MO-7444_36096_CA_SCH_20190903_Diesel Pump #20 Site Check Report

A L
AV C
X4T
ENVIRONMENTAL - AEOTECHNICAi
BUILURNG SCIENCES • MATERIALS TESTING
September 3, 2019
Mr. Jack Stutts, UST Inspector
North Carolina Department of Environmental Quality
Division of Waste Management — UST Section
1646 Mail Service Center
Raleigh, North Carolina 27699-1646
Ms. Trudy Beverly, L.G.
North Carolina Department of Environmental Quality
Division of Waste Management — UST Section
Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Re: Site Check Report
Pilot Travel Centers 056
2825 Lane Street
Kannapolis, Cabarrus County, North Carolina
NCDEQ Facility ID #00-0-0000011084
609A Piner Road., Suite 115
Wilmington, North Carolina 28409
Telephone [phone]
Fax [phone]
www.atcgroupservices.com
Dear Mr. Stutts and Ms. Beverly:
ATC Associates of North Carolina, LLC (ATC), on behalf of Pilot Travel Centers, LLC, is submitting this Site
Check Report for the referenced facility.
If you have any questions or require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, LLC
qylljx�
Maureen Jackson, P.G.
Senior Project Manager
cc: Pilot Travel Centers, LLC
/A-FWL�
Max Burmeister
Program Manager

SITE CHECK REPORT
PILOT TRAVEL CENTERS 056
2825 Lane Street
Kannapolis, Cabarrus County, North Carolina
NCDEQ Facility ID #00-0-0000011084

Pilot Travel Centers 056
NCDEO Facility ID 9004MMI 1094
September 3. 2019
Site Check Remit
Site Check Report
A. Site Information
1. Site Identification
Daze of Report: OS120119
Facility ID #: 00-0-0000011084 UST Incident N 36096(Oneoina Remndistion)
Site Name: Pilot Travel Centers 056
Site Street Address: 2825 lane Street
City/Town: Kannaoolis Zip Code: 28081 County: Call —
Description of Geographical Data Point: C-store Building
Location Method: Gooale Earth
Latitude: 35029'53.20" N Longitude 80033'39.54"
Information About Contacts
UST Owner and Operator. Pilot Travel Comm LLC
Address: 5508 Lonas Road Knoxville, Tennessee 37909 Tel: [phone]
Property Owner: Pilot Travel CentersLLC
Address: 5508 Lonas Road Knoxville, Tennessee 37909
Property Occupant Pilot Travel Centers 056
Address: 2825 Lane Street Known lis. North Carolina 28081
ConsulnndConmactor. ATC Associates of North Carolina, P.C.
Address: 609A Piner Road. Suite 115 Wilminmon. North Carolina 28409 Tel: [phone]
Analytical Laboratory: Pace Analytical Cen h: 375
Address: 12065 Lebanon Road Mt. Juliet. Tennessee 37122 Tel: [phone]
3. Information About Release
Date Discovered: August 20. 2019
Estimated Quantity of Release: Unknown
Cause of Release: Fuel wcep under diesel dispenser N20
Some of Release: Diesel Dispenser 420
Sim and Contents of UST System: See Table 2
Complete and Include In reW*JFJF M*1)� q`gh H in the order listed.
1. Maureen A. Jackson of pri e . Geologist ircle one) fur ATC Associates of
North Carolina. P.C. do is report is correct and accurate to the
best of my knowledge. ' ��•„ -_
(Please Affix Seal and Si ULO�
FN .:^ (:ns
A. 3:
A01
TC Associates of North Carolina. pi"ol) licensedu)prectic eolugylengineerin 2ireleoneorland)in
North Carolina The certification number of the company or corpora
ATC Associates of Noah Camellia

Pilot Travel Centers 056
NCDEQ Facility ID #00-0-0000011084
B. Site History
1. Provide UST Owner and Operator Information
See Table 1.
2. Provide UST Information
See Table 2.
3. Provide Non -UST Information
September 3, 2019
Site Check Report
In a review of the North Carolina Department of Environmental Quality (NCDEQ), it was
learned that a surface spill occurred at the property on February 8, 2012 due to a third party
truck releasing approximately 75 gallons of diesel fuel in the parking lot due to a damaged fuel
tank. The release was contained to the parking lot/asphalt and cleaned up by emergency
response contractors. A 24-Hour Release Form was submitted to NCDEQ and the incident was
issued AST Incident #91187. No further activities were required by NCDEQ.
4. Describe relation of location of current UST system to historical UST releases.
The referenced facility has reportedly been a retail fuel outlet since at least 1984. From 1966 to
1972, the site was owned and operated by Humble Oil Company. In 1972, retail fuel operations
and property ownership was transferred to Exxon Corporation due to a name change. In 1984,
the property was the site of a Starvin Marvin and at some point in time; Speedway America
took over operations until October 26, 2001 when Pilot Travel Centers, LLC purchased the
property.
During May 1994, underground storage tank (UST) closure activities were conducted in which
seven USTs were removed from the property. It was also noted at that time that two
12,000-gallon USTs were removed from service in 1991. A release was noted during these
activities and UST incident #6379 was assigned. Following active remediation activities in
1998, the incident was closed by NCDEQ.
In April 2006, prior to well abandonment activities for wells associated with UST incident
#6379, free product (gasoline) was gauged in two on -site monitoring wells. The source of free
product was determined to be a leaking product line. NCDEQ considered the presence of free
product to be an indication of a new release and UST incident #36096 was assigned.
Since 2006, several phases of assessment have been performed. The site was ranked "high
risk" due to the presence of water supply wells within 1,000 feet of the source area. An active
remediation system (air sparge/soil vapor extraction (AS/SVE)) was placed into operation at the
site on April 18, 2012 and is currently active.
ATC Associates of North Carolina

