 460221
North Carolina Wastewater Certification #: 12
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 2 of 17

aceAnalytical
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i
SAMPLE ANALYTE COUNT
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project:
Pace Project No.:
WINDSTREAM - SARDIS ROAD NORTH
92413142
Analytes
Lab ID
Sample ID
Method
Analysts
Reported
Laboratory
92413142001
TANK #1
EPA 8015C Modified
BAJ
2
PASI-C
EPA 8015C Modified
LMB
2
PASI-C
ASTM D2974-87
KDF
1
PASI-C
92413142002
TANK #2
EPA 8015C Modified
BAJ
2
PASI-C
EPA 8015C Modified
LMB
2
PASI-C
ASTM D2974-87
KDF
1
PASI-C
92413142003
LINE
EPA 8015C Modified
BAJ
2
PASI-C
EPA 8015C Modified
LMB
2
PASI-C
ASTM D2974-87
KDF
1
PASI-C
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 3 of 17

aceAnalytical
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i
SUMMARY OF DETECTION
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project:
Pace Project No.:
WINDSTREAM - SARDIS ROAD NORTH
92413142
Lab Sample ID
Client Sample ID
Method
Parameters
Result
Units
Report Limit
Analyzed Qualifiers
92413142001
TANK #1
ASTM D2974-87
Percent Moisture
17.7
%
0.10
01/09/19 15:51
92413142002
TANK #2
ASTM D2974-87
Percent Moisture
12.0
%
0.10
01/09/19 15:51
92413142003
LINE
ASTM D2974-87
Percent Moisture
23.3
%
0.10
01/09/19 15:51
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 4 of 17

aceAnalytical
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PROJECT NARRATIVE
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
Method: EPA 8015C Modified
Description: 8015 GCS THC-Diesel
Client: Carolina Environmental Response Team
Date: January 12, 2019
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
General Information:
3 samples were analyzed for EPA 8015C Modified. All samples were received in acceptable condition with any exceptions noted below
or on the chain -of custody and/or the sample condition upon receipt form (SCUR) attached at the end of this report.
Hold Time:
The samples were analyzed within the method required hold times with any exceptions noted below.
Sample Preparation:
The samples were prepared in accordance with EPA 3546 with any exceptions noted below.
Initial Calibrations (including MS Tune as applicable):
All criteria were within method requirements with any exceptions noted below.
Continuing Calibration:
All criteria were within method requirements with any exceptions noted below.
Surrogates:
All surrogates were within QC limits with any exceptions noted below.
Method Blank:
All analytes were below the report limit in the method blank, where applicable, with any exceptions noted below.
Laboratory Control Spike:
All laboratory control spike compounds were within QC limits with any exceptions noted below.
Matrix Spikes:
All percent recoveries and relative percent differences (RPDs) were within acceptance criteria with any exceptions noted below.
Additional Comments:
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services, LLC. Page 5 of 17

aceAnalytical
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i
PROJECT NARRATIVE
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
Method: EPA 8015C Modified
Description: Gasoline Range Organics
Client: Carolina Environmental Response Team
Date: January 12, 2019
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
General Information:
3 samples were analyzed for EPA 8015C Modified. All samples were received in acceptable condition with any exceptions noted below
or on the chain -of custody and/or the sample condition upon receipt form (SCUR) attached at the end of this report.
Hold Time:
The samples were analyzed within the method required hold times with any exceptions noted below.
Sample Preparation:
The samples were prepared in accordance with EPA 5030B with any exceptions noted below.
Initial Calibrations (including MS Tune as applicable):
All criteria were within method requirements with any exceptions noted below.
Continuing Calibration:
All criteria were within method requirements with any exceptions noted below.
Surrogates:
All surrogates were within QC limits with any exceptions noted below.
Method Blank:
All analytes were below the report limit in the method blank, where applicable, with any exceptions noted below.
Laboratory Control Spike:
All laboratory control spike compounds were within QC limits with any exceptions noted below.
Matrix Spikes:
All percent recoveries and relative percent differences (RPDs) were within acceptance criteria with any exceptions noted below.
Duplicate Sample:
All duplicate sample results were within method acceptance criteria with any exceptions noted below.
Additional Comments:
This data package has been reviewed for quality and completeness and is approved for release.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 6 of 17

