MO-29372_48527_CA_CLO_20220621_UST Leak Reporting Form & UST Closure Report

Mid Atlantic
Engineering & Environmental Solutions
1125 E. Morehead Street, Suite 104
Charlotte, NC 28204-2849
Office: 980. 585.1271
Facsimile: 980. 585.1272
MAAONLINE.COM
June 21, 2022
Mr. Daniel P. Bowser, P.G.
North Carolina Department of Environmental Quality
Underground Storage Tank Section -Corrective Action Branch
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Subject: Residential Heating Oil UST Closure Report & UST-61 Form
Cudia Property — 2114 Salome Church Road
Charlotte, North Carolina 28207
Mid -Atlantic Project No.: 021 H1547.00
Dear Mr. Bowser:
Mid -Atlantic submits our UST Closure Report and UST-61 Form for the above property.
This is being submitted on behalf of our client, Bradford Preparatory School, the
purchaser of the property from the responsible party, the Cudia family. It was discovered
that this release had not been reported during a refinancing of the property by the
current property owner and non -responsible party.
As the refinancing of the property is ongoing, we would appreciate your review and
feedback as soon as practicable. We appreciate your attention to this matter. Please
contact the undersigned should you have any questions.
With best regards,
MID -ATLANTIC ASSOCIATES, INC.
Greg D. Icenhour, P.G., MBA
Principal Geologist
Attachments: UST Closure Report
UST-61 Form
Cameron D. Moore, P.G.
Project Geologist
EXPERIENCED CUSTOMER FOCUSED INNOVATIVE

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 storage tank (UST) system. This form is required to be submitted within 24 hours of discovery of a known or
in NC suspected release
(DWM USE ONLY)
Suspected Contamination? (Y/N) Y
Facility ID Number Unassigned
Incident # Risk (H,I,L,U)
Confirmed GW Contamination? (Y/N) N
Date Leak Discovered 2/17/2021
Received On Received By
Confirmed Soil Contamination ?(Y/N) Y
Comm/Non-Commercial? Non -Comm
Reported by (circle one): Phone, Fax or Report
Samples Taken?(Y/N) y
Reg/Non-regulated? Non -Regulated
Region
Free Product? (Y/N) N If Yes, State Greatest
Thickness N/A
INCIDENT DESCRIPTION
Incident Name: Former Heating Oil UST - 2114 Salome Church Road
Address: 2114 Salome Church Road
County: Mecklenburg
Regional Office (circle one): Asheville, Mooresville, Fayetteville,
City/Town: Charlotte
Zip Code: 28262
Raleigh, Washington, Wilmington, Winston-Salem
Latitude (decimal degrees): N 35.340515 Longitude (decimal degrees) : W-80.717940
Obtained by:
❑GPS
Briefly describe suspected or confirmed release: (including but not limited to: nature of release, date of release, amount
of release, amount of free product present and recovery efforts, initial responses conducted, impacts to receptors)
❑Topographic map
❑GIS Address matching
[g]Other
❑ Unknown
One UST, a 500-gallon capacity heating oil UST, was removed during closure activities on February 17, 2021. Post
excavation soil sampling indicated that soil concentrations above the Action Limit for TPH-DRO (1,120 mg/kg) were
detected in the base of the UST excavation. No water supply wells were identified within 150 feet of the source area,
and groundwater was not encountered within the extent of the excavation. Excavation ceased at five feet below land
Describe location:
surface when rock was encountered.
Google Earth location of UST
HOW RELEASE WAS DISCOVERED (Release code)
(Check one)
❑Release Detection Equipment or Methods ❑Visual/Odor ❑Groundwater Contamination
x]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)
xj Tank ❑ Spill X❑ Petroleum ❑ Gasoline/ Diesel/ ❑ Diesel/Veg. Oil
❑ Piping ❑ Overfill ❑ Non -Petroleum Kerosene Blend
X❑ Heating Oil ❑ Vegetable Oil 100%
❑ Dispenser ❑X Corrosion ❑Both
❑ Other Petroleum ❑ E10 - E20
❑ Submersible Turbine Pump ❑Physical/Mechanical
Location Products
❑ (Check one) Metals Delivery Problem Damage ❑ E21 - E84
❑
❑ Install Problem ❑ E85 - E99
❑ Spill Bucket ❑ Other Inorganics
❑ Other [-]Facility ❑Ethanol 100%
❑ Other ❑ Other Organics
❑ Unknown X❑Residence ❑ E01 - E09
❑ Unknown
❑Other
Definitions presented on reverse
Definitions presented on reverse
Ownership
1. Municipal 2. Military 3. Unknown 4. Private 5. Federal 6. County 7. State
Operation Type
1. Public Service 2. Agricultural 3. Residential 4. Education/Relig. 5. Industrial 6. Commercial 7. Mining
UST Form 61 (02/19) Page 1 of 2

IMPACT ON DRINKING WATER SUPPLIES
Water Supply Wells Affected? 1. Yes 2. No 3. Unknown
Number of Water Supply Wells Affected
Water Supply Wells Contaminated: (Include Users Names, Addresses and Phone Numbers. Attach additional sheet if necessary)
1.
2.
3.
UST SYSTEM OWNER
UST Owner/Company
Benigno Cudia, Aurora Cudia, and Benjamin Cudia
Point of Contact
Address
Cameron Moore
2114 Salome Church Road
City
State
Zip Code
Telephone Number
Charlotte
NC
28262
704-230-8059
UST SYSTEM OPERATOR
UST Operator/Company
Address
Same as UST System Owner
City
State
Zip Code
Telephone Number
LANDOWNER AT LOCATION OF UST INCIDENT
Landowner
Address
Same as UST System Owner
City
State
Zip Code
Telephone Number
Draw Sketch of Area (showing two major road intersections) or Attach Map
SEE ATTACHED MAPS
Person Reporting Incident Cameron Moore
Company Mid -Atlantic Associates, Inc.
Telephone Number 980-585-1271
Title Project Geologist
Address 1125 E. Morehead St. Suite 104, Charlotte, NC 28204
Date 06/17/2022
UST Form 61 (02/19)
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

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CONTOUR INTERVAL = 10 FEET
REFERENCES: SCALE:1:24,000
1. USGS TOPOGRAPHIC QUADRANGLE:
HARRISBURG, NC - 2019 0 1,000 2,000 4,000
2. INSET MAP DATA DOWNLOADED FROM DATA.GOV Feet
DRAWN DATE:
BY: MARCH 2O21
SITE LOCATION MAP DRAFT JOB NO:
IN Mid Atlantic 2114 SALOME CHURCH ROAD CHECK: CDM 021H1547.00
Eng.neering 6 Environmental Solutions CHARLOTTE, NORTH CAROLINA ENG. GIS NO:
CHECK: 05G-H 1547.00-01
APPROVAL: GD1 DWG NO: 1