Pilot Travel Centers 056
NCDEQ Facility ID #00-0-0000011084
5. Provide a Brief Description of Site Characteristics
September 3, 2019
Site Check Report
The subject property consists of one convenience store building and petroleum fueling
equipment. The subject property and surrounding area are fairly level. The subject property is
located in a commercial, residential, and industrial area. Public water is supplied to the
property and area; however, water supply wells are present within 1,000 feet of the property as
reported by others in reports on file at the NCDEQ Mooresville Regional Office. A
topographic map and site map are attached as Figures I and 2, respectively.
C. Site Check Procedures
1. UST System Testing
On June 5, 2019, during a NCDEQ UST compliance inspection, liquid was noted in the
contaminant sump under diesel dispenser #20. On June 5, 2019, a Notice of Violation (NOV)
was issued to Pilot Travel Centers (Pilot) for these noted conditions. A UST-17B UST
Suspected Release 7-Day Notice was submitted. On June 14, 2019, SPATCO personnel
repaired a loose entry boot. Following the repair, the containment sump was hydrostatically
tested and passed. A UST-6D/23A Triennial UST Spill Bucket Integrity Testing form was
submitted to NCDEQ on June 14, 2019. On August 20, 2019, upon receipt of the laboratory
analytical results, ATC personnel submitted a UST-61 24-Hour Release and UST Leak
Reporting Form to NCDEQ.
Copies of the referenced notifications are provided in Attachment I.
2. Site Check Procedure
On August 9, 2019, ATC personnel contracted with Dewberry to air knife a soil boring adjacent
to diesel dispenser #20. The soil boring for SB-1 was air knifed to 5 feet below ground surface
(bgs). Groundwater was not encountered in the soil boring. ATC personnel collected a soil
sample at the termination depth for laboratory analysis. The location of the soil sample is
provided on Figure 2.
3. Soil Excavation Activities
Soil excavation was not performed as part of this site check.
D. Site Investigation
1. Field Screening
Soil sample SB-1 was screened with a photoionization detector (PID). The respective PID
reading is provided on Table 3.
2. Soil Sampling Information
Soil sample SB-1 was collected at an approximate depth of 5 feet bgs. The soil encountered at
the respective sampling depth was noted to be gray to green sandy silt with a strong petroleum
odor. Groundwater was not encountered during site check activities.
The soil sample was shipped to a N.C. certified laboratory in a chilled cooler following proper
chain -of -custody procedures. Soil sample SB-1 was requested to be analyzed by Total
ATC Associates of North Carolina

Pilot Travel Centers 056
NCDEQ Facility ID #00-0-0000011084
September 3, 2019
Site Check Report
Petroleum Hydrocarbons (TPH) — Gasoline Range Organics and TPH — Diesel Range Organics
(TPH-DRO).
3. Groundwater and Surface Sampling Information
Groundwater samples and surface water samples were not collected.
4. Quality Control Measures
The soil sample was placed in laboratory provided jars and vials. The sample was immediately
placed on ice and contained in a cooler during transportation. The sample was then transported
by courier under a chain -of -custody to the laboratory for analysis.
5. Investigation Results
Laboratory analytical results of the soil sample detected a TPH-DRO concentration above its
established State Action Level. The results are shown in Table 3. A copy of the laboratory
report and chain -of -custody documents are provided in Attachment IT
E. Conclusion and Recommendations
Laboratory analytical results of the soil sample detected a TPH-DRO concentration above its
established State Action Level. Based on the soil analytical data, it appears a release of
petroleum has occurred from diesel dispenser #20.
F. Figures
Figure 1 — Topographic Map
Figure 2 — Site Map
G. Tables
Table 1 — UST Owner and Operator Information
Table 2 — UST/AST System Information
Table 3 — Soil Analytical Results
H. Attachments
I — Notifications and Testing Results
II — Soil Laboratory Report and Chain -of -Custody Documents
ATC Associates of North Carolina

FIGURES

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TABLES

TABLE I
UST OWNER AND OPERATOR INFORMATION
PILOT TRAVEL CENTERS 056
2825 LANE STREET
KANNAPOLIS, CABARRUS COUNTY, NORTH CAROLINA
Revision Date: 8/20/2019 Incident Number and Name: Pilot Travel Centers 056
UST ID Number
All
Facility ID Number 00-0-0000011084
Name of Owner
Dates of Operation (MM/DD/YY to MM/DD/YY)
Pilot Travel Centers, LLC
2001 to Present
Street Address
5508 Lonas Road
City
I State
Zip
ITelephone Number
Knoxville
ITN
37909
865-474-3106
Name of Operator
Dates of Operation (MM/DD/YY to MM/DD/YY)
As Above
Street Address
City
I State
Izip
ITelephone Number

