WI-2027_23104_G_UST-23A_20201216_Fail and Pass Results

TESTING SUMMARY
COMPLIANCE TESTING PERFORMED ---- PASS (P) or FAIL (F) or Inconclusive (I)
Tank Tightness Test UST-22B / Sensor Function UST-23B / Sump Integrity
P/I Line Tightness Test P UST-22B / ATG Cert. UST-23C / Secondary Line Tightness
F UST-22A / Overfill Prevention F UST-22C / Sump Visual Inspection UST-23D / Tank Interstitial Tightness
P/I UST-22B / Leak Detector Test F UST-23A / Spill Bucket Integrity UST-7A/7B Cathodic Protection Eval
OTHER TESTING / SERVICES PERFORMED / MILEAGE
Installation of Parts (see page 2) Labor/Repair (One Man) Hours Labor/Repair (Two Man) Hours
Vac Truck Hours (Travel Included) PCW Gallons Removed Round Trip Mileage
Drop Tube Verification Helium Detection
ADDITIONAL COMMENTS/SUMMARY FINDINGS:
We were unable to test the premium line and leak detector at this time. We were unable to energize the premium STP pump.
There is power going to the pump but we were unable to get it to run. A service company will need to be called to make
repairs to the STP pump, and purge product back through the line to get the line and leak detector testing performed.
The UST 22A overfill failed on the unleaded, premium, diesel and off road diesel products. The site will need 2-8ft non poppet
coaxial with flapper drop tubes with adaptors, and 2-8ft standard with flapper drop tubes installed to correct the issues.
The UST 22C visual failed on all containment sumps. All dispenser and STP sumps are ½ full of water. The STP sump lid gaskets
are in poor condition on the unleaded, premium, diesel and off road diesel products. The bad gaskets are allowing water to
enter the containment sumps. The off road diesel outer steel manway lid does not sit properly along the concrete (pics are
available).
The UST 23A spill bucket testing failed on the unleaded and diesel products. The buckets failed the 1 hour hydrostatic testing.
The unleaded bucket has a breach in the rubber boot in the bottom of the bucket. The diesel bucket is damaged at the top and
bottom (pics are available). Repairs will need to be made.
SPD dispenser # 4 has a broken shear valve fulcrum arm. The broken fulcrum arm is currently wired in the open position. The
fulcrum arm will need to be replaced (pics are available).
Customer Name: RD White & Son Inc. Facility Address: 4541 White Street
Facility Name: RD White & Son Inc. City/State: Shallotte, NC
Facility/Site ID: 00-0-0000035021 Test Date: 12/16/2020
County: Brunswick WO# or PO#: N/A

TESTING SUMMARY

COMPLIANCE TESTING PERFORMED ---- PASS (P) or FAIL (F) or Inconclusive (I)
Tank Tightness Test UST-22B / Sensor Function UST-23B/ Sump Integrity
Line Tightness Test P
UST-22B / Spill Bucket Visual
Gauge

UST-23C/ Secondary Line Tightness
P UST-22A / Overfill Prevention UST-22C / Sump Visual Inspection UST-23D / Tank Interstitial Tightness

UST-22B / Leak Detector Test P UST-23A/ Spill Bucket Integrity UST-7A/7B Cathodic Protection Eval

OTHER TESTING/SERVICES PERFORMED / MILEAGE

Installation of Parts (see page 2) Labor/Repair (One Man) Hours Labor/Repair (Two Man) Hours

Vac Truck Hours (Travel Included)

PCW Gallons Removed Round Trip Mileage

Drop Tube Verification

Helium Detection

ADDITIONAL COMMENTS/SUMMARY FINDINGS:
Replaced existing OR Diesel drop tube with OPW 71SO 8’ and adaptor to correct previous failure.
Replaced existing Premium drop tube with OPW 61SO 8’ with coaxial adaptor to correct previous failure.
Re-tested and completed UST-22A, and performed UST-23A testing.

Customer Name: RD White & Sons Inc. Facility Address: 4541 White Street
Facility Name: RD White & Sons Inc. City/State: Shallotte, NC
Facility/Site ID: 00-0-0000035021 Test Date: 1/28/2021
County: Brunswick WO# or PO#: N/A
OPW
1 Top Seal Fuel Cap 634TT-7085-EVR 3" Slip On Adapter PV Vent 523SA-1003
Top Seal Vapor Cap 1711T-7085-EVR 3" Thread On Adapter PV Vent 523A-1003
2" Standard Open Vent Cap 23-0033 3 X 4 VR Adaptor (VR Poppett) 1611AV-1620
PV Vent Cap, 2” WC 623V-2203 1 Coaxial Fill Adaptor Aluminum 633TC-8090
3" VR Cap Low Profile 1711LPC-0300 Swivel Adaptor Bronze 61SALP-1020-EVR
2" Slip On Adapter PV Vent 523SA-1002 Swivel Vapor Adaptor Bronze 61VSA-1020-EVR

