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HomeMy WebLinkAboutMO-9473_40915_CA_UST-61_20190418UST-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) Yes Facility ID Number Incident # Risk (H,I,L,U) Confirmed GW Contamination? (Y/N) NO Date Leak Discovered March 29, 2019 Received On Received By Confirmed Soil Contamination ?(Y/N) Yes Comm/Non-Commercial? NON Reported by (circle one): Phone, Fax or Report Samples Taken?(Y/N) Yes - Lab Data Attached Reg/Non-regulated? NON Region Free Product? (Y/N) If Yes, State Greatest Thickness INCIDENT DESCRIPTION Incident Name: 7609 Linda Lake Drive Address: 7609 Linda Lake Drive County: Mecklenburg City/Town: Charlotte Zip Code: 28215 Regional Office (circle one): Asheville Mooresville, ayetteviIle, Raleigh, Washington, Wilmington, Wins on- a em Latitude (decimal degrees): 35.245964 Longitude (decimal degrees) : 80.733156 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 Earth ❑unknown Describe location: One soil sample collected on March 29, 2019 as part of real estate due diligence indicated TPH GRO concentrations of 45.2 mg/kg and DRO concentrations of 3,770 mg/kg. UST system was not in use at the time of discovery. No known sensitive receptors are believed to be impacted. UST remains in place. Single-family residential neighborhood. 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 x]Property Transfer ❑Water Supply Well Contamination ❑Other (specify) SOURCE OF CONTAMINATION Source of Release Cause of Release Type of Release Product Type Released (Check primary source) (Check primary cause) (Check one) (Check primary product type released) ❑X Tank ❑ Spill X❑ Petroleum ❑ Gasoline/ Diesel/ ❑ Diesel/Veg. Oil ❑ Piping ❑ Overfill ❑ Non -Petroleum Kerosene Blend ❑X ❑ ❑ Dispenser ❑X Corrosion (Suspected) ❑Both Heating Oil Vegetable Oil 100% ❑ Other Petroleum ❑ E10 - E20 ❑ Submersible Turbine Pump ❑Physical/Mechanical Location Products ❑ (Check one) Metals Delivery Problem Damage ❑ E21 - E84 ❑ ❑ Install Problem ❑ E85 - E99 ❑ Spill Bucket ❑ Other Inorganics ❑ Other [-]Facility ❑Ethanol 100% ❑ Other ❑ Other Organics ❑ Unknown ❑X Residence ❑ E01 - E09 ❑ Unknown ❑Other Definitions presented on reverse Definitions presented on reverse Ownership 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 UST Form 61 (02/19) Page 1 of 2 IMPACT ON DRINKING WATER SUPPLIES Water Supply Wells Affected? 1. Yes 2. No 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 UST Operator/Company Address Unknown City State Zip Code Telephone Number LANDOWNER AT LOCATION OF UST INCIDENT Landowner Lifespan Inc. Address 1511 Shopton Road, Suite A City Charlotte State NC Zip Code 28217 Telephone Number (704) 944-5100 Draw Sketch of Area (showing two major road intersections) or Attach Map Map Attached _77Person Reporting Incident Greg D. Icenhour Company Mid -Atlantic Associates, Inc. Telephone Number (980) 585-1271 Title Principal Geologist Address 1125 E. Morehead Street, Ste. 104, Charlotte, NC 28204 Date April 18, 2019 UST Form 61 (02/19) Page 2 of 2 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 LO 0\so VP qO .O 0 7609 Linda Lake Drive 0 40 ds � J Date Printed: 4/18/2019 9:04:38 AM 0 0.005)'01 0.02 Miles E This map or report is prepared for the inventory of real property within Mecklenburg County and is compiled from recorded deeds, plats, tax maps, surveys, planimetric maps, and other public records and data. Users of this map or report are hereby notified that the aforementioned public primary information sources should be consulted for verification. Mecklenburg County and its mapping contractors assume no legal responsibility for the information contained herein. aceAnalytical —pacelabs.com Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 April 05, 2019 Lee Shank Carolina Environmental Respons 5648 Daphne Drive Charlotte, NC 