WS-3254_9547_CA_RPTS_20140718_ECS StatusUpdate

PROJECT STATUS REPORT
DATE: 07/18/2014

SITE INFORMATION
Site Name Site Address County PIN Lat. / Long. Incident #
Jerry’s Place 983 Highway 21
State Road, Surry County 4953011864476 36.3259656 N/80,867567 W TF-9547

SITE OWNER / OCCUPANT INFORMATION
Name Relationship
to Site Address Phone # e-Mail
Ted & Jamie Roberts Owner 425 Sylvan Road
Thurmon, NC 28683 [phone] NA
Ted’s Used
Truck/Bulldog Gym Occupant 983 Highway 21
State Road, NC 28676 NA NA

Site Access Agreement Yes No If Yes, Date: __________________

RECEPTOR INFORMATION
Potable Wells
Within 1,000 Ft.
Non-Potable Wells
within 250 Ft.
Public Water Available
within 1,000 Ft.
Surface Waters
within 500 Ft.
Wellhead Protection Areas
within 1,500 Ft.
Yes No Yes No No

CONTAMINANT INFORMATION
Free Product Known
GW Violations
GW Plume
Defined
Soil
Contamination
Known Soil
Violations
Soil Plume
Defined
No GCLs Yes Yes Residential yes

CURRENT SCOPE OF WORK

Field Activities Reports

Procure Permits UST Closure Report / IAAR
Access Agreements Monitoring Report
NCDOT Agreement Soil Remediation Report
Install MWs/ RWs Site Check
Sample MWs / WSWs Free Product Check
Receptor Survey Free Product Recovery Report
Soil Sampling LSA
Procure Bids CSA
AFVR / MMPE CAP
Soil Remediation Site Closure Report
UST Removal Other __________________________
Surface Water Sampling
Water Line Connections
Injection
Well Abandonment
NRP / Public Notice NCDENR TASK AUTHORIZATION NUMBER: TA-01
Other _WSW Site Access Letters REPORT DUE DATE: August 14, 2014

SCHEDULE

Services Provided During Week Ending – Saturday, July 12, 2014

• Prepare Report Template

Services Scheduled for Week Ending – Saturday, July 19, 2014

• Prepare Report

Other Notables: