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Home My WebLink AboutWA-29026_48218_CA_RPTS_20220201_SCHAn Equal Opportunity Employer February 2, 2022 Ms. Sylvia Hunneke NCDEQ, UST Section Washington Regional Office 943 Washington Square Mall Washington, North Carolina 27889 Re: Site Check Report Speedway #8654 5068 NC Highway 33 East Greenville, Pitt County, NC Incident Number: Pending GRI Project Number: 3389 Dear Ms. Hunneke, Please find enclosed the referenced report for the above mentioned site. If you have any questions, please do not hesitate to contact Michael Mastbaum P.G., Joanna Alley E.I.T. and/or Nicole Long with Geological Resources, Inc. at 704-845-4010. Sincerely, Speedway, LLC. Chuck Chiara Environmental Representative Enclosure Speedway LLC Speedway Office P.O. Box 1500 Springfield, OH 45501 Telephone 937-864-3000 3502 Hayes Road • Monroe, North Carolina 28110 113 West Firetower Road, Suite G • Winterville, North Carolina 28590 Phone (704) 845-4010 • (888) 870-4133 • Fax (704) 845-4012 Engineering Certification: C-2727 • Geology Certification: C-127 Site Check Report Speedway #8654 5068 NC Highway 33 East Greenville, Pitt County North Carolina Facility ID Number: 0-036281 Incident Number: Pending GRI Project Number: 3389 Prepared for: Charles Chiara Speedway, LLC 500 Speedway Drive Enon, Ohio 45323 February 1, 2022 Nicole Long Project Manager Michael S. Mastbaum Report Writer ___________________________________________________________________________________________ Prepared by: Geological Resources, Inc. Site Check Report Prepared on: February 1, 2022 Speedway #8654 Project Manager: Nicole Long GRI Project No. 3389 i EXECUTIVE SUMMARY The Speedway #8654 site is located at 5068 NC Highway 33 East in Greenville, Pitt County, North Carolina. The property operates as a petroleum retail facility and convenience store. The site is covered by concrete and grass. There are one 12,000-gallon gasoline, two 6,000-gallon gasoline, and one 6,000-gallon diesel USTs currently in use at the site with eight associated dispenser islands. On September 29, 2021, during triennial hydrostatic testing activities, one non-passing spill bucket was reported for the 6,000-gallon diesel UST. Therefore, a site check was required by the NCDEQ. The non- passing spill bucket was replaced and received passing compliance testing results on December 2, 2021. On December 2, 2021, GRI conducted a site check in the vicinity of the 6,000 diesel UST spill bucket. One soil sample (DSL-2’) was collected approximately 2 feet BGS beneath the non-passing spill bucket. The RALs were below the TPH-GRO and TPH-DRO concentrations. Two previous releases were documented at the site in 2013 (Incident No. 38440) and 2018 (Incident No. 38752). A Notice of NFA for the 2013 incident was issued by the NCDEQ on July 7, 2014, and an NRP (recorded July 18, 2014) was filed on the property. A Notice of NFA for the 2018 incident was issued by the NCDEQ on December 6, 2019. Based on this information, GRI recommends conducting an LSA, including an update to the January 2014 receptor survey, to establish the current risk classification for the site and assess ground water. ___________________________________________________________________________________________ Prepared by: Geological Resources, Inc. Site Check Report Prepared on: February 1, 2022 Speedway #8654 Project Manager: Nicole Long GRI Project No. 3389 ii SITE INFORMATION 1. Site Identification  Speedway #8654 (Facility ID 0-036281)  Incident Number Pending – Risk Ranking Undetermined  Location of Source Area: 5068 NC Highway 33 East Greenville, NC 27858 Pitt County 35.5834070°N, 77.2867350°W (Topographical Map) 2. Information about Contacts Associated with the Leaking UST System UST/AST Owner Speedway, LLC (Table 1) 500 Speedway Drive Enon, OH 45323 cachiara@speedway.com 919-516-8069 UST/AST Operator Speedway, LLC 500 Speedway Drive Enon, OH 45323 cachiara@speedway.com 919-516-8069 Property Owner Williams Family Heirs, LLC 539 South Main Street Findlay, Ohio 45840 Email Unknown Phone No. Unknown Property Occupant Speedway, LLC 500 Speedway Drive Enon, OH 45323 cachiara@speedway.com 919-516-8069 Consultant/Contractor Geological Resources, Inc. 3502 Hayes Road Monroe, NC 28110 