�. `f ' '' .;;;;`' LOCATION � `•
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+ r
1
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Legend
UNDERGROUND
r STORAGE TANK
y, (UST)
; 2114 SITE BOUNDARY
m
+ STREET
PARCEL
BOUNDARY
� r �
SCALE:1:480
0 20 40 80 120 160
Feet
DRAWN BY: f DATE: MARCH 2O21
UST LOCATION MAP DRAFT CHECK JOB NO.: 021H1547.00
MidAtlantic 2114 SALOME CHURCH ROAD BY CDM
Engineering & Environmental Solutions
CHARLOTTE, NORTH CAROLINA -BY:
YGINEERCHECK GIS NO.: 05G-H1547.00-02
APPROVED
DRAWING NO.: 2
REFERENCE: 2020 AERIAL IMAGERY, PARCEL, AND ROAD GIS DATA FROM MECKLENBURG COUNTY GIS. MID -ATLANTIC FIELD NOTES.

UST CLOSURE REPORT
2114 SALOME CHURCH ROAD
CHARLOTTE, MECKLENBURG COUNTY, NORTH CAROLINA
MID -ATLANTIC JOB NO. 021 H1547.00
Risk Classification: Unassigned
Land Use: Residential
Latitude: N 35.340515
Longitude: W-80.717940
Date Discovered: February 17, 2021
Estimated Quantity of Release: Unknown
Cause/Source of Release: Heating Oil UST
Prepared For:
Mr. Darius Grady
HEPACO, LLC.
2711 Burch Drive
Charlotte, North Carolina 28269
Prepared By:
Mid -Atlantic Associates, Inc.
1125 E. Morehead Street, Suite 104
Charlotte, North Carolina 28204
March 10, 2021
Mid Atlantic
Engineering & Environmental Solutions

A. Site Information
Site Identification
D Date of Report: March 10, 202
D Facility I.D.: NIA UST Incident Number (if known): NIA
Y Site Name: Single Family Residential Mom_e at 2114 Salome Church Road
A Site Street Address: 2114 Salome Churr_goad _
D CltyiTown: Charlotte Zip Code: 28262 County:_ _ Mecklenhurg County
➢ Description of Geographical Data Point (e.g. diesel fill port): Nome Heating Oil Tank
D Location method (GPS, topographical map, other): ggpqle Earth Software
> latitude (decimal degrees): 35.340515° N Longitude (decimal degrees):-80.717940° W
Information about Contacts Associated with the Release (Addresses must include street, city, state, rip code and mailing
address, if different).
UST Owner: 8enigno _Cudia, Aurora Cudia, and Benjamin Cudla_ _
D Address: 2114 Salome_ Church Road, Charlotte, NC 28207 Phone:
UST Operatcr: NIA
D Address: Phone:
D Property Owner: Same as UST Owner
A Address: Same as UST Owner Phone-. Same
➢ Property Occupant: Same as UST Owner _
➢ Address: Phone:
Y Consultant/Contractor:— Mid -Atlantic Associates. Inc.
A Address., 1125 E. Morehead %reet, Charlotte, NC 28204 Phone: _(980) 586-1271
D Analytical Laboratory: Pace Analytical _ State Certification No. 32.9
A Address:106 Vantage Point Drive, West Calumbi2 SC 29172 Phone: [phone]
Information about Release:
A Date Discovered: _. February 17, 2021
D Estimated Quantity of Release:_ _ Unknown _
Cause of Release Corrosion of UST system.
9 Source of Release (e.g. Dlspenser/PipinglUST) _UST
9 Sizes and Contents of UST(s) (or other Containment from which the release occurred): One 500-galion heating oil UST
Certification (Tice title page must display the seal and signature of the certifying PE. or L.G. and the name and
certify caftan number of the company or corporation, if applicable (See 15A NCAC 2LO103(e)1.)
I, Cameron D, Moore _ , a Professional Engineer! icensed eologist (circle
one) for Mid -Atlantic Associates Inc. (firm or company of employment), do certify that the information con arced in this report is
Correct and accurate to the treat of my knowledge.
(Please Aix Sear and Signature)
Mid-AllanticlAssacistes_Ipq. (Name of Company or Corporation) is licensed to practice geology/engineeflng (circle one or both) in North
Carolina. The certification number of the companpive ptlt'8t46 is C-186 and_F-0967
CARO
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Mid Atlantic
Engineering & Environmental Solutions

r..
Mid Atlanb'c
Engineering & Environmental SaWtions
409 Rogers View Court.
Raleigh, NC 27610
office 919.250.9918
facsimile 919.250.995D
MAAONLINE.COM
UST CLOSURE REPORT
500-GALLON HEATING OIL UST
2114 SALOME CHURCH ROAD
CHARLOTTE, MECKLENBURG COUNTY, NORTH CAROLINA
March 10, 2021
Mid -Atlantic Job No. 021 H1547.00
Prepared For: Prepared By:
HEPACO, LLC.
2711 Burch Drive
Charlotte, North Carolina 28269
MID -ATLANTIC ASSOCIATES, INC.
�/Ltew�-
Cameron D. Moore, P.G.
Project Geologist
Greg D. Icenhour, P.G.
Principal Geologist
EXPERIENCED CUSTOMER FOCUSED INNOVATIVE

TABLE OF CONTENTS
1.0 SITE HISTORY AND CHARACTERIZATION..............................................................................1
1.1
Introduction................................................................................................................1
1.2
Owner/Operator of the UST.......................................................................................1
1.3
Property Owner..........................................................................................................1
1.4
Facility Information.....................................................................................................1
1.5
Contacts.....................................................................................................................2
1.6
UST Information.........................................................................................................2
1.7
Site Characteristics....................................................................................................2
1.8
Summary of Activities Performed To Date................................................................2
2.0 UST CLOSURE PROCEDURES..................................................................................................3
2.1
Pre -Closure Procedures............................................................................................3
2.2
Excavation Procedures..............................................................................................3
2.3
Excavated Soil...........................................................................................................3
2.4
Sampling Procedures.................................................................................................3
2.5
Quality Control Measures..........................................................................................4
2.6
Investigative Results..................................................................................................4
3.0 REGULATORY STATUS..............................................................................................................4
4.0 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
a]:7_Vi9IzccRI
Drawing 1 Topographic Site Map
Drawing 2 UST Location Map
TABLES
Table 1 UST Information
Table 2 Soil Sampling Results
APPENDICES
5
Appendix A UST Disposal Documentation
Appendix B Photo Log
Appendix C Laboratory Analytical Report and Chain -of -Custody Record for
Soil Samples
Mid Atlantic
Engineering & Environmental Solutions

