WS-96243_96843_CA_IAR_20230125

491

APPENDIX A

Drawing / Project Name
Client
Project # Date
N
Base diagram from Bing Maps
Incident Location Diagram
Diesel Fuel Release
HWY 421 South Bound, near MM 190, Julian, NC
First Call Environmental/Fed Ex Ground

DB Fig. Scale
340054
Not to Scale
December 2022
1
PM PG
RS
PE
RS
S
JB
Site Location

Client
Project # Date
N
Base diagram from USGS Topographic Quadrangle; Climax, NC
First Call Environmental/Fed Ex Ground

Drawing / Project Name
Topographic Location Diagram
Diesel Fuel Release
HWY 421 South Bound, near MM 190, Julian, NC

DB Fig. Scale
340054
As Shown
December 2022
2
PM PG
RS
PE
RS
S
JB
Approximate Scale
feet
0 2,300 1,150
Site Location

Drawing / Project Name
Client
Project #
N
Date
Base diagram from Google Earth
Area Diagram
Diesel Fuel Release
HWY 421 South Bound, near MM 190, Julian, NC
First Call Environmental/Fed Ex Ground

Approximate Scale
feet
0 110
DB Fig. Scale
340054
As Shown
December 2022
3 PM PG
RS
PE
RS
S
JB
55
Site Location
Limits of Excavation: (12' by 8' at depth of 6.0') D r a in a g e D it c h
U S H i g h w a y 4 2 1 (S o u t h b o u n d )CS-2CS-5CS-3CS-4MedianCS-1Heavy Vegetation/TreesPG:DB:Project Number:Date:Scale:PE:PM:Drawing NameSite / Client NameFig.LegendApproximate Scale015 30NfeetExcavation and Sample Location DiagramDiesel Fuel ReleaseFirst Call Environmental / Fed Ex GroundJulian, NCJBRSRS340054Dec. 2022As Shown4Soil Sample Location
491

APPENDIX B

Highlands Environmental Solutions, Inc.

HEALTH AND SAFETY PLAN

For Site Activities at:

Diesel Fuel Release
US Hwy 421 SB @ MM 190
Julian, NC

December 2022

Minimum Level of Protection at this site is Level D
Contaminants of Concern are Petroleum Hydrocarbons

Robert Shaut
Project Manager

The information in this HASP is provided solely for the protection of the health and safety of Highlands
Environmental Solutions employees and subcontractors working under the direct supervision and control of
Highlands Environmental Solutions on this project. Highlands Environmental Solutions assumes no liability
for, or responsibility to, any other parties for the accuracy or completeness of the information contained herein
for any use or reliance upon this HASP by any other party.
Health and Safety Plan
Diesel Fuel Release; Julian, NC
Page 2

IN THE EVENT OF ANY EMERGENCY, CONTACT PROJECT MANAGER OR
HEALTH AND SAFETY REPRESENTATIVE
SITE EMERGENCY FORM
Contaminants of Concern: Petroleum Hydrocarbons
Minimum Level of Protection: Level D

Do not endanger your life. Survey the situation before taking any action.
Highlands Environmental Solutions Office
Telephone: [phone]
Site Location Address: US Hwy 421 SB @ MM 190; Julian, NC
Telephone Located at: HES Personnel (cellular phone)

EMERGENCY
PHONE NUMBERS

Ambulance: 911
Fire: 911
Police: 911
Hospital Name: Cone Health
Hospital Phone: [phone]
Project Manager: Robert Shaut (984-289-9992)
Health and Safety Specialist: Joe Beaman (919-414-7081)
Client Contact: Taylor Hartman (First Call) (804-305-1171)
Poison Control: [phone]
State Agency: NCDEQ (FRO) 910-486-0707

UTILITY MARKER EMERGENCY TELEPHONE NUMBERS

Utility

Color Code

Telephone Number
Water
Gas
Electric
Telephone
Cable
Sewer
Blue
Yellow
Red
Orange
Orange
Green
[phone]
[phone]
[phone]
[phone]
[phone]
[phone]
Dig Safe Telephone Number: [phone]
Health and Safety Plan
Diesel Fuel Release; Julian, NC
Page 3

