MO-1435_0_CA_UST-3_19940908

(GW/UST-3) , t ;Noll 'e, of Intent: UST Permanent Closure or Change -In -Service::
FOR
r C3 ;
giw ted Form To:
TANKS Th6E,a�rboate DEM �i naI Office according to the county of the facility's State Use Only
IN location. [S EVQ�9L'S3DE OF OWNERS COPY (PINK) FOR REGIONAL I. D. Number
NC OFFICE AMESS]. c1�1�Ftt� Date Received
xr";�t1tt�A1.QINSTRUCTIONS
p1Vla,'l�g(�d return thirty (30) days prior to closure or change -in-service.
I. OWNERSHIP OF TANKS) Ill 'LOCATION OF TANK(S)
Tank Owner Name: LARAY 40ATM Facility Name or Company LARRV W,4M
(Corporation, Irdr,xJual, Piblb Agency, or Other Entity)
Street Address: P•0• &X tob77a9 Facility ID .# (if available)
County: h76CkL.ENA8t/t<6 Street Add r or Sta Road: 78 BUPP4LO AUE., NW
City: MR' State: NC Zip Code: 48264 County. C LA214WS ity: CUNCdRD Zip Code: M
Tele. No. (Area Code): (t700 97.2 - 9/2a Tele. No. Area C ):
III; CONTACT PERSON
Name:_ E• 1040" Job Title: Telephone Number:( 704t 4SS-5743
IV. TANK REMOVAL, CLOSURE IN PLACE, !' CHANGE4N-SERVICE
1. Contact Local Fire Marshall. 5. Provide a sketch locating piping, tanks and soil
2. Plan the entire closure event. sampling locations.
3. Conduct Site Soil Assessments. 6. Fill out form GW/UST-2 "Site Investigation Report for
4. If Removing Tanks or Closing in Place refer to API Permanent Closure" and return within 30 days
Publications. 2015 "Cleaning Petroleum Storage following the site investigation.
Tanks" & 1604 "Removal & Disposal of Used 7. Keep records for 3 years.
Underground Petroleum Storage Tanks".
V. WORK'' TO BE PERFORMED BY:
(Contractor) Name: j-IA?'S :sown STbA)E, /NC.
Address:__- F.0. State: hlaQ21S BURG Zip Code: a 8 U?S
Contact:_ J701MY 6 . PL077- Phone: (7044) 4S5'-5?4.3
VI. TANK(S) SCHEDULED > FOR. CLOSURE OR CHANGE -IN-SERVICE
TANK ID# TANK CAPACITY LAST CONTENTS
PROPOSED
ACTIVITY
CLOSURE
CHANGE -IN-SERVICE
--- —tom
Removal
Abandonment
In Place
New Contents Stored
E
VII. OWNER OR OWNER'S 'AUTHORIZED REPRESENTATIVE
Print name and official title
Jlmmy E Gorr "Scheduled Removal Date:.b/qy�
Signature:.- '/ - _ ' Date Submitted:�� l8A
'If schedul 'w , date changes, noWzur appropriate DEM Regional Office 48 hours prior to originally scheduled date.
GW/UST-3 Rev.7/29/91 White Copy - Regional Office Yellow Copy - Central Office Pink Copy - Ovyne-r

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Cabarrus County Web Site
Page 1 of 2
6656
Parcel Information Map
, (D, 0, n 0 5;o 8 -
Z00111 In Zoom Out Zoom full Pori Idenfily tllmr Query Print
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Owner Information:
Parcel Information:
CAMP LARRY M TRUSTEE
PIN:
5621509500
CAMP LARRY M REVOCABLE
TRST Site Address:
00078 BUFFALO AV NW
AGREEMENT DATED 2-5-02
City, ZIP:
CONCORD 28025
677 ABINGTON DRIVE
Jurisdiction:
CITY OF CONCORD
CONCORD, NC 28025-0000
Real ID:
12-016-0101.00
Sales Data:
Deed Book Page:
039490308
Sale Date:
08/2002 Tax Map:
562118
Layer Name Visible
iopo - 4ft
r
Streams
r
Structures
F
Easement
F
Lot Dimensions
F
Road Labels
F
Zip Code
r
Parcel
F
Municipalities
F
Aerial Photos -
1-
2001
County
F
3553 r
l4
I
Legend
/ Streams
Easement
RDaa Labe Jr.
El Parcel
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Cabarrus County Web Site Page 2 of 2
Sale Price:
$0 Legal Description: LTS 1,2 LOCKE COTTON
MILL BLK B
Appraisal Data:
Building Value:
$327,620 Land Units:
1.00 LOT
Market Land Value:
$65,450 Front Footage:
77
Extra Features:
$50,640 Year Built:
1920
Appraised Value:
$443,710 Heated Sq Ft:
7812
Total Sq Ft:
7812
Subdivision:
Neighborhood:
NORTH CHURCH
Neighborhood #:
50018
LonmInformation fortiis parceg..l
Voting Information for this parcel
Floodpla_i_n Information for this._parcel
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Copyright@1999, 2000, 2001 Cabarrus County. All rights reserved. Pryac..y.._5tatern,e,nt.
http:// 166.82.128.222/ParcelInfo.asp?Function=ShowMap&PanDirection=&MapAction=identify&LayerI... 10/17/2005