aceAnalytical
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i
ANALYTICAL RESULTS
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Sample: TANK #1 Lab ID: 92413142001 Collected: 01/08/19 09:15 Received: 01/08/19 14:30 Matrix: Solid
Results reported on a "dry weight" basis and are adjusted for percent moisture, sample size and any dilutions.
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
8015 GCS THC-Diesel
Analytical Method: EPA 8015C Modified Preparation Method: EPA 3546
Diesel Range Organics(C10-C28)
ND mg/kg 6.0 1 01/08/19 17:14
01/09/19 17:14
Surrogates
n-Pentacosane (S)
65 % 33-129 1 01/08/19 17:14
01/09/19 17:14 629-99-2
Gasoline Range Organics
Analytical Method: EPA 8015C Modified Preparation Method: EPA 5030B
Gas Range Organics (C6-C10)
ND mg/kg 15.2 1 01/09/19 15:48
01/10/19 17:11
Surrogates
4-Bromofluorobenzene (S)
112 % 63-130 1 01/09/19 15:48
01/10/19 17:11 460-00-4
Percent Moisture
Analytical Method: ASTM D2974-87
Percent Moisture
17.7 % 0.10 1
01/09/19 15:51
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01 /12/2019 08:59 AM without the written consent of Pace Analytical Services, LLC. Page 7 of 17

aceAnalytical
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i
ANALYTICAL RESULTS
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Sample: TANK #2 Lab ID: 92413142002 Collected: 01/08/19 09:30 Received: 01/08/19 14:30 Matrix: Solid
Results reported on a "dry weight" basis and are adjusted for percent moisture, sample size and any dilutions.
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
8015 GCS THC-Diesel
Analytical Method: EPA 8015C Modified Preparation Method: EPA 3546
Diesel Range Organics(C10-C28)
ND mg/kg 5.7 1 01/08/19 17:14
01/09/19 17:38
Surrogates
n-Pentacosane (S)
73 % 33-129 1 01/08/19 17:14
01/09/19 17:38 629-99-2
Gasoline Range Organics
Analytical Method: EPA 8015C Modified Preparation Method: EPA 5030B
Gas Range Organics (C6-C10)
ND mg/kg 6.0 1 01/09/19 15:48
01/10/19 17:40
Surrogates
4-Bromofluorobenzene (S)
106 % 63-130 1 01/09/19 15:48
01/10/19 17:40 460-00-4
Percent Moisture
Analytical Method: ASTM D2974-87
Percent Moisture
12.0 % 0.10 1
01/09/19 15:51
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01 /12/2019 08:59 AM without the written consent of Pace Analytical Services, LLC. Page 8 of 17

aceAnalytical
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i
ANALYTICAL RESULTS
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Sample: LINE Lab ID: 92413142003 Collected: 01/08/19 09:45 Received: 01/08/19 14:30 Matrix: Solid
Results reported on a "dry weight" basis and are adjusted for percent moisture, sample size and any dilutions.
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
8015 GCS THC-Diesel
Analytical Method: EPA 8015C Modified Preparation Method: EPA 3546
Diesel Range Organics(C10-C28)
ND mg/kg 6.6 1 01/08/19 17:14
01/09/19 17:38
Surrogates
n-Pentacosane (S)
77 % 33-129 1 01/08/19 17:14
01/09/19 17:38 629-99-2
Gasoline Range Organics
Analytical Method: EPA 8015C Modified Preparation Method: EPA 5030B
Gas Range Organics (C6-C10)
ND mg/kg 9.0 1 01/09/19 15:48
01/10/19 18:36
Surrogates
4-Bromofluorobenzene (S)
107 % 63-130 1 01/09/19 15:48
01/10/19 18:36 460-00-4
Percent Moisture
Analytical Method: ASTM D2974-87
Percent Moisture
23.3 % 0.10 1
01/09/19 15:51
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01 /12/2019 08:59 AM without the written consent of Pace Analytical Services, LLC. Page 9 of 17

Pace Analytical Services, LLC
ceAnalX cal ® 9800 Kiney Ave. Suite 100
Huntersville, NC 28078078
www.pacelabs.com [phone]
i
QUALITY CONTROL DATA
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
QC Batch: 451555 Analysis Method: EPA 8015C Modified
QC Batch Method: EPA 5030E Analysis Description: Gasoline Range Organics
Associated Lab Samples: 92413142001, 92413142002, 92413142003
METHOD BLANK: 2469161 Matrix: Solid
Associated Lab Samples: 92413142001, 92413142002, 92413142003
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Gas Range Organics (C6-C10) mg/kg ND 6.0 01/10/19 16:43
4-Bromofluorobenzene (S) % 102 63-130 01/10/19 16:43
LABORATORY CONTROL SAMPLE:
2469162
Spike LCS
LCS
% Rec
Parameter
Units
Conc. Result
% Rec
Limits
Qualifiers
Gas Range Organics (C6-C10)
mg/kg
49.7 45.8
92
70-130
4-Bromofluorobenzene (S)
%
104
63-130
MATRIX SPIKE SAMPLE:
2469164
92413142003 Spike
MS
MS
% Rec
Parameter
Units
Result Conc.
Result
% Rec
Limits Qualifiers
Gas Range Organics (C6-C10)
mg/kg
ND 75
69.3
92
40-155
4-Bromofluorobenzene (S)
%
99
63-130
SAMPLE DUPLICATE: 2469163
92413142002 Dup
Parameter
Units
Result Result
RPD
Qualifiers
Gas Range Organics (C6-C10)
mg/kg
ND ND
4-Bromofluorobenzene (S)
%
106 108
2
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01 /12/2019 08:59 AM without the written consent of Pace Analytical Services, LLC. Page 10 of 17

aceAnalytical
—pacelabs.com
i
QUALITY CONTROL DATA
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
QC Batch: 451238 Analysis Method: EPA 8015C Modified
QC Batch Method: EPA 3546 Analysis Description: 8015 Solid GCSV
Associated Lab Samples: 92413142001, 92413142002, 92413142003
METHOD BLANK: 2467825 Matrix: Solid
Associated Lab Samples: 92413142001, 92413142002, 92413142003
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Diesel Range Organics(C10-C28) mg/kg ND 5.0 01/09/19 14:25
n-Pentacosane (S) % 79 33-129 01/09/19 14:25
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
LABORATORY CONTROL SAMPLE: 2467826
Spike LCS LCS % Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
Diesel Range Organics(C10-C28) mg/kg 67.6 54.7 81 43-130
n-Pentacosane (S) % 80 33-129
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01 /12/2019 08:59 AM without the written consent of Pace Analytical Services, LLC.
Page 11 of 17

Pace Analytical Services, LLC
ceAnalX cal ® 9800 Kiney Ave. Suite 100
Huntersville, NC 28078078
www.pacelabs.com [phone]
i
QUALITY CONTROL DATA
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
QC Batch: 451547 Analysis Method: ASTM D2974-87
QC Batch Method: ASTM D2974-87 Analysis Description: Dry Weight/Percent Moisture
Associated Lab Samples: 92413142001, 92413142002, 92413142003
SAMPLE DUPLICATE: 2469139
3549795001 Dup
Parameter Units Result Result RPD Qualifiers
Percent Moisture % 14.4 19.3 29 D6
SAMPLE DUPLICATE: 2469140
92413341004 Dup
Parameter Units Result Result RPD Qualifiers
Percent Moisture % 10.6 11.4 8
Results presented on this page are in the units indicated by the "Units" column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01 /12/2019 08:59 AM without the written consent of Pace Analytical Services, LLC.
Page 12 of 17

aceAnalytical
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i
QUALIFIERS
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND - Not Detected at or above adjusted reporting limit.
TNTC - Too Numerous To Count
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
PQL - Practical Quantitation Limit.
RL - Reporting Limit - The lowest concentration value that meets project requirements for quantitative data with known precision and
bias for a specific analyte in a specific matrix.
S - Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is
a combined concentration.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TNI -The NELAC Institute.
LABORATORIES
PASI-C Pace Analytical Services - Charlotte
ANALYTE QUALIFIERS
D6 The precision between the sample and sample duplicate exceeded laboratory control limits.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01 /12/2019 08:59 AM without the written consent of Pace Analytical Services, LLC. Page 13 of 17

