MO-28475_47727_CA_UST-3_20210127_Notice of Intent UST Permanent Closure‐Change in Service

UST-UST-3 Notice of intent: UST Permanent Closure or Change -In- ervice
NUM UM ONLY
Retum "rn pled form to:
Di DWrlr'I Reig rwl Orf6vo &H*A d wl the area where flee FACiIHk iE; faeWm AND Wnd a a}py kv the CCrtrpI affi-,Q m RA12gh I D x
MAR ON T14E GACK OF Tif6S FORM TW C12NTHV�;- AND HE4DNAL OFricE ADDRESSES
LIMc ia�
INSTRUCTKM JRE D THIS FIFti�Tj _
Corn" ai-Fif fVurn a UST-3 fofm a least Ihktyr �34ys priaf M do�LLr*e a chsr':tje-m-Servbe adiviUes. I! :a Rraressiaaial Emginee r 4P.E.} of a I w*nrlr+
13Cob9ist (L C ' prov*r. sw�or *ian t*r r cure Or ch2rnge-YFSi t-oD sflo 35sessm4?nt sa%litres and s&n5 and seals a!1 -oIosure ropor;s .hen at Wst a M "B
�5) wwking days' ixotioe is aoceplable
r„ onVrrppd! Uu1` cloSum w r riggi-Inter ico sW a zcmo runt repoU., prong YoHh s Wy ol the UST-2A ar!dfor 2E3 Wms. s+loubd ; o subm tc the
approprre* DwisrOn Or ValgEe filanNen'res i. (CUM; Regitmal Offira within thirty (30} days Fallowing cbsrae ac-&ific , The LF.S'T.2 f,,m 53hould 31so btu
w4rn4Ie4 W.W CcrArv1 ffficc In Ralcgh so teal the s'=s of Me tanM may be changed kff perrrkareritly =ed and your tank tee wwurrt can ba dosM oul
Ntrie Tank N.Le& ni" be due fir unrra,3isbrmai iankv;
UST ❑Ocurr_ and charjgr_•5qt en irn Site � rn45t tc Q: +mpWW in ar 0an[� %%Mh .rq Ii�7 ve7 �)n o�;h� Cf�+d5 +0? rS+ r#h7r�µ, Tyr �r L.
ar.+d ff3WO The gu6eline3 Can be ebu3if*d 211 Ye_ Pb you c . _ •• _•�:r w ^�L4iui�•ar_•.va_'�. Vim, u�r •n � f�_� r� k� o rr 7sn 3 ifr r�
abtw prior zipormRr from Sh$ D'irN on onipq WAted in It* %e h 0 n wfrrf# the taco# is 10cated. -
Yqv moat mafaa suro that t*I s fQrrroved from +dour property ere dispozed or properIV. Whers one 3 CJo#ure emLfaLin f, a3R whefe the :snNa.) vra be
bakers Fa dish 1. tJsuzflyr. USTg &q gbannd F n d c3A up fqr aMp mCaI Tft* is 4arig mroM wgrk end mftl W pgr'fp-KI, by a qU;3IKW VXrp;Rnyr Tank
dtspawc: of iusgacy In fields or Ot!w Wmpsdas can leak netft{evn products and 9?ndge irrlo Lhe enyifrnment. Ir vouf links are diLpaaea or kWmerly, you
miald bc! Wd ruWpnpible for the clii;�Rnup of err!' e-oor--,rd�,I !;.3—]e nal oG ors
t, iA_Ww KP OF TANKS — ®. LO�CATf)N
Owner Name { CLWrst�r-i, Indi-YWj1. Public Abe", Or 0Ww. • CfAILY) Faci1�yy Nnrsra tc 06ri' yr im
VSP luskivm LLiC 501; 0!1� �afr `yr
t�lr"t A"c"
Faplky rD :g (If xngwn j
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W4-I30X004437
5tru0t Add e:s
coy
CoU*
Mscklacbur9
4&Q MWr-0Sui;I0 R _
Slale
zip code
zo CO*
KC
262e2
Kannaswis M1131
Piv rr� Numow
F'hor* NunttLL-
Email
9dCi-722.3751
Swpanara&hatn-.;ail.ccCn
7 1 741
Ill. CONTACT PERSONNEL Tr
Nafr*
= Cump,]r5V Nftirtra'_ LMb Tih- harp NWrbat-
Mfrrlhew Smrih
CsdSolp[�^ 9! F¢e�.a3uree :_LnO.- --- .l#Inior Rro or_w-Msyr, r 704-945_4010
FV. TAW !��L, gLOSURFF IN KAgk t ILEM 3JERVICE
1 CtrntzcA head fife rrerrshal.
5. PFovkIk! a mketch k "g pQirr3 lark and a P r or L.G , with al dvsuse nde nssgssrnrrl
2. Plan eMife dosure a real
s011:5xMiln9 sn"Ons roporta boaralg VA v9satwo and seal of Me
3. Coildl�Cl Si6e `mod Assessment.
C. txcJinSun9 a closdro report trle format dUS7- Pr�I 4DF L Grr. rgna a8 o P rnoDr L C
7� (inuding the form 1�$T•2} wvF n mirtyr ,'
d It irernoY•ig ranks w Gaa+ng RI
place. refer to (30r dep rOli.--MN 1P* inveogmian. is not rKuifed.