nml@geologicalresourcesinc.com 704-845-4010 Analytical Laboratory Geological Resources, Inc. 3502 Hayes Road Monroe, NC 28110 State Certification No. n/a 704-845-4010 3. Information about Release  Release was discovered on December 2, 2021  An unknown amount of product was released from the leaking UST System via a non-passing spill bucket  One 12,000-gallon gasoline UST, two 6,000-gallon gasoline USTs, and one 6,000-gallon diesel UST are in use at the site Certification: I, Michael S. Mastbaum, 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. Site Check Report Prepared on: February 1, 2022 Speedway #8654 Project Manager: Nicole Long GRI Project No. 3389 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 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. Site Check Report Prepared on: February 1, 2022 Speedway #8654 Project Manager: Nicole Long GRI Project No. 3389 TABLE OF CONTENTS EXECUTIVE SUMMARY ....................................................................................................................... i SITE INFORMATION ............................................................................................................................ ii ACRONYMS ....................................................................................................................................... iii A. SITE HISTORY AND CHARACTERIZATION ..............................................................................1 B. SITE CHECK PROCEDURES ....................................................................................................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 Quality Map TABLES Table 1: UST Owner/Operator Information Table 2: UST System Information Table 3: Summary of Soil Sample Analytical Results APPENDICES Appendix A: UST Suspected Release 24 Hour Notice Form (UST-17A) Appendix B: 24-Hour Release and UST Leak Reporting Form (UST-61) Appendix C: Certificate of Storage Tank System Testing Appendix D: Laboratory Analytical Report - UVF ___________________________________________________________________________________________ Prepared by: Geological Resources, Inc. Site Check Report Prepared on: February 1, 2022 Speedway #8654 Project Manager: Nicole Long GRI Project No. 3389 1 A. SITE HISTORY AND CHARACTERIZATION 1. UST Owner and Operator Information: In accordance with the Site Check Report guidelines, the UST owner and operator information is summarized in Table 1. 2. UST System Information: In accordance with the Site Check Report guidelines, the UST system information is summarized in Table 2. There are one 12,000-gallon gasoline, two 6,000-gallon gasoline and one 6,000-gallon diesel USTs currently in use at the site with eight associated dispenser islands. The dispensers are located on both sides of the store building. There are approximately 284 feet of product piping from the tanks to the dispenser islands. A copy of the NCDEQ Registered Tank Report is shown below: 3. Non-UST Information: There are currently no ASTs and no known ASTs formerly at the site. 4. Comprehensive Description of the Release: Triennial hydrostatic compliance testing was completed on September 29, 2021. Based on the testing, non-passing hydrostatic results were reported for the 6,000-gallon diesel UST spill bucket. The non- passing spill bucket was replaced and received passing compliance test results on December 2, 2021. The UST Suspected Release 24 Hour Notice (UST-17A) form is included as Appendix A. A site check was required according to the NCDEQ. During spill bucket replacement on December 2, 2021, one soil sample (DSL-2’) was collected from directly beneath the non-passing diesel spill bucket at a depth of approximately two feet BGS. Upon receipt of the UVF analytical results on December 10, 2021, a release was confirmed at the site. A copy of the UST-61 Form is included as Appendix B. ___________________________________________________________________________________________ Prepared by: Geological Resources, Inc. Site Check Report Prepared on: February 1, 2022 Speedway #8654 Project Manager: Nicole Long GRI Project No. 3389 2 5. Description of the Site Characteristics: The Speedway #8654 site is located at 5068 NC Highway 33 East in Greenville, Pitt County, North Carolina. (Figure 