aceAnalytical
—pacelabs.com
i
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: WINDSTREAM - SARDIS ROAD NORTH
Pace Project No.: 92413142
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Lab ID
Sample ID
QC Batch Method
QC Batch
Analytical Method
Analytical
Batch
92413142001
TANK #1
EPA 3546
451238
EPA 8015C Modified
451470
92413142002
TANK #2
EPA 3546
451238
EPA 8015C Modified
451470
92413142003
LINE
EPA 3546
451238
EPA 8015C Modified
451470
92413142001
TANK #1
EPA 5030B
451555
EPA 8015C Modified
451578
92413142002
TANK #2
EPA 5030B
451555
EPA 8015C Modified
451578
92413142003
LINE
EPA 5030B
451555
EPA 8015C Modified
451578
92413142001
TANK #1
ASTM D2974-87
451547
92413142002
TANK #2
ASTM D2974-87
451547
92413142003
LINE
ASTM D2974-87
451547
Date: 01/12/2019 08:59 AM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 14 of 17

Document Name: Document Revised: February7, 2018
Sample Condition Upon Receipt(SCUR) Page 1 of 2
Document No.: Issuing Authority:
F-CAR-CS-033-Rev.06 Pace Carolinas Quality Office
Laboratory receiving samples;
Asheville ❑ Eden❑ Greenwood ❑ Huntersville ... Sample Condition.: Raleigh❑ Mechanicsville❑
Cllent Name IWO : 92413142
Upon Receipt C. ect
Courlert ZFed Ex ❑UPS ❑USP5 enttllll I fl
11l ll�� {tip
❑ Commerdal ❑Other: 92413142 q
Custody Seal Present? []Yes \\ �o Seals Intact? [—]Yes t,_fNo
____ ` Oate/initials Person Examining contents:
Packing Material: ❑Bubble Wrap []Bubble Bags ❑None Other Biological Tiss Frozen?
Thermo e f ❑Yes ❑No A
1 3 Gun 16:
92T046 Type of Ice: �t ❑Blue ❑None
Cooler Temp ('Q ? C) Correctlon Factor: Add/Subtract ('C) �— Temp should be above freezingto 6'C
Cooler Temp Corrected ('C): ❑531Tples out of temp criteria. Samples on Ice, cooling process
has begun
USDA Regulated Soil (❑ N/A, water sample)
Did samples ' • mate In a quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate From a Foreign source (i
❑Yes including Hawaii and Puerto Rico)? []Yes
CarnmentslDlscrepancy:
Chain of Custody Present?
Samples Arrived within Hold Time?
Short Hold Time Analysis (<72 hr.)?
R us In Turn Around rime Requested?
Sufficlent Volume?
Correct Containers Used?
-Pace Containers Used?
Containers Intact?
Dissolved analysis; Samples Field Filtered?
Sample Labels Match COC?
-Includes
Matrix: S
Headspace in VOA Vials(>5-6mm)?
Trip elankPresent?
Trip glankCustody Seals Present? _
COMMENTSISAMPLE DISCREPANCY
CLIENT NOTIFICATION/RESOLUTION
Person contacted:
Yes ❑No El MIA 1.
Yes ❑No El MIA 2.
Yes -UNo ❑N/A 3.
Yes
ENo
❑MIA
4.
yes
❑MIA
S.
Yes
❑No
[]MIA
6.
Yes
❑No
❑N/A
Yes
[]No
❑NIA
7•
}Yes
❑No
NIA
8•
[Yes
❑No
11N/A
9.
❑Yes []NO
Date/Time:
ID ofsolit containers:
Field Data Required? ❑Yes ❑No
Project Manager SCURF Review; Date:
Project Manager SRF Revlew: Date:
Page 15 of 17

