MO-9573_47004_CA_UST-61_20200317_24 Hour Release and UST Leak Reporting Form

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capstone
ENGINEERING
March 12, 2020
Mr. Ed Leach
North Carolina Department of Environmental Quality
Mooresville Regional Office
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Subject: Notice of Petroleum Release / 24 Hour Report
7200 Old Pineville Road
Charlotte, Mecklenburg County, North Carolina
Facility ID# - Not Applicable
Dear Ed:
As authorized by Victory Christian Center Inc., Capstone personnel performed environmental activities
at the subject site (see Figure 1). On March 11, 2020 Capstone's subcontractor removed one 500-gallon
heating oil underground storage tank (UST) from the property. The steel tank was in good condition but
several small holes were observed in the north end of the tank. Soil with a petroleum odor was observed
beneath the tank. On March 11, 2020 we removed approximately 30 tons of petroleum -impacted soil
from the heating oil tank pit and transported the material off -site for disposal. Field personnel collected
soil samples below the base and sidewalls of the excavation and submitted the samples to a lab for
analysis.
Attached is a 24-Hour Release and UST Leak Reporting Form summarizing the information available to
date. We will submit an Initial Abatement Action Report summarizing the assessment and remediation
activities and results to your office following receipt of the lab data. We appreciate your consideration of
this information. Please contact the undersigned if you have questions concerning this letter or need
additional information.
Sincerely,
J�O¢; C.ENS,. �Iti4i�4
SEAL
1141 �Y e
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nnu`�
Jeffrey L. Gerlock, L.G.
NC Licensed Geologist #1141
Attachments — Figure, 24-Hour Release Report Form
Cc: Victory Christian Center Inc.
Capstone Civil Companies, 9814 Garrison Road, Charlotte, North Carolina 28217 — 980-938-6770

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Site Location Map
7200 Old Pineville Road
Charlotte, North Carolina
REF.: Mecklenburg Co Polaris March 2020 1 Figure 1

UST-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
in NC
storage tank (UST) system. This form is required to be submitted within 24 hours of discovery of a known or
suspected release
(DWM USE ONLY)
Suspected Contamination? (Y/N)
Facility ID Number
Incident # Risk (H,I,L,U)
Confirmed GW Contamination? (Y/N)
Date Leak Discovered
Received On Received By
Confirmed Soil Contamination ?(Y/N)
Comm/Non-Commercial?
Reported by (circle one): Phone, Fax or Report
Samples Taken?(Y/N)
Reg/Non-regulated?
Region
Free Product? (Y/N) If Yes, State Greatest
Thickness
INCIDENT DESCRIPTION
Incident Name: / y `
Address: r73r, W At
Vj'1L $ fi
County: ti
y l �j
City/Town: C��1f✓Yl�'i J�
- .
Zip Code:` )
Regional Office (circle one): Asheville Mcores Ie ,,Fayetteville,
Raleigh, Washington, Wilmington, Winston- a em
Latitude (decimal degrees): � !j
j. r Longitude (decimal degrees) : .� ' L�, >''J �
Obtained by:
❑
Briefly describe suspected or confirmed release: (including but not limited to: nature of release, date of release, amount
of release, amount of free product resent and recoveryefforts, initial responses conducted, impacts to receptors)
GPS
❑Topographic map
❑GIS Address matching
❑Other
Unknown
Describe location:
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HOW RELEASE WAS DISCOVERED (Release code)
(Check one)
❑Release Detection Equipment or Methods ❑Visual/Odor ❑Groundwater Contamination
N.During UST Closure/Removal
❑Water in Tank ❑Surface Water Contamination
❑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)
004
A Tank
❑ Spill Petroleum ❑ Gasoline/ Diesel/ ❑ Diesel/Veg. Oil
❑ Piping
Overfill Kerosene Blend
❑ ❑ Non -Petroleum
❑ Dispenser
Corrosion ❑ Both J4 Heating Oil ❑ Vegetable Oil 100%
Submersible Turbine Pump
❑ p
❑ Other Petroleum ❑ E10 - E20
El
❑ Delivery Problem
Location Products ❑
Damage 9 (Check one) ❑ Metals E21 - E84
❑ Spill Bucket
Install Problem ❑ E85 - E99
❑Other
❑ Other ❑Facility ❑ Other Inorganics
❑Ethanol 100%
❑ Unknown
❑ Unknown Residence ❑ Other Organics
❑ E01 - E09
Definitions presented on reverse
Definitions presented on reverse ❑Other
Ownership
1. Municipal 2. Military 3. Unknown 4 rivate 5. Federal 6. County 7. State
Operation. -Ty" -
1 ublic Service . Agricultural 3. Residential 4. Education/Relig. 5. Industrial 6. Commercial 7. Mining
I IRT P- Al 109110%
Page 1 of 2