TABLE 2
UST/AST SYSTEM INFORMATION
PILOT TRAVEL CENTERS 056
2825 LANE STREET
KANNAPOLIS, CABARRUS COUNTY, NORTH CAROLINA
Revision Date: 8 20 2019 Incident Number and Name: Pilot Travel Centers 056
UST ID Numberl
Current/Last
Contents
Previous
I Contents
Capacity
(gallons)
Construction
Details
Tank
Dimensions
Description of
Associated
Piping and
Pumps
Date Tank
Installed
Status of UST
Was Release
Associates with
the UST System?
1
Gasoline
None
15,000
Unknown
STiP3
FRP
Unknown
Active
Unknown
2
Gasoline
None
10,000
Unknown
STiP3
FRP
Unknown
Active
Unknown
3
Auto Diesel
None
5,000
Unknown
STiP3
FRP
Unknown
Active
Unknown
4
Diesel
None
20,000
Unknown
STiP3
FRP
Unknown
Active
Unknown
5
L
Diesel
None
20,000
Unknown
STiP3
FRP
Unknown
Active
Unknown
r
Description of
Associated
Was Release
Current/Last
Previous
Capacity
Construction
Tank
Piping and
Date Tank
Associates with
AST ID Number
Contents
Contents
(gallons)
Details
Dimensions
Pumps
Installed
Status of AST
the AST System?
None associated with this site

TABLE 3
SOIL ANALYTICAL RESULTS
PILOT TRAVEL CENTERS 056
2825 LANE STREET
KANNAPOLIS, CABARRUS COUNTY, NORTH CAROLINA
Analytical Method
EPA Method 8015
PID
A
Reading
x
x
Sample
Depth feet
m
Date Sampled
Cam-
H
SB-1
5
452.5
8/9/2019
48.7
4,890
State Action Level
50
100
Notes:
1. Concentrations reported in milligrams per kilogram (mg/kg).
2. Bold type denotes concentration exceed the State Action Level.

ATTACHMENT

UST.61
24-Hour Release and UST Leak Reporting Form.
For Releases This loan should be CNnolelPA aM submJlb la the UST SediunsregiDu"Oh'ce lollovnng a known w suspetletl release from
eo undergaund soage lank DST) syvlem. This tom+ is noosed tO be submetee Within2a hours of discovery of a known a
In NC so
release
(DWM USE ONLYt
IwJUenl# Reek(l4j,4U)_
SUSlaeded 2011lemmaew9 IYIN) Y
Confirmed GW Conlaminsul tym-F
Fatlllly ID Numher 00L-00b001 ION
pale leak Discovered
Recelvetl On Recalveb By _
Reported by lc/ncleowy Phone. Faxes Report
Confirmed Sal Cwtamvavor 1( nk) N.
SamPles Taken>(YINt Y
�gI30/19
CPTMNOhCammarcian
ReWiNon+egulaed'+ Ree
Reglw
Free ptodlCYMI N I(YPssualectisbael
Try[Itnass
INCIDENT DESCRIPTION
IMdent Name
Pilot Tnval Cantata O50
AJtlress' U25 Laos Street
County- Csbxrrus
Clly?avn' ➢ Cotle-
Wnnvpolls F - 280tlt
Rajlonal OOke (time One): Rankles Mowesvll* arseze.
Refth, Washington Wllmntlan. Wins
Lathkal Cewl ewnO 3%029-5310"N LOnBllude laws .). W33'3954"W
Obviincd by:
❑�
BneflY deecribesuspededamnMneb reloaee;/llKlutlin9Ouf mflimiledro nxule of crease, Cafe almlwe. amoum
OITJeaae em0enf
a//TP YCI mSel)(erida nflan Ml(IaIT BS [DIMY[{ed,i e(E ie once (pa
Iv❑1TppagaPhm cep
a ento.Y envy ¢a resu o •mr exmpew me x yeas 0 ese spacer a a asa lee set
yyGlSAddtess malcninB
Doubt
❑UnNnaVRI
Describe location:
h#e tleterlN aTPli-pRO a'xlue(nc'emJ aflM1e Sek Anioo L<eel of 100 msea. These gctivifies were
conducted es per the Notice a Vfa(adon doled Jones, 2019. A She Check Report is being peepard.
HOW RELEASE WAS DISCOVERED (Raease code)
(atecxael
QReleuse adecllon Eeulptnunl or Methods QVuueYOda QGroundwater Contamination
QWdtq UST ClosonvRemoval ❑Weler N Tank QSulhoe Water Oonlaminallon
❑Property Trensler QWalw Bupplyweh Contaminator
SOURCE OF
CONTAMINATION
Source of Release
Cause of Release
Type of Release Product Type Released
fched Mfflry®Ux)
(Check vnmery sconce)
(Cwter ate) (C/recx Primary Pmtlua NPe reeesM)
❑Tank
[]SP10
Iprenaeum awOnevDleseb ❑DxrseWes at
❑Plpin9
❑Over011
11NOn-PeboleJm `t Kerosene Blend
PisPenser
❑Corrosion
Bath ❑-eating Oil ❑ Vegetable Od 100%
❑ SUPnartible TurGre Pump
❑Pleysicamechanlral
El other Pelmlevm ElEll) -E20
❑Delsery Problem
Damage
Location Praducts E]ebt -Eas
El Sol, so"❑Other
❑ Install Probem
(Check one)MBUIa
�EBS-E9g
[:law
QOlhw
ko
�FacllilY ryanl® LlEthand 10o4n
❑Unknown
�UMnown
❑Paesder10e ❑amet omerv[e
❑ EOt -EgB
Depmfrora remaeean rekmrse
D.rmeau wesarcadw revere
QgM1er
aumnlp
t Municipal 2. Millbury 3, UnNnuwPrivaten .Fed9al 0. gwnry 1. stale
Oowadon Tow
'. Public Sarviw 2: Agdoullual S. Rasdenbal <. EducatiaaRNlg. S. Indoors B. Cancer' T. Mining
UST Fann 61 MINIM
Pape IaI.

IMPACT ON DRINKING WATER SUPPLIES
Winer Supply Wells AOemetl9 I. Y® 2 No 3 V
Number of Water Supply Wells Arcan0
Water SUWIY Welt CW"Inahed: llltdutle Users NamK, Atltlrea eS BM FMare NumOers. AMach Btlo"rfimel.SXeef 11 neresSnrYl
1_
2
3.
UST SYSTEM OWNER
UST OwnerfCompany
Pilot Travel Centers, LLC
Pam a cmtmm Addmes
Keith Cllrlmn, Environmental Project Mounter 550E Lunn Rend
city
Sale Lp Cede
Tek'beenNumber
Knoxville
TN 3P309
lfl -07 d106
UST SYSTEM OPERATOR
LIST OperermlCanpsnY
Aceene
Pilot Travel Cenlae. LL(:
5500 Lenea Revd
C�ly Stele
by Coee
Teepnene Number
Knoxville TN
17909
0 "741J106
LANDOWNER AT LOCATION OF UST INCIDENT
largowner
Address
Pilot Travel Cermon. LLC
551111 Linn Rand
OIN
SWte
Lp COEo
relepnone rvumber
Knoxville
1]909
86L47i-31116
Draw Sketch of Area (showing two major road Intersections) or Attach Map
See attached site map
Pathan Radical bra ent M. Jnekeen
I CSa"InY ATG\nacho orNC(on behalf of Pilot)
Telepaone Number 919_ W I-Jtl'IJ
TiatPC/Sr.Project Manager
Addma 609.k Pinar Rd. Suite ilS Wilmington. NC 384A)9
Owe y2WE019
Peen i of 3
Talk minim
theO
Talk ®m the pinkthat ztotm the protect and ¢mthe coM1e.opnrnandSenateobura renksyaem
Piping finMoore icouhe piping and mnnamm moraine ram memnk orwbmeriib4 wmine pump lniMNssenm or. ether Intl-ur MwpmentlVenL vapor rarosnry, nr llll
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Overml She when her overfill moment a, overfill; meyawrr r the fill Pipeaut pick or when mes9ale tots to Shut arm medlspenher)
Pkymi or MaMmN Manager a¢ fw ran type, ofpbyvrel rx mrtnanlcnl anmagr. recent cormsam leg. ptmnum of who Or ptpmy, have thing, beck M
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UST-17B UST Suspected Release 7 Day Notice KC
Q�
➢ This form must be used to report to DEQ, within 7 days of discovery, the investigation results for a Suspected Release from any of the following:
a) Failed or inconclusive leak detection or tightness test results. This includes positive test results, such as "Increase", which indicates the level in the
UST system has increased more than 0.2 gph.
b) Unusual operating conditions which can include, but are not limited to, the erratic behavior of dispensing equipment; the unexplained presence of
water in the tank; the presence of fuel in containment sumps or interstitial spaces; or the degradation of any equipment or element of an underground
storage tank system to the point where that equipment or element can not reasonably be expected to perform its intended function.
c) Internal inspection results such as, perforations, corrosion holes, weld failures, or other similar defects that indicate a release could have occurred.
➢ If you have more than four UST systems to report suspected release investigations, then attach additional sheets of the UST-17B form.
➢ Please submit this form along with the supporting documentation to:
NCDEQ/DWM, UST Section
1646 Mail Service Center
Raleigh, North Carolina 27699-1646
OR
Fax to [phone] OR UST.PermitsCaLncdenr.gov
I. UST OWNER II. UST FACILITY
Name: : Name: Facility ID
P, �nZ— 005 c�
Address: Address:
v
City: State: Zip: City: County:
�� c71 4S INr— 2 2tpq �w,r. v.c� 0 1 t S C_0 Jc�v'1 U S
Person Reporting: Title of Pin Reporting: Telephone Number:
1 rL�.s. s icA, v,(74 5—leg. yLl7'r
III. INVESTIGATION RESULTS
Tank Number / Size:
Product Stored:��. '
Reason for Suspected
Release Investigation
(Check all that apply):
You must attach the
supporting documentation
specified in the footnote for
the reason(s) selected.
❑ Data entry error'
❑ Dispensing fuel while
test is being conducted 2
❑ Faulty equipment 3
❑ Incorrect stick or meter
reading '
❑ Incorrect tank chart °
❑ Internal Inspection 5
❑ Meter not calibrated 6
❑ Other (Attach
explanation)'
❑ Tank/Dispenser
containment sump
contains liquid 7
❑ Tilted tank 6
❑ Unknown'
' Conduct a tank and/or line tightness test and attach the results, along with all of the supporting data sheets for the test method, to this form for submittal.
The summary page listing the results by itself is not acceptable. If the tightness test results are fail, then you must repair or replace your UST system and
conduct a site check in accordance with 15A NCAC 2N .0603.
2 Provide sales receipts or other comparable documentation that shows fuel was being dispensed from the UST during the test.
3 Provide invoices (with a description of the work completed) or other documentation that shows the equipment has been repaired.
4 Correct your leak detection results using the correct tank chart and submit copies with this form.
5 Repair the UST in accordance with the manufacturer's instructions or a national standard (e.g., PEI API 1631) and conduct a site check in accordance with
15A NCAC 2N .0603. If the UST is not repaired, then it must be permanently closed in accordance with the latest version of the UST Sections Guidelines
for Tank Closure.
❑ Data entry error'
❑ Dispensing fuel while
test is being conducted 2
❑ Faulty equipment 3
❑ Incorrect stick or meter
reading'
❑ Incorrect tank chart °
❑ Internal Inspection 5
❑ Meter not calibrated 6
❑ Other (Attach
explanation)'
KTank/Dispenser
containment sump
contains liquid'
❑ Tilted tank 6
❑ Unknown'
❑ Data entry error'
❑ Dispensing fuel while
test is being conducted 2
❑ Faulty equipment 3
❑ Incorrect stick or meter
reading'
❑ Incorrect tank chart °
❑ Internal Inspection 5
❑ Meter not calibrated 6
❑ Other (Attach
explanation)'
❑ Tank/Dispenser
containment sump
contains liquid 7
❑ Tilted tank 6
❑ Unknown'
❑ Data entry error'
❑ Dispensing fuel while
test is being conducted 2
❑ Faulty equipment 3
❑ Incorrect stick or meter
reading'
❑ Incorrect tank chart °
❑ Internal Inspection 5
❑ Meter not calibrated 6
❑ Other (Attach
explanation)'
❑ Tank/Dispenser
containment sump
contains liquid'
❑ Tilted tank 6
❑ Unknown'
6 Correct your leak detection results using the amount your meter was adjusted following calibration and submit copies of the meter calibration and leak
detection results with this form.
' Conduct a tightness test (e.g., hydrostatic test) of the sump and submit the test result along with this form. If the test results are fail, then you must repair
or replace the containment sump and conduct a site check in accordance with 15A NCAC 2N .0603.
6 Submit documentation from your UST equipment contractor explaining how they determined the UST was tilted. Correct your leak detection results using a
tank chart adjusted for the tilt and submit with this form.
Note: Tank, piping, spill bucket and containment sump replacements must be done in accordance with 15A NCAC 2N .0900
UST-17B Revised 10/2016 http://www.wastenotnc.org/web/wm/