HOSPITAL LOCATION MAP

Directions:
North on USS 421; continue onto JM Hunt Jr
Expressway; left on Patton Ave; continue onto
Randolph Ave; left on E Florida Street; right onto
Randleman Road; Right onto Freeman Mill
Road; right onto N Edgeworth Street; left onto
Friendly Ave, continue to hospital.
Hospital Information:
Name: Cone Health
Address: 2400 W Friendly Ave
City, State: Greensboro, NC
Phone: [phone]
Health and Safety Plan
Diesel Fuel Release; Julian, NC
Page 4

FIRST AID FOR PETROLEUM HYDROCARBON EMERGENCIES

Ingestion: DO NOT INDUCE VOMITING. Call Poison Control; follow instructions. Administer
cardiopulmonary resuscitation (CPR), if necessary. Seek medical attention.

Inhalation: Remove person from contaminated environment. DO NOT ENTER A CONFINED
SPACE TO RESCUE SOMEONE WHO HAS BEEN OVERCOME UNLESS
PROPERLY EQUIPPED AND A STANDBY PERSON IS PRESENT. Administer
CPR if necessary. Seek medical attention.

Skin Contact: Brush off dry material, remove wet or contaminated clothing. Flush skin thoroughly
with water. Seek medical attention if irritation persists.

Eye Contact: Flush eyes with water for 15 minutes. Seek medical attention.

Exposure Symptoms: Headache, dizziness, nausea, drowsiness, irritation of eyes, nose, throat, breathing
difficulties.

Contingency Plan: Report incident to Project Manager (PM) after emergency procedures have been
implemented.

RESPONDER MUST HAVE A CURRENT CERTIFICATE TO ADMINISTER FIRST AID OR CPR

1. Survey the situation. Do not endanger your own life. DO NOT ENTER A CONFINED SPACE TO
RESCUE SOMEONE WHO HAS BEEN OVERCOME UNLESS PROPERLY EQUIPPED AND A
STANDBY PERSON IS PRESENT.

2. Call 911 (if available) or the fire department IMMEDIATELY. Explain the physical injury, chemical
exposure, fire, or release.

3. Decontaminate the victim without delaying life-saving procedures.

4. If the victim's condition appears to be noncritical, but seems to be more severe than minor cuts,
he/she should be transported to the nearest hospital by trained Emergency Medical Services (EMS)
personnel: let the doctor assume the responsibility for determining the severity of the injury. If the
condition is obviously serious, EMS must transport the victim.

5. Notify the PM.
Health and Safety Plan
Diesel Fuel Release; Julian, NC
Page 5

EMERGENCY FIRST AID PROCEDURES
To Stop Bleeding

CPR
1. Give medical statement.
2. Assure airway, breathing, and
circulation.
3. Use DIRECT PRESSURE over the
wound with clean dressing or your
hand (use nonpermeable gloves).
Direct pressure will control most
bleeding.
4. Bleeding from an artery or several
injury sites may require DIRECT
PRESSURE on a PRESSURE
POINT. Use pressure points for
30 - 60 seconds to help control
severe bleeding.
5. Continue primary care and seek
medical aid as needed.
1. Call for help.
2. Arousal: check for consciousness.
3. Open airway with chin-lift.
4. Look, listen, and feel for breathing.
5. If breathing is absent, give 2 slow, full
rescue breaths.
6. Check the pulse for 5 to 10 seconds.
7. If pulse is present, continue rescue
breathing: 1 breath every
5 seconds
8. If pulse is absent, start CPR:
15 compressions, 2 breaths (1 man)
Health and Safety Plan
Diesel Fuel Release; Julian, NC
Page 6

Project and Health and Safety Information
HES will be performing an environmental remediation at the subject site for First Call Environmental.

All work will comply with the Occupational Safety and Health Act (OSHA) standard, "Hazardous Waste
Operations and Emergency Response," (29 CFR 1910.120), and other federal, state and local procedures
that require the development and implementation of a HASP. Generation of this document certifies that the
workplace has been evaluated for the hazards as described. A hazard assessment has been performed and
the adequacy of the personal protective equipment (PPE) selected is hereby certified per
29 CFR 1910.132(d) and is duly noted by the signature(s) and date appearing on the cover page of this
document. If any site conditions are encountered that are different from typical retail petroleum operations,
the field investigator is to stop work immediately and notify the Project Manager.