28269 RE: Project: 7609 Linda Lake Dr Pace Project No.: 92423343 Dear Lee Shank: Enclosed are the analytical results for sample(s) received by the laboratory on March 29, 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 amanda.payne@pacelabs.com (704)875-9092 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 14 aceAnalytical j—pacelabs.com I Project: 7609 Linda Lake Dr Pace Project No.: 92423343 Charlotte Certification IDs Pace Analytical Services, LLC 9800 KinceyAve. Suite 100 Huntersville, NC 28078 (704)875-9092 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 Louisiana/NELAP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 CERTIFICATIONS South Carolina Certification #: 99006001 Florida/NELAP Certification #: E87627 Kentucky UST Certification #: 84 Virginia/VELAP Certification #: 460221 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 14 aceAnalytical —pacelabs.com i SAMPLE ANALYTE COUNT Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Pace Project No.: 7609 Linda Lake Dr 92423343 Analytes Lab ID Sample ID Method Analysts Reported Laboratory 92423343001 Tank #1 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 14 aceAnalytical —pacelabs.com i Project: 7609 Linda Lake Dr Pace Project No.: 92423343 Lab Sample ID Method 92423343001 EPA 8015C Modified EPA 8015C Modified ASTM D2974-87 SUMMARY OF DETECTION Client Sample ID Parameters Tank #1 Diesel Range Organics(C10-C28) Gas Range Organics (C6-C10) Percent Moisture Result Units 3770 mg/kg 45.2 mg/kg 24.8 % REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Report Limit Analyzed 66.3 04/04/1915:42 7.1 03/31 /19 19:06 0.10 03/29/1916:22 Qualifiers Page 4 of 14 aceAnalytical —pacelabs.com i PROJECT NARRATIVE Project: 7609 Linda Lake Dr Pace Project No.: 92423343 Method: EPA 8015C Modified Description: 8015 GCS THC-Diesel Client: Carolina Environmental Response Team Date: April 05, 2019 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 General Information: 1 sample was 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. QC Batch: 466960 S4: Surrogate recovery not evaluated against control limits due to sample dilution. • Tank #1 (Lab ID: 92423343001) • n-Pentacosane (S) 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: REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, without the written consent of Pace Analytical Services, LLC. Page 5 of 14 aceAnalytical —pacelabs.com i PROJECT NARRATIVE Project: 7609 Linda Lake Dr Pace Project No.: 92423343 Method: EPA 8015C Modified Description: Gasoline Range Organics Client: Carolina Environmental Response Team Date: April 05, 2019 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 General Information: 1 sample was 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. QC Batch: 466516 S5: Surrogate recovery outside control limits due to matrix interferences (not confirmed by re -analysis). • Tank #1 (Lab ID: 92423343001) • 4-Bromofluorobenzene (S) 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 14 aceAnalytical —pacelabs.com i ANALYTICAL RESULTS Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: 7609 Linda Lake Dr Pace Project No.: 92423343 Sample: Tank #1 Lab ID: 92423343001 Collected: 03/29/19 13:10 Received: 03/29/19 14:05 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) 3770 mg/kg 66.3 10 04/03/19 15:53 04/04/19 15:42 Surrogates n-Pentacosane (S) 0 % 33-129 10 04/03/19 15:53 04/04/19 15:42 629-99-2 S4 Gasoline Range Organics Analytical Method: EPA 8015C Modified Preparation Method: EPA 5030B Gas Range Organics (C6-C10) 45.2 mg/kg 7.1 1 03/31/19 14:46 03/31/19 19:06 Surrogates 4-Bromofluorobenzene (S) 161 % 63-130 1 03/31/19 14:46 03/31/19 19:06 460-00-4 S5 Percent Moisture Analytical Method: ASTM D2974-87 Percent Moisture 24.8 % 0.10 1 03/29/19 16:22 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 04/05/2019 