�11
UST-6Fif23B Triennial UST Containment Sump 1 UDC Integrity Testing E
Full height hydrostatic or vacuum test mow— v
If any periodic test fails, a suspected release report must be submitted on a UST-17A form, UST Suspected Release 24 Hour Notice. The suspected
release must be investigated, in accordance with 15A NCAC 2N .0603, and defective equipment repaired or replaced in accordance with 15A NCAC
2N .0404/.0900. Results of the investigation must be submitted on a UST-17B form, UST Suspected Release 7 Day Notice.
Containment sumps installed on or after 11/1/2007 that are not monitored continuously for releases using vacuum, pressure, or hydrostatic interstitial
monitoring methods and all other containment sumps installed prior to 11/1/2007 that are used for interstitial monitoring shall be tightness tested at
installation and every three (3) years thereafter in accordance with the manufacturer's written guidelines, PEI/RP100 "Recommended Practices for
Installation of Underground Liquid Storage Systems" and/or PEI/RP1200 "Recommended Practices for the Testing and Verification of Spill, Overfill,
Leak Detection and Secondary Containment Equipment at UST Facilities."
If a UDC / containment sump fails a periodic tightness test, the sump must be replaced or repaired by the manufacturer, or the manufacturer's
authorized representative in accordance with the manufacturer's specifications, or in accordance with a code of practice developed by a nationally
recognized association.
UST FACILITY
O Operator Name R
OT 51.4
Facility Street Address F;
Z$2� L-C -t 'Sit —
TESTING CONTRACTOR INFORMATION
Company Name rnone E-mail Address
of law, that the testing data provided on this form documents the UST system equipment was tested in accordance with the
nes and the applicable national industry standaisted in 15A NCAC 2N .0406 and/or 15A NCAC 2N .0900.
ity Name
�, at 5(
I certify, under
manufacturer's
e of person conducting test
person conducting test Test Date
Identify UDC/sump (By
Dispenser No. or Tank Number,ispenser,
❑Dispenser
❑Dispenser
Tank Size, Stored Product, e.g.
❑Tank
❑Tank
❑Tank
#1 10k Regular STP, Disp 112,
#; LISP ZO
#
#:
etc.
Transition sumps should be listed above as "TS-XX" (with XX= sump ID#)
Sump Material
❑ FRP
❑ FRP
❑ FRP
Plastic
❑ Plastic
❑ Plastic
Test Type
Hydrostatic
❑ Hydrostatic
❑ Hydrostatic
❑ Vacuum
❑ Vacuum
1 ❑ Vacuum
Indicate units for all measurements sump?Eland debris removed from i _
TcxYes No
Visual inspection (No cracks,
loose parts or separation of the XPass ❑ Fail
containment sump}
Sump Depth in inches I i s"
Height from sump bottom to top
of highest penetration or sump i
sidewall seam in inches
Wait time between applying
vacuum/water and start of test 3c) tr\1d1
Begin i End Test Time
(minimum test time: 1 hour) IC 1 I 1151
Begin i End values (inches) 16 rr i 6 A
[]Dispenser
❑Tank
❑ FRP
❑ Plastic
❑ Hydrostatic
❑ Vacuum
❑Dispenser
❑Tank
❑ FRP
❑ Plastic
❑ Hydrostatic
❑ Vacuum
❑Dispenser
❑Tank
❑ FRP
❑ Plastic
❑ Hydrostatic
❑ Vacuum
❑ Yes ❑ No I ❑ Yes ❑ No I ❑ Yes ❑ No I ❑ Yes ❑ No I ❑ Yes ❑ No
❑ Pass ❑ Fail I ❑ Pass ❑ Fail 1 ❑ Pass ❑ Fail I ❑ Pass ❑ Fail I ❑ Pass ❑ Fail
Pass/Fail criteria: Must pass visual inspection. Hydrostatic: Water level drop of 1/8 inch or more fails the test; Vacuum: No change in vacuum
Test Result Pass El Fall El Pass Elail ❑Pass ❑Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail
Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests)
Date next Containment Sump/UDC integrity test due (required every 3 years)
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY, DIVISION OF WASTE MANAGEMENT, UST SECTION
1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646 PHONE [phone] FAX [phone] http://www.wastenotne.ora
2/2019