This plan addresses the safety issues associated environmental investigation and assessment activities
performed at retail petroleum operations. For this project, site investigation activities will involve the
following (checked items):

Phase I Environmental Site Assessment Phase II Environmental Site Assessment
x Spill Response and Abatement x Soil sampling (hand auger)
Soil sampling (drilling) Monitoring well installation
UST removal (requires full HASP) x Soil excavation
Groundwater sampling/monitoring Groundwater remediation
Drum removal Site surveying
Soil Gas / VI assessment/survey Pump/Slug testing

All activities of this project will be carried out under Level D or Modified Level D. At a minimum, all personnel
will wear the following PPE based on the task to be performed at the site (checked items):

x Hard Hat x Safety Vest
x Steel Toe Boots Chemical Boots
x Nitrile gloves (sampling gloves) Heavy Nitrile gloves
x Safety glasses Ear plugs/ear muffs (sound suppression)
White Tyvek Yellow (polycoated) Tyvek

Site is on a major highway. Use caution.
Health and Safety Plan
Diesel Fuel Release; Julian, NC
Page 7

HAZARD IDENTIFICATION AND CONTROL
Precautions must be taken to prevent injuries and exposures to the following potential hazards.

. Potential Hazards and Control

Potential Hazard

Control

Exposure to
Petroleum
Products

1. Stand up-wind of petroleum products whenever possible.
2. Minimize contact and contact time with petroleum products.
3. Avoid walking through discolored areas, puddles, leaning on drums, or
contacting anything that is likely to be contaminated.
4. Do not eat, drink, smoke and/or apply cosmetics in the hot or warm
zones.
5. Wear gloves when in contact with contaminated surfaces.
6. Safety glasses must be worn at a minimum.
7. Splash goggles must be worn when working with liquids.
8. >25 ppm organic vapors in breathing zone requires upgrade to Level C.
9. >250 ppm organic vapors in breathing zone requires upgrade from
Level C to Level B.
10. If unknown materials are encountered, call the HSS.
Vehicular
Traffic

1. Wear traffic safety vest when vehicle hazard exists.
2. Use cones, flags, barricades, and caution tape to define work area.
3. Use vehicle to block work area.
4. Engage police detail for high-traffic situations.
Vault Entry

1. HES Personnel do not perform Confined Space Entry.

Utility Lines
Contact

1. Contact Dig Safe to have utility lines marked prior to excavation/trenching.
2. Refer to site drawings or customer interviews if on private property for
utility locations.
3. Hand dig 3 to 5 feet down and 5 feet each side of utility marker to avoid
breaking utility lines.
Inclement
Weather

1. Stop outdoor work during electrical storms and other extreme weather
conditions such as extreme heat or cold temperatures.
2. Take cover indoors or in vehicle.
3. Listen to local forecasts for warnings about specific weather hazards such
as tornados, hurricanes, and flash floods.
Noise

1. Wear hearing protection when equipment such as a drill rig, jackhammer,
cut saw, air compressor, blower or other heavy equipment is operating on
the site.
2. Wear hearing protection whenever you need to raise your voice above
normal conversational speech due to a loud noise source; this much noise
indicates the need for protection.
Health and Safety Plan
Diesel Fuel Release; Julian, NC
Page 8

Potential Hazard

Control

Electric
Shock

1. Maintain appropriate distance from overhead utilities;
20-foot minimum clearance from power lines required;
10-foot minimum clearance from shielded power lines.
2. Use ground-fault circuit interrupters as required.
3. Perform lockout/tagout procedures (Appendix C).
4. Use three-pronged plugs and extension cords.
5. Contact your local underground utility-locating service.
6. Follow code requirements for electrical installations in hazardous
locations.
Physical
Injury

1. Wear hard hats and safety glasses when on-site.
2. Maintain visual contact with the equipment operator and wear orange
safety vest when heavy equipment is used on-site.
3. Avoid loose-fitting clothing (driller and driller's helper).
4. Prevent slips, trips and falls; keep work area uncluttered.
5. Keep your hands away from moving parts (i.e., augers).
6. Test the emergency shutoff switch on the drill rig daily.
Back Injury

1. Use a mechanical lifting device or a lifting aid where appropriate.
2. If you must lift, plan the lift before doing it.
3. Check your route for clearance.
4. Bend at the knees and use leg muscles when lifting.
5. Use the buddy system when lifting heavy or awkward objects.
6. Do not twist your body while lifting.
Heat Stress

