MO-88752_91550_CA_UST-62_20190624

UST-62
24-Hour Notification of Discharge
Form
For Non -UST This form should be completed and submitted to the UST Section's regional office following a known or suspected release of
Releases of petroleum from a source other than an underground storage tank. This form is required to be submitted within 24 hours of
discovery of a known or suspected petroleum release
Petroleum in NC
(DWM USE ONLY)
Suspected Contamination? (Y/N) Y
Release discovered
Incident # Priority Rank (H,I,L,U)
Confirmed GW Contamination? (Y/N) N
(time/date):
Received (time/date)
Confirmed Soil Contamination ?(Y/N) Y
.06-24-19 a) 0430HRS
Received by Region
Samples taken?(Y/N) Y Free product? (Y/N) N
Reported by (circle one): Phone, Fax or Report
If Yes(free product), state greatest thickness: feet
INCIDENT DESCRIPTION
Incident Name: Hilco - Diesel Fuel Release
Address (street number/name):4293 NC Hwy 24/27
County: Cabarrus
City/Town: Midland
Zip Code: 28107
Regional Office (circle one): Asheville, Mooresville, Fayetteville,
Raleigh, Washington, Wilmin
on, Winston-Salem
Latitude (decimal degrees): 35.251586N Longitude (decimal degrees) :-80.501555W
Obtained by:
GPS
Describe suspected or confirmed release (nature of release, time/date of release, quantity of release, amount of free
product):
❑ Electronic topographic map
A diesel fuel release occurred due to a motor vehicle collision. Most of the fuel was released to paved surfaces.
Sorbent were used to stabilize the released fuel, and recover the fuel. A stormwater inlet was impacted, but was
a GIS
flushed with clean water and recovered.
Address matching
Describe initial response/abatement (time/date release stopped, cleanup begun/completed, quantity of product
❑ Other
soil removed, confirmation sampling):
Unknown
Initial 6/24/19. Estimated = 85
abatement activities completed on release volume gallons.no
Describe location:
Municipal town hall and roadway
Describe impacted receptors:
None
HOW RELEASE WAS DISCOVERED (Release code)
(Check one)
[X]Observation of Release at Occurrence Water Supply Well Contamination
❑ Visual or Olfactory Evidence Surface Water Contamination
Soil Contamination Other (specify)
Groundwater Contamination
SOURCE OF CONTAMINATION
Source of Release Cause of Release Type of Release Product Type Released
(Check one to indicate primary (Check one to indicate primary (Check one) (Check one to indicate primary petroleum product
source) cause)
type released)
❑AST (tank) ❑ Spill (Accidental) ❑X Petroleum Gasoline/ Diesel/ ❑ Diesel/Veg. Oil
❑ AST Piping/ Dispenser ❑ Spill (Intentional) ❑ Both Petroleum Kerosene Blend
AST Delivery Problem ❑ Corrosion & Non -Petroleum ❑ Ell — E20
❑ Vegetable Oil 100%
8 OTR Vehicle Tank ❑ Physical or Mechanical ❑ E21 — E84
❑ Heating Oil
❑ OTR Bulk Transport Tank Damage Location ❑ E85 — E99
❑ Waste Oil
❑ RR Bulk Transport Tank ❑ Equipment Failure (Check one) ❑ Ethanol 100% ❑ Mineral Oil -no
❑ Transformer ❑ AST Overfill
❑ Facility
PCBs
❑ Unknown ❑AST Installation Problem ❑Residence
❑ Mineral Oil -PCBs
❑ Other Petroleum
❑ Other El Unknown ❑X Highway/Road
El Other
❑ Railway
Products
Definitions presented on reverse Definitions presented on reverse
❑ Other
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
Guidance presented on reverse
UST Form 62 (04/10) 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
List of Water Supply Wells Contaminated: (Include Users Names, Addresses and Phone Numbers. Attach additional sheet if necessary)
1.
2.
3.
PARTY RESPONSIBLE FOR RELEASE
(if the source of the release is not an AST system or if it is an AST system and there is a responsible party other than the AST system owner/operator)
Name of Person/Company
Address
Hilco Transport Company
7700 Kemont Road
City
State
Zip Code
Telephone Number
Greensboro
NC
27409
336-273-9441
AST SYSTEM OWNER (if the source of the release is an AST system)
AST Owner/Company
Address
Same
City
State
Zip Code
Telephone Number
AST SYSTEM OPERATOR (if the source of the release is an AST system)
UST Operator/Company
Address
Same
City
State
Zip Code
Telephone Number
LANDOWNER AT LOCATION OF INCIDENT
Landowner
Address
Presnell Family LTD Partnership
14352 Brook Knoll Ln
City
State
Zip Code
Telephone Number
Mint Hill
NC
28227
TBD
Draw Sketch of Area or Provide Map (showing incident site, location of release, two major road intersections, potential
receptors)
Attach sketch or map to form.
Give Directions to Incident Site Attach directions to form if necessary.
See Attached
Person Reporting Incidentioe Beaman
Company Highlands Environmental Solutions, Inc.
Telephone Number9198483155
Title Principal Geologist
Address 8410-D Falls of Neuse Road; Raleigh, NC 27615
Date 6/24/19
UST Form 62 (04/10) Page 2 of 2
Definitions of Sources
AST (Tank): means the tank is used to store product
AST Piping: means the piping and connectors running from the tank to the dispenser or other end -use equipment
AST Dispenser: includes the dispenser and the equipment used to connect the dispenser to the piping
AST Delivery Problem: identifies releases that occurred during product delivery to the tank.
OTR Vehicle Tank: means the tank is used to store product to fuel an over the road vehicle
OTR Bulk Transport Tank: means a tank that is used to transport product in bulk over the road (by truck)
RR :bulk Transport Tank: means a tank that is used to transport product in bulk by train
Transformer: means electrical transformer
Other: serves as the option to use when the release source is known but does not fit into one of the preceding categories
Unknown: identifies releases for which the source has not been determined
Definitions of Causes
Spill (Accidental): use this cause when a spill occurs accidentally(e.g., when the delivery hose is disconnected from a fill pipe)
Spill (Intentional): use this cause when a spill occurs intentionally (e.g., intentional dumping or breakage)
Corrosion: use when a metal tank, piping, or other component has a release due to corrosion
Physical or Mechanical Damage: use for all types of physical or mechanical damage, except corrosion
Equipment failure: use when a release occurs due to equipment failure other than corrosion or physical or mechanical damage
AST 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)
AST Installation Problem: use when the problem is determined to have occurred specifically because the AST system was not installed properly
Other: use this option when the cause is known but does not fit into one of the preceding categories
Unknown: use when the cause has not been determined
Guidance: Ownership and Operator Type
Ownership select the category which describes owner of the AST system, bulk transport tank, or other release source
Operator Type select the category which describes the operation in which owner uses the AST system, bulk transport tank, or other release source