Occument Name: Document Revised: February 7, 2018
Sample Conditlon Upon Recelpt(SCUR) Page 1 of 2
Analytical' Document No.: Issuing Authority:
F-CAR-05.033•Rev.06 Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is
verified and within the acceptance range for preservation
samples.
Exceptions: VOA, Coliform fOC, Oil and Grease, ORO/8015 (water) DOC, LLHg
"Bottom half of box is to list number of bottle
Projer w# . 924131- 5/19
M. Due Date: Ol/1
;*Ij t A?
CLIENT' 92-CERT
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5ampie SD Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative Lot #
adjuslad added
Note; Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will to sent to the North Carolina OEHNIt Certification Office {i,e.
Out of hafd, incorrect preservative, out of temp, incorrect containers.
Page 16 of 17

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Page 17 of
17

APPENDIX C
Disposal Manifests -Tank and Liquid

NON -HAZARDOUS WASTE MANIFEST
Please print or type (Form designed for use on elite (12 Ditch) tvnewriter)
NON -HAZARDOUS ]]MXPA
ID No.
Manifest
Document No.
2. PageWASTE
MANIFEST
3. Generators me a d Mailing Address y
L� i!'v' S-Rc ►4`�
4. Genera1 s hone (' f
5. Transporter 1 Com an Name 6. US EPA ID Number
r
//�,y,/� r A
7Cal
C. � S plJ
A. State Transporters ID
B. Transporter 1 Phone
eIle I 1Y 1 t(C
7. Transporter 2 Company Name 8. US EPA ID Number
C. State Transporter's ID
D. Transporter 2 Phone
9. Designated Facility Name and Site Addres 10, US EPA ID Number
; I�ac�'�l11}VC
E. State Facility's ID
` I�
' V f_ Lo r o fti N t C t
F. Facility's Phone
)
11. WASTE DESCRIPTION
12. Containers
13.
14.
No.
Type
Total
Quantity
Unit
Wt.Nol.
a.
rue
G
b.
E
N
E
R
a.
A
T
O
R
d.
G. Additional Descriptions for Materials Listed Above
H. Handling Codes for Wastes Listed Above
15. Special Handling Instructions and Additional Information
Em
16. GENERATOR'S CERTIFICATION. 1 hereby certify that the contents of this shipment are fully and accurately described and are in all respects
in proper condition for transport. The materials described on this manifest are not subject to federal hazardous waste regulations.
Date
rinted/ryped Name }
Signature
Month
Day Year
T
R
17. Tra porter 1 Acknowledgement of Rkeipt of Materials
Date
A
N
"nted/Type Name
Sign re
Month
Day Year
P
1e
1
R
18. Transporte 2 Acknowledgement of Receipt of Materials
Date
T
E
Printed/Typed d Name
YPe
Signature
Month
Day Year
R
F
19. Discrepancy Indication Space
A
C
1
L
20. Facility Owner or Operator; Certification of receipt of the waste materials covered by this manifest, except as noted in item 19.
Date
T
Y
Printed/Typed Name
Signature
Month
Day Year
Copyright © 2006, ShipMate, Inc.®, All Rights Reserved [phone] www.shipmate.com

M
C
•EOR•T
CRROUNR ENVIRONMENTAL RESPONSE TERM
Emergency Response: 877-505-6799
PO Box 681016
Charlotte, NC 28216
Phone: [phone]
Fax: [phone]
www.cert-usa.com
CERTIFICATE OF DISPOSAL
Tank ID- WCSRN-1 Tank Size-1 ea.1,000 Gallon Fiberglass
Site location: Windstream Communications
1813 Sardis Road North
Charlotte, N. C. 28270
Date removed: 1/8/19
The tank was removed to: Carolina Environmental Response Team
5640 Daphne Drive
Charlotte, N. C. 28269
Disposal method: The tank was emptied, cleaned and crushed for
disposal.
Date: 1/11/19
This is to certify that the above tank was disposed of in accordance
with EPA and American Petroleum Institute regulations.
Certified by: Le&Sh nk

I.1 I 1 010111
'J
Health and Safety Plan and
North Carolina One Call Information

Sign -Off
All personnel have read the attached plan and are familiar with its provisions.
Name
Signature
AI
Larry Boone
Ryan Osborne
Steve Hamilton
Trudy Beverly
Lee Shank
�Ev-
10
e ve
MWW_V_Y\­d_hwL_fi.t"I_