UST Closure Report March 10, 2021
2114 Salome Church Road Page 1
Charlotte, North Carolina
1.0 SITE HISTORY AND CHARACTERIZATION
1.1 Introduction
The subject site is the location of a single-family residential home. The subject site is
located at 2114 Salome Church Road, Charlotte, Mecklenburg County, North Carolina
(Drawing 1). During field activities on February 17, 2021, HEPACO employees
uncovered and removed a 500-gallon capacity heating oil underground storage tank
(UST). The location of the former UST is shown on Drawing 2.
This report presents background information; a summary of the UST removal and closure
assessment procedures; documentation of the over -excavation of contaminated soil; the
laboratory analytical results; and our findings, conclusions and recommendations. The
opinions included herein are based on our experience and the information obtained during
the study. This report is based on limited observations made on the dates noted using the
procedures described herein. If additional information becomes available, we request the
opportunity to review the information, reassess the potential environmental concerns and
modify our conclusions and recommendations, if appropriate.
1.2 Owner/Operator of the UST
Benigno Cudia, Aurora Cudia, & Benjamin Cudia
2114 Salome Church Road
Charlotte, North Carolina 28262
1.3 Property Owner
Benigno Cudia, Aurora Cudia, & Benjamin Cudia
2114 Salome Church Road
Charlotte, North Carolina 28262
1.4 Facility Information
2114 Salome Church Road
Charlotte, North Carolina 28262
Latitude: 35.440515' N
Longitude:-80.717940' W
Mid Atlantic
Engineering & Environmental Solutions

UST Closure Report
2114 Salome Church Road
Charlotte, North Carolina
1.5 Contacts
Closure Contractor:
HEPACO, LLC.
2711 Burch Drive
Charlotte, North Carolina 28269
Consultant: Mid -Atlantic Associates, Inc.
1125 E. Morehead Street
Suite 104
Charlotte, North Carolina 28204
[phone]
Mr. Troy L. Holzschuh
Laboratory: Pace Analytical
106 Vantage Point Drive
West Columbia, South Carolina 29172
[phone]
Mr. Michael Kilpatrick
1.6 UST Information
March 10, 2021
Page 2
One 500-gallon capacity heating oil UST was used at the subject site to provide fuel for
the associated former residence. See Drawing 2 for the former location of the tank and
Table 1 for UST Information.
1.7 Site Characteristics
The subject site is the location of a single-family residential home. The area surrounding
the subject site is residential. Surface drainage is generally to the east. An unnamed
tributary of Mallard Creek runs approximately 1000 feet to the southeast of the subject site.
According to the North Carolina Department of Environment and Natural Resources
(NCDENR), Division of Water Resources (DWR) webpage, Mallard Creek is a Class C
waterbody. During UST closure excavation activities, stained soils exhibiting a petroleum
odor were encountered in the subsurface adjacent to the UST system. Groundwater was
not encountered during excavation activities.
1.8 Summary of Activities Performed To Date
The subject parcel has no known previous releases. The subject UST was excavated on
February 17, 2021.
'�•- Mid Atlantic
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UST Closure Report March 10, 2021
2114 Salome Church Road Page 3
Charlotte, North Carolina
2.0 UST CLOSURE PROCEDURES
2.1 Pre -Closure Procedures
Prior to removal, HEPACO personnel ensured the tank was empty and free of potentially
hazardous vapors.
2.2 Excavation Procedures
The top of the UST was located approximately 2 feet below land surface (BLS). Soil was
initially removed from the top and three sides of the UST so that it could be removed from
the excavation. Upon removal of the tank, heavy corrosion and pitting were noted along
the bottom of the UST. HEPACO removed the UST from the excavation, loaded it onto a
trailer and transported the UST to Zero Waste of Charlotte, North Carolina. A UST
Disposal certificate is included in Appendix A. A photographic log documenting
excavation activity on site is provided in Appendix B.
2.3 Excavated Soil
Tank overburden soil removed from the excavation was screened for evidence of
volatile organic vapors with a Flame Ionization/Photo Ionization Detector combination
unit (FID/PID). During removal activities, the FID/PID was used to determine the
presence of potentially contaminated soils. No potentially contaminated soils were
encountered while removing the first three feet of overburden soil from the UST. The
FID/PID combination unit recorded field screening values between 35 and 55 parts per
million (ppm) from soils removed in the four to five foot below land surface (BLS) range.
The top of the UST was located approximately one foot BLS. Excavation ceased at 5
feet BLS where rock was encountered. No contaminated soil was removed from the
site during this UST closure.
2.4 Sampling Procedures
Upon UST removal, one closure soil sample UST-1 (5) was collected according to
procedures outlined in the NCDENR's Underground Storage Tank Section Guidelines for
Site Checks, Tank Closure, and Initial Response and Abatement. The closure sample was
collected from the native soil below the former UST at an approximate depth of 5 feet BLS.
The sample was placed into pre -labeled, laboratory -supplied glassware, placed into an
ice -filled cooler and transported under chain -of -custody to Pace Analytical (Pace) in West
Columbia, South Carolina for analysis of total petroleum hydrocarbons gasoline range
organics (TPH-GRO) and diesel range organics (TPH-DRO) by EPA Methods 5035 and
3550, respectively.
Ob Mid Atlantic
Engineering & Environmental Solutions