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Beverly, Trudy
From: Joe Beaman <[e-mail]>
Sent: Tuesday, June 25, 2019 9:04 AM
To: Beverly, Trudy
Subject: RE: [External] UST-62 form submittal
ernal email. Do not click links or open attachments unless you verify. Send all suspicious email as an
tachment to [e-mail]
Will do! Thanks.
Joe
From: Beverly, Trudy <[e-mail]>
Sent: Tuesday, June 25, 2019 8:57 AM
To: Joe Beaman <[e-mail]>
Cc: Taraban, Ron <[e-mail]>
Subject: RE: [External] UST-62 form submittal
Good Morning Joe,
Since this site is in Cabarrus County, please send the initial abatement report to my attention when completed.
Thanks,
Trudy
DE
NORTH CAROLINA i
Department at Environmental Duality
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Wank C=16a Dqmunm aeR�� Quft
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L-rnail correspondence to and from this address is subject to the
rllarth Carolina Public Recxxds Law and may be disclased to third parties.
Office Mailing Address:
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Branch's Underground Storage Tanks Website Address: https:Hdeq.nc.gov/about/divisions/waste-management/ust
Branch's Above Ground Storage Tanks Website Address: https:Hdeq.nc.gov/about/divisions/waste-mana,gement/ust/ast-
program
INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES:
https://deq.nc.gov/about/divisions/waste-management/waste-management-rules-data/waste-mana eg ment- ig s maps
File Review Procedures:
hiips://deq.nc. gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office
ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche):

hl�2s:Hedocs.deg.nc.jzov/WasteManagement/Search.asp
Document Submittal & UST File Names for Laserfiche Policies:
https:Hfiles.nc. gov/ncdeq/Waste%20Management/DWM/UST/Corrective%20Action/Electronic%20Document%20Submittal
%20Memo%20Update.pdf
https:Hfiles.nc. gov/ncdeq/Waste%20Mana,gement/DWM/IJST/Corrective%20Action/UST%20file%20names%20for%20Las
erfiche.docx
From: Taraban, Ron
Sent: Monday, June 24, 2019 4:00 PM
To: Beverly, Trudy <[e-mail]>
Subject: FW: [External] UST-62 form submittal
From: Joe Beaman <[e-mail]>
Sent: Monday, June 24, 2019 3:44 PM
To: Taraban, Ron <[e-mail]>
Subject: [External] UST-62 form submittal
External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to [e-mail]
Ron,
Good afternoon. Attached, please find a UST 62 for a diesel fuel spill that occurred this morning in Cabarrus
County. Initial response activities have been completed. We will have to perform some limited soil remediation
later this week or early next week.
Joe
J11ft-\ Highland
Environmental
Solutions, Inc,
Joe Beaman, P.G., RSM
Principal Geologist
8410-D Falls of Neuse Road; Raleigh, NC 27615
O: 919-848-3155
F: 919-848-4265
C: 919-414-7081
24-Hr Emergency Response: 1-855-437-3278