FA-7741_42026_CA_RPTS_20230314_Piping Upgrade Sample Report

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
March 14, 2023

Ms. Pamela D. Harrelson
NCDEQ
Compliance Inspector
1646 Mail Service
Raleigh, NC 27699-1646

Re: UST Product Line Closure Report
Minuteman Food Mart #40
100 Wintergreen Drive
Lumberton, Robeson County
North Carolina
Facility ID Number: 00-0-0000034495
Incident Number: N/A
GRI Project Number: 4222

Dear Ms. Harrelson,

Please find enclosed the referenced report for the above mentioned site.
If you have any questions, please contact Laura Minor at 704-845-4010.

Sincerely,
Geological Resources, Inc.

Leslie Maxtone-Graham
Administrative Assistant

Enclosure

Cc: Ms. Jill Johnson-Smith; The Gas Mart, Inc., file

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
UST Product Line Closure Report
Minuteman Food Mart #40
100 Wintergreen Drive
Lumberton, Robeson County, North Carolina
Facility ID Number: 00-0-0000034495
Incident Number: N/A
GRI Project Number: 4222

Prepared for:

Ms. Jill Johnson-Smith
The Gas Mart, Inc.
Post Office Box 637
Elizabethtown, North Carolina 28337

March 14, 2023

Laura Minor
Project Manager
Xavier T. Farmer, G.I.T.
Staff Scientist

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. UST Product Line Closure Report
Prepared on: March 14, 2023 Minuteman Food Mart #40
Project Manager: Laura Minor GRI Project No. 4222
i
SITE INFORMATION
1. Site Identification
 Minuteman Food Mart #40 (Facility ID 00-0-0000034495)
 Incident Number N/A
 Location of Source Area: 100 Wintergreen Drive (Figure 1)
Lumberton, NC 28312
Robeson County
34.667809°N, 79.002931°W
2. Information about Contacts Associated with the Leaking UST System (Table 1)

UST Owner
Five Star Propane, LLC
P.O. Box 637
Elizabethtown, NC 28337
[e-mail]
910-876-1582

UST Operator
The Gas Mart, Inc.
P.O. Box 637
Elizabethtown, NC 28337
[e-mail]
910-876-1582

Property Owner
RSO Holdings, LLC
P.O. Box 637
Elizabethtown, NC 28337
Email unknown
Phone No. Unknown

Property Occupant
Minuteman Food Mart #40
100 Wintergreen Drive,
Fayetteville, NC 28
Email: Unknown
Phone No. Unknown

Consultant/Contractor
Geological Resources, Inc.
3502 Hayes Road
Monroe, NC 28110
[e-mail]
[phone]

Analytical Laboratory
Geological Resources, Inc.
3502 Hayes Rd.
Monroe, NC 28110
[e-mail]
[phone]

Certification:

I, Samuel L. McKay, a Licensed Geologist for Geological Resources, Inc., do certify that the information
contained in this report is correct and accurate to the best of my knowledge.

Geological Resources, Inc. is licensed to practice geology and engineering in North Carolina. The
certification numbers of the corporation are C-127 and C-2727, respectively.

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. UST Product Line Closure Report
Prepared on: March 14, 2023 Minuteman Food Mart #40
Project Manager: Laura Minor GRI Project No. 4222
ii
EXECUTIVE SUMMARY
The Minuteman Food Mart #40 site is located at 100 Wintergreen Drive in Lumberton, Robeson County,
North Carolina. The property operates as a petroleum retail facility and convenience store. There are
one 12,000-gallon gasoline, two 10,000-gallon gasoline and one 6,000-gallon diesel USTs, associated
dispensers, and product lines located at the site. The USTs, associated dispensers, and product piping are
to be removed and replaced with newer UST components during current site reconstruction. The site is
not currently covered, and the surrounding properties are mainly used for commercial and residential
purposes.

This sampling event was conducted in conjunction with the closure of the UST system components
(product lines). No release or incident is associated with this sampling event.

There was a previous release at the site (Incident 42026) which was discovered upon receipt of analytical
results after soil sampling activities at the site in October 2016. This incident was remediated and closed
out on October 2, 2018, with a conditional NFA.

On March 7, 2023, GRI arrived to sample the product piping trenches onsite. The soil samples were
analyzed onsite for TPH-GRO and TPH-DRO.

No concentrations of TPH-GRO or TPH-DRO exceeded the RALs in the soil samples collected. Based on
this information, soil quality violations related to the product lines do not exist at the site. No further
assessment is required.

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. UST Product Line Closure Report
Prepared on: March 14, 2023 Minuteman Food Mart #40
Project Manager: Laura Minor GRI Project No. 4222
iii
ACRONYMS
ACM: Asbestos Containing Materials
AFVR: Aggressive Fluid-Vapor Recovery
ARR: Acknowledgement of Report Receipt
AS: Air Sparging
AST: Aboveground Storage Tank
ASTM: American Society for Testing and
Materials
BGS: Below Ground Surface
CAP: Corrective Action Plan
CFR: Code of Federal Regulations
CSA: Comprehensive Site Assessment
DPE: Dual Phase Extraction
DRO: Total Petroleum Hydrocarbons Diesel
Range Organics
DWM: Division of Waste Management
DWR: Department of Water Resources
EPA: Environmental Protection Agency
EPH: Extractible Petroleum Hydrocarbons
ESA: Environmental Site Assessment
GCL: Gross Contamination Level
GRI: Geological Resources, Inc.
GRO: Total Petroleum Hydrocarbons
Gasoline Range Organics
LSA: Limited Site Assessment
MAC: Maximum Allowable Concentration as
specified in T15A NCAC 2L.0202
MADEP: Massachusetts Department of
Environmental Protection
MCC: Maximum Contaminant Concentrations
MMPE: Mobile Multi-Phase Extraction
NAPL: Non-Aqueous Phase Liquid, “Free
Product”
NCDEQ: North Carolina Department of
Environmental Quality
NCDOT: North Carolina Department of
Transportation
NFA: Notice of No Further Action
NORR: Notice of Regulatory Requirements
NOV: Notice of Violation
NPDES: National Pollutant Discharge
Elimination System
NRP: Notice of Residual Petroleum
O&M: Operation and Maintenance
PAHs: Polynuclear Aromatic Hydrocarbons
PCA: Pre-Construction Assessment
RAL: Regulatory Action Level
SCLs: Soil Cleanup Level
SPCC: Spill Prevention Control and
Countermeasures
SVE: Soil Vapor Extraction
SVOCs: Semi-Volatile Organic Compounds
SWAP: Source Water Assessment and
Protection
SWPPP: Stormwater Pollution Prevention Plan
TCLP: Toxicity Characteristic Leaching
Procedure (EPA Method SW-846 1311)
TOC: Top of Casing
TPH: Total Petroleum Hydrocarbons
USGS: United States Geological Survey
UST: Underground Storage Tank
UVF: Ultraviolet Fluorescence
VOCs: Volatile Organic Compounds
VPH: Volatile Petroleum Hydrocarbons

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. UST Product Line Closure Report
Prepared on: March 14, 2023 Minuteman Food Mart #40
Project Manager: Laura Minor GRI Project No. 4222

TABLE OF CONTENTS

SITE INFORMATION ............................................................................................................................ i
EXECUTIVE SUMMARY ....................................................................................................................... ii
ACRONYMS ....................................................................................................................................... iii
A. SITE HISTORY AND CHARACTERIZATION ......................................................................................1
B. UST LINE CLOSURE PROCEDURE ..................................................................................................2
C. SITE INVESTIGATION ...................................................................................................................2
D. SUMMARY AND CONCLUSIONS ...................................................................................................3
E. LIMITATIONS ..............................................................................................................................3

FIGURES

Figure 1: Site Location Map
Figure 2: Site Map
Figure 3: Soil Sample Location Map

TABLES

Table 1: UST Owner/Operator Information
Table 2: UST System Information
Table 3: Summary of Soil Sample Analytical Results

APPENDICES

Appendix A: NCDEQ Registered Tank Report
Appendix B: Site Specific Health and Safety Plan
Appendix C: Mobile Laboratory Report – Soil Samples

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. UST Product Line Closure Report
Prepared on: March 14, 2023 Minuteman Food Mart #40
Project Manager: Laura Minor GRI Project No. 4222
1
A. SITE HISTORY AND CHARACTERIZATION
1. UST Owner and Operator Information:
UST owner and operator information has been summarized in Table 1.

2. UST System Information:
UST system information has been summarized in Table 2. There are one 12,000-gallon gasoline, two
10,000-gallon gasoline and one 6,000-gallon diesel USTs, associated dispensers, and product lines
located at the site. Currently, the USTs, associated dispensers, and product piping are being removed
and replaced with newer components. A copy of the NCDEQ Registered Tank Report is shown below
and included in Appendix A.

This sampling event was conducted in conjunction with the closure and removal of the UST system
components. No release or incident is associated with this sampling event. However, there was a previous
release at the site (Incident 42026) which resulted from contaminant concentrations exceeding the NC 2L
standard in October of 2016 during soil sampling activities. This incident was closed on October 2, 2018,
with a conditional NFA.

3. Non-UST Information:
No known AST is located at the site.

4. Comprehensive Description of the Release:
There is no release or incident associated with this sampling event. This event was conducted due to the
removal and replacement of the UST system product lines.

5. Description of the Site Characteristics:
The Minuteman Food Mart #40 site is located at 100 Wintergreen Drive in Lumberton, Robeson County,
North Carolina. A topographic map showing the general site location and the surrounding area is included

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. UST Product Line Closure Report
Prepared on: March 14, 2023 Minuteman Food Mart #40
Project Manager: Laura Minor GRI Project No. 4222
2
as Figure 1. The property operates as a petroleum retail facility and convenience store. The site is not
currently covered due to reconstruction. Three gasoline and one diesel USTs, associated dispensers, and
product lines are located at the site. The surrounding properties are used for commercial, and residential
purposes. A Site Map is included as Figure 2.

B. UST LINE CLOSURE PROCEDURE
1. Summary of Closure Procedure:
On March 7, 2023, GRI supervised the collection of twenty-seven soil samples (PP-1 through PP-27)
beneath the product line trench to satisfy the closure requirement for the product lines. The work was
performed while the site renovation contractor, Piedmont Pump & Tank, LLC was uncovering and
replacing the product lines. The samples were submitted for onsite UVF analyses of TPH-GRO and TPH-
DRO petroleum hydrocarbons. The location of the soil samples collected are shown on Figure 3. No soil
excavation activities were conducted by GRI. A copy of the Site Health and Safety Plan is included as
Appendix B.

C. SITE INVESTIGATION
1. Field Screening:
The soil samples collected during the March 2023 line closure sampling were not screened with a PID prior
to UVF analyses.

2. Soil Sampling Information:
No concentrations of TPH-GRO or TPH-DRO that exceeded the RALs were reported in the soil samples
collected. A summary of soil sample analytical results is presented in Table 3. The UVF laboratory report
is provided as Appendix C. A summary of the UVF analyses from the soil sampling conducted during the
product line closure and replacement is summarized below:
Sample ID Sample Depth (ft-BGS) TPH GRO TPH DRO RAL (mg/kg) 50 100
PP-1 4 <20 <4
PP-2 4 <20 <4
PP-3 4 <20 <4
PP-4 4 <20 <4
PP-5 4 <20 <4
PP-6 4 <20 <4
PP-7 4 24.8 <4
PP-8 4 20.8 <4
PP-9 4 30 <4
PP-10 4 28.8 <4
PP-11 4 <20 <4
PP-12 4 26 <4
PP-13 4 29.6 <4
PP-14 4 24.8 <4
PP-15 4 <20 <4
PP-16 4 21.6 <4
PP-17 4 23.2 <4
PP-18 4 21.6 <4
PP-19 4 <20 <4
PP-20 4 19.2 7
PP-21 4 15 6
PP-22 4 15.4 2.2
PP-23 4 <10 <2
PP-24 4 <10 4.6
PP-25 4 42.8 32.4
PP-26 4 15.6 6.6
PP-27 4 36 8