SITE HEALTH AND SAFETY PLAN
IMPORTANT: Items marked with "1910.120...." are required by 29 CFR 1910.120 in the
paragraph noted.
A. General Information (1910.120) (c)(4)
Project Name:
Location:
Client:
Plan Prepared By:
Plan Approved By:
Project Start Date:
Windstream Communications, Inc.
Project Number:
1813 Sardis Road North -Charlotte, N. C.
Windstream Corporation
Little Rock, Ar.
Larry Boone
Date:l/6/19
1/8/19
B. Site Description (1910.120) (c)(4)
Facility History: There are no documented releases at this location.
General Site Description: Site is a telephone maintenance facility.
C. Project Objective(s) (1910.120) (b)(3)
Description of work activities planed:
An underground storage tank will be removed. Soil samples will be taken and the area backfilled.
Product and return lines from the former generator also will be removed and a soil sample taken
from below them.
D. Project Organization (1910.120) (b)(2)
Team Member
Responsibility
Training
Larry Boone, (Spectrum)
Coordination
OSHA 40 Hr. Hzw.
Steve Hamilton, (Spectrum)
Coordination
OSHA 40 Hr. Hzw.
Mw\docs\may\sitehealth&safetyplan

E. Chemical Hazard Analvsis (1910.120 (11)(4)
Hazard
PEUMV
PPm
IDLH
PPm
LEL
%
UEL
% o
Flash Point
OF
Routes of
Exposure
Diesel Fuel
(may contain
%
Ca (NIoSH)
N.D.
1.4
7.6
0
inh, abs, ing, con
Benzene
0-5
1
500
1.2
7.8
12
inh, abs, ing, con
M 1-benzene-
0-5
100
800
0.8
6.7
55
inh, ing, con
MTBE-
0-15
40 (ACGIH)
-
-
-
-
_
Toluene
1-15
200
500
1.1
7.1
40
inh, abs, ing, con
X lens
1-15
100
900
1.1
7
82
inh, abs, ing, con
1,2,4-Trimethlbebzene
0-5
25 NOSH)
N.D.
0.9
6.4
112
inh, ing, con
Site Control (1910.120) (d)
Work Zones have been established as shown on the attached site diagram.
Site Security: Security on site will be maintained by:
To Accompany "other" Temporary Barricades and/or warning tape.
Security fence.
24-Hour security guard.
Other: Access to be blocked by placement of vehicles.
H. Personal Protective Equipment (1910.120) (b)(4)
Based on Evaluation of potential hazards, the following levels of personal protection have
been designed for applicable work zones:
Work Zone Level of Protection Required Protective Equipment
Exclusive Zone Respirator: None
Filters/Cartridges: None
Boots: Steel toe boots
Inner Gloves: None
Outer Gloves:
Protective Coverall:
Hard Hat:
Eye Protection:
Other:
As Necessary
As Necessary
As Necessary
Safety glasses
None
MW\aocs\rnaY\sitebealth&saretyplan
2

Work Zone Level of Protection Required Protective Equipment
Contamination Respirator:
None
Reduction Zone Filters/Cartridges:
None
Boots:
Steel toe boots
Inner Gloves:
None
Outer Gloves:
As Necessary
Protective Coverall:
As Necessary
Hard Hat:
As Necessary
Eye Protection:
Safety glasses
Other:
None
I. Decontamination (1910.120) (k)
Please describe below the decontamination procedures for personnel
and equipment.
Personnel decontamination is accomplished by coverall and glove removal and disposal.
All contamination remaining can be washed off with soap and water.
Coveralls,
gloves, and used absorbent pads are to be collected in trash bags for proper
disposal.
Equipment Decontamination:
Gross Removal By: Physical Means
Decon Solution: Water -No decontamination planned.
Decontamination Liquid:
Collection Method: None present.
Disposal Firm:
I Ambient Air Monitoring (1910.120) (b)(4)
Not required.
K. Personnel Air Monitoring (1910.120) (b)(4)
Not required.
Activity/Location
Contaminan s
NIOSHIOSHA Protocol
A UST will be removed.
Diesel Fuel
See above
No air monitoring to be performed. Site is an exterior open area and cross winds are possible.
Mw\dm\nw\dteneann&a &etypIm

