RA-29682_48805_C_UST-2_20221207

UST-2A Site Investigation Report for Permanent Closure or Change-in-
Service of
REGISTERED UST

Return completed form to:
NC DEQ / DWM / UST SECTION
1646 MAIL SERVICE CENTER
RALEIGH, NC 27699-1646
ATTN: REGISTRATION & PERMITTING
phone [phone] fax [phone] http://www.wastenotnc.org/

STATE USE ONLY: Facility ID #

Date Received

INSTRUCTIONS (READ THIS FIRST)
1. UST permanent closure or change in service must be completed in accordance with the latest version of the Guidelines for Site Checks, Tank
Closure and Initial Response and Abatement. The guidelines can be obtained at http://portal.ncdenr.org/web/wm/ust/guidance.
2. Permanent closure: Complete all sections of this form.
3. Change-in-service: Where a UST system will be converted from storing a regulated substance to a non-regulated substance, complete sections I, II,
III, IV, and VI
4. For more than 5 registered UST systems, attach additional forms as needed
5. Tank Fee Refund: An annual tank fee may be refunded for a tank for which a tank fee was not required. An owner or operator must submit
a written request and include: (1) contact information, (2) federal identification # or SSN, and (3) a copy of UST-2 form. The annual tank
fee will be prorated based on the date of permanent closure.
6. UNREGISTERED USTs use Form UST-2B
I. OWNERSHIP OF TANKS II. LOCATION OF TANKS
Owner Name (Corporation, Individual, Public Agency, or Other Entity)
SARA ROBERTSON
Facility Name or Company
BJS GROCERY
Street Address
PO BOX 773
Facility ID # (If known)
00-0-0000021728
City
WENDELL
County
WAKE
Street Address
3317 ROLESVILLE ROAD
State
NC Zip Code
27591-0773 City
WENDELL
County
WAKE
Zip Code
27591-9762
Phone Number
919-740-6536 Phone Number
[phone]
III. CONTACT PERSONNEL
Contact for Facility:
SARA ROBERTSON
Job Title:
UST OWNER
Phone #:
919-740-6536
Closure Contractor Name:
ROBBIE OAKES
Closure Contractor Company:
OAKES GRADING, INC.
Address:
P.O. BOX 17
YOUNGSVILLE 27586
Phone #
[phone]
Primary Consultant Name: HENRY NEMARGUT Primary Consultant Company: HENRY NEMARGUT ENGINEERING SER Address: 2211 CHESTNUT ST,
WILMINGTON, 28405
Phone # [phone]
IV. UST INFORMATION FOR REGISTERED UST SYSTEMS
UNREGISTERED USTs use Form UST-2B V. EXCAVATION CONDITION
Tank ID
No.
Size in
Gallons
Last
Contents
Last
Use
Date
Permanent
Close Date Method of Permanent Closure:
Indicate REMOVED or enter fill
material, such as foam/
concrete/ sand
Change-in-
Service
Date
Water in
excavation Free product
Notable odor or visible soil contaminatio
n
Yes No Yes No Yes No
1 8000 Gasoline, G 11/2022 12/2/2022 REMOVED
2 8000 Gasoline, G 11/2022 12/2/2022 REMOVED
3 8000 Gasoline, G 11/2022 12/5/2022 REMOVED
4 3000 Dielsel, Die 11/2022 12/5/2022 REMOVED
5 1000 Dielsel, Die 11/2022 12/5/2022 REMOVED

VI. CERTIFICATION
I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents and that
based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true accurate
and complete.
Print name and official title of owner or owner’s authorized representative
HENRY NEMARGUT/CONSULTING ENGINEER
Signature Date Signed 9/26/2022
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.wastenotnc.org/ 1/2016