UST Closure Report
2114 Salome Church Road
Charlotte, North Carolina
2.5 Quality Control Measures
March 10, 2021
Page 4
The UST closure sample was collected from the track hoe bucket. New nitrile gloves were
worn during the collection and handling of the soil. Each sample was placed into pre -
labeled, laboratory -supplied glassware, placed into an ice -filled cooler and shipped under
chain -of -custody control to Pace for analysis.
2.6 Investigative Results
A laboratory analytical report for the UST closure soil sample is provided in Appendix C
and summarized in Table 2. As summarized, the closure sample UST-1 (5) exhibited
DRO concentrations exceeding the NCDENR UST Section's action level of 100 milligrams
per kilogram (mg/Kg).
3.0 REGULATORY STATUS
UST closure soil sampling indicated that a release had occurred from the UST. The UST
is a non -regulated, non-commercial tank based on the capacity being less than 1,000
gallons and contained heating oil that was oil on the premises where stored. For releases
from non -regulated non-commercial USTs, the responsible party is required to take action
to address any emergency conditions, such as vapor, fire, explosion hazards, or imminent
threats to public health, safety, welfare, or the environment. However, the responsible
party is not required to comply with the initial response and initial abatement action
requirements of 15A NCAC 2N .0702, 30703, and .0705, and 15A NCAC 2L .004(1),
unless specifically directed to by the NCDEQ based upon risk posed by the release.
Post excavation soil sampling indicates that soil concentrations above the Action Limit for
TPH-DRO were detected in the base of the UST excavation. No water supply wells were
identified within 150 feet of the source area, and groundwater was not encountered within
the extents of the excavation. As such, the subject site is considered low risk.
Mid Atlantic
Engineering & Environmental Solutions

UST Closure Report March 10, 2021
2114 Salome Church Road Page 5
Charlotte, North Carolina
4.0 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
UST closure and initial abatement activities are summarized as follows:
• One UST, a 500-gallon capacity heating oil UST, was removed during closure
activities;
• No petroleum -contaminated soil was excavated or transported off -site for disposal;
• Based on the laboratory results for the post -excavation confirmatory soil sample,
the base of the former UST area contains soil above NCDEQ standards; and,
• The site is considered low risk according to the NCDEQ Guidelines for Site Checks,
Tank Closure, and Initial Response and Abatement for UST Releases.
Mid Atlantic
Engineering & Environmental Solutions

DRAWINGS
Mid Atlantic
Engineering & Environmental Solutions

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Lincoln
Concord
•
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AREA SHOWN WITHIN
NORTH CAROLINA
RP
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Stowes
Chapel
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t- T
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o M�R91y fpRp UR ­RSHAM PR
a G"eNl; LN
CONTOUR INTERVAL = 10 FEET
REFERENCES: SCALE:1:24,000
1. USGS TOPOGRAPHIC QUADRANGLE:
HARRISBURG, NC - 2019 0 1,000 2,000 4,000
2. INSET MAP DATA DOWNLOADED FROM DATA.GOV Feet
DRAWN DATE:
BY: MARCH 2O21
SITE LOCATION MAP DRAFT JOB NO:
IN Mid Atlantic 2114 SALOME CHURCH ROAD CHECK: CDM 021H1547.00
Eng.neering 6 Environmental Solutions CHARLOTTE, NORTH CAROLINA ENG. GIS NO:
CHECK: 05G-H 1547.00-01
APPROVAL: GD1 DWG NO: 1

�. `f ' '' .;;;;`' LOCATION � `•
i -
+ r
1
Ar
I;
Legend
UNDERGROUND
r STORAGE TANK
y, (UST)
; 2114 SITE BOUNDARY
m
+ STREET
PARCEL
BOUNDARY
� r �
SCALE:1:480
0 20 40 80 120 160
Feet
DRAWN BY: f DATE: MARCH 2O21
UST LOCATION MAP DRAFT CHECK JOB NO.: 021H1547.00
MidAtlantic 2114 SALOME CHURCH ROAD BY CDM
Engineering & Environmental Solutions
CHARLOTTE, NORTH CAROLINA -BY:
YGINEERCHECK GIS NO.: 05G-H1547.00-02
APPROVED
DRAWING NO.: 2
REFERENCE: 2020 AERIAL IMAGERY, PARCEL, AND ROAD GIS DATA FROM MECKLENBURG COUNTY GIS. MID -ATLANTIC FIELD NOTES.

TABLES
Mid Atlantic
Engineering & Environmental Solutions

TABLE 1
UST SYSTEM INFORMATION
2114 SALOME CHURCH ROAD
CHARLOTTE, MECKLENBURG COUNTY, NORTH CAROLINA
MID -ATLANTIC JOB NO: 021H1547.00
Release
UST ID
Current/Last
Previous
Capacity
Tank
Construction
Date Installed
Status of UST
Associated
Number
Contents
Contents
(Gallons)
Dimensions
Details
with System?
Single -walled
Removed
0001
Heating Oil
Same
500
36"-D X 96"-L
Unkown
Yes
steel
2/17/2021

TABLE 2
SOIL SAMPLING RESULTS
2114 SALOME CHURCH ROAD
CHARLOTTE, NORTH CAROLINA
MID -ATLANTIC PROJECT NO.: 0211-11547.00
Method
TPH
Action Level
50
100
Sample Depth
PID Measurement
GRO
DRO
Sample
Sample Date
(FT)
(PPM)
(mg/kg)
(mg/kg)
UST-1 5'
02/17/21
5
52.0
< 1.0
1,120
Notes:
mg/kg - milligrams per kilogram
Bold values exceed the NCDEQ Action Level

APPENDIX A
UST DISPOSAL
DOCUMENTATION
'�•- Mid Atlantic
Engineering & Environmental Solutions

NONHAZARDOUS
I. Ganeralar* Nombar
2; Pogo i o[.
1 EmArgency Raspanse Phone
c. waste Tracking Number
;.
WASTE MANIFEST
S. Gannmipr'S Name and Mallh> Address Gancratcr's Site Address fI dllferani than m'alling address)
Genaratar's Phone:
i
6. Transpador 1 Company Name U,S, FPA ID Number
7. Transporiar 2 Company Name US. EPA ID Number
8, Deslgnalod I'Millly Mama and Silo Address U.B. EPA ID Number
y4
Fadllt 's Phone -far- q43 ig
-
9. Waste ShOping Nama and Descrlpllan 10. Contalnera il. Told f2, Unit
Na. o Quarnily WUVol,
TyP
s
> :
y:.
64
W
I$, &po;lpl Handling Inslnrslions and Addhiaeal Informalloh
% GiN RATOR-8/OFFERCR'S CE'RTIFICA71ON: I hereby declare Oat tho conlenio of This conolghmodl ago iully dnc a0wrately descabod o4ove by Wo propor shipping name, and are ctasaMed, packaged,
inagked'and lahalad ararcied, and are In al mspeets In proper condllion for IranFporl aaeording to appllCaO Inlamallanal and ndilandl gowmmental reguialions,
i
GoneralatarDigarar a PrintsdlTypod Name Slgnaiule Monih Day Year
u
itx lntamaliannl SMpmanle ❑ Impod to U.B. ❑ Fxport irum u&. PAR of enlryfoxll:
Tens ader 5 naltre or ex cds on : Pals leaving U.S.:
rx
16, Transporter AckrWadgment of Reaetpt of Materials
T
Ira r t PdMe ypod Nam Signelure Month Day Year
Transpadar 2,PrinledlTypnd Name Slgealure Month Day Year
S7: D 500parlty.
ITu. Dlicrepsncy uldlCallon Space Qupnllly ❑ Typo ❑ Hooldue ❑ Pedial Rajeollan ❑ Full Raleotion
WHIM Referanoa Number:
17b, Allomaio Facility (orGanaralor) U.S. EPA IDNumbar
Fadlity'a Phone:
. tk Slgnatureof Allelllalo Faclllly (ar Gerleralaq Munih D&y Year
e
Ia. f)esignaled PacRy sooner or Operator. CCrillicofran of mcalpi of Malaria Is cavpred by the donifasl ezca'pl as noted fh Item S
Pri d pad Name Sign Month Day Yew
I II
I— - 7l-
169.OLC-0 5 11977 (Rov. 9109) DE-SK-k dlll"-r M FACILITYTO GENERATOR

