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Home My WebLink AboutWS-29805_48910_CA_UST-61_20230302UST-61 24-Hour Release and UST Leak Reporting Form. For Releases in NC 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 suspected release (DWM USE ONLY) Incident # ________ Risk (H,I,L,U)_______ Received On ________ Received By ________ Reported by (circle one): Phone, Fax or Report Region _______ Suspected Contamination? (Y/N) ________ Confirmed GW Contamination? (Y/N) ______ Confirmed Soil Contamination ?(Y/N) ______ Samples Taken?(Y/N) ______ Free Product? (Y/N) _____ If Yes, State Greatest Thickness ______________ Facility ID Number ______________ Date Leak Discovered ___________ Comm/Non-Commercial? ________ Reg/Non-regulated? _____________ INCIDENT DESCRIPTION Incident Name: Address:County: City/Town: Zip Code: Regional Office (circle one): Asheville, Mooresville, Fayetteville, Raleigh, Washington, Wilmington, Winston-Salem Latitude (decimal degrees): Longitude (decimal degrees) :Obtained by: 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)T GPS T Topographic map T GIS Address matching T Other T Unknown Describe location: HOW RELEASE WAS DISCOVERED (Release Code) (Check one) T Release Detection Equipment or Methods T During UST Closure/Removal T Property Transfer T Visual/Odor T Water in Tank T Water Supply Well Contamination T Groundwater Contamination T Surface Water Contamination T Other (specify) _______________ SOURCE OF CONTAMINATION Source of Release (Check one to indicate primary source) Cause of Release (Check one to indicate primary cause) Type of Release (Check one) Product Type Released (Check one to indicate primary product type released) TTank TPiping TDispenser TSubmersible Turbine Pump TDelivery Problem TOther TUnknown Definitions presented on reverse TSpill TOverfill TCorrosion TPhysical or Mechanical Damage TInstall Problem TOther TUnknown Definitions presented on reverse TPetroleum TNon-Petroleum TBoth Location (Check one) T Facility T Residence T Other T Gasoline/ Diesel/ Kerosene T Heating Oil T Other Petroleum Products T Metals T Other Inorganics T Other Organics T Diesel/Veg. Oil Blend T Vegetable Oil 100% T E10 – E20 T E21 – E84 T E85 – E99 T Ethanol 100% T E01 – E09 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 (02/08)Page 1 of 2 NA N 3/01/23 Y Non-Com Y Non-regulated N NA StriderBuickGMCSubaru 1011 E. Dixie Drive Guilford Asheboro 27203 -79.799086 On February 25, 2023, Pyramid Environmental conducted a Phase II soil assessment at the subject site. Five soil borings were installed inside a auto service garage that previously included in-ground hydraulic lifts. The lab results of 3 samples collected a depth of 7.5-10 ft. in 3 separate borings show DRO and GRO concentrations that exceed the NCDEQ action limits. The lab results of soil samples collected from 12-15 ft. from the same 3 borings indicate no DRO or GRO concentrations that exceed the NCDEQ action limits. See attached lab report and maps. 35.693124 Google Earth 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 Point of Contact Address City State Zip Code Telephone Number UST SYSTEM OPERATOR UST Operator/Company Address City State Zip Code Telephone Number LANDOWNER AT LOCATION OF UST INCIDENT Landowner Address City State Zip Code Telephone Number Draw Sketch of Area (showing two major road intersections) or Attach Map Person Reporting Incident Company Telephone Number Title Address Date UST Form 61 (02/08)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 NA - The hydraulic lifts were taken out of service many years ago when the property was under different ownership. Toby Strider 336-963-2524 Not Applicable - See above Strider Properties, LLC 1011 E. Dixie Drive Asheboro NC 27203 336-963-2524 See attached maps Brett Higgins Pyamid Environmental & Engineering, P.C. :336-335-3174 Sr. Project Manager 503 Industrial Avenue, Greensboro, NC 03/02/23 64(45PQPHSBQIJD.BQ 4USJEFS1SPQFSUJFT --$ &BTU%JYJF%SJWF "TIFCPSP/PSUI$BSPMJOB "TIFCPSP /PSUI$BSPMJOB :-& 3BOEPMQI %6+ h 4USJEFS#VJDL(.$4VCBSV Asheboro, NC 2019 N/A Site Location 'JHVSF 3BOEPMQI4USJEFS1SPQFSUJFT --$ /PSUI$BSPMJOB"TIFCPSP "FSJBM1IPUPHSBQI &BTU%JYJF%SJWF JO_GU hh.HQPRUH 6 W UHH W 6KDQQRQ5G ('L[L H ' UL Y H Vacant / Undeveloped Subject Property Residential Homes Car Wash Hammer Village Shopping Center Calderon Automotive Inc. Residential Homes Truliant Federal Credit Union Residential Homes Goodwill Undeveloped Undeveloped Subject Property 7D[,'JO_GU h h4USJEFS1SPQFSUJFT --$&BTU%JYJF%SJWF"TIFCPSP /PSUI$BSPMJOB"FSJBMXJUI4JUF%FUBJMT%FUBJM#4)#4)&%JYJF%SJWF4IBOO P O 3 EOffices & ShowroomAuto Repair/Service BaysParts StorageAuto Detail ShopUsed Vehicle Sales LotAuto Repair/ Service BaysFormer location of 550-gal gasoline UST removed in 1991. State Lead incident 8860. Closed out NFA on 12/19/22Offices & ShowroomLocation of former in-ground hydraulic lifts where soil contamination was found Hydrocarbon Analysis ResultsClient:PYRAMID ENVIRONMENTALSamples takenSaturday, February 25, 2023Address:503 INDUSTRIAL AVENUESamples extractedSaturday, February 25, 2023GREENSBORO NC 27406Samples analysedWednesday, March 01, 2023Contact:BRETT HIGGINSOperatorMAX MOYERProject:VANN YORK AUTO / 2023 - 03922U04049Matrix Sample IDDilution usedBTEX (C6 - C9)GRO (C5 - C10)DRO (C10 - C35)TPH (C5 - C35)Total Aromatics (C10-C35)16 EPA PAHsBaP HC Fingerprint Match% light % mid% heavys B1A - 2.5-5 FT 21.3 <0.53 2.4 8.3 10.7 4.5 0.23 <0.021 45 43.5 11.5Deg Fuel 76.8%,(FCM)s B2A - 5-7.5 FT 23.2 <0.58 <0.58 <0.58 <0.58 <0.12 <0.19 <0.023 0 0 0PHC not detected,(BO)s B3 - 7.5-10 FT 71.3 <1.8 74 1015 1089 103 11.6 <0.071 75.5 22.9 1.6Waste Oil 87.6%,(FCM)s B3 - 12.5-15 FT 26.0 <0.65 <0.65 <0.65 <0.65 <0.13 <0.21 <0.026 0 0 0PHC not detecteds B4 - 7.5-10 FT 23.9 <0.6 <0.6 0.6 0.6 0.34 <0.19 <0.024 0 54.9 45.1V.Deg.PHC 58.5%,(FCM),(BO)s B5 - 7.5-10 FT 846.0 <42.3 <21.2 425.1 425.1 85.6 <6.8 <0.85 19.4 72.2 8.4Deg.Diesel 81.4%,(FCM)s B5 - 12.5-15 FT 20.6 <0.52 <0.52 1.1 1.1 0.46 <0.17 <0.021 0 88.3 11.7Deg Fuel 54.1%,(FCM)s B6 - 7.5-10 FT 22.2 <0.56 1.6 20.5 22.1 0.92 <0.18 <0.022 83.2 14 2.8Deg.Fuel 83.1%,(FCM)InitialCalibratorQCcheckOKFinalFCMQCCheckOK 98 %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 contentFingerprints 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 presentRatios Hydrocarbon Analysis ResultsClient:PYRAMID ENVIRONMENTALSamples takenSaturday, February 25, 2023Address:503 INDUSTRIAL AVENUESamples extractedSaturday, February 25, 2023GREENSBORO NC 27406Samples analysedWednesday, March 01, 2023Contact:BRETT HIGGINSOperatorMAX MOYERProject:VANN YORK AUTO / 2023-0394U04049Matrix Sample IDDilution usedBTEX (C6 - C9)GRO (C5 - C10)DRO (C10 - C35)TPH (C5 - C35)Total Aromatics (C10-C35)16 EPA PAHsBaP HC Fingerprint Match% light % mid% heavys B7 - 7.5-10 FT 952.0 <23.8 243.9 5447 5691 284.8 31.4 <0.95 71.6 26.7 1.7Waste Oil 92.9%,(FCM)s B7 - 12.5-15 FT 25.0 <0.63 3.2 5.5 8.7 0.54 <0.2 <0.025 96.2 3.5 0.3Deg.Diesel 66.9%,(FCM)s B8 - 1.5-3 FT 21.8 <0.55 <0.55 <0.55 <0.55 <0.11 <0.17 <0.022 0 60.2 39.8Residual HCs B9 - 1.5-2 FT 22.4 <0.56 <0.56 <0.56 <0.56 <0.11 <0.18 <0.022 0 100 0Residual HCInitialCalibratorQCcheckOKFinalFCMQCCheckOK 100.7 %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 contentFingerprints 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 presentRatios QEDHydrocarbonFingerprints Project: VANNYORKAUTO/2023Ͳ039 Wednesday,March01,2023 QEDHydrocarbonFingerprints Project: VANNYORKAUTO/2023Ͳ039 Wednesday,March01,2023