1). The property operates as a petroleum retail facility and convenience store. The site is covered by concrete and grass. There are one 12,000-gallon gasoline, two 6,000-gallon gasoline and one 6,000- gallon diesel USTs currently in use at the site with eight associated dispenser islands. The surrounding properties are commercial and residential. A Site Map is included as Figure 2. B. SITE CHECK PROCEDURES 1. Results of Tank and Line Tightness Testing: On September 29, 2021, one non-passing UST spill bucket was reported at the site. The non-passing spill bucket was repaired and received passing compliance test results on December 2, 2021. A copy of the retesting results are provided as Appendix C. 2. Summary of Site Check Procedure: On December 2, 2021, GRI performed a site check that included collection of one soil sample from beneath the spill bucket associated with the 6,000-gallon diesel UST. The sample was collected beneath the spill bucket from a depth of approximately 2 feet BGS during replacement of the non-passing spill bucket 3. Soil Excavation Activities: No soil excavation activities were conducted. C. SITE INVESTIGATION 1. Field Screening: The soil sample (DSL-2’) collected on December 2, 2021, was not field screened for VOCs with a PID. 2. Soil Sampling Information: Soil sample DSL-2’ was collected on December 2, 2021 and analyzed for TPH-GRO and TPH-DRO using UVF technology. The RALs were below the reported TPH-GRO and TPH-DRO concentrations in soil sample DSL- 2’. No free product was noted at the site. A soil quality map is presented as Figure 3. A summary of soil sample analytical results is presented in Table 3. The laboratory analytical report is provided as Appendix D. A summary of the soil sampling data from the December 2021 Site Check activities is shown below: Sample ID Sample Depth (ft-BGS) Gasoline-Range TPH Diesel-Range TPH RAL (mg/kg) 50 100 DSL-2’ 2 963 891 3. Ground Water and Surface Water Sampling Information: Ground water samples were not collected during the December 2, 2021 Site Check. 4. Quality-Control Measures: Clean, disposable nitrile gloves were used for collection of the soil sample. The sample was collected and delivered to GRI’s Monroe, North Carolina office in a cooler following proper chain-of-custody procedures. A duplicate was prepared from the extract of the primary sample, diluted to the same ___________________________________________________________________________________________ Prepared by: Geological Resources, Inc. Site Check Report Prepared on: February 1, 2022 Speedway #8654 Project Manager: Nicole Long GRI Project No. 3389 3 factor, then analyzed. D. SUMMARY AND CONCLUSIONS • The site is commercial and surrounding properties are commercial and residential. • On September 29, 2021, non-passing hydrostatic testing results were reported for the 6,000- gallon diesel UST spill bucket. The non-passing spill bucket was replaced and received passing compliance test results on December 2, 2021. • A Site Check was conducted on December 2, 2021, to determine if a petroleum release had occurred. • One soil sample (DSL-2’) was collected from approximately 2 feet BGS beneath the non-passing spill bucket. The RALs were below the TPH-GRO and TPH-DRO concentrations. • Two previous releases were documented at the site in 2013 (Incident No. 38440) and 2018 (Incident No. 38752). A Notice of NFA for the 2013 incident was issued by the NCDEQ on July 7, 2014, and an NRP (recorded July 18, 2014) was filed on the property. A Notice of NFA for the 2018 incident was issued by the NCDEQ on December 6, 2019. • Based on this information, GRI recommends conducting an LSA, including an update to the January 2014 receptor survey, to establish the current risk classification for the site and assess ground water. E. LIMITATIONS This report has been prepared for the exclusive use of Speedway, LLC for the specific application to the referenced site in Pitt County, North Carolina. The assessment was conducted based on the scope of work and level of effort specified by the 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 (C) 2009 MyTopo, 2006-2018 TomTom 077.3000000° W 077.3000000° W 077.2833333° W 077.2833333° W 077.2666666° W 077.2666666° W35.6000000° N35.6000000° N35.5833333° N35.5833333° N35.5666666° N35.5666666° NSCALE 