APPENDIX B
PHOTO LOG
Mid Atlantic
Engineering & Environmental Solutions

' 11irr, K

Moto ,
- A
0 'V rr, K

�vm- N,
4
L
i E

UST Closure Report March 10, 2021
2114 Salome Church Road, Charlotte, NC Appendix B
Photograph 6: View of the UST pit after the tank was removed.
Mid Atlantic
Engineering & Environmental Solutions

APPENDIX C
LABORATORY ANALYTICAL REPORT
AND CHAIN -OF -CUSTODY RECORD
FOR SOIL SAMPLES
Mid Atlantic
Engineering & Environmental Solutions

�t
w
W44
i
aceAnalXical o ANALYTICAL
tional Center for Testing &Innovation March 03, 2021
Mid -Atlantic Associates, Inc.
Sample Delivery Group: L1319515
Samples Received: 02/24/2021
Project Number: 021H1547
Description:
REPORT
Report To: Mr. Chuck Hoffman
409 Rogers View Court
Raleigh, NC 27610
Entire Report Reviewed By
iLllc�'
T. Alan Harvill
Project Manager
Results relate only to the items tested or calibrated and are reported as rounded values. This test report shall not be
reproduced, except in full, without written approval of the laboratory. Where applicable, sampling conducted by Pace
Analytical National is performed per guidance provided in laboratory standard operating procedures ENV-SOP-MTJL-0067 and
ENV-SOP-MTJL-0068. Where sampling conducted by the customer, results relate to the accuracy of the information provided,
and as the samples are received.
M
FSS
4
Cn
FSr
FC-1
E7GI
rAl
FSC
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
Mid -Atlantic Associates, Inc. 021H1547 L1319515 03/03/21 16:24 1 of 11

TABLE OF CONTENTS
ONE LAB. NATIONWIDE.
Cp: Cover Page
1
Fn
Tc: Table of Contents
2
Ss: Sample Summary
3
Cn: Case Narrative
4
Sr: Sample Results
5
FS
UST-1 (5') L1319515-01
5
[Cn]
Qc: Quality Control Summary
6
Total Solids by Method 2540 G-2011
6
Fr
Volatile Organic Compounds (GC) by Method 8015C
7
Semi -Volatile Organic Compounds (GC) by Method 8015C
8
RC
GI: Glossary of Terms
9
F
Al: Accreditations & Locations
10
Sc: Sample Chain of Custody
11
rAl
FSC
ACCOUNT: PROJECT: SDG:
DATE/TIME: PAGE:
Mid -Atlantic Associates, Inc. 021H1547 L1319515
03/03/21 16:24 2 of 11

SAMPLE SUMMARY ONE LAB. NATIONWIDE.
Collected by Collected date/time Received date/time
UST-1 (5') L1319515-01 Solid Troy Holzschuh 02/17/2113:00 02/24/2110:30 , C
P
Method
Batch
Dilution Preparation
Analysis Analyst
Location
date/time
date/time
Total Solids by Method 2540 G-2011
WG1627359
1 03/02/2109:44
03/02/2109:58 KDW
Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015C
WG1626192
25 02/17/2113:00
02/26/2122:39 ADM
Mt. Juliet, TN
Semi -Volatile Organic Compounds (GC) by Method 8015C
WG1626149
5 02/28/2107:45
02/28/2117:18 JN
Mt. Juliet, TN
ACCOUNT:
PROJECT:
SDG:
DATE/TIME:
PAGE:
Mid -Atlantic Associates, Inc.
021H1547
L1319515
03/03/21 16:24
3 of 11
FTC
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CASE NARRATIVE
ONE LAB. NATIONWIDE.
All sample aliquots were received at the correct temperature, in the proper containers, with the FP1
appropriate preservatives, and within method specified holding times, unless qualified or notated within
the report. Where applicable, all MDL (LOD) and RDL (LOQ) values reported for environmental samples FTChave been corrected for the dilution factor used in the analysis. All Method and Batch Quality Control
are within established criteria except where addressed in this case narrative, a non-conformance form
or properly qualified within the sample results. By my digital signature below, I affirm to the best of my FSS
knowledge, all problems/anomalies observed by the laboratory as having the potential to affect the
quality of the data have been identified by the laboratory, and no information or data have been
knowingly withheld that would affect the quality of the data.
FSr
6
QC
r �GI
iz
T. Alan Harvill FAI
Project Manager
FSC
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
Mid -Atlantic Associates, Inc. 021H1547 L1319515 03/03/21 16:24 4 of 11

UST-1 (5')
Collected date/time: 02/17/21 13:00
Total Solids by Method 2540 G-2011
SAMPLE RESULTS - 01
L1319515
Result Qualifier Dilution Analysis
Analyte % date / time
Total Solids 81.7 1 03/02/202109:58
Volatile Organic Compounds (GC) by Method 8015C
Batch
WG1627359
Result (dry) Qualifier MDL (dry) RDL (dry) Dilution Analysis
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 0.819 3.77 25 02/26/202122:39
(S) a, a, a-Trifluorotoluene(FID) 97.5 77.0-120 02726/202122:39
Semi -Volatile Organic Compounds (GC) by Method 8015C
Analyte
TPH (GC/FID) High Fraction
(S) o-Terphenyl
Result (dry) Qualifier MDL (dry) RDL (dry) Dilution Analysis
mg/kg mg/kg mg/kg date / time
1120 4.71 24.5 5 02/28/202117:18
148 18.0-148 02728/20211718
ONE LAB. NATIONWIDE.
FP1
FTC
FSS
Batch
4
Cn
WG1626192
WG1626192
6
QC
Batch
WG1626149
G I
WG1626149
FAI
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Mid -Atlantic Associates, Inc. 021H1547 L1319515 03/03/21 16:24 5 of 11