___________________________________________________________________________________________
Prepared by: Geological Resources, Inc. UST Product Line Closure Report
Prepared on: March 14, 2023 Minuteman Food Mart #40
Project Manager: Laura Minor GRI Project No. 4222
3

3. Quality-Control Measures:
Clean, disposable nitrile gloves were used for the collection of the soil samples. The samples were
collected at a depth of 4 feet BGS from the open product line trench using a decontaminated hand auger
and analyzed onsite immediately after collection. Strict chain-of-custody procedures were followed.

D. SUMMARY AND CONCLUSIONS
 On March 7, 2023, GRI collected twenty-seven soil samples (PP-1 through PP-27) beneath the product
lines to satisfy the closure requirements for the product lines.
 A previous release (UST Incident #42026) at the site was confirmed in October of 2016, upon receipt
of laboratory results for soil sampling. This incident was closed on October 2, 2018, with a conditional
NFA. Currently, there is no active incident or release at the site.
 UVF analytical results of the samples collected beneath the UST product lines revealed no TPH
concentrations above the RALs. Based on this information, a soil quality violation does not exist at the
site. No further assessment is required.
E. LIMITATIONS
This report has been prepared for the exclusive use of The Gas Mart, Inc. for the specific application to
the referenced site in Robeson County, North Carolina. The assessment was conducted based on the
scope of work and level of effort specified by NCDEQ and with resources adequate only for that scope of
work. Our findings have been developed in accordance with generally accepted standards of geology and
hydrogeology practices in the State of North Carolina, available information, and our professional
judgment. No other warranty is expressed or implied.

The data that are presented in this report are indicative of conditions that existed at the precise locations
sampled and at the time the samples were collected. In addition, the data obtained from samples would
be interpreted as being meaningful with respect to parameters indicated in the laboratory report. No
additional information can logically be inferred from these data.

FIGURES
Copyright:© 2013 National Geographic Society, i-cubed
FIGURE 1SITE LOCATION MAPEXXON SHOP #5100 WINTERGREEN STREETLUMBERTON, ROBESON COUNTY,NORTH CAROLINAGRI PROJECT NO. 4222
PREPARED BY:GEOLOGICAL RESOURCES, INC.SEPTEMBER 8, 2016
0 2,000 4,0001,000 Feet
SCALE: 1 INCH = 2,000 FEET
MAP CENTER LOCATIONLATITUDE: 34.667809° NLONGITUDE: 79.002931° W
`
SITE LOCATION
³

TABLES
UST ID Number 1-4 Facility ID Number
Owner or Operator?
Owner
UST ID Number 1-4 Facility ID Number
Owner or Operator?
Operator
UST ID Number 1-4 Facility ID Number
Owner or Operator?
Owner/Operator
P.O. Box 637, Elizabethtown, NC 28337 910-876-1582
00-0-0000034495
Name of Owner or Operator Dates of Ownership / Operation
Five Star Propane, LLC 7/18/2017 - Present
TABLE 1
UST OWNER/OPERATOR INFORMATION
MINUTEMAN FOOD MART #40 (INCIDENT NO. N/A)
Address Telephone Number
Address Telephone Number
Unk.Unk.
00-0-0000034495
Name of Owner or Operator Dates of Ownership / Operation
Red Springs Fuel Oil Co., Inc.7/31/1993 - 7/18/2017
Address Telephone Number
P.O. Box 637, Elizabethtown, NC 28337 910-876-1582
00-0-0000034495
Name of Owner or Operator Dates of Ownership / Operation
The Gas Mart, Inc. 7/18/2017 - Present
Page 1 of 1
Date: 03/09/2023
Was Release
Associated
with UST
System?
(Yes / No)
1 Gas mix 12,000 7/31/1993 Single Wall
Steel/FRP 8' x 32'Other Current Unk.
2 Gas mix 10,000 7/31/1993 Single Wall
Steel/FRP 8' x 26' 8"Single Wall Flex Current Unk.
3 Gas mix 10,000 7/31/1993 Single Wall
Steel/FRP 8' x 26' 8"Single Wall Flex Current Unk.
4 Diesel 6,000 7/31/1993 Single Wall
Steel/FRP 8' x 16'Single Wall Flex Current Unk.
TABLE 2
UST SYSTEM INFORMATION
MINUTEMAN FOOD MART #40 (INCIDENT NO. N/A)
UST
ID
No.
Current
or Most
Recent
Contents
Capacity
(gallons)
Date
Installed
Construction
Details
Tank
Dimensions
Description of
Associated
Product Piping
and
Pumps
Status
of
UST
Facility ID #: 00-0-0000034495
Page 1 of 1
Date: 3/7/2023
Sample IDDate Collected (mm/dd/yy)Sample Depth(ft-BGS)GRO Range TPHDRO Range TPH50 100
PP-1 03/07/23 4 <20 <4
PP-2 03/07/23 4 <20 <4
PP-3 03/07/23 4 <20 <4
PP-4 03/07/23 4 <20 <4
PP-5 03/07/23 4 <20 <4
PP-6 03/07/23 4 <20 <4
PP-7 03/07/23 4 24.8 <4
PP-8 03/07/23 4 20.8 <4
PP-9 03/07/23 4 30 <4
PP-10 03/07/23 4 28.8 <4
PP-11 03/07/23 4 <20 <4
PP-12 03/07/23 4 26 <4
PP-13 03/07/23 4 29.6 <4
PP-14 03/07/23 4 24.8 <4
PP-15 03/07/23 4 <20 <4
PP-16 03/07/23 4 21.6 <4
PP-17 03/07/23 4 23.2 <4
PP-18 03/07/23 4 21.6 <4
PP-19 03/07/23 4 <20 <4
PP-20 03/07/23 4 19.2 7
PP-21 03/07/23 4 15 6
PP-22 03/07/23 4 15.4 2.2
PP-23 03/07/23 4 <10 <2
PP-24 03/07/23 4 <10 4.6
PP-25 03/07/23 4 42.8 32.4
PP-26 03/07/23 4 15.6 6.6
PP-27 03/07/23 4 36 8
Notes:
• Results reported in mg/kg (milligrams per kilograms)
• ft-BGS: feet below ground surface.
• RAL: Regulatory Action Level.
• NE: Not Established
• < : Less than the method detection limit specified in the
laboratory report
• Concentrations in bold face type indicate the reported
concentration exceeded the RAL
TABLE 3
SUMMARY OF SOIL SAMPLE ANALYTICAL RESULTS
MINUTEMAN FOOD MART #40 (INCIDENT NO. N/A)
Facility ID #: 00-0-0000034495
RAL (mg/kg)
Analytical Method UVF
Page 1 of 1

APPENDICES

Appendix A
NCDEQ Registered Tank Report

NCDEQ Registered Tank Report
Facility Name MINUTEMAN FOOD MART #40
Facility Id 00-0-0000034495
Address 100 WINTERGREEN STREET
City LUMBERTON State NC
Zip 28358
Tank Owner FIVE STAR PROPANE, LLC
Address PO BOX 637
City ELIZABETHTOWN
State NC Zip 28337
County Robeson
Latitude 34.66776 Longitude -79.00329
Tank Information
Tank Id CapacityProduct Name Installation Date Perm Close Date Tank Construction Piping Construction Spill Protection Tank Status OverFill Protection
1 12000Gasoline, Gas Mix 7/31/1993 Single Wall Steel/FRP Other Catchment Basin CurrentBall Float Valve
2 10000Gasoline, Gas Mix 7/31/1993 Single Wall Steel/FRP Single Wall Flex Catchment Basin CurrentBall Float Valve
3 10000Gasoline, Gas Mix 7/31/1993 Single Wall Steel/FRP Single Wall Flex Catchment Basin CurrentBall Float Valve
4 6000Diesel 7/31/1999 Single Wall Steel/FRP Single Wall Flex Catchment Basin CurrentBall Float Valve
Thursday, March 9, 2023 Page 1 of 1

Appendix B
Site Specific Health and Safety Plan

1
GEOLOGICAL RESOURCES, INC.
Site Specific Health and Safety Plan

1.0 General Information:
a. Project name: Minuteman Food Mart #40
b. Location: 100 Wintergreen Street, Lumberton NC
c. GRI Job #: 4222

2.0 Project Organization:
a. Site Supervisor/H&S Officer: Kyle Perry/Xavier Farmer
b. Project Manager: Laura Minor 803-371-0997
c. Subcontractor(s):
d. Site Contact: Same as PM

3.0 Safety Plan Preparation:
a. Prepared by & date: Laura Minor 3/5/23
b. Reviewed/approved by & date: T. Kennedy 3/5/23

4.0 Site History and Description:
a. Type of site (i.e., spill, leaking UST system, etc.): UST Site; product
replacement
b. Site/project description: Soil sampling
Sample beneath piping

5.0 Potential Hazards:
Physical Hazards: (check)
X Slips X Overhead X Explosion Sun burn X Electricity
X Trips utilities X Noise Cold Weather X Pressurized line/vessels
X Falls X Underground X Pinch points Hot Weather
X
Fire utilities X Burns X Crush X
Check for Weather
alerts and make sure
your phone has the
alerts set for the area

Chemical Hazards: (check)
X Gasoline Used Oil
X Diesel Solvents
Kerosene Antifreeze
New Oil Acid (sample preservative)

Equipment/Vehicular/Other: (i.e., Geoprobe, drill rig, back hoe, track hoe, traffic, skid steer etc.)
GRI support trucks, drill rig, UVF mobile lab

2

Biological Hazards: (i.e., toxic insects, spiders, poisonous plants, poisonous snakes, aggressive dogs)

6.0 Site Organization and Safety Control: (Evaluate the need for site control to protect
persons from exposure to hazardous conditions; i.e. work permits, cones, barricade tape,
exclusion zones, etc.)
a. Work area(s) identified: __Entire site _________________________________________
b. Work area marked _____ Yes_____ No
c. Work area barricaded _____ Yes _____ No
d. Support area established: ________________________________________________
e. Entry and escape routes identified: ________________________________________
f. Rally point identified: _____ Yes ____ No Location:____________________________
g. Emergency shut-off for water identified _____ Yes _____ No
h. Emergency fuel shut-off identified _____ Yes _____ No
i. Site map attached: _____ Yes _____ No
**Emergency Response Procedures**
Action (i.e. shut off all power equipment) Assemble at rally point
Call 911 for medical or utilities emergency Do NOT enter confined spaces
Discuss what to do if …..cut product line, water line, cable/electric line

7.0 Job Activities in Work Plan:
UST Removal x Soil Sampling Manual FP Recovery
Soil Excavation System O&M Other (specify)
x Powered Drilling MMPE/AFVR __________________
Hand Augering x Water sampling __________________

8.0 Required Education and/or Training:
X OSHA 40 hr X Annual 8 hr Refresher OSHA Site Supervisor

9.0 Air Monitoring:
If, in the opinion of the site supervisor, petroleum hydrocarbon vapor concentrations are
excessive, site activities will cease until petroleum hydrocarbon vapor concentrations diminish to
acceptable levels.

10.0 Equipment:
FID/PID Combustible gas indicator Interface Probe
O2 meter Other

11.0 Personnel Protection Equipment:
X Hard hat Rubber boots Respirator X Hearing
X Safety glasses X Work gloves Sun screen protection
X Steel toe boots X First aid kit Repellent X Nitrile
Tyvek suit X Fire extinguisher Dust mask gloves

3

12.0 Decontamination Procedures: (evaluate need for decon, describe procedures)
Use Alconox and DI water to decontaminate WLM between gauging each well. Use new, clean
bailers, gloves and string for each temporary monitoring well. Decon augers/rods as needed.