OPW Drop Tubes Morrison
1 Standard Overfill Valve 8' 71SO-400C 4” Fill Brass Adaptor with Lugs 305L-0200AA
Standard Overfill Valve 10' 71SO-410C 4” Tank Monitor Cap and Adaptor 305XPA-1200AK
Coaxial Poppet Overfill Valve 8’ 61SOP-4002 4" Vapor Recovery Cap 323C--0100AC
Coaxial Poppet Overfill Valve 10' 61SOP-4012 Drain Plug Kit EBW 705/71 A1005-505DPEB
1 Coaxial Non-Poppet Valve 8’ 61SOC-4001 Rag Stopper Rag Stopper
Coaxial Non-Poppet Valve 10 61SOC-4011

Franklin Fueling/FE Petro EMCO Wheaton
Syphon Jet Valve Assembly 400562903 4” Extractor Pipe Cap-Bar Style A0585-003
Syphon Check Valve 400137937 4” Low Profile Orange Vapor Adapter A0099-004LP
FE Petro STP-MLD+AG 403169901

Universal Liquid Sump Sensor TSP-ULS

¾ HPFixed Speed STP No Riser STP75-VL2

Model R Check Valve 400988932

Standard Check Valve 400988931

4” Coaxial Fill Adaptor
(HC Aluminum) (EBW) 306-300-01

Red Jacket Veeder Root
Adjustable Functional Element 323-001-5 DPLLD Without Swift Check Valve 859080-001
Stainless Check valve w/ Spring 144-184-5 WPLLD (wireless) 849490-002
FX1V Mechanical Leak Detector 116-056-5 PLLD With Swift Check Valve 848480-003
FX1DV Mechanical Leak Detector 116-058-5 PLLD Without Swift Check Valve 848480-001
Adjust FunctElemt O-Ring Kit 172-003-5

Packer Discharge Seal (.240) Viton 144-193-1

O-Ring, Packer Manifold, 7 ½
Viton (-443) 072-718-1

Universal Miscellaneous
Top Seal Flat Top Cap 731-40 Scotchcast Connector Sealing Pack 3570G-N
VR Flat Top Cap 0613VC-30 Brass Fittings 027-274-1
Vent Tubing 085-330-1
Steel Hex Head Cap Screw 026-176-1
Hex Head Packer Manifold Screw 026-205-11
Helium Gas (% of bottle)
4” x 6” Pipe Nipple 406Nipple

UST-22A
Page 2
Overfill Prevention Equipment Operability Check
AUTOMATIC SHUTOFF AND BALL FLOATS
UST FACILITY
Owner / Operator Name

Facility Name

Facility ID#:

Facility Street Address

Facility City

County

CONTRACTOR/PERSON CONDUCTING INSPECTIONS
Company Name

Phone

Email Address

I certify, under penalty of law, that the testing data provided on this form documents the UST system equipment was checked in accordance with
the manufacturer’s guidelines and the applicable national industry standards listed in 15A NCAC 2N .0406 and/or 15A NCAC 2N .0900.

Print Name of person conducting inspection Signature of person conducting inspection Inspection Date
Overfill Equipment Check Tank # Tank # Tank # Tank # Tank #
Product:
Tank chart volume (gallons):
Tank diameter (inches):
Tank Type: FRP Steel FRP Steel FRP Steel FRP Steel FRP Steel
If FRP Compartment tank, select: Base End Base End Base End Base End Base End
Overfill device manufacturer/model
Flapper Valve/Auto Shut Off A “No” answer to any items below or ball float length not determined and flapper/auto shut-off greater than 90%
indicates an operability check failure.
Drop tube removed from tank? Yes No Yes No Yes No Yes No Yes No
Drop tube and float mechanism are
free of debris? Yes No Yes No Yes No Yes No Yes No
Float moves freely without binding
and poppet moves into flow path? Yes No Yes No Yes No Yes No Yes No
Bypass valve in the drop tube is open
and free of blockage (if present)?
Yes No
Not Present
Yes No
Not Present
Yes No
Not Present
Yes No
Not Present
Yes No
Not Present
Current length from tank top to final
shutoff point (inches) FSP
Percent tank volume when final
shutoff occurs (%)
If tank has a ball float, is the flapper
installed lower in tank than the ball
float? (If present, complete ball float
length and percent set point below)
Yes No
Length not
Determined
Not Present
Yes No
Length not
Determined
Not Present
Yes No
Length not
Determined
Not Present
Yes No
Length not
Determined
Not Present
Yes No
Length not
Determined
Not Present
Ball Float Valve A “No” answer to any items below indicates an operability check failure.
Tank top fittings are vapor tight? Yes No Yes No Yes No Yes No Yes No
Ball Float removed from tank? Yes No Yes No Yes No Yes No Yes No
Cage intact & ball in good condition,
ball moves freely & seats firmly? Yes No Yes No Yes No Yes No Yes No
Vent hole in pipe is open and near
top of tank? Yes No Yes No Yes No Yes No Yes No
Current length from tank top to ball
float set point (inches) BFSP
30-minute flow restrictor installed (if
ball float set at more than 90%)
(Provide documentation such as
pictures/hole diameter)
Yes N/A Yes N/A Yes N/A Yes N/A Yes N/A
Percent tank volume when flow
restriction occurs (%)

Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail
Inspection result
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 5/2020
00-0-0000035021RD White & Sons Inc.
4541 White Street Shallotte Brunswick
RD White & Sons Inc.
PetroTest, Inc.[phone] [e-mail]
Stephen G. Pope 01/28/2021
2 134
Unleaded Premium Diesel OffRoadDiesel
10,171 6,027 10,171 6,027
94.5 94.5 94.5 94.5
OPW 61S0C OPW 61SOC OPW 71SO OPW 71SO
■■■■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
9.5 9.5 9.5 9.5
95.0 95.0 95.0 95.0
■■■■
■■■■
UST-22B

Annual Leak Detection Equipment Operability Check
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/12/2020
Page 2 (Automatic Tank Gauge / Spill Bucket Visual Gauge)
Inspect the leak detection equipment in accordance with manufacturer guidelines and PEI RP 1200, “Recommended Practices for the Testing and Verification of Spill, Overfill, Leak Detection, and
Secondary Containment Equipment at UST Facilities”.
Results must be maintained for at least one year at the UST site or the tank owner or operator's place of business and be readily available for inspection.
UST FACILITY
Owner / Operator Name
RD White & Sons
Facility ID
00-0-0000035021
Facility Name
RD White & Sons
Facility Street Address
4541 White Street
Facility City
Shallotte
County
Brunswick
CONTRACTOR/PERSON CONDUCTING INSPECTIONS
Company Name
PetroTest, Inc.
Phone
[phone]
Email address
[e-mail]
I certify, under penalty of law, that the testing data provided on this form documents the UST system equipment was checked in accordance with the
manufacturer's guidelines and the applicable national industry standards listed in 15A NCAC 2N .407/.0501.
Print Name of person conducting inspection
Stephen G. Pope
Signature of person conducting inspection Inspection Date
01/28/2021
Tank Volume (gallons):10,171 10,171
Tank Diameter (inches):94.5 94.5
Product:Unleaded Diesel
Automatic Tank Gauge (ATG)N/A Note: If the facility is using the ATG to obtain data for SIR then the ATG
operability check must be completed.
ATG Brand and Model
1. Using tank stick measure fuel level. Stick value agrees with
Fuel float level displayed on console?Yes No Yes No Yes No Yes No
2. Using tank stick measure water level. Stick value agrees
with Water float level displayed on console?Yes No Yes No Yes No Yes No
3. After removing the ATG probe from the tank, has it been
inspected and any damaged or missing parts replaced?Yes No Yes No Yes No Yes No
Magnetostrictive Probes
4. Float moves freely on the stem without binding?Yes No Yes No Yes No Yes No
5. Inch level from bottom of stem when 90% alarm is
triggered.
6. Inch level at which the overfill alarm activates corresponds
with value programmed in the gauge?Yes No Yes No Yes No Yes No
7. Inch level from bottom when the water float first triggers an
alarm.
8. Inch level at which the water float alarm activates
corresponds with value programmed in gauge?Yes No Yes No Yes No Yes No
9. Alarm reports attached?NoYes NoYes NoYes NoYes
If any answers in Lines 1, 2, or 3 (all ATGs); 4, 6, 8 or 9 (for Mag Probes); 10 or 11 (for Cap Probes) are “No”, the system has failed the test.
Test Results Pass Fail Pass Fail Pass Fail Pass Fail
Capacitance Probes
10. Initiated diagnostic check of probes from console?Yes No Yes No Yes No Yes No
11. Diagnostic check does not show any open or shorted
segments in measurement section of probe? (Attach
diagnostic report to form)
NoYes NoYes NoYes NoYes
Comments and explanation of failing results and other problems noted during inspection:
Spill Bucket Interstice Visual Gauge N/A
Gauge manufacturer OPW OPW
Gauge removed and visually inspected, and no damage noted?Yes No Yes No Yes No Yes No
O-ring/seals on entry fitting of gauge are present and not
damaged?Yes No Yes No Yes No Yes No
Float mechanism moves freely up and down?Yes No Yes No Yes No Yes No
Indicator arrow rotates when float moved up and down (Franklin
Fueling and OPW) or Indicator shows red, “TEST”, when float in
up position and green, “Ok” when float in down position (Emco
