MO-29309_48472_CA_LSA_20230622_Phase I LSA

hart hickman
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Via Email
June 22, 2023
NC DEQ Division of Waste Management
UST Section
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Attention: Ms. Trudy Beverly
RE: Phase I LSA Report
Former D's Express
Concord, NC
H&H Job No. HVS.001
Dear Trudy,
On behalf of Hidden Valley Solutions, LLC, Hart & Hickman is submitting the attached Phase I
Limited Site Assessment (LSA) Report for the above referenced property located in Concord,
Cabarrus County, North Carolina.
If you have any questions or comments, please do not hesitate to contact me.
Sincerely,
Hart & Hickman, PC
Stephen R. Libbey, P.G.
Project Manager
Enclosures
cc: Hidden Valley Solutions, LLC (via email)
2923 South Tryon Street, Suite 100 3921 Sunset Ridge Rd, Suite 301
Charlotte, NC 28203 Raleigh, NC 27607 www.harthickman.com
704.586.0007 main 919.847.4241 main

Phase I Limited Site Assessment
Former D's Express
223 Cabarrus Avenue West
Concord, North Carolina
DEQ Incident No. 48472
H&H Job No. HVS-001
June 22, 2023
hart � hickman
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C-1269 Engineering
#C-245 Geology
2923 South Tryon Street, Suite 100 3921 Sunset Ridge Rd, Suite 301
Charlotte, NC 28203 Raleigh, NC 27607 www.harthickman.com
704.586.0007 main 919.847.4241 main

Phase I Limited Site Assessment Information
Site Location:
Former D's Express
223 Cabarrus Avenue West
Concord, North Carolina 28025
Site & UST Owner:
Hidden Valley Solutions, LLC
3207 Genevieve Drive
Columbus, OH 43219
[phone]
UST Operator:
MANGIKA, LLC (formerly)
204 Boulder Creek Road
Kathleen, GA 31047
General Site Information:
Facility ID Number: 00-0-000007440
NC DEQ Incident Number: 48472
Site Priority Ranking: anticipate low
Land Use Category: commercial
Latitude: 35.4057 N Longitude:-80.5880 W
Release Discovery Date: May 10, 2022
Estimated Quantity of Release: unknown
Cause/Source of Release: Unknown
Sizes and contents of UST system: Two 6,000-gallon gasoline USTs and one 10,000-gallon
gasoline
I, Stephen Libbey, PG a Licensed Geologist at Hart & Hickman, PC, do certify that
the information contained in this report is correct and accurate to the best of my knowledge.
,��auu1ui°nuu��
�``� \A CAROBlk,
SEAL. St
1658
m 06/22/23
Hart & Hickman, PC is licensed to practice geology/engineering in North Carolina. The
certification numbers of the company are C-245/C-1269.
-49
hart hickman
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Table of Contents
Section Pate No.
1.0 Executive Summary and Recommendations........................................................................1
2.0 Introduction and Site History................................................................................................3
3.0 Receptor Information and Risk Characterization...............................................................4
3.1 Receptor Information.............................................................................................................4
3.1.1 Water Supply Wells........................................................................................................4
3.1.2 Surface Water..................................................................................................................4
3.1.3 Subsurface Structures......................................................................................................4
3.1.4 Property Owners and Land Use......................................................................................5
3.1.5 Wellhead Protection Areas...............................................................................................5
3.2 Risk and Land Use Characterization.....................................................................................5
4.0 Geology and Hydrogeology....................................................................................................6
4.1 Regional Geology and Hydrogeology...................................................................................6
4.2 Site Hydrogeology..................................................................................................................6
5.0 Groundwater Sampling..........................................................................................................7
5.1 Soil Sampling Results.............................................................................................................8
5.1 Groundwater Sampling Results.............................................................................................8
5.2 Summary and Recommendations..........................................................................................8
Table 1 Summary Closure Sample Results
Table 2 Summary of Contiguous Properties
Table 3 Summary of Phase I LSA Groundwater Sample Results
List of Figures
Figure 1 Site Location Map
Figure 2 Sample Locations Map
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Figure 3 Contiguous Properties and Receptor Survey Map
List of Appendices
Appendix A
IAA Soil Sampling Locations Maps
Appendix B
Risk Classification and Land Use Form
Appendix C
Water Supply Well Survey Forms
Appendix D
Boring Log, Well Completion Record, and Low -Flow Form
Appendix E
Laboratory Analytical Report
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Phase I Limited Site Assessment
Former D's Express
Concord, North Carolina
H&H Job No. HVS-001
1.0 Executive Summary and Recommendations
This Phase I Limited Site Assessment (LSA) report documents assessment activities related to
two 6,000-gallon gasoline Underground Storage Tank (USTs) and one 10,000-gasoline
UST at the Former D's Express located at 223 Cabarrus Avenue West in Concord, Cabarrus
County, North Carolina. The site is approximately 0.30 acre in area and contained an
approximately 2,861 ft2 convenience store and grill.