13.0 Emergency Contacts:
a. Local Assistance:
Site Phone Fire Department 911
Police 911 Ambulance 911
Water Department Sanitary Sewer
Natural Gas Power Company

b. National or Regional Sources of Assistance:
1) Geological Resources, Inc. [phone]
2) Chemtrec (24 Hours) [phone]
3) Bureau of Explosives (24 Hours) [phone]
4) National Response Center, NRC [phone]
(Oil/Hazardous Substances)
5) DOT, Off. Of Haz. Operations [phone]

14.0 Signatures:

This plan has been reviewed by all on-site personnel and all provisions are clear (signatures
required).

Project Manager:
3/5/23
Site Supervisor:
Other personnel:

4

15.0 Amendments:

a. Site Specific Health and Safety Plans are based on information available at the time of
plan preparation. Unexpected conditions may arise. It is important that personal
protective measures be thoroughly assessed prior to and during the planned activities.
Unplanned activities and/or changes in the hazard status should initiate a review of this
plan and may result in major changes to it.
b. Changes in the hazard status or unplanned activities are to be submitted on “Amendment
to the Site Specific Health and Safety Plan” which is included bellow.
c. Amendment must be approved by the Project Manager prior to implementation of the
amendment.

AMENDMENT TO THE SITE SPECIFIC HEALTH AND SAFETY PLAN

A. Changes in field activities or hazards:

B. Proposed amendment:

C. Approval:

Proposed by: ___________________________________date ______________________

Approved by: ___________________________________date _____________________

Amendment number: ____________________________

Amendment effective date: _______________________

Appendix C
Mobile Laboratory Report – Soil Samples

3502 Hayes Road • Monroe, North Carolina 28110
113 West Firetower Road, Suite G • Winterville, North Carolina 28590
Phone [phone] • [phone] • Fax [phone]
Engineering Certification: C-2727 • Geology Certification: C-127
UVF Trilogy Analytical Report

Samples Collected: November March 7, 2023
Samples Analyzed: March 7, 2023
Site Name: Minuteman Food Mart #40
Site Address: 100 Wintergreen Street, Lumberton, NC 28358
GRI Project Number: 4222

March 8, 2023

Xavier T. Farmer, G.I.T.
Operator

Technical Procedures
Calibration
The UFV Trilogy has standard calibrations stored for the following analysis:
 GRO
 DRO
 Total PAH
 Target PAH
 Heavy PAH
Prior to use, calibration standards are used to perform a 5-point verification on the factory stored
calibrations for GRO and DRO. The calibration standards used are as follows:
GRO
 0.5 ppm
 1 ppm
 3 ppm
 5 ppm
 10 ppm
DRO
 0.1 ppm
 0.5 ppm
 1 ppm
 3 ppm
 5 ppm
Operation
Sample Extraction
 5mg of soil are weighed into a clean extraction jar
 Methanol is added to the extraction jar to create a 2x or 4x dilution
o 2x Dilution: 10 mL of methanol
o 4x Dilution: 20 mL of methanol
 The extraction jar is shaken for several minutes to thoroughly mix the soil with solvent
(methanol)
 The mixture is allowed to settle for several minutes
 A clean syringe is used to draw liquid from the extraction jar
 A clean filter is attached to the end of the syringe and the liquid dispensed through the filter
into a clean test tube
 This liquid is referred to as the extraction
Dilution Preparation
 An adjustable micropipette is used to precisely measure out the amount of extract needed for
the dilution
 The measured out amount of the extract is added to a clean test tube and methanol is added
dilute the extract. Examples of dilutions are shown below:

Extract Amount
500 μL
200 μL
100 μL
50 μL
25 μL

Add Solvent to the
5 mL line
5 mL line
5 mL line
5 mL line
5 mL line
2x Extract
Dilution Factor
20x
50x
100x
200x
400x
4x Extract
Dilution Factor
40x
100x
200x
400x
800x