1:24000 0 1000 2000 3000 4000 5000 FEET Declination MN 9.98° W MN Figure 1 Site Location Map Speedway #8654 5068 NC Highway 33 East, Greenville Pitt County, NC Incident No. N/A GRI Project No. 3389 Date: 10/29/18 Scale: 1 inch = 2,000 ft.Copyright (C) 2009 MyTopo Location: 035.5834070° N 077.2867350° W TABLES UST ID Number 1-5 Facility ID Number Owner or Operator? Owner/Operator UST ID Number 1-5 Facility ID Number Owner or Operator? Owner/Operator UST ID Number 1-5 Facility ID Number Owner or Operator? Owner/Operator 3602 Highway 264 East, Greenville, NC 27834 1-252-752-4366 5446 University Parkway, Winston-Salem, NC 27105-1366 1-800-642-0945 0-036281 Trade Oil Company 08/01/2001 - 06/01/2005 500 Speedway Drive, Enon, Ohio 45323 1-937-591-1283 0-036281 WilcoHess, LLC.06/01/2005 - 01/01/2016 TABLE 1 UST OWNER/OPERATOR INFORMATION SPEEDWAY #8654 (INCIDENT NO. PENDING) Address Telephone Number Name of Owner or Operator Dates of Ownership / Operation 0-036281 Speedway, LLC.01/01/2016 - Current Address Telephone Number Name of Owner or Operator Dates of Ownership / Operation Address Telephone Number Name of Owner or Operator Dates of Ownership / Operation Page 1 of 1 Date: 01/19/22 Was Release Associated with UST System? (Yes / No) 1 Gasoline NA 12,000 8/1/2001 Single Wall Steel/FR 8' x 32'Other Current No 2 Gasoline NA 6,000 8/1/2001 Single Wall Steel/FR 8' x 16'Other Current No 3 Gasoline NA 6,000 8/1/2001 Single Wall Steel/FR 8' x 16'Other Current No 4 Diesel NA 6,000 8/1/2001 Single Wall Steel/FR 8' x 16'Other Current Yes UST ID No. TABLE 2 UST SYSTEM INFORMATION SPEEDWAY #8654 (INCIDENT NO. PENDING) Facility ID #: 0-036281 Tank Dimensions Description of Associated Product Piping and Pumps Status of UST Current or Most Recent Contents Previous Contents Capacity (gallons) Date Installed Construction Details Page 1 of 1 Date: 01/19/22 Sample IDDate Collected (mm/dd/yy)Sample Depth(ft-BGS)Gasoline-Range TPHDiesel-Range TPHBenzeneTolueneEthylbenzeneTotal Xylenes50 100 NE NE NE NE NE NE 0.0072 5.4 8 6 NE NE 12 1,250 60.3 3,120 SB-1 3'10/10/18 3 13.3 NR 0.00834 0.0110 0.0552 0.322 SB-2 3'10/10/18 3 28.9 NR 0.358 0.537 0.353 2.39 SB-3 3'10/10/18 3 8.69 NR 0.917 0.243 0.289 1.03 DSL-2'12/02/21 2 963 891 NR NR NR NR Trip Blank 10/10/18 -NR NR <1.00 <1.00 <1.00 <3.00 Notes: • Results reported in mg/kg (milligrams per kilograms) • Trip Blank results reported in μg/l (micrograms per liter) • ft-BGS: feet below ground surface. • RAL: Regulatory Action Level. • MCCs: Maximum Contaminant Concentrations (soils). • SCLs: Soil Cleanup Levels. • < : Less than the method detection limit specified in the laboratory report • Concentrations in bold face type indicate the RALs or soil to water MCCs were below the reported concentrations. • Concentrations in italic type indicate that Residential SCLs were below the reported concentrations. • NE: Not Established • NR: Not Requested. RAL (mg/kg) Soil to Water MCC (mg/kg) Residential SCLs (mg/kg) TABLE 3 SUMMARY OF SOIL SAMPLE ANALYTICAL RESULTS SPEEDWAY #8654 (INCIDENT NO. PENDING) Facility ID #: 0-036281 Analytical Method →EPA Method 8260B5030/ 8015D/ UVF Page 1 of 1 APPENDICES Appendix A UST Suspected Release 24 Hour Notice Form (UST-17A) UST-17A UST Suspected Release 24 Hour Notice Do not use this form to report a 24 hour notice of a Pollution Incident. You must use form UST-61, 24 Hour Release and UST Leak Reporting Form.  This form must be used to report to DEQ, within 24 hours of discovery, a Suspected Release from any of the following: a) Failed or inconclusive leak detection or tightness test results. This includes positive test results, such as “Increase”, which indicates the level in the UST system has increased more than 0.2 gph. b) Unusual operating conditions which can include, but are not limited to: the erratic behavior of dispensing equipment; the unexplained presence of water in the tank; the presence of fuel in containment sumps or interstitial spaces; or the degradation of any equipment or element of an underground storage tank system to the point where that equipment or element can not reasonably be expected to perform its intended function. c) Internal inspection results such as, perforations, corrosion holes, weld failures, or other similar defects that indicate a release could have occurred.  