1. Increase water intake while working.
2. Increase number of rest breaks and/or rotate workers in shorter work
shifts.
3. Watch for signs and symptoms of heat exhaustion and fatigue.
4. Plan work for early morning or evening during hot months.
5. Use ice vests when necessary.
6. Rest in cool, dry areas.
7. In the event of heat stroke, bring the victim to a cool environment and
initiate first aid procedures.
Cold Stress

1. Take breaks in heated shelters when working in extremely cold
temperatures .
2. Remove the outer layer of clothing and loosen other layers to promote
evaporation of perspiration, upon entering the shelter.
3. Drink warm liquids to reduce the susceptibility to cold stress.
High Crime
Areas

1. Be aware of surroundings.
2. Use the buddy system.
3. Request police detail when appropriate.
Insects

1. Tuck pants into socks.
2. Wear long sleeves.
3. Use insect repellent.
Health and Safety Plan
Diesel Fuel Release; Julian, NC
Page 9

Potential Hazard

Control

Poisonous Plants
(Such as Poison
Ivy, Oak, etc.)

1. Don't enter areas infested with poisonous plants.
2. Immediately wash any areas that come into contact with poisonous
plants.
Ladders

1. Make sure ladder rungs are sturdy and free of cracks.
2. Use ladders with secure safety feet.
3. Pitch ladders at a 4:1 ratio.
4. Secure ladders at the top when possible.
5. Do not use ladders for access to air stripper towers.
6. Use non-conductive ladders near electrical wires.
Fire Control

1. Smoke only in designated areas.
2. Keep flammable liquids in closed containers.
3. Keep site clean; avoid accumulating combustible debris such as paper.
4. Follow Hot Work Safety Procedures when welding or performing other
activities requiring an open flame.
5. Isolate flammable and combustible materials from ignition sources.
6. Ensure fire safety integrity of equipment installations according to Hazard
Classification Diagram (Appendix G).
Static Electricity

1. Do not create static discharge in flammable atmospheres.
2. Electrically bond and ground pumps transfer vessels, tanks, drums,
bailers and probes, when moving liquids.
3. Electrically bond and ground vacuum trucks and the tanks they are
emptying.
4. Do not splash fill containers with flammable liquids.
Drilling/Boring
Operations

1. Driller and helper must be present during all active operations.
2. Driller helper and other site personnel must know location of emergency
shut off switch.
3. Unauthorized personnel must be kept clear of drilling rig.
4. Area of drilling operation must be cordoned off/barricaded.
5. When hazardous conditions are deemed present, operation must be shut
down.
Well Installation,
Well
Development,
Well Gauging,
Well Bailing,
Soil/Ground-
water Sampling

1. Wear appropriate PPE to avoid skin, eye, and inhalation contact with
contaminated groundwater and/or soil.
2. Stand upwind when conducting tasks and minimize possible inhalation
exposure; especially when first opening monitoring wells.
3. Conduct air monitoring to determine level of respiratory protection.
4. Utilize engineering controls such as portable venturi air movers to draw
away or blow away chemical vapors.
Welding, Cutting,
Brazing

1. Before conducting welding at a project site, contact the Project Manager..

Cleaning
Equipment

1. Wear appropriate PPE to avoid skin and eye contact with isopropyl
alcohol, alconox, or other cleaning materials.
2. Stand upwind to minimize any potential inhalation exposure.
3. Dispose of spent cleaning solutions and rinses accordingly.
Health and Safety Plan
Diesel Fuel Release; Julian, NC
Page 10

Potential Hazard

Control

First aid kit, emergency eye wash station, fire extinguisher, and absorbent
pads will be located on-site in the vehicle or site remediation system.
Health and Safety Plan
Diesel Fuel Release; Julian, NC
Page 11

Signature Sheet

All persons entering the work zone, or visiting the subject site for the purposes associated with the subject
investigation(s), or activities associated with the subject investigation(s) are required to notify the HES
representative on-site immediately upon arrival. All persons entering the work zone, or visiting the subject
site for the purposes associated with the subject investigation(s), or activities associated with the subject
investigation(s) are required to review appropriate health and safety procedures, and provide a signature
documenting they have been properly briefed on health and safety policies and procedures to be followed
while on-site. HES will not be responsible for personal injuries or death resulting from personal actions that
are considered negligent, or that result from personal activities that are contrary to this health and safety plan.