Technical Procedures
Sample Analyzation
 The dilution is shaken to thoroughly mix, then poured into a clean glass cuvette
 The desired module is inserted into the UVF Trilogy and the corresponding factory calibration is
selected
 “Measure Fluorescence” is pressed on the touchscreen and the reading is recorded
 The reading should be between the concentrations of the calibration standards (GRO: 0.5-10
ppm; DRO 0.1-5 ppm)
o Reading below the calibration standard range are recorded as below the detection limit
 Detection Limit = (lower range of calibration standards range) x dilution factor
(i.e. a GRO sample with a 100x dilution factor has a detection limit of 50 ppm)
o Readings above the calibration standard range should be further diluted and reanalyzed
o Negative readings are an indication of quenching (see below)
 The reading is multiplied by the dilution factor to calculate the final concentration
 Check suspected contaminated samples for quenching by running additional dilutions
o According to the siteLAB Quick Reference Guide:
“Quenching” can occur when the detector is swamped by too many hydrocarbons or
organic interferences, producing low or negative concentrations. Test the sample at
multiple dilutions to confirm results are linear and accurate.”
QA/QC
Method Blank
 A method blank of methanol will be analyzed following calibration and following the last sample
analyzed each day
Duplicates
 One duplicate will be analyzed for every 20 samples
 The duplicate will be prepared from the extract of the sample and diluted to the same factor as
the sample analyzed
Project Name:Date Collected:
Project Number:Date Analysed:
Project Manager:Operator:
Sample ID Matrix Dilution
Factor x
GRO
Output
(ppm)
=GRO Value
(mg/Kg)
Dilution
Factor x
DRO
Output
(ppm)
=DRO Value
(mg/Kg)
PP-1 Soil 40 <0.5 <20 40 <0.1 <4
PP-2 Soil 40 <0.5 <20 40 <0.1 <4
PP-3 Soil 40 <0.5 <20 40 <0.1 <4
PP-4 Soil 40 <0.5 <20 40 <0.1 <4
PP-5 Soil 40 <0.5 <20 40 <0.1 <4
PP-6 Soil 40 <0.5 <20 40 <0.1 <4
PP-7 Soil 40 0.62 24.8 40 <0.1 <4
PP-8 Soil 40 0.52 20.8 40 <0.1 <4
PP-9 Soil 40 0.75 30 40 <0.1 <4
PP-10 Soil 40 0.72 28.8 40 <0.1 <4
PP-11 Soil 40 <0.5 <20 40 <0.1 <4
PP-12 Soil 40 0.65 26 40 <0.1 <4
PP-13 Soil 40 0.74 29.6 40 <0.1 <4
PP-14 Soil 40 0.62 24.8 40 <0.1 <4
PP-15 Soil 40 <0.5 <20 40 <0.1 <4
PP-16 Soil 40 0.54 21.6 40 <0.1 <4
PP-17 Soil 40 0.58 23.2 40 <0.1 <4
PP-18 Soil 40 0.54 21.6 40 <0.1 <4
PP-19 Soil 40 <0.5 <20 40 <0.1 <4
PP-20 Soil 20 0.96 19.2 20 0.35 7
PP-21 Soil 20 0.75 15 20 0.3 6
PP-22 Soil 20 0.77 15.4 20 0.11 2.2
PP-23 Soil 20 <0.5 <10 20 <0.1 <2
PP-24 Soil 20 <0.5 <10 20 0.23 4.6
PP-25 Soil 40 1.07 42.8 40 0.81 32.4
PP-26 Soil 20 0.78 15.6 20 0.33 6.6
PP-27 Soil 40 0.9 36 40 0.2 8
UVF Analytical Report
siteLAB UVF Trilogy
3/7/2023
3/7/2023
Xavier T. Farmer
Minuteman Food Mart #40
4222
Laura Minor
Report Date:
3/8/2023
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