IMPACT ON DRINKING WATER SUPPLIES
Water Supply Wells Affected? 1. Yes No 3. Unknown
Number of Water Supply Wells Affected W A
Water Supply Wells Contaminated: (Include Users Names, Addresses and Phone Numbers. Attach additional sheet if necessary)
1.
2.
3.
UST SYSTEM OWNER
UST Owner/Comb 1pany
V i C� C,k yi '" cictd-er
Point of Contact
Address C�
'% 90 K)nr PJDi►vc'_,
City
State A, !�
Zip Code
,,-' ?J %
Telephone Number
UST SYSTEM OPERATOR
UST Operator/Company jd %
Address "
City
State
Zip Mcle J
Telephone Number
LANDOWNER AT LOCATION OF UST INCIDENT
Landowner
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Address
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d� isrr�
City 41�
State A)
C,
Zip Code ��
Tele hone Number
Draw Sketch of Area (showing two major road intersections) or Attach Map
G8
Person Reporting Incident
Company L, $ idlKe
phone Number 3� , &,) ...-
Title
Address
Date
u0 i rune o 1 tvu It))
Ala ,-IXyt J7 / 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

Beverly, Trudy
From: Beverly, Trudy
Sent: Thursday, April 2, 2020 6:51 AM
To: Jeff Gerlock
Subject: RE: [External] 24 Hour Report, 7200 Old Pineville Road, Charlotte
No
From: Jeff Gerlock [mailto:[e-mail]]
Sent: Wednesday, April 1, 2020 5:41 PM
To: Beverly, Trudy <[e-mail]>
Subject: Re: [External] 24 Hour Report, 7200 Old Pineville Road, Charlotte
External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
[e-mail]
Thanks. Did you send out any letter yet?
Jeff Gerlock
336-382-6849
On Apr 1, 2020, at 3:19 PM, Beverly, Trudy <trudy.beverlykncdenr. _oovv> wrote:
Good Afternoon Jeff — The Mooresville UST office has had some database issues for the last 3 weeks. It
was finally fixed this afternoon.
Site Name: Victory Christian Center Missions Center
UST # MO-9573
Incident #47004
Trudy
<image001.jpg> Trudy Beverly, L.G.
Hydrogeologist, Division of Waste Management
North Carolina Department of Environmental Quality
UST Section, Mooresville Regional Office
704.235.2182 (Office)
Trudy.BeverlyL&ncdenr. gov
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
1

Office Mailing Address:
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Branch's Underground Storage Tanks Website Address: https://deq.nc.gov/about/divisions/waste-management/ust
Branch's Above Ground Storage Tanks Website Address: https://deq.nc.gov/about/divisions/waste-management/ust/ast-proaam
INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES:
httn s: //deu .nc.2ov/about/divi sions/waste-management/waste-manaeement-rules-data/waste-manaeement-ais-man s
File Review Procedures:
https:Hdcq.nc. gov/about/divisions/waste-manaaement/ust/file-review-procedures#mooresville-regional-office
ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche):
httns://deo.nc. eov/about/divisions/waste-manaeement/laserfiche
Document Submittal & UST File Names for Laserfiche Policies:
https:Hfiles.nc.gov/ncdeg/Waste%20Management/DWM/UST[WhatsNew/Final-Electronic-Document-Submittal-Policy.pdf
https:Hfiles.nc.gov/ncdeq/Waste%20Management/DWM/UST/Corrective%2OAction/UST%20filc%20names%20for%2OLaserfiche.docx
From: Jeff Gerlock [mailto:[e-mail]]
Sent: Wednesday, April 1, 2020 12:20 PM
To: Beverly, Trudy <[e-mail]>
Subject: Re: [External] 24 Hour Report, 7200 Old Pineville Road, Charlotte
W111116 t lick links or open attachmen Ify. Send all suspicious email as an
Good afternoon Trudy. hope you are doing well.
I received the lab results for this project and am preparing the IAA Report. did you ever send a
NORR letter for this site or assign an incident number that I can put on this report?
Virus -free. www.avq.com [avq.coml
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On Tue, Mar 17, 2020 at 3:22 PM Beverly, Trudy <trudy.beverly(c�ncdenngov> wrote:
Received. Thanks!
From: Jeff Gerlock [mailto:jeff. erg lock(c,gmail.com]
Sent: Tuesday, March 17, 2020 3:20 PM
To: Beverly, Trudy <trudy.beverly(&ncdenr.gov>
Subject: Re: [External] 24 Hour Report, 7200 Old Pineville Road, Charlotte
r• External email. Do not click links or open attachments unless you verify. Send all suspicious email as
ttachment to report.spamAnc. oovv
Here you go.