M
+� A
-SPATCB
E N E A C Y S O L U T 1 0 W&
Site Information
Service #9712049 PO #19124880-6040919
PILOT TRUCK STOP # 56 Customer #54770
2825 LANE STREET
KANNAPOLIS,NC 28083
United States
Work Performed by Travis Furr
Arrived on site checked in with mod. Pulled up to fp 20 to run a hydrostatic test on the entry boots.
Opens the bottom door and found liquid in the pan I use the compliance trailer to pump out 10 gallons.
I was able to inspect the entry boots and found one completely open I was able to tighten the boot
back to the piping. I filled a 5 gallons bucket up with water and filled the diesel pan on fp 20 to the top
of the entry boot I took measurements of the liquid test started at 10:51 and at 11:51 the test was done
and check my measurements and it was the same the hydrostatic test pass. I pumped the water that I
put in the pan out.
Time On Site
Time Arrived: 6/14/19, 8:45 AM
Time Departed: 6/14/19, 10:30 AM
Total Time on Site: 1 Hours 45 Minutes
Follow up Required?
No followup required.
Customer Signature
Savannah Crainshaw
6/14/19,12:10 PM

ATTACHMENT II

l
ceAnalytical ANALYTICAL REPORT
National Center for Testing & Innovation August 19, 2019
FTC
FS
ATC Group Services - NC Pilot I
Sample Delivery Group: L1127728 4Cn
Samples Received: 08/10/2019 FSr
Project Number: 56-605-13
6
Description: Pilot 56 Qc
7GI
Report To: Maureen Jackson
609A Piner Road Suite 115 rAl
Wilmington, NC 28409
FSC
Entire Report Reviewed By
Jeff Carr
Project Manager
Results relate only to the items tested or calibrated and are reported as rounded values. This test report shall not be
reproduced, except in full, without written approval of the laboratory. Where applicable, sampling conducted by Pace
Analytical National is performed per guidance provided in laboratory standard operating procedures ENV-SOP-MTJL-0067 and
ENV-SOP-MTJL-0068. Where sampling conducted by the customer, results relate to the accuracy of the information provided,
and as the samples are received.
a
V
41
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
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TABLE OF CONTENTS
ONE LAB. NATIONWIDE.
Cp: Cover Page
1
Fn
Tc: Table of Contents
2
Ss: Sample Summary
3
Cn: Case Narrative
4
Sr: Sample Results
5
FS
SB-1 L1127728-01
5
[Cn]
Qc: Quality Control Summary
6
Total Solids by Method 2540 G-2011
6
Fr
Volatile Organic Compounds (GC) by Method 8015D/GRO
7
Semi -Volatile Organic Compounds (GC) by Method 8015C
8
RC
Gl: Glossary of Terms
9
F
Al: Accreditations & Locations
10
Sc: Sample Chain of Custody
11
rAl
FSC
ACCOUNT: PROJECT: SDG:
DATE/TIME: PAGE:
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08/19/19 17:16 2 of 11