If you have more than four UST systems to report suspected releases, then attach additional sheets of the UST-17A form. You only need to list the UST systems at your site that have suspected releases.  Within 7 days of discovery, submit a UST-17B form to document the response activities taken to investigate the suspected release.  Please submit this form to: NCDEQ/DWM, UST Section 1646 Mail Service Center Raleigh, North Carolina 27699-1646 OR Fax to (919) 715-1117 OR UST.Permits@ncdenr.gov I. UST OWNER II. UST FACILITY Name: Speedway LLC Name: Speedway 8654 Facility ID: 36281 Address: 500 Speedway Drive Address: 5068 NC Hwy 33 East City: Enon State: OH Zip: 45323 City: Greenville County: Pitt Person Reporting: Andrew McMillan Title of Person Reporting: Env. Compliance Coordinator Telephone Number: (919) 268-7176 Date Submitted: 10/8/2021 III. UST INFORMATION Tank Number / Size: 4 / 6k / / / Product Stored: DSL Location and/or source of suspected release: (check all that apply) Tank Piping Tank Sump Dispenser Sump Spill Bucket Internal Inspection Other (Explain in comments) Tank Piping Tank Sump Dispenser Sump Spill Bucket Internal Inspection Other (Explain in comments) Tank Piping Tank Sump Dispenser Sump Spill Bucket Internal Inspection Other (Explain in comments) Tank Piping Tank Sump Dispenser Sump Spill Bucket Internal Inspection Other (Explain in comments) Leak detection method or other observation that indicates a suspected release. (e.g., ATG, SIR, visual contamination, fuel in sump, etc.): Failed triennal hydro test Failed/Inconclusive date or date that leak detection method suspected release discovered: 9/29/2021 IV. COMMENTS Third party repair contractor completed triennial testing of DSL spill bucket resulting in a failure. A third party contractor has been scheduled repair the sump. UST-17A Revised 10/2018 http://www.wastenotnc.org/ Appendix B 24-Hour Release and UST Leak Reporting Form (UST-61) UST-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)  GPS  Topographic map  GIS Address matching  Other  Unknown Describe location: HOW RELEASE WAS DISCOVERED (Release Code) (Check one)  Release Detection Equipment or Methods  During UST Closure/Removal  Property Transfer  Visual/Odor  Water in Tank  Water Supply Well Contamination  Groundwater Contamination  Surface Water Contamination  Other (specify) _______________ SOURCE OF CONTAMINATION Source of Release (Check primary source) Cause of Release (Check primary cause) Type of Release (Check one) Product Type Released (Check primary product type released)  Tank  Piping  Dispenser  Submersible Turbine Pump  Delivery Problem  Spill Bucket  Other  Unknown Definitions presented on reverse  Spill  Overfill  Corrosion  Physical/Mechanical Damage  Install Problem  Other  Unknown Definitions presented on reverse  Petroleum  Non-Petroleum  Both Location (Check one)  Facility  Residence  Other  Gasoline/ Diesel/ Kerosene  Heating Oil  Other Petroleum Products  Metals  Other Inorganics  Other Organics  Diesel/Veg. Oil Blend  Vegetable Oil 100%  E10 – E20  E21 – E84  E85 – E99  Ethanol 100%  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 (02/19) 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 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 (02/19) 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 Spill Bucket Appendix C Certificate of Storage Tank System Testing Appendix D Laboratory Analytical Report - UVF 3502 Hayes Road • Monroe, North Carolina 28110 113 West Firetower Road, Suite G • Winterville, North Carolina 28590 Phone (704) 845-4010 • (888) 870-4133 • Fax (704) 845-4012 Engineering Certification: C-2727 • Geology Certification: C-127 UVF Trilogy Analytical Report Samples Collected: December 2, 2021 Samples Analyzed: December 10, 2021 Site Name: Speedway #8654 Site Address: 5068 NC Highway 33 East, Greenville, NC GRI Project Number: 3389 December 13, 2021 Joanna Alley, E.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) DSL-2'Soil 100 9.63 963 100 8.91 891 Dup DSL-2'Soil 100 10.00 1000 100 9.39 939 UVF Analytical Report siteLAB UVF Trilogy 12/10/2021 12/2/2021 Joanna Alley Speedway #8654 3389 Nicole Long Site: Speedway #8654 Report Date: 12/13/2021 Page: 1 of 1