In May 2022, H&H oversaw the removal of the UST system. No impacted soils were excavated
from the base of the UST basin due to lack of observed free product in soils below the USTs,
evidence of shallow groundwater, and safety concerns due to the nearby building. Results of
closure soil sampling indicated gasoline -range total petroleum hydrocarbons (TPH-GRO)
concentrations as high as 1,490 mg/kg in three soil samples collected below the USTs.
Land Use/Risk Characterization
As part of the LSA activities, H&H performed a site land use and risk characterization survey.
Municipal water is available to all properties within 1,000 ft of the source area. Water supply wells
were not identified within 1,000 ft of the source area. According to the United Stated Geological
Survey (USGS) topographic map dated 2019, no surface water bodies are located within 500 feet
of the source area.
The zoning of the site is General Commercial District (C-2). The properties in the surrounding
area are primarily zoned as General Commercial District (C-2), Light Industrial District (I-1),
Light Commercial Conditional District (C-1-CD), and Residential Compact (RC). The nearest
residentially zoned property is located approximately 190 ft east of the source area.
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Phase I LSA Sampling
On January 27, 2023, H&H oversaw the advancement of temporary monitoring well TMW-1 in
the approximate former location of soil sample UST-3B which contained the highest compound
concentrations during the UST closure in May 2022. Soil samples were not collected from the
boring for temporary well TW-1 because the previous soil excavation extended to the water
table.
The results of the groundwater sample analyses indicated the presence of C5-C8 aliphatics, C9-
C 18 aliphatics, C9-C22 aromatics, benzene, isopropylbenzene, naphthalene, and n-
propylbenzene in TMW-1 above the North Carolina NC 15A NCAC 02L.0202 Groundwater
Standards (2L Standards). No detected compound concentrations exceeded North Carolina
Gross Contamination Levels for groundwater (GCLs) in TMW-1.
Recommendations
Based upon the results of the IAA and Phase I LSA, H&H recommends that the North Carolina
Department of Environmental Quality (DEQ) issue a no further action (NFA) letter for the UST
incident subject to filing a Notice of Residual Petroleum (NRP) on the property deed restricting
groundwater usage at the property.
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2.0 Introduction and Site History
This Phase I LSA report documents assessment activities conducted in the vicinity of two 6,000-
gallon gasoline USTs (UST-1 and UST-2) and one 10,000-gallon gasoline UST (UST-3) at the
former D's Express located at 223 Cabarrus Avenue West, Concord, Cabarrus County, North
Carolina. The site is approximately 0.30 acre in area and contains an approximately 2,681 ft2
convenience store and grill. A site location map is presented as Figure 1, and the site layout is
depicted on Figure 2.
In May 2022, UST-1, UST-2, and UST-3 were removed from the subject property. Based on
field screening with a photoionization detector (PID), soil impacts were identified in soils
immediately below the USTs. No impacted soils were excavated from the base of the UST basin
due to the lack of observed free product in the soils below the USTs, evidence of shallow
groundwater, and safety concerns due to the nearby building. Results of closure soil sampling
indicated TPH-GRO concentrations as high as 1,490 mg/kg. UST closure soil analytical data are
summarized in Table 1. Closure soil sample locations are depicted on the figure in Appendix A
excerpted from H&H's Initial Abatement Action (IAA) Report dated June 20, 2022.
Because closure soil sample concentrations exceeded DEQ action levels, H&H recommended the
completion of a Phase I LSA within the IAA in accordance with DEQ guidelines. H&H
performed the Phase I LSA in January 2023. The methods and results of the Phase I LSA are
provided in the following sections.
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3.0 Receptor Information and Risk Characterization
As part of the Phase I LSA, H&H performed a site land use and risk characterization survey.
The LSA Risk Classification and Land Use Form is provided in Appendix B. A discussion of
potential receptors and land use is provided below.
3.1 Receptor Information
3.1.1 Water Supply Wells
H&H conducted a water supply well survey for the area within a 1,000-ft radius of the former
UST basin. The survey was conducted by performing area reconnaissance and checking for
municipal water connections. H&H also interviewed tenants and landowners of occupied
properties within 500 ft of the source area regarding their water usage.
Based on the water supply well survey, municipal water is available to all properties within a
1,000-ft radius of the site and no water supply wells were identified.
3.1.2 Surface Water
H&H conducted a visual survey for surface water bodies in the area during the receptor survey.
According to the USGS topographic map, no surface water bodies are located within 500 feet of the
source area. The closest surface water body is an unnamed tributary of Irish Buffalo Creek located
approximately 1,490 ft west-northwest of the source area (Figure 1). Irish Buffalo Creek is located
greater than 2,200 ft south-southwest of the source area.