L. Contingency Plan (1910.120) (1)
Emergency Communication Signals: Hand waving over head to alert
Emergency Escape Routes: Site has good access, escape routes obvious
Emergency Equipment on Site: First Aid Kit, fire extinguishers
First Aid Kit: Larry Boone's truck.
Fire Extinguishers: On site
Telephone: Mobile: Steve Hamilton-704-309-4252
Boone-704-201-9358
Eye Wash/Safety Shower None
Other: None
M. Other Required Information
In order to comply with OSHA standards, the following documents should be maintained
on site:
1.) Material Safety Data Sheets for all chemicals brought onto site, or
expected to be encountered.
2.) Respirator fit test records for all employees who will be required to wear
respirators (1910.134).
MWom\may\mtd=th&sdf typlsn

Emergency Phone Numbers
Post in Full View
Chemtec------------------------------------------------------------------------------------- [phone]
Bureau of Explosives ---------------------------------------------------------------------- [phone]
Communicative Disease Center -------------------------------------------------- -------- [phone]
(Biological Agents)
National Response Center ----------------------------------------------------------------- [phone]
DOT Office of Hazardous Operations —------------------------------------------ ------- [phone]
Project Manager's Office (Larry Boone) ------------------------------------------------ [phone]
Local Emergency Numbers (to be determined at site): 911
Paramedics: 911
Fire Department: 911
Local Police: 911
Utilities: N. C. One Call- [phone], -Priority Locating Service- (704)
650-1191
Medical facility: Novant Health -Matthews Medical Center. Go to the right
out of the facility onto Sardis Road North, go 2/10 mile to Monroe Road and
go left for 1.3 miles to Matthews Township Parkway and go left for 9/10 mile.
The hospital is on the right, the emergency entrance is marked.
MwWmVn"WWheaWi&se4"Im

1/9/2019 Read Message - carolina.mcom
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From: North Carolina 811 <[e-mail]-
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Cc:
Subject: NCOC EMLCFM 2019/01/09 #05219 C183532689-OOC SHIRT RESP LR
Priority: Normal Date: Wednesday, January 9, 2019 1:03 PM Size: 6 KB
EMLCFM 05219 NCOCc 01/09/19 13:03:23 C183532689-OOC SHIRT RESP GRID LR
Thank you for calling North Carolina 8111
This is an automatically generated response from the utilities
who received your notice of excavation. For your safety,
please respect and protect the marks, and excavate carefully
around the marked utility lines.
This email comes from an automated program that is NOT MONITORED.
DO NOT REPLY BACK TO THIS EMAIL.
Ticket : C183532689 Rev: BBC Taken: 12/19/18 03:51 PM
State: NC Cnty: MECKLENBURG Place: CHARLOTTE
Subdivision: THE COLONNADE BUSINESS PARK
Address : 1813 SARDIS RD N
Work date: 12/27/18 09:00 AM
Good thru: 01/15/19 11:59 PM Update by: 01/10/19 11:59 PM
Member Description Response
Code
ALT02* WINDSTREAM COMMUNICATIONS, INC.
WINDSTREAM PHONE [phone]:S3 AM 10
No conflict, utility is outside of stated work area
CDT01 CITY OF CHARLOTTE DEPT OF TRANSPORTATION
TRAFFIC AND FIBER OPTICS 12/21/18 07:20 PM 10
No conflict, utility is outside of stated work area
CHAel CITY OF CHARLOTTE
WATER AND SEWER 12/19/18 05:00 PM 10
No conflict, utility is outside of stated work area
CHA02* CITY OF CHARLOTTE
STORM WATER SERVICES 12/20/18 06:38 AM 10
No conflict, utility is outside of stated work area
DPC1L* DUKE ENERGY
POWER 12/26/18 12:56 PM 20
Marked
LEV01 CENTURYLINK
FIBER OPTIC 12/26/18 12:56 PM 10
No conflict, utility is outside of stated work area
MCI01 MCI
FIBER OPTIC 12/19/18 04:18 PM 10
No conflict, utility is outside of stated work area
PAL01* SPIRIT COMMUNICATIONS
FIBER OPTIC 12/21/18 06:08 PM 10
No conflict, utility is outside of stated work area
PNG02* PIEDMONT NATURAL GAS COMPANY
GAS 01/09/19 01:03 PM 10
No conflict, utility is outside of stated work area
TWCO2* TIME WARNER CABLE -CHARTER
CABLE TV 12/26/18 12:56 PM 10
No conflict, utility is outside of stated work area
Member
Type
Contact
Phone
ALT02*
Field
DISPATCH
800-289-1901
Damage
DAMAGE PREVENTION (6AM - 7PM)
800-289-2901
Damage
ECSC - AFTER 7 PM
800-289-1901
CDT01
Field
STEVE PHIFER
704-336-3919
Damage
PERSONNEL
704-336-7600
CHA01
Field
1 - DON CANIPE
704-400-9278
Field
2 - SHUHURAH LEE (8AM-5PM)
704-336-6794
Field
3 - AFTER HOURS & WEEKENDS
704-378-6632
Damage
SHUHURAH LEE
704-361-8755
CHA02*
Field
BRIAN MERRITT
704-996-3594
Damage
CORKY BOTKIN
704-432-5536
<< Prev I Next >>
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1/2