Wheaton)?
Yes No Yes No Yes No Yes No
Test Results Pass Fail Pass Fail Pass Fail Pass Fail
Any “No” answer indicates the equipment fails the test.
UST-6D/23A Triennial UST Spill Bucket Integrity Testing
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/5/2020
Page 1 (Hydrostatic/Vacuum Test)
• If any periodic test fails, a suspected release report must be submitted on a UST-17A form, UST Suspected Release 24 Hour Notice. The suspected
release must be investigated, in accordance with 15A NCAC 2N .0603, and defective equipment repaired or replaced in accordance with 15A NCAC
2N .0404/.0900. Results of the investigation must be submitted on a UST-17B form, UST Suspected Release 7 Day Notice.
• The primary containment and interstitial space of the spill bucket shall be tested in accordance with the manufacturer's written guidelines, PEI/RP100
“Recommended Practices for Installation of Underground Liquid Storage Systems” and/or PEI/RP1200 “Recommended Practices for the Testing and
Verification of Spill, Overfill, Leak Detection and Secondary Containment Equipment at UST Facilities.”
• The primary and secondary walls are both considered to be tested at the same time if vacuum is used to test the interstice.
UST FACILITY
Owner / Operator Name Facility IDFacility Name
Facility Street Address Facility City County
TESTING CONTRACTOR INFORMATION
Company Name Phone Email address
I certify, under penalty of law, that the testing data provided on this form documents the UST system equipment was checked in accordance with the
manufacturer's guidelines and the applicable national industry standards listed in 15A NCAC 2N .407/.0501 and/or 15A NCAC 2N .0900.
Print Name of person conducting inspection Signature of person conducting inspection Test Date
Identify Spill Bucket (By Tank Number,
Stored Product, etc.)Tank #Tank #Tank #Tank #Tank #
Tank Size
Product
Indicate units for all measurements
Bucket Manufacturer/Model
Bucket Depth
Construction SW DW SW DW SW DW SW DW SW DW
Bucket Installation Type
Direct Bury
Direct Bury w/Liner
Containment
sump
Direct Bury
Direct Bury w/Liner
Containment
sump
Direct Bury
Direct Bury w/Liner
Containment
sump
Direct Bury
Direct Bury w/Liner
Containment
sump
Direct Bury
Direct Bury w/Liner
Containment
sump
Test Type Hydrostatic
Vacuum
Hydrostatic
Vacuum
Hydrostatic
Vacuum
Hydrostatic
Vacuum
Hydrostatic
Vacuum
Liquid and debris removed from spill
bucket?Yes No Yes No Yes No Yes No Yes No
Visual inspection (No cracks, loose parts or
separation of the bucket from the fill pipe.)Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail
Tank riser cap included in test?Yes No
N/A
Yes No
N/A
Yes No
N/A
Yes No
N/A
Yes No
N/A
Drain valve included in test?Yes No
N/A
Yes No
N/A
Yes No
N/A
Yes No
N/A
Yes No
N/A
Wait time between applying vacuum/water
and start of test
Primary Section Test Hydrostatic: Water level must be within 1.5 inches of top of bucket Vacuum: Apply vacuum of 30 inches WC
Begin End Test Time
Begin End Reading
Secondary Interstice Test Vacuum: Apply vacuum of 15 inches WC
Begin End Test Time
Begin End Reading
Pass/fail criteria: Must pass visual inspection. Hydrostatic: Water level drop of less than 1/8 inch in 1 hour; Vacuum single-walled only: Maintain
at least 26 inches water column for 1 minute; Vacuum double-walled: Maintain at least 12 inches water column for 1 minute
Test Results Pass Fail Pass Fail Pass Fail Pass Fail Pass Fail
Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests)
Date next Spill Bucket integrity test due (required every 3 years)
RD White & Sons Inc.00-0-0000035021RD White & Sons
4541 White Street Shallotte Brunswick
PetroTest, Inc. [phone] [e-mail]
Stephen G. Pope 01/28/2021
2134
10,171 6,027 10,171 6,027
Unleaded Premium Diesel Off Road Diesel
OPW 1C-3112P Pemeco 111-L OPW 1C-3112P Pemeco 111L
12.0"12.0" 12.0"12.0"
30 Seconds 15 Minutes 30 Seconds 15 Minutes
12:15pm 1:15pm 12:15pm 1:15pm
12.0" 12.0"12.0" 12.0"
11:51am 11:56am 11:51am 11:56am
-15" -15"-15" -15"
01/28/2024