APL Ruhlirakm 2015 C,bardurg Pr.-jm:Jaalh R ° Keep :GurC r4Nxr#s fgr khr#e 1 3) � iDm
754�1 Kdemvar � fr a f4�6�Sa tram Ms thas Ocwrred,
Smf%ia Tanks arrd and
re
� �Rd �� Pch�leiam siL� aSsesSaYrePs p8ilio�n r5 t+f the! Lanktrri:utrt
muss tie cond=M under tree suporaf:ron Or
V, WORK TO BE PERFORMED BY
114r.7aPr mi-no,
Corntf&CW CQMWny Ndma
Matthew Sffm
Gw1 RP toUr0e5, the
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U502 HVve's Aw. morkrp0
NG 2al 10 704-a45-4010
P�idr]r 6ar*su rrt•Harnc'
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�'rffZ3 Camularft ComDeny Name: Cflnwftant PMorts lea:
r f of wr rnl�fl
G#?INi� FIteOurces. Feic 71014-84 i-4QEO
VI- TANKS SCHEDULED FOR C'LOGURE: OR CHAHGE4N �—
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VIL GMER 0R 04iRER°S AUTHOFUZED REPRES£NTATIVr
Hdt a release Flom a UST sps:erm accun and a I* la}raWn? ❑ Yr* [) RD ® U"now.
1 urrdw-amd that f -can be held -wu. oneiA Fir erwiforimrrtal dwfflMe feSufhsv frtm the "roper ftpcmd d my tjFs -s
Prrrk nam: and q ipol mic- Shd PrIn Owrw
SFynfrruro [/� Date SiWied SCI iEUEAL M ROM)VAL DAT>= IN4 your DYA1 Rtgio� rot
+i_ j r i—I } : S f �RDR1 44h0UF5 N90rG#tvi ijWW rf
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Beverly, Trudy
From:
Sent:
To:
Beverly, Trudy
Tuesday, February 2, 2021 7:59 AM
Taraban, Ron; Matt Smith
Subject: RE: [External] Facility ID # 00-0-0000004437 - Bethpage Grocery UST-3 Form
Good Morning Matt,
Ron forwarded the UST-3 for Bethpage Grocery, 4940 Mooresville Road in Kannapolis. I am the CAB UST project
manager for Cabarrus County. Please send future communications tome about this property.
Thank you and have a wonderful day,
Trudy
Trudy Beverly, L.G.
Hydrogeologist, Division of Waste Management
_ North Carolina Department of Environmental Quality
NR,vN7en[al �� �UST Section, Mooresville Regional Office
704.235.2182 (Office)
Trudy.Beverlykncdenr. gov
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://deq.nc.gov/about/divisions/waste-management/ust
Branch's Above Ground Storage Tanks Website Address: hgps://deg.nc.gov/about/divisions/waste-management/ust/ast-prosram
INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES:
httns://deo.nc. eov/about/divisions/waste-management/waste-management-rules-data/waste-management-eis-mans
File Review Procedures:
https://deq.nc. gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office
ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche):
hi�2s://deg.nc.gov/about/divisions/waste-management/laserfiche
Document Submittal & UST File Names for Laserfiche Policies:
https://files.nc.aov/ncdep/Waste%2OManaeement/DWM/UST/WhatsNew/Final-Electronic-Document-Submittal-Policv.adf
htips://files.nc.,gov/ncdegiWaste%2OManagement/DWM/UST/Corrective%2OAction/UST%20file%20names%20for%2OLaserfiche.docx
From: Taraban, Ron
Sent: Tuesday, February 2, 2021 7:47 AM
To: Beverly, Trudy <[e-mail]>
Subject: FW: [External] Facility ID # 00-0-0000004437 - Bethpage Grocery UST-3 Form
From: Matt Smith <msmith@geological resourcesinc.com>
Sent: Sunday, January 31, 2021 8:46 PM
To: Taraban, Ron <[e-mail]>
Subject: [External] Facility ID # 00-0-0000004437 - Bethpage Grocery UST-3 Form
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Good Evening Ron,

Please find attached the UST-3 form - Notice of Intent for the removal of the UST system located at the Bethpage
Grocery, 4940 Mooresville Road in Kannapolis, NC. Our plan is to commence this removal on Monday February 8,
2021. Please let me know if you have any questions regarding this matter.
Thanks,
Matthew T. Smith
Junior Project Manager
Geological Resources, Inc.
3502 Hayes Road
Monroe, NC 28110
Main [phone] Cell [phone]
Fax [phone]
[e-mail]
www.geologicalresourcesinc.com