12:46 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 14 aceAnalytical —pacelabs.com i QUALITY CONTROL DATA Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: 7609 Linda Lake Dr Pace Project No.: 92423343 QC Batch: 466516 Analysis Method: EPA 8015C Modified QC Batch Method: EPA 5030E Analysis Description: Gasoline Range Organics Associated Lab Samples: 92423343001 METHOD BLANK: 2535606 Matrix: Solid Associated Lab Samples: 92423343001 Blank Reporting Parameter Units Result Limit Analyzed Qualifiers Gas Range Organics (C6-C10) mg/kg ND 6.0 03/31/19 13:20 4-Bromofluorobenzene (S) % 93 63-130 03/31/19 13:20 LABORATORY CONTROL SAMPLE: 2535607 Spike LCS LCS % Rec Parameter Units Conc. Result % Rec Limits Qualifiers Gas Range Organics (C6-C10) mg/kg 50.4 51.6 102 70-130 4-Bromofluorobenzene (S) % 117 63-130 MATRIX SPIKE SAMPLE: 2535609 92423362004 Spike MS MS % Rec Parameter Units Result Conc. Result % Rec Limits Qualifiers Gas Range Organics (C6-C10) mg/kg ND 58.9 73.0 114 40-155 4-Bromofluorobenzene (S) % 123 63-130 SAMPLE DUPLICATE: 2535608 92423362001 Dup Parameter Units Result Result RPD Qualifiers Gas Range Organics (C6-C10) mg/kg 10.9 13.8 24 4-Bromofluorobenzene (S) % 110 129 16 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: 04/05/2019 12:46 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 14 aceAnalytical —pacelabs.com i QUALITY CONTROL DATA Project: 7609 Linda Lake Dr Pace Project No.: 92423343 QC Batch: 466960 Analysis Method: EPA 8015C Modified QC Batch Method: EPA 3546 Analysis Description: 8015 Solid GCSV Associated Lab Samples: 92423343001 METHOD BLANK: 2537732 Matrix: Solid Associated Lab Samples: 92423343001 Blank Reporting Parameter Units Result Limit Analyzed Diesel Range Organics(C10-C28) mg/kg ND 5.0 04/03/19 12:50 n-Pentacosane(S) % 74 33-129 04/03/1912:50 LABORATORY CONTROL SAMPLE: 2537733 Parameter Units Diesel Range Organics(C10-C28) mg/kg n-Pentacosane(S) % MATRIX SPIKE SAMPLE: 2537734 Parameter Units Diesel Range Organics(C10-C28) mg/kg n-Pentacosane(S) % SAMPLE DUPLICATE: 2537735 Parameter Diesel Range Organics(C10-C28) n-Pentacosane(S) Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Qualifiers Spike LCS LCS % Rec Conc. Result % Rec Limits Qualifiers 67.1 61.8 92 43-130 79 33-129 92423331003 Spike MS Result Conc. Result ND 98.6 88.8 92423331004 Dup Units Result Result mg/kg ND ND % 67 66 MS % Rec % Rec Limits Qualifiers 90 10-130 80 33-129 RPD Qualifiers N 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: 04/05/2019 12:46 PM without the written consent of Pace Analytical Services, LLC. Page 9 of 14 aceAnalytical —pacelabs.com i QUALITY CONTROL DATA Project: 7609 Linda Lake Dr Pace Project No.: 92423343 QC Batch: 466378 Analysis Method: ASTM D2974-87 QC Batch Method: ASTM D2974-87 Analysis Description: Dry Weight/Percent Moisture Associated Lab Samples: 92423343001 SAMPLE DUPLICATE: 2535004 92423163001 Dup Parameter Units Result Result RPD Qualifiers Percent Moisture % 11.9 14.0 16 SAMPLE DUPLICATE: 2535005 92423197001 Dup Parameter Units Result Result RPD Qualifiers Percent Moisture % 81.1 82.8 2 Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 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: 04/05/2019 12:46 PM without the written consent of Pace Analytical Services, LLC. Page 10 of 14 aceAnalytical —pacelabs.com i QUALIFIERS Project: 7609 Linda Lake Dr Pace Project No.: 92423343 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 (704)875-9092 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 S4 Surrogate recovery not evaluated against control limits due to sample dilution. S5 Surrogate recovery outside control limits due to matrix interferences (not confirmed by re -analysis). REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 04/05/2019 12:46 PM without the written consent of Pace Analytical