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Home My WebLink AboutFA-29816_0_C_CI_20230426 8410-D Falls of Neuse Road; Raleigh, NC 27615 Phone: 919-848-3155 / Fax: 919-848-4265 24-Hour Emergency Response: 1-855-HES-fast (1-855-437-3278) Highlands Environmental Solutions, Inc. Incident Response Summary Report HES Project #186607 Date of Report: April 26, 2023 Location of Release: Gasoline Release Incident Circle K Store #2704394; Hope Mills, North Carolina Client Information: Name: Circle K Stores, Inc. Address: 1100 Situs Court, Suite 100; Raleigh, North Carolina 27606 Contact Name: Ms. Connor Pearce Contact Telephone Number: 919-770-4776 Release Information: A release of gasoline occurred at the site due to the failure of a customer’s vehicle fuel tank. The volume of the release was estimated at 20 gallons to the paved surfaces at the site. A small volume of fuel migrated to and entered a stormwater inlet. The location of the site and release are depicted on Figure 1, included in Attachment A. Response Information: Highlands Environmental Solutions, Inc. (HES) was contacted by Mr. Tucker Chastain (of the store) at 18:10 hours on March 15, 2023. Based on information provided by Mr. Chastain, a customer was fueling their vehicle when the vehicle fuel tank failed. Gasoline was released to the paved surfaces of the driveway and parking areas at the site. A small volume of fuel migrated to and entered a stormwater inlet at the site. Weather conditions at the time of the release were clear. HES dispatched personnel from Chase Environmental, Inc. (Chase) to investigate and remediate the release. Personnel and equipment from Chase responded to the release on March 15, 2023, arriving at approximately 19:00 hours (EST). Upon arrival, Chase personnel noted that the vehicle from which the release occurred had left the scene. Granular sorbents were applied to the area of impacted pavement to absorb the released fuel. A small volume of fuel was found inside a stormwater inlet, however, the fuel did not migrate beyond the stormwater inlet box. The stormwater inlet was flushed and all liquids were recovered. Sorbents applied to the ground surface were also recovered. All waste materials were containerized in 55-gallon drums, and transported to the Chase facility in Dunn, NC for disposal Select photographs of the site and site activities are included in Attachment B. A copy of the waste disposal documentation is included in Attachment C. Because the fuel entered a stormwater inlet, the incident was considered to be reportable, a UST-62 (24-Hour Notification of Discharge) form was prepared and submitted to the North Carolina Department of Environmental Quality (NCDEQ). A copy of this document is included in Attachment D. Incident Response Report Gasoline Release Incident – Circle K Store #2704394; Hope Mills, NC Page 2 8410-D Falls of Neuse Road; Raleigh, NC 27615 Phone: 919-848-3155 / Fax: 919-848-4265 24-Hour Emergency Response: 1-855-HES-fast (1-855-437-3278) Unpaved areas were not impacted by the release. Additionally, other than the stormwater inlet, sensitive receptors were not impacted by the release. The release did not impact surface water bodies. All response activities have been completed. HES does not recommend additional environmental assessment or remediation activities for this incident. HES recommends that this incident be closed. Kendall Sutler Signature Name of Project Manager April 26, 2023 Date UBMItt ATTACHMENT A Drawing / Project Name Client Project # Date N Base diagram from Google Earth. Site Location Diagram Gasoline Release Incident 4173 Legion Road; Hope Mills, North Carolina Circle K Stores, Inc. Site Location DB Fig. Scale 186607 As Shown March 2023 1 PM PG JB PE JB JB ATTACHMENT B Photograph Number 1: Impacted area prior to abatement. Photograph Number 2: Impacted area at stormwater inlet prior to abatement.. Photograph Number 3: Abatement of impacted stormwater inlet. Photograph Number 4: Impacted area during abatement. Photograph Number 5: Impacted area after abatement. Photograph Number 6: Impacted area after abatement. Photograph Number 7: Hydrocarbon boom temporarily left in the stormwater inlet as a precaution. Photograph Number 8: Name and telephone number of responsible party. ATTACHMENT C ATTACHMENT D UST-62 24-Hour Notification of Discharge Form For Non-UST Releases of Petroleum in NC This form should be completed and submitted to the UST Section’s regional office following a known or suspected release of petroleum from a source other than an underground storage tank. This form is required to be submitted within 24 hours of discovery of a known or suspected petroleum release (DWM USE ONLY) Incident # ___________ Priority Rank (H,I,L,U) _____ Received (time/date) ___________________________ Received by ________________ Region __________ Reported by (circle one): Phone, Fax or Report Suspected Contamination? (Y/N) ___ Confirmed GW Contamination? (Y/N) ___ Confirmed Soil Contamination ?(Y/N) ___ Samples taken?