3.1.3 Subsurface Structures
Visual observations were made for potential subsurface contamination conduits in the immediate
vicinity of the former UST. Based upon our review, there are no anticipated subsurface
contamination conduits of concern in the area of the former USTs.
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3.1.4 Property Owners and Land Use
The site is currently an active convenience store and grill. Surrounding properties are used
primarily for commercial and residential purposes.
The zoning of the site is General Commercial District (C-2). The properties in the surrounding
area are primarily zoned as General Commercial District (C-2), Light Industrial District (1-1),
Light Commercial Conditional District (C-1-CD), and Residential Compact (RC). The nearest
residentially zoned property is located approximately 190 ft east of the source area. Contiguous
property owners are shown on Table 2 and cross-referenced on Figure 3.
3.1.5 Wellhead Protection Areas
Based on our review of the DEQ Wellhead Protection Program's (WHPP) SWAPInfo2.0
mapping database, the site is not located in a wellhead protection area.
3.2 Risk and Land Use Characterization
Based upon the receptor data, as well as the Phase I LSA groundwater analytical data presented
in Section 5.0, the site qualifies for a low -risk designation. In addition, based on the zoning of
the site and surrounding area, the site qualifies for an industrial/commercial land use
classification.
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4.0 Geology and Hydrogeology
4.1 Regional Geology and Hydrogeology
The subject property is located in the Piedmont Physiographic Province of North Carolina.
According to the Geologic Map of North Carolina dated 1985, the subject property lies within
the Charlotte Belt. In the site area, underlying bedrock is composed of metavolcanic rock. The
land surface of the area is generally characterized as gently sloping, which may become
moderately steep where intersected by streams.
In the Piedmont, the bedrock is overlain by a mantle of weathered rock termed saprolite or
residuum. The saprolite consists of unconsolidated clay, silt, and sand with lesser amounts of
rock fragments. Due to the range of parent rock types and their variable susceptibility to
weathering, the saprolite ranges widely in color, texture, and thickness. Generally, the saprolite
is thickest near interstream divides and thins toward streambeds. In profile, the saprolite
normally grades from clayey soils near the land surface to highly weathered rock above
competent bedrock.
The occurrence and movement of groundwater in the Piedmont is typically within two separate
but interconnected water -bearing zones. A shallow water -bearing zone occurs within the
saprolite, and a deeper water -bearing zone occurs within the underlying bedrock.
4.2 Site Hydrogeology
Visual observations during the UST closure activities and Phase I LSA activities indicate that the
soil at the site consists of brown silty clays to clayey silts. The UST basin was backfilled with
brown to black silty sands to a depth of approximately 12 to 13 ft bgs. The LSA soil boring was
terminated at 13 ft bgs due to DPT refusal. Bedrock was not encountered.
Groundwater was encountered in the LSA soil boring at a depth of approximately 6 ft bgs.
Based on topography, H&H expects that the groundwater flow direction is to the southeast.
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5.0 Groundwater Sampling
On January 27, 2023, H&H oversaw the advancement of temporary monitoring well TMW-1 in
the approximate former location of UST basin closure soil sample UST-3B (Figure 2). Closure
soil sample UST-313 contained the highest TPH-GRO concentration during UST closure
activities conducted in May 2022. Soil samples were not collected from the boring for
temporary well TW-1 because the initial abatement excavation extended to the water table.
The temporary monitor well was installed by Geologic Exploration, Inc. of Statesville, North
Carolina using hollow -stem augers advanced with a direct push technology (DPT) rig. The
temporary well was installed to a depth of approximately 13 ft using a 1-inch diameter, 10-ft
long, 0.010-inch slot PVC screen with 3 feet of riser. The well screen was installed to bracket
the water table. The boring log for TW-1 is included in Appendix D.
After installation, H&H utilized a peristaltic pump and new silicon tubing to complete low -flow
purging and sampling techniques. The purging process was considered complete when field
measurements of temperature, pH, and specific conductivity had stabilized. The low -flow
sampling form is included in Appendix D. The groundwater sample from TMW-1 was
submitted for laboratory analysis of VOCs by EPA Method 6200B, VPH by the MADEP
Method, lead by EPA 601OD, and ethylene dibromide (EDB) by EPA 504.1.
The groundwater sample was submitted to Waypoint Analytical, a North Carolina -certified
laboratory. Dedicated laboratory -supplied bottles were used for sample collection. The samples
were placed in an iced cooler after collection. A chain -of -custody record was completed for the
samples collected and included the sample description, date collected, time collected, matrix,
sample container information, and analyses required. The chain -of -custody was signed by field
personnel prior to placement in the iced sample cooler for shipment to the laboratory. The chain -
of -custody record and laboratory analytical data sheets are provided in Appendix E.