By my signature, I acknowledge that I have been briefed on site specific health and safety procedures,
that I am familiar with said health and safety procedures, and that I will follow all indicated health and
safety procedures while on-site.

Name Signature

491

APPENDIX C

Photograph Number 1: Incident location looking South (12-14-22).

Photograph Number 2: Incident site location, looking West (12-14-22).

Photograph Number 3: Pre-existing abatement measures prior to excavation (12-14-22).

Photograph Number 4: Soil excavation activities (12-14-22).

Photograph Number 5: Impacted soils were loaded and transported off site for final disposal.

Photograph Number 6: Excavation activities (12-14-22).

Photograph Number 7: Final limits of excavation, looking South (12-14-22).

Photograph Number 8: Final limits of excavation, looking West (12-14-22).

Photograph Number 11: Backfilling activities (12-14-22).

Photograph Number 12: Repaired site (12-14-22).
491

APPENDIX D

Field
Collection Date Sample Depth
(feet BGS)
CS-1 10/28/2022 1.0 0.0 ND 9.2
CS-2 10/28/2022 1.0 0.0 ND ND
CS-3 10/28/2022 1.0 19.6 ND ND
CS-4 10/28/2022 1.5 178.0 30.2 31.3
CS-5 10/28/2022 6.0 12.8 4.6 9.4
50 100
Notes:"ND" denotes not detected. "cs" denotes compound specific.
Bold denotes concentration greater than State Action Limits.
Table 1
First Call Environmental /
Diesel Fuel Release Incident - HWY 421 South Bound, near MM 190, Julian, NC
HES Project #340054
Summary of Analytical Data
NCDEQ State Action Limit (mg/kg)Gasoline Range Organics (GRO) (Soil Samples)
Constituent of Concern
Analytical Method (e.g., VOC by EPA 8260B)
Sample ID
Number
PID Screening (ppm)Diesel Range Organics (DRO)UVF
TPH 1 of 1
491

APPENDIX E

Hydrocarbon Analysis Results
Client:HIGHLANDS ENVIRONMENTAL SOLUTIONS Samples taken Wednesday, December 14, 2022
Address:8410-D FALLS OF NEUSE Samples extracted Wednesday, December 14, 2022
RALEIGH NC 27615 Samples analysed Thursday, December 15, 2022
Contact:ROB SHAUT Operator MAX MOYER
Project:#340054
5 F03640
Matrix Sample ID Dilution
used
BTEX
(C6 - C9)
GRO
(C5 - C10)
DRO
(C10 - C35)
TPH
(C5 - C35)
Total
Aromatics
(C10-C35)
16 EPA
PAHs BaP HC Fingerprint Match
% light % mid %
heavy
s CS-1 26.3 <0.66 <0.66 9.2 9.2 4.5 <0.21 <0.026 0 87.3 12.7 Deg.Fuel 48.7%,(FCM)
s CS-2 22.2 <0.56 <0.56 <0.56 0.29 0.29 <0.18 <0.022 0 0 0 ,(FCM),(P)
s CS-3 10.9 <0.27 <0.27 <0.27 0.2 0.2 <0.09 <0.011 0 50.3 49.7 Residual HC,(BO)
s CS-4 23.9 <0.6 30.2 31.3 61.5 6.9 0.26 <0.024 98.5 1.4 0.1 Deg.Diesel 94.2%,(FCM)
s CS-5 27.4 <0.68 4.6 9.4 14 2.2 <0.22 <0.027 96.3 3.4 0.3 Deg.Diesel 81.3%,(FCM)
Initial Calibrator QC check OK Final FCM QC Check OK 100.5 %
Results generated by a QED HC-1 analyser. Concentration values in mg/kg for soil samples and mg/L for water samples. Soil values are not corrected for moisture or stone content
Fingerprints provide a tentative hydrocarbon identification. The abbreviations are:- FCM = Results calculated using Fundamental Calibration Mode : % = confidence for sample fingerprint match to library
(SBS) or (LBS) = Site Specific or Library Background Subtraction applied to result : (PFM) = Poor Fingerprint Match : (T) = Turbid : (P) = Particulate present
Ratios
491

APPENDIX F