(Y/N) ___ Free product? (Y/N) ___ If Yes(free product), state greatest thickness: _____feet Release discovered (time/date):______________ _______________________ INCIDENT DESCRIPTION Incident Name: Address (street number/name):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: Describe suspected or confirmed release (nature of release, time/date of release, quantity of release, amount of free product): GPS Electronic topographic map GIS Address matching Describe initial response/abatement (time/date release stopped, cleanup begun/completed, quantity of product soil removed, confirmation sampling): Other Unknown Describe impacted receptors: Describe location: HOW RELEASE WAS DISCOVERED (Release Code) (Check one) Observation of Release at Occurrence Visual or Olfactory Evidence Soil Contamination Groundwater Contamination Water Supply Well Contamination Surface Water Contamination 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 petroleum product type released) AST (tank) AST Piping/ Dispenser AST Delivery Problem OTR Vehicle Tank OTR Bulk Transport Tank RR Bulk Transport Tank Transformer Unknown Other ______________ Definitions presented on reverse Spill (Accidental) Spill (Intentional) Corrosion Physical or Mechanical Damage Equipment Failure AST Overfill AST Installation Problem Unknown Other ______________ Definitions presented on reverse Petroleum Both Petroleum & Non-Petroleum Location (Check one) Facility Residence Highway/Road Railway Other Gasoline/ Diesel/ Kerosene E11 – E20 E21 – E84 E85 – E99 Ethanol 100% Diesel/Veg. Oil Blend Vegetable Oil 100% Heating Oil Waste Oil Mineral Oil-no PCBs Mineral Oil-PCBs Other Petroleum Products ________ 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 Guidance presented on reverse UST Form 62 (04/10) Page 1 of 2 N N N 3-15-2023 @ 1800 HRS N N Gasoline Release 4173 Legion Road Cumberland Hope Mills 28348 34.983511N -78.930210 W A vehicle fuel tank failed on a customer vehicle during fueling resulting in the release of approximately 20 gallons of gasoline. Impacts were to paved surfaces and one stormwater inlet. Incident was abated on 3/15/2023. No off-site, surface water, or unpaved area impacts occurred. ✔ Clean up completed on 3/15/2023 None Convenience Store \ IMPACT ON DRINKING WATER SUPPLIES Water Supply Wells Affected? 1. Yes 2. No 3. Unknown Number of Water Supply Wells Affected ______ List of Water Supply Wells Contaminated: (Include Users Names, Addresses and Phone Numbers. Attach additional sheet if necessary) 1. 2. 3. PARTY RESPONSIBLE FOR RELEASE (if the source of the release is not an AST system or if it is an AST system and there is a responsible party other than the AST system owner/ operator) Name of Person/Company Address City State Zip Code Telephone Number AST SYSTEM OWNER (if the source of the release is an AST system) AST Owner/Company Address City State Zip Code Telephone Number AST SYSTEM OPERATOR (if the source of the release is an AST system) UST Operator/Company Address City State Zip Code Telephone Number LANDOWNER AT LOCATION OF INCIDENT Landowner Address City State Zip Code Telephone Number Draw Sketch of Area or Provide Map (showing incident site, location of release, two major road intersections, potential receptors) Attach sketch or map to form. Give Directions to Incident Site Attach directions to form if necessary. Person Reporting Incident Company Telephone Number Title Address Date UST Form 62 (04/10) Page 2 of 2 Definitions of Sources AST (Tank): means the tank is used to store product AST Piping: means the piping and connectors running from the tank to the dispenser or other end-use equipment AST Dispenser: includes the dispenser and the equipment used to connect the dispenser to the piping AST Delivery Problem: identifies releases that occurred during product delivery to the tank. OTR Vehicle Tank: means the tank is used to store product to fuel an over the road vehicle OTR Bulk Transport Tank: means a tank that is used to transport product in bulk over the road (by truck) RR :bulk Transport Tank: means a tank that is used to transport product in bulk by train Transformer: means electrical transformer Other: serves as the option to use when the release source is known but does not fit into one of the preceding categories Unknown: identifies releases for which the source has not been determined Definitions of Causes Spill (Accidental): use this cause when a spill occurs accidentally(e.g., when the delivery hose is disconnected from a fill pipe) Spill (Intentional): use this cause when a spill occurs intentionally (e.g., intentional dumping or breakage) Corrosion: use when a metal tank, piping, or other component has a release due to corrosion Physical or Mechanical Damage: use for all types of physical or mechanical damage, except corrosion Equipment failure: use when a release occurs due to equipment failure other than corrosion or physical or mechanical damage AST 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) AST Installation Problem: use when the problem is determined to have occurred specifically because the AST system was not installed properly Other: use this option when the cause is known but does not fit into one of the preceding categories Unknown: use when the cause has not been determined Guidance: Ownership and Operator Type Ownership select the category which describes owner of the AST system, bulk transport tank, or other release source Operator Type select the category which describes the operation in which owner uses the AST system, bulk transport tank, or other release source TBD TBD TBD Circle K Stores, Inc. 1100 Situs Court, Suite 100 Raleigh NC 27606 919-774-6700 See Attached Joe Beaman, P.G.Highlands Environmental Solutions, Inc. 919-848-3155 Principal Geologist 8410-D Falls of Neuse Road; Raleigh, NC 27615 03-16-2023 900 ft N➤➤N