APPENDIX E
City of Charlotte Fire Department Tank Removal Permit

CHARLOTTE FIRE DEPARTMENT
FIRE PREVENTION BUREAU
Tank Removal and Safeguarding Permit Application
Applicant
T his is the company name and mailing address oJ the tank removal company. �7�
Name �fRGi.li�ij=} �`hlvi►�C/v/1'�CIti IvS� 2 fl% t
Address: '((� 11A �11. Je OVA , fire- City/State:(J1 oA( 0 4 )v Zip Code���
Phone Number: (� �/`� } O� 6 7 7 Cell Number: (76V go
Location and Type of: Project
This is thef
acilit
y name and {address o the tank remoJva�l , ro'ect. I vacant roe indicate "Vacant" or acility name.
Facility Name: Wi 1�1 _s4Aeyrm (?0MA1t�'�/�tt h d,,dress: 813 S d► S �OA ,l! %VO
Type of Project: �_ Tank Removal TankAbandonmentBoth A/G: B/G:
Tank Information
If more than 4 tanks, complete a separate sheet.
Tank 1) Produc"Dese� FUCK 1 Size:5-,,,, 19 �^ Tank2) Product: Size:
Tank 3) Product: Size: Tank 4) Product: Size:
Tanks Transported T �
t_s is !} �v3I�-in ,4l)� t3eRg%ss —no?* w.')l & ClR,drd
.Responsible Applicant
Name: rJ Title: ,�Z� p w-5OR - L"! Signature- ' C%a`Q. Date: / / %p
I certify that the info anon provided and contained herein is true and accurate to the best of my knowledge. The issuance of a
permit shall not be deemed as approval to violate any provisions of the North Carolina State Fire Code. The code official has the
right to inspect the site to ensure compliance with provisions of the fire code, and to issue a Stop Work Order for unsafe practices.
NU YE! A site plan of the job site shall be submitted with this application
Return the completed and signed application, site plan, and check to:
Charlotte Fire Department — Fire Prevention Bureau
500 Dalton Avenue
Charlotte, North Carolina 28206
Phone:[phone] Facsimile:704-632-8451
Check Enclosed Payable to "The City of Charlotte"
If you wish to pay by credit card, contact the Fire Prevention Bureau Office to provide necessary information.
Permit Code: 16 Fee: $ 0� 3 Permit No.
Check No. Issue Date:
Issued by Inspector: Emp. #:
Information Collected By:
Entry Date: / l Entered By:

APPENDIX F
Photos of the Activities

iM
�'��. ..
� �.
- M � �'.::
� x�
_ r
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r 2�:.
- +�.
a Y.1

Windstream Communications
Sardis Road North -Charlotte, N. C.
The 1,000 gallon fiberglass tank
uncovered.
Windstream Communications
Sardis Road North -Charlotte, N. C.
The 1,000 gallon fiberglass tank
model number and size.

MAI
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