SAMPLE SUMMARY ONE LAB. NATIONWIDE.
Collected by Collected date/time Received date/time
S13-1 L1127728-01 Solid Austen Rubenstein 08/09/1911:15 08/10/19 09:00 C
P
Method
Batch Dilution Preparation Analysis
date/time date/time
Analyst Location
Total Solids by Method 2540 G-2011
WG1330214
1 08/19/19 09:52
08/19/19 09:58 KBC
Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO
WG1330422
25 08/09/1911:15
08/17/1919:09 ACG
Mt. Juliet, TN
Semi -Volatile Organic Compounds (GC) by Method 8015C
WG1329660
20 08/16/1916:01
08/19/19 01:57 KME
Mt. Juliet, TN
ACCOUNT:
PROJECT:
SDG:
DATE/TIME:
ATC Group Services - INC Pilot
56-605-13
L1127728
08/19/19 17:16
PAGE:
3 of 11
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CASE NARRATIVE
ONE LAB. NATIONWIDE.
All sample aliquots were received at the correct temperature, in the proper containers, with the FP1
appropriate preservatives, and within method specified holding times, unless qualified or notated within
the report. Where applicable, all MDL (LOD) and RDL (LOQ) values reported for environmental samples FTChave been corrected for the dilution factor used in the analysis. All Method and Batch Quality Control
are within established criteria except where addressed in this case narrative, a non-conformance form
or properly qualified within the sample results. By my digital signature below, I affirm to the best of my FSS
knowledge, all problems/anomalies observed by the laboratory as having the potential to affect the
quality of the data have been identified by the laboratory, and no information or data have been
knowingly withheld that would affect the quality of the data.
FSr
6
QC
GI
Jeff Carr FAI
Project Manager
FSC
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
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SB-1
Collected date/time: 08/09/19 11:15
Total Solids by Method 2540 G-2011
SAMPLE RESULTS - 01
L1127728
Result Qualifier Dilution Analysis Batch
Analyte % date / time
Total Solids 85.2 1 08/19/2019 09:58 WG1330214
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry) Qualifier MDL (dry) RDL (dry)
Dilution Analysis Batch
Analyte
mg/kg
mg/kg mg/kg
date/time
TPH (GC/FID) Low Fraction
48.7
0.636 2.94
25 08/17/201919:09 WG1330422
(S)
a, a, a- Trifluorotoluene(FID)
91.7
77.0-120
081771201919:09 WG1330422
Semi -Volatile Organic Compounds
(GC) by Method 8015C
Result (dry) Qualifier MDL (dry) RDL (dry) Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date/time
TPH (GC/FID) High Fraction 4890
(S) o-Terphenyl 0.000
18.1 93.9 20 08/19/2019 01:57 WG1329660
J7 18.0-148 0811912019 01:57 WG1329660
ONE LAB. NATIONWIDE.
FP1
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QC
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WG1330214
Total Solids by Method 2540 G-2011
Method Blank (MB)
(MB) R3441897-1 08/19/19 09:58
MB Result MB Qualifier MB MDL
Analyte % %
Total Solids 0.000
L1127738-01 Original Sample (OS) • Duplicate (DUP)
MB RDL
(OS) L1127738-01 08/19/19 09:58 • (DUP) R3441897-3 08/19/19 09:58
Original Result DUP Result Dilution DUP RPD
Analyte % % _ %
Total Solids 82.4 82.5 1 0.113
Laboratory Control Sample (LCS)
(LCS) R3441897-2 08/19/19 09:58
Spike Amount LCS Result LCS Rec.
Analyte % %_ %
Total Solids 50.0 50.0 100
QUALITY CONTROL SUMMARY
L1127728-01
DUP Qualifier DUP RPD
Limits
10
Rec. Limits LCS Qualifier
o/
85.0-115
ONE LAB. NATIONWIDE.
- I
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WG1330422
Volatile Organic Compounds (GC) by Method 8015D/GRO
Method Blank (MB)
QUALITY CONTROL SUMMARY
L1127728-01
(MB) R3441600-2 08/17/1912:43
MB Result MB Qualifier MB MDL
MB RDL
Analyte
mg/kg mg/kg
mg/kg
TPH (GC/FID) Low Fraction
0.0256 J 0.0217
0.100
(S)
o, o, o-Trifluorotoluene(FID)
93.7
77.0-120
Laboratory Control Sample (LCS)
(LCS) R3441600-1 08/17/1911:18
Spike Amount LCS Result LCS Rec. Rec. Limits LCS Qualifier
Analyte mg/kg mg/kg % %
TPH (GC/FID) Low Fraction 5.50 5.59 102 72.0-127
(S) 104 77.0-120
a, a, a- Trifluorotoluene(FID)
L1127738-14 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1127738-14 08/17/19 20:31 • (MS) R3441600-3 08/17/19 20:51 • (MSD) R3441600-4 08/17/19 21:12
Spike Amount Original Result MS Result MSD Result MS Rec. MSD Rec.
Analyte mg/kg mg/kg mg/kg mg/kg % %
TPH (GC/FID) Low Fraction 5.50 0.988 112 109 76.1 74.4
(S) 102 101
a, a, a- Trifluorotoluene(FID)
Dilution Rec. Limits MS Qualifier MSD Qualifier RPD
26.5 10.0-151 2.26
77.0-120
ONE LAB. NATIONWIDE.
RPD Limits
28
FP1
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5
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WG1329660
Semi -Volatile Organic Compounds (GC) by Method 8015C
Method Blank (MB)
(MB) R3441376-1 08/16/19 23:22
MB Result MB Qualifier MB MDL MB RDL
Analyte mg/kg mg/kg mg/kg
TPH (GC/FID) High Fraction U 0.769 4.00
(S) o-Terpheny/ 64.0 18.0-148
Laboratory Control Sample (LCS)
I
QUALITY CONTROL SUMMARY
L1127728-01
(LCS) R3441376-2 08/16/19 23:35
Spike Amount LCS Result LCS Rec. Rec. Limits LCS Qualifier
Analyte mg/kg mg/kg % %
TPH (GC/FID) High Fraction 50.0 27.6 55.2 50.0-150
(S) o-Terpheny/ 67.1 18.0-148
ONE LAB. NATIONWIDE.
FP1
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FSS
4
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GLOSSARY OF TERMS
ONE LAB. NATIONWIDE.
Guide to Reading and Understanding Your Laboratory Report
The information below is designed to better explain the various terms used in your report of analytical results from the Laboratory. This is not
intended as a comprehensive explanation, and if you have additional questions please contact your project representative.
Results Disclaimer - Information that may be provided by the customer, and contained within this report, include Permit Limits, Project Name,
Sample ID, Sample Matrix, Sample Preservation, Field Blanks, Field Spikes, Field Duplicates, On -Site Data, Sampling Collection Dates/Times, and
Sampling Location. Results relate to the accuracy of this information provided, and as the samples are received.
Abbreviations and Definitions
(dry) Results are reported based on the dry weight of the sample. [this will only be present on a dry report basis for soils].
MDL Method Detection Limit.
MDL (dry) Method Detection Limit.
RDL Reported Detection Limit.
RDL (dry) Reported Detection Limit.
Rec. Recovery.
RPD Relative Percent Difference.
SDG Sample Delivery Group.
Surrogate (Surrogate Standard) - Analytes added to every blank, sample, Laboratory Control Sample/Duplicate and
(S) Matrix Spike/Duplicate; used to evaluate analytical efficiency by measuring recovery. Surrogates are not expected to be
detected in all environmental media.
U Not detected at the Reporting Limit (or MDL where applicable).
Analyte The name of the particular compound or analysis performed. Some Analyses and Methods will have multiple analytes