WG1627359
Total Solids by Method 2540 G-2011
Method Blank (MB)
(MB) R3626828-1 03/02/21 09:58
MB Result MB Qualifier MB MDL
Analyte % %
Total Solids 0.00200
L1319517-03 Original Sample (OS) • Duplicate (DUP)
MB RDL
(OS) L1319517-03 03/02/21 09:58 • (DUP) R3626828-3 03/02/21 09:58
Original Result DUP Result Dilution DUP RPD
Analyte % %
Total Solids 88.3 87.1 1 1.37
Laboratory Control Sample (LCS)
(LCS) R3626828-2 03/02/21 09:58
Spike Amount LCS Result LCS Rec.
Analyte % %_ %
Total Solids 50.0 50.0 100
QUALITY CONTROL SUMMARY
L1319515-01
DUP Qualifier DUP RPD
Limits
10
Rec. Limits LCS Qualifier
o/
85.0-115
ONE LAB. NATIONWIDE.
— I
Cp
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FSS
4
— Cn
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— �GI
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ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
Mid -Atlantic Associates, Inc. 021H1547 L1319515 03/03/2116:24 6 of11

WG1626192
Volatile Organic Compounds (GC) by Method 8015C
Method Blank (MB)
QUALITY CONTROL SUMMARY
L1319515-01
(MB) R3625698-3 02/26/21 13:24
MB Result MB Qualifier MB MDL
MB RDL
Analyte
mg/kg mg/kg
mg/kg
TPH (GC/FID) Low Fraction
U 0.0217
0.100
(S)
o, o, o-Trifluorotoluene(FID)
96.4
77.0-120
Laboratory Control Sample (LCS)
(LCS) R3625698-1 02/26/21 12:21
Spike Amount LCS Result LCS Rec. Rec. Limits LCS Qualifier
Analyte mg/kg mg/kg % %
TPH (GC/FID) Low Fraction 5.50 5.84 106 72.0-127
(S) 106 77.0-120
a, a, a- Trifluorotoluene(FID)
L1319231-02 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1319231-02 02/26/21 21:37 • (MS) R3625698-4 02/27/21 04:18 • (MSD) R3625698-5 02/27/21 04:39
Spike Amount
Original Result
MSD Result
MS Result (dry) MS Rec. MSD Rec.
(dry)
(dry)
(dry)
Analyte
mg/kg
mg/kg
mg/kg mg/kg % %
TPH (GC/FID) Low Fraction
70.1
4.27
82.9 89.1 112 121
oo-Trifluorotoluene(FID)
a,,
112 114
Dilution Rec. Limits MS Qualifier MSD Qualifier RPD
25 10.0-151 7.23
77.0-120
ONE LAB. NATIONWIDE.
RPD Limits
28
FP1
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ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
Mid -Atlantic Associates, Inc. 021H1547 L1319515 03/03/2116:24 7 of11