Services, LLC. Page 11 of 14 aceAnalytical —pacelabs.com i QUALITY CONTROL DATA CROSS REFERENCE TABLE Pace Analytical Services, LLC 9800 Kincey Ave. Suite 100 Huntersville, NC 28078 (704)875-9092 Project: Pace Project No.: 7609 Linda Lake Dr 92423343 Analytical Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch 92423343001 Tank #1 EPA 3546 466960 EPA 8015C Modified 467087 92423343001 Tank #1 EPA 5030B 466516 EPA 8015C Modified 466519 92423343001 Tank #1 ASTM D2974-87 466378 REPORT OF LABORATORY ANALYSIS This report shall not be reproduced, except in full, Date: 04/05/2019 12:46 PM without the written consent of Pace Analytical Services, LLC. Page 12 of 14 m S o m c 3 3 0 0 3 s o y o ro m a D a n ° C n_ ° n C Off v 3 3 o o C �• xbQa 4 �' v rp ` D 'n' f m '� m o _ q ra 3 A y /�• N T m rn+ X [ P a �f Q 5N J ° ID Q Er rD a cr rp a H� m ID 3 -J -4 V1 m 3 On Yna m m ° o < a rb EY 3 f 3 L3 in — Er C N C * C 'i`F.. O p J l v 4 c N cC ° N m p .�•. ° rD `e u N 3 , d n ` f Q f CL m n �-. 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A m r„� a rC rC v 3 ti 3 rq ma m nranermr+an n R 3 ID w w w fD ET rt rt ro r- 0. fp N C w rli G Id m rt 7w•rn u� rtrt h r 3 zm �n�D °�3 3 CD ' �3 m b`Qin� �m O n rp. m 3-0 rp -° rnDw� IDm n H w iD 'U a n CC' fD V� @ m N m n 3p6a v.. m w H m tiN M �n n K fb z'I m 4 v (D rt- N. rt rt M ry ro ° o oq zzp0zzz z _ zz zzzzzzz n n n Page 13 of 1 Document Name: Sample Condition Upon Recei Document No.: F-CAR-05-033-Rev.06 Document Revised: February 7, 2018 Page 1 of 2 Issuing Authority: 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,TOC, Oil and Grease, DRO/8015 (water) DOC, LLHg **Bottom half of box is to list number of bottle Project # rWo# ; g2423343 PM: AP Due Date: 04/05/19 CLIENT: 92—CERT # a u, a)�i Z C a E N 7 a m ' a a E N 7 d m m 2 a E 6n 7 a 0 n m 2. v CN � `w rl 7 i m v S m a E N i%1 a m v c p y a E N z ii m o m Q V m a E , 4 N a Co n o b a E N %J a m c C ro �0. o a Y'. 3 a z Z C a E Q `v ri w l7 a ry a _ E Q `m ri .=-1 0 a V w n E a J' o N M t9 a N v S0. O a E ¢ m n .�I to a N = a O V E ¢ J E N en !� a U Z -0 ¢ N zM 8 M t7 a ZO U 4 0 7 E q 01 [9 n Q 0 7 E Q t7 > C c ¢ o } E q 01 47 > 'C m ¢ O > E q 0, 0 a ma m` a v d 0 > N a � a R � N y E rN-1 a of ni J E Lnf�Y a N l� I r 1� 1J r. N m J E a m an `m E J E a a z N � '2 c V1 E N z ? Z dn C2 E Q E Q o 2 3 4 5 b 7 8 9 10 11 12 pH Adjustment Log for Preserved Samples Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation adjusted Amount of Preservative added tot k Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certiftcation Office [I,e. Out of hold, incorrect preservative, out of temp, incorrect containers. Page 14 of 14 Beverly, Trudy From: Beverly, Trudy Sent: Monday, April 22, 2019 12:54 PM To: Black, Sherry Subject: RE: [External] FW: UST-61 Form-7609 Linda Lake Drive, Charlotte, NC 28215 Thank you! Trudy DE NnRTH CARC7l.INA i Department of Environmental Duality Tle i*, Lam. Mzw Aem4pMM Nor& Cmiln Dqwhrmut dE OT kown, Xoml1tk offin (7235,2182 (O ahr 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: h!Ws:Hdeq.nc.,gov/about/divisions/waste-management/ust Branch's Above Ground Storage Tanks Website Address: hllps:Hdeq.nc.gov/about/divisions/waste-management/ust/ast- program INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES: https://deq.nc.gov/about/divisions/waste-management/waste-management-rules-data/waste-mane eg ment- ig s 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): hltps:Hedocs.deq.nc.aov/WasteManagement/Search.asp Document Submittal & UST File Names for Laserfiche Policies: httDs:Hfiles.nc. izov/ncdea/Waste%2OManaizement/DWM/UST/Corrective%2OAction/Electronic%2ODocument%2OSubmittal %20Memo%20Update.pdf httt)s://files.nc. eov/ncdea/Waste%2OManaeement/DWMIUST/Corrective%2OAction/UST%20file%20names%20for%2OLas erfiche.docx From: Black, Sherry Sent: Monday, April 22, 2019 12:47 PM To: Beverly, Trudy <trudy.beverly@ncdenr.gov> Subject: FW: [External] FW: UST-61 Form-7609 Linda Lake Drive, Charlotte, NC 28215 Importance: High Trudy I printed and dated stamp this ... It's in your box. Have a good day! See you tomorrow, Sherry Sherry Black Office Assistant IV Mooresville Regional Office Division of Environmental Assistance and Customer Service Department of Environmental Quality 704 235 2112 Office 704 663 6040 FAX sherry.black@ncdenr.gov 610 East Center Avenue, Suite 301 Mooresville, North Carolina 28115 Copies of archived documents are available at: http://edocs.deg.nc.gov/WasteManagement/Search.aspx?cr-1 Check out What's New at http://deq.nc.gov/about/divisions/waste-management/underground-storage-tanks- for our current guidelines. Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties. From: Greg Icenhour <Glcenhour@maaonline.com> Sent: Monday, April 22, 2019 11:23 AM To: Black, Sherry <sherry.black@ncdenr.gov> Subject: [External] FW: UST-61 Form-7609 Linda Lake Drive, Charlotte, NC 28215 Importance: High External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to 2 Sherry — here is the form I sent to Ron. I mistakenly mistyped your e-mail address in the first attempt. With best regards, MidAtlanticc Greg D. Icenhour, P.G., MBA Vice President/Charlotte Branch Manager MID -ATLANTIC ASSOCIATES, INC. 1125 E. Morehead Street, Suite 104 Charlotte, NC 28204-2849 (980) 585-1271— Phone (980) 585-1272 — Fax (704) 604-5201— Mobile Corporate Office: 409 Rogers View Court Raleigh, NC 27610 Office: (919) 250-9918 Facsimile: (919) 250-9950 Outstanding service since 1993 http://www.maaonline.com Confidentiality Notice: The information contained in this e-mail is intended only for the individual or entity to whom it is addressed. Its contents (including any attachments) may contain confidential and/or privileged information. If you are not an intended recipient you must not use, disclose, disseminate, copy or print its contents. If you receive this e-mail in error, please notify the sender by reply e-mail and delete and destroy the message. From: Greg Icenhour Sent: Monday, April 22, 2019 11:21 AM To:'ron.taraban@ncdenr.gov' <ron.taraban@ncdenr.gov> Cc: 'sherry.bIack@ncdeq.gov' <sherry.black@ncden.gov> Subject: UST-61 Form-7609 Linda Lake Drive, Charlotte, NC 28215 Importance: High Ron — I was contacted late last week by the real estate broker for this property. After speaking with the owner, a non-profit organization, I advised them to submit the attached as required. They have asked me to do so on their behalf. Once this is routed to one of your PM's could you please advise me so I can make sure this is handled appropriately? They owner would like to sell the property, so I imagine that a UST closure is the next step. If there are any specific requirements beyond those in the Guidance, please so advise. Thanks for the assistance. With best regards, Mid Atlantic Engimaonng R EmixonmbsiAl Sulu c-.. Greg D. Icenhour, P.G., MBA Vice President/Charlotte Branch Manager MID -ATLANTIC ASSOCIATES, INC. 1125 E. Morehead Street, Suite 104 Charlotte, NC 28204-2849 (980) 585-1271— Phone (980) 585-1272 — Fax (704) 604-5201— Mobile Corporate Office: 409 Rogers View Court Raleigh, NC 27610 Office: (919) 250-9918 Facsimile: (919) 250-9950 Outstanding service since 1993 http://www.maaonline.com Confidentiality Notice: The information contained in this e-mail is intended only for the individual or entity to whom it is addressed. Its contents (including any attachments) may contain confidential and/or privileged information. If you are not an intended recipient you must not use, disclose, disseminate, copy or print its contents. If you receive this e-mail in error, please notify the sender by reply e-mail and delete and destroy the message.