<imagc002.png>
Jeff Gerlock
336-382-6849
On Mar 17, 2020, at 10:58 AM, Beverly, Trudy <trudy.beverly&ncdenr. og_v>
wrote:
Jeff,
Do you have a name, phone number, and email address for the contact person
with Victory Christian Center Inc.?
Thanks,
Trudy
<image001.jpg>
Trudy Beverly, L.G.
Hydrogeologist, Division of Waste Management
North Carolina Department of Environmental Quality
UST Section, Mooresville Regional Office
704.235.2182 (Office)
Trudy. B everly@ncdenr. gov
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Beverly, Trudy
Sent: Tuesday, March 17, 2020 10:41 AM
To: Jeff Gerlock <jeff. erg lock(&,gmail.com>
Cc: Bowser, Daniel P <dan.bowserkncdenr.gov>
Subject: RE: [External] 24 Hour Report, 7200 Old Pineville Road, Charlotte
Hi Jeff,
I handle nonregulated usts in Mecklenburg County. Dan Bowser forwarded the
UST-61 form to me. Ed Leach has taken a position in another state. I will send
you an Initial Abatement Notice of Regulatory Requirements after the
information has been added to the database.

Have a wonderful day,
Trudy
<image001.jpg>
Trudy Beverly, L.G.
Hydrogeologist, Division of Waste Management
North Carolina Department of Environmental Quality
UST Section, Mooresville Regional Office
704.235.2182 (Office)
Trudy.Beverlykncdenr. og_v
Email correspondence to and from this address is subject 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: hops:Hdeg.nc.gov/about/divisions/waste-management/ust
Branch's Above Ground Storage Tanks Website Address: hops://deg.ne.gov/about/divisions/waste-management/ust/ast-program
INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES:
hi!ps:Hdeq. nc. gov/about/divisions/waste-managementlwaste-management-rules-datalwaste-management-gis-maps
File Review Procedures:
https:Hdeg.nc. gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office
ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche):
https:Hdeg.nc.gov/about/divisions/waste-management/laserfiche
Document Submittal & UST File Names for Laserfiche Policies:
htips:Hfiles.nc. gov/ncdcgiW aste%2OManai4ementID WM/UST/Corrective%2OAction/Electronic%2ODocument%2OSubmiUal%2OMemo%2OUpdate.pdf
https:Hfiles.nc. aovincdeq/Waste%2OManagementIDWMIUST/Corrective%2OAction/UST%20file%20names%20for%2OLaserfiche.docx
-----Original Message -----
From: Bowser, Daniel P
Sent: Tuesday, March 17, 2020 10:26 AM
To: Beverly, Trudy <trudy.beverlyAncdenr.gov>
Subject: FW: [External] 24 Hour Report, 7200 Old Pineville Road, Charlotte

See below and attached.
Thank you,
Daniel P. Bowser, PG
Hydrogeologist
North Carolina Department of Environmental Quality Underground Storage
Tank Section - Corrective Action Branch
[phone]
[e-mail]
610 East Center Ave
Suite 301
Mooresville, North Carolina 28115
Email correspondence to and from this address is subject to the North Carolina
Public Records Law and may be disclosed to third parties.
-----Original Message-----

From: Jeff Gerlock <[e-mail]>
Sent: Thursday, March 12, 2020 11:40 PM
To: Leach, Edward <[e-mail]>
Cc: Bowser, Daniel P <[e-mail]>
Subject: [External] 24 Hour Report, 7200 Old Pineville Road, Charlotte
CAUTION: External email. Do not click links or open attachments unless you
verify. Send all suspicious email as an attachment to
report. [e-mail]<mailto:report. spam@nc. gov>
Good afternoon. we removed a tank yesterday and encountered evidence of a
release. attached is our report. please acknowledge receipt of this email and
attachment for our records and send me a letter with the incident number so I can
add it to the initial abatement report prior to sending it to you next month.
Jeff Gerlock
336-382-6849
Jeff Gerlock, P.G.
Blue Ridge Geological Services
7356 Belmont Drive
Trinity, North Carolina 27370
336-382-6849 mobile
www.blueridgegeo.com fblueridgegeo.coml
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