WG1626149
Semi -Volatile Organic Compounds (GC) by Method 8015C
Method Blank (MB)
(MB) R3625954-1 02/28/21 13:57
MB Result MB Qualifier MB MDL MB RDL
Analyte mg/kg mg/kg mg/kg
TPH (GC/FID) High Fraction U 0.769 4.00
(S) o-Terpheny/ 81.5 18.0-148
Laboratory Control Sample (LCS)
QUALITY CONTROL SUMMARY
L1319515-01
(LCS) R3625954-2 02/28/21 14:11
Spike Amount LCS Result LCS Rec. Rec. Limits LCS Qualifier
Analyte mg/kg mg/kg % %
TPH (GC/FID) High Fraction 50.0 38.1 76.2 50.0-150
(S) o-Terpheny/ 84.5 18.0-148
L1319470-02 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
ONE LAB. NATIONWIDE.
(OS) L1319470-02 02/28/21 14:24 • (MS) R3625954-3 02/28/21 14:38 • (MSD) R3625954-4 02/28/21 14:51
Spike Amount
Original Result MS Result
MSD Result MS Rec.
MSD Rec.
Dilution Rec. Limits
MS Qualifier MSD Qualifier RPD RPD Limits
Analyte mg/kg
mg/kg mg/kg
mg/kg %
%
%
% %
TPH (GC/FID) High Fraction 48.5
U 23.7
29.5 48.9
60.7
1 50.0-150
J6 J3 21.8 20
(S) o-Terphenyl
53.7
62.3
18.0-148
ACCOUNT:
PROJECT:
SDG:
DATE/TIME: PAGE:
Mid -Atlantic Associates, Inc.
021H1547
L1319515
03/03/2116:24 8 of11
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GLOSSARY OF TERMS
ONE LAB. NATIONWIDE.
Guide to Reading and Understanding Your Laboratory Report
The information below is designed to better explain the various terms used in your report of analytical results from the Laboratory. This is not
intended as a comprehensive explanation, and if you have additional questions please contact your project representative.
Results Disclaimer - Information that may be provided by the customer, and contained within this report, include Permit Limits, Project Name,
Sample ID, Sample Matrix, Sample Preservation, Field Blanks, Field Spikes, Field Duplicates, On -Site Data, Sampling Collection Dates/Times, and
Sampling Location. Results relate to the accuracy of this information provided, and as the samples are received.
Abbreviations and Definitions
(dry)
Results are reported based on the dry weight of the sample. [this will only be present on a dry report basis for soils].
MDL
Method Detection Limit.
MDL (dry)
Method Detection Limit.
RDL
Reported Detection Limit.
RDL (dry)
Reported Detection Limit.
Rec.
Recovery.
RPD
Relative Percent Difference.
SDG
Sample Delivery Group.
Surrogate (Surrogate Standard) - Analytes added to every blank, sample, Laboratory Control Sample/Duplicate and
(S)
Matrix Spike/Duplicate; used to evaluate analytical efficiency by measuring recovery. Surrogates are not expected to be
detected in all environmental media.
U
Not detected at the Reporting Limit (or MDL where applicable).
Analyte
The name of the particular compound or analysis performed. Some Analyses and Methods will have multiple analytes
reported.
If the sample matrix contains an interfering material, the sample preparation volume or weight values differ from the
Dilution
standard, or if concentrations of analytes in the sample are higher than the highest limit of concentration that the
laboratory can accurately report, the sample may be diluted for analysis. If a value different than 1 is used in this field, the
result reported has already been corrected for this factor.
These are the target % recovery ranges or % difference value that the laboratory has historically determined as normal
Limits
for the method and analyte being reported. Successful QC Sample analysis will target all analytes recovered or
duplicated within these ranges.
Original Sample
The non -spiked sample in the prep batch used to determine the Relative Percent Difference (RPD) from a quality control
sample. The Original Sample may not be included within the reported SDG.
This column provides a letter and/or number designation that corresponds to additional information concerning the result
Qualifier
reported. If a Qualifier is present, a definition per Qualifier is provided within the Glossary and Definitions page and
potentially a discussion of possible implications of the Qualifier in the Case Narrative if applicable.
The actual analytical final result (corrected for any sample specific characteristics) reported for your sample. If there was
no measurable result returned for a specific analyte, the result in this column may state "ND" (Not Detected) or "BDL"
Result
(Below Detectable Levels). The information in the results column should always be accompanied by either an MDL
(Method Detection Limit) or RDL (Reporting Detection Limit) that defines the lowest value that the laboratory could detect
or report for this analyte.
Uncertainty
(Radiochemistry)
Confidence level of 2 sigma.
A brief discussion about the included sample results, including a discussion of any non -conformances to protocol
Case Narrative (Cn)
observed either at sample receipt by the laboratory from the field or during the analytical process. If present, there will
be a section in the Case Narrative to discuss the meaning of any data qualifiers used in the report.
Quality Control
This section of the report includes the results of the laboratory quality control analyses required by procedure or
Summary (Qc)
analytical methods to assist in evaluating the validity of the results reported for your samples. These analyses are not
being performed on your samples typically, but on laboratory generated material.
This is the document created in the field when your samples were initially collected. This is used to verify the time and
Sample Chain of
date of collection, the person collecting the samples, and the analyses that the laboratory is requested to perform. This
Custody (Sc)
chain of custody also documents all persons (excluding commercial shippers) that have had control or possession of the
samples from the time of collection until delivery to the laboratory for analysis.
This section of your report will provide the results of all testing performed on your samples. These results are provided
Sample Results (Sr)
by sample ID and are separated by the analyses performed on each sample. The header line of each analysis section for
each sample will provide the name and method number for the analysis reported.
Sample Summary (Ss)
This section of the Analytical Report defines the specific analyses performed for each sample ID, including the dates and
times of preparation and/or analysis.
Qualifier
Description
J3
The associated batch QC was outside the established quality control range for precision.
J6
The sample matrix interfered with the ability to make any accurate determination; spike value is low.
ACCOUNT:
PROJECT: SDG: DATE/TIME: PAGE:
Mid -Atlantic Associates, Inc.
021H1547 L1319515 03/03/21 16:24 9 of 11
FP1
FTC
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[Cn]
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ACCREDITATIONS & LOCATIONS ONE LAB. NATIONWIDE.
Pace National is the only environmental laboratory accredited/certified to support your work nationwide from one location. One phone call, one point of contact, one laboratory. No other lab is as
accessible or prepared to handle your needs throughout the country. Our capacity and capability from our single location laboratory is comparable to the collective totals of the network
laboratories in our industry. The most significant benefit to our one location design is the design of our laboratory campus. The model is conducive to accelerated productivity, decreasing
turn -around time, and preventing cross contamination, thus protecting sample integrity. Our focus on premium quality and prompt service allows us to be YOUR LAB OF CHOICE.
Not all certifications held by the laboratory are applicable to the results reported in the attached report.
Accreditation is only applicable to the test methods specified on each scope of accreditation held by Pace National.
Pace Analytical National 12065 Lebanon Rd Mount Juliet, TN, 37122
Alabama
40660
Nebraska
NE-OS-15-05
Alaska
17-026
Nevada
TN000032021-1
Arizona
AZ0612
New Hampshire
2975
Arkansas
88-0469
New Jersey—NELAP
TN002
California
2932
New Mexico
TN00003
Colorado
TN00003
New York
11742
Connecticut
PH-0197
North Carolina
Env375
Florida
_
E87487
North Carolina'
_
DW21704
Georgia
NELAP
North Carolina'
41
Georgia'
923
North Dakota
R-140
Idaho
TN00003
Ohio—VAP
CL0069
Illinois _
200008
Oklahoma
9915
Indiana
C-TN-01
Oregon
TN200002
Iowa
364
Pennsylvania
68-02979
Kansas
E-10277
Rhodelsland
LA000356
Kentucky' 6
KY90010
South Carolina
84004002
Kentucky z
16
South Dakota
n/a
Louisiana
A130792
Tennessee' 4
2006
Louisiana
LA018
Texas
T104704245-20-18
Maine
TN00003
Texas 5
LAB0152
Maryland
324
Utah
TN000032021-11
Massachusetts
M-TN003
Vermont
VT2006
Michigan
9958
Virginia
110033
Minnesota
047-999-395
Washington
C847
Mississippi
TN00003
West Virginia
233
Missouri
340
Wisconsin
998093910
Montana
CERT0086
Wyoming
A21LA
A21LA— ISO 17025
1461.01
AIHA-LAP,LLC EMLAP
100789
A21LA — ISO 17025 5
1461.02
DOD
1461.01
Canada
1461.01
USDA
P330-15-00234
EPA—Crypto
TN00003
ACCOUNT:
PROJECT:
SDG:
DATE/TIME: PAGE:
Mid -Atlantic Associates, Inc.
021H1547
L1319515
03/03/21 16:24 10 of 11
FP1
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CHAIN -OF -CUSTODY Analytical Request Document
_- c3CB.7;1)c7��lCe3�e
Chain -of -Custody is a LEGAL DOCUMENT - Complete all relevent fields
LMIlISEONLY- Affix Woriwrder/Login Label Here or111APam Wrw<rmdusftmderor
MTIL Logan Number Here
8198
ALL SHADED AREAS are for LAB USE ONLY
_
Container Preservative Type•• Lab Project Manager-
u 1 s 1 i
Company: Mid Atlantic Associates
Bolling Information:
409 Rogersview Ct.
Raleigh, NC 27610
Mdress.-1125 E Morehead St
Report To: TroyL. Holzschuh
Email To: boglesby [e-mail]
•• Prmervative
(6) nredwwl,
(C) anwrorrum
Tom: (I) nitriradd, (2) sum
(7) sodiwn blsr ftM (8) sorixrm etvosulfare,
hydnmude, (D) IV, (u) Unpreserved,
add,
(o)
(3) hydruchkiric
(9)
Other
add, (4) smd"n ��dt5) � ate,
hmne. V4 asmrtie add. (g) amru>:m �ilaie
Copy To:
Site Collection I nfo/Address:
u omr" Ame Cheriolte
Analyses
Lab profiejliDc
Customer Project flame/Number.
021H1547
State: County/City: Time Zone Collected:
NCMlecklenburg [ ]PTt [MT[ 1cT (SET
0
17
Q
(7
laid Samle Reteipt Cttecid ist-
Custody Seals Present/Intact(NA
custody Signatures Present
Coll�tHotslesotntact Signature PresentNA
Correct Bottles
Sufficient valme Saerples Received on Ice
VOA - Headspaae Acceptable Y m
USDA Regulated Soils N
Samples is Holding Time 43g V
Residual diiorine present T 4t
Cl strips:
sa.ple pw Acceptable Y au
PH Strips:
Sulfide Present Y 3u�
Lea4 ]acetate Strips:
LAB USE CIEL :
tab S.Uwle s ! cam ts-
P(�e:98Qr5B,rr1271
Email: #v vwhuh@mawdin.00m
Site/Facility ID #:
Compliance Monitoring?
[ ] Yes ( ] No
Collected By (print):
Tro L. Holzschuh
Purchase Order#:
Quote #:
OW PWS 10 #:
DW Location Code:
Collected By (signature):
Turnaround Date Required:
standard
himmeditately Packed on Ice:
Dyes [ ] No
Sample Disposal:
[t11 Dispose as appropriate [ ) Return
[ ) Ard0ve:
[ ]Hold:
Rush:
[ I Same Day [ j Next Day
t ) 2 Day [ ] 3 Pay [ j 4 Day ( ) 5 Day
(Expedite Charges Apply)
Field Filtered (if applicable):
[ ( Yes ( ] No
Analysis:
• Matrix Codes (Insert in Matrix box below): Drinking Water (DW), Ground Water (GW), Wastewater (WW),
Product (P), So#/Solid (SL), Oil (OL), Wipe (WP), Air (AR), Tissue (TS), Bioassay (B), Vapor (V), Other (OT)
Customer Sample ID
Matrix
Comp/
Grab
Collected (or
Composite Start)
Composite End
Res
C1
`of
Ctns
Date
Time
Date
Time
UST-1 (6)
Soil
IS
2-12-21
1300
Customer Remitrts / Special Conditions / Possible Hazards:
Type of Ice Used: Blue Dry None
SHORT HOLDS PRESENT (c72 hours): Y N N/A
Lab Sample Temnp watune Ydo:
Temp Blank � N (i1
�
Cooler � Lipon ^ ,� aC
Coder 1 Therm Corr_ Factor aC
Cooler I Corrected Temp: oC
Comments:
Packing Ma rial L C
�`{'
Lab Tracking g:_ I ' �j �f/�
�7 �!/or+ V
Radchem sample(s) screened (��r Y N NA
Samples received via:
FEDEX UPS bier) courier Pace Courier
Relinquished / y: igna re)
,r _�
' M
Datefrime:
2-98-21 �3,�
Received by/Company: (Signature)
�` I�cL
Date/rime:
�1?-r.t �3r�Table
--�Acctnum:
IIATIL LAB USE OILY
Inquist►ed /Company: gnature)
Date/Time:'Received
/Company: (Signature)
Date,/Tlme:
Template:
.Prelogin-
Trip BDa1tReceired r>Y N
HCL MKIN TV QUM
Relinquished by/Company: {Signature)
Dateffime:
Received/Company: (Signature]
Datefrime: ipM
PB:
Non ,�� ):
YEs /` nu
Page:
of:
` K4PAI

Beverly, Trudy
From: Beverly, Trudy
Sent: Tuesday, June 21, 2022 1:24 PM
To: Bowser, Daniel P; Cameron Moore
Subject: RE: [External] Residential Heating Oil UST Closure Report & UST-61 Form
Received. I'll try to get it reviewed by the end of the week. I'll update you if that should change.
Have a great day,
Trudy
Trudy Beverly, L.G.
Hydrogeologist, Division of Waste Management
ic���D,IEQ North Carolina Department of Environmental Quality
rL�n[O ��" UST Section, Mooresville Regional Office
LMW704.235.2182 (Office)
Trudy. B everlykncdenn 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-manaaement/ust
Branch's Above Ground Storage Tanks Website Address: ht!ps:Hdeg.nc.gov/about/divisions/waste-management/ust/ast-proeram
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):
hops: //deg.nc. gov/about/divisions/waste-management/laserfiche
Document Submittal & UST File Names for Laserfiche Policies:
httys:Hfiles.nc.eov/nedeci/Waste%2OMana2ement/DWM/UST/WhatsNew/Final-Electronic-Document-Submittal-Policy.odf
htips:Hfiles.nc. gov/ncdeq/\Vaste%2OManagement/D WMiUST/Corrective%2OAction/UST%20file%20names%20for%2OLaserfiche.docx
From: Bowser, Daniel P
Sent: Tuesday, June 21, 2022 1:05 PM
To: Cameron Moore <[e-mail]>
Cc: Beverly, Trudy <[e-mail]>
Subject: RE: [External] Residential Heating Oil UST Closure Report & UST-61 Form
Trudy Beverly handles non -regulated incidents in Meck I have copied her on this.
Thank you,
Daniel P. Bowser, PG
Hydrogeologist
North Carolina Department of Environmental Quality
Underground Storage Tank Section - Corrective Action Branch
[phone]
dan.bowser(bncdenr.gov
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.
From: Cameron Moore <[e-mail]>
Sent: Tuesday, June 21, 2022 1:02 PM
To: Bowser, Daniel P <[e-mail]>
Subject: [External] Residential Heating Oil UST Closure Report & UST-61 Form
Importance: High
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Mr. Bowser,
It has recently been discovered that the UST-61 form and UST Closure Report (attached) associated with a petroleum
release in Mecklenburg County have not been reported. As refinancing of the property is currently ongoing, we would
appreciate your review and feedback as soon as practicable.
We appreciate your attention to this matter. Please contact me should you have any questions.
Thank you,
Cameron Moore
'r.
MidAtlantic
Cameron Moore, P.G.
Project Geologist
MID -ATLANTIC ASSOCIATES, INC.
1125 E. Morehead Street, Suite 104 1 Charlotte, NC 28204-2816
980-585-1271 1 980-585-1272 (Facsimile) 1 704-230-8059 (Mobile)
www.MAAONLINE.com I Outstanding Service Since 1993
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