reported.
If the sample matrix contains an interfering material, the sample preparation volume or weight values differ from the
Dilution standard, or if concentrations of analytes in the sample are higher than the highest limit of concentration that the
laboratory can accurately report, the sample may be diluted for analysis. If a value different than 1 is used in this field, the
result reported has already been corrected for this factor.
These are the target % recovery ranges or % difference value that the laboratory has historically determined as normal
Limits for the method and analyte being reported. Successful QC Sample analysis will target all analytes recovered or
duplicated within these ranges.
Original Sample The non -spiked sample in the prep batch used to determine the Relative Percent Difference (RPD) from a quality control
sample. The Original Sample may not be included within the reported SDG.
This column provides a letter and/or number designation that corresponds to additional information concerning the result
Qualifier reported. If a Qualifier is present, a definition per Qualifier is provided within the Glossary and Definitions page and
potentially a discussion of possible implications of the Qualifier in the Case Narrative if applicable.
The actual analytical final result (corrected for any sample specific characteristics) reported for your sample. If there was
no measurable result returned for a specific analyte, the result in this column may state "ND" (Not Detected) or "BDL"
Result (Below Detectable Levels). The information in the results column should always be accompanied by either an MDL
(Method Detection Limit) or RDL (Reporting Detection Limit) that defines the lowest value that the laboratory could detect
or report for this analyte.
Uncertainty Confidence level of 2 sigma.
(Radiochemistry)
A brief discussion about the included sample results, including a discussion of any non -conformances to protocol
Case Narrative (Cn) observed either at sample receipt by the laboratory from the field or during the analytical process. If present, there will
be a section in the Case Narrative to discuss the meaning of any data qualifiers used in the report.
Quality Control This section of the report includes the results of the laboratory quality control analyses required by procedure or
Summary (Qc) analytical methods to assist in evaluating the validity of the results reported for your samples. These analyses are not
being performed on your samples typically, but on laboratory generated material.
This is the document created in the field when your samples were initially collected. This is used to verify the time and
Sample Chain of date of collection, the person collecting the samples, and the analyses that the laboratory is requested to perform. This
Custody (Sc) chain of custody also documents all persons (excluding commercial shippers) that have had control or possession of the
samples from the time of collection until delivery to the laboratory for analysis.
This section of your report will provide the results of all testing performed on your samples. These results are provided
Sample Results (Sr) by sample ID and are separated by the analyses performed on each sample. The header line of each analysis section for
each sample will provide the name and method number for the analysis reported.
Sample Summary (Ss) This section of the Analytical Report defines the specific analyses performed for each sample ID, including the dates and
times of preparation and/or analysis.
Qualifier Description
J The identification of the analyte is acceptable; the reported value is an estimate.
J7 Surrogate recovery cannot be used for control limit evaluation due to dilution.
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
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FP1
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ACCREDITATIONS & LOCATIONS ONE LAB. NATIONWIDE.
Pace National is the only environmental laboratory accredited/certified to support your work nationwide from one location. One phone call, one point of contact, one laboratory. No other lab is as
accessible or prepared to handle your needs throughout the country. Our capacity and capability from our single location laboratory is comparable to the collective totals of the network
laboratories in our industry. The most significant benefit to our one location design is the design of our laboratory campus. The model is conducive to accelerated productivity, decreasing
turn -around time, and preventing cross contamination, thus protecting sample integrity. Our focus on premium quality and prompt service allows us to be YOUR LAB OF CHOICE.
Not all certifications held by the laboratory are applicable to the results reported in the attached report.
Accreditation is only applicable to the test methods specified on each scope of accreditation held by Pace National.
State Accreditations
Alabama
40660
Nebraska
NE-OS-15-05
Alaska
17-026
_
Nevada
TN-03-2002-34
Arizona
AZO612
New Hampshire
2975
Arkansas
88-0469
NewJersey_NELAP
TNO02
California
2932
New Mexico
n/a
Colorado
TN00003
New York
11742
Connecticut
PH-0197
North Carolina
Env375
Florida
E87487
North Carolina'
DW21704
Georgia
NELAP
North Carolina'
41
Georgia'
923
North Dakota
R-140
Idaho
TN00003
Ohio—VAP
CL0069
Illinois
200008
Oklahoma
9915
Indiana
C-TN-01
Oregon
TN200002
Iowa
364
Pennsylvania
68-02979
Kansas
E-10277
Rhode Island
LA000356
Kentucky76
90010
South Carolina
84004
Kentucky 2
16
South Dakota
n/a
Louisiana
A130792
Tennessee' 4
2006
Louisiana'
LA180010
Texas
T104704245-18-15
Maine
TN0002
Texas'
LABO152
Maryland
324
Utah
TN00003
Massachusetts
M-TNO03
Vermont
VT2006
Michigan
9958
Virginia
460132
Minnesota
047-999-395
Washington
C847
Mississippi
TN00003
West Virginia
233
Missouri
340
Wisconsin
9980939910
Montana
CERT0086
Wyoming
A21LA
Third Party
Federal Accreditations
A21LA — ISO 17025
1461.01
AIHA-LAP,LLC EMLAP
100789
A21LA — ISO 17025 5
1461.02
DOD
1461.01
Canada
1461.01
USDA
P330-15-00234
EPA—Crypto
TN00003
' Drinking Water 'Underground Storage Tanks 3 Aquatic Toxicity 4 Chemical/Microbiological 5 Mold 6 Wastewater n/a Accreditation not applicable
Our Locations
Pace National has sixty-four client support centers that provide sample pickup and/or the delivery of sampling supplies. If you would like assistance from one of our support offices, please contact
our main office. Pace National performs all testing at our central laboratory.
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ATC Group Services - NC Pilot
PROJECT: SDG: DATE/TIME: PAGE:
56-605-13 L1127728 08/19/19 17:16 10 of 11

ATC Group Services • NC Pilot
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