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5.1 Soil Sampling Results
Because the initial abatement action excavation extended to the water table, no soil samples were
collected during drilling of the temporary monitor well.
5.1 Groundwater Sampling Results
Groundwater analytical results are summarized in Table 3. The results of analysis of the
groundwater sample indicated the presence of C5-C8 aliphatics (2,290 µg/L), C9-C18 aliphatics
(4,830 µg/L,), C9-C22 aromatics (2,190 µg/L), benzene (65.9 µg/L,), isopropylbenzene (79.5
µg/L,), naphthalene (244 µg/L), and n-propylbenzene (268 µg/L) in TMW-1 above the 2L
Standards of 400 µg/L, 700 µg/L, 200 µg/L, 1 µg/L, 7 µg/L, 6 µg/L, and 70 µg/L, respectively.
No detected compound concentrations exceeded GCLs in TMW-1.
5.2 Summary and Recommendations
Based on the Phase I LSA, the site qualifies for a low risk industrial/commercial classification.
Results of the Phase I LSA groundwater sampling indicated target compound concentrations
above 2L Standards, but below GCLs.
Based upon the results of the IAA and Phase I LSA, H&H recommends that DEQ issue an
NFA letter for the UST incident subject to filing a NRP on the property deed restricting
groundwater usage at the property.
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Table 1
Summary of Closure Soil Sample Results
Former D's Express
223 Cabarrus Ave West
Concord, North Carolina
H&H Job. No. HVS-001
Analytical Method
5030/
8015C
Contaminant of Concern
O
C�
=
a_
Sample ID
Date
Collected
Source Area
Sample
Depth (ft)
Incident
Phase
UST-1A
05/10/22
UST
13
IA
<2.44
UST-1 B
05/10/22
UST
13
IA
73.8
UST-2A
05/10/22
UST
13
IA
2.94 J
UST-213
05/10/22
UST
13
IA
49.0
UST-3A
05/11/22
UST
13
IA
10.0
UST-313
05/10/22
UST
13
IA
1,490
UST-3C
05/10/22
UST
13
IA
1,230
D-1
05/09/22
Dis
3
IA
2.95J
D-2
05/09/22
Dis
3
IA
<2.50
L-1
05/11/22
PL
3
IA
<2.63
L-2
05/11/22
PL
3
IA
<2.62
Action Level (mg/kg)
50
Notes:
Concentrations are reported in milligrams per kilogram (mg/kg).
Values in bold exceed the North Carolina Department of Environmental Quality Action Level.
TPH = Total Petroleum Hydrocarbons; GRO = Gasoline Range Organics; UST = Underground
Storage Tank; PL = Product Line; Dis. = Dispenser; IA = Initial Abatement; J = Estimated Value
Above Method Detection Limit, But Below Laboratory Reporting Limit
Table 1 (Page 1 of 1)
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Table 2
Summary of Contiguous Properties
Former D's Express
223 Cabarrus Avenue West
Concord, North Carolina
H&H Job. No. HVS-001
Direction
Parcel ID No.
Map ID
Property Street Address
Owner
Owner Address
From Site
12-028-0095.00
A
233 Cabarrus Ave W
Gary Adcock
704 East 10th Street
South
Charlotte, NC 28202
12-027-0016.00
B
232 Cabarrus Ave W
Paulino Curiel
215 N Bostian Street
West
China Grove, NC, 28023
12-027-0054.00
C
224 Cabarrus Ave W
Paulino Curiel
215 N Bostian Street
Northwest
China Grove, NC, 28023
12-028-0097.00
D
NA
City of Concord
P.O. Box 308
North
Concord, NC, 28026
12-028-0106.00
E
13 Dorland Ave SW
Reginald White
13 Dorland Avenue Southwest
East
Concord, NC, 28025
12-028-0110.00
F
17 Dorland Ave SW
Polly Buchanan
17 Dorland Avenue Southwest
Southeast
Concord, NC 28025
Notes:
Property owner information is based on Cabarrus County GIS Online Database.
Contiguous properties are shown on Figure 3.
Table 3 (Page 1 of
1)
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Table 3
Summary of Phase I LSA Groundwater Sample Results
Former D's Express
223 Cabarrus Avenue West
Concord, North Carolina
H&H Job. No. HVS-001
Analytical Method
MADEP
MADEP
MADEP
MADEP
MADEP
6200B
6200B
6200B
6200B
6200B
6200B
6200B
6200B
6200B
6200B
6200B
6010D
504.1
U
U
�
C
Contaminant of Concern
U
Q
Q
Q
(0
E
Q
E
Q
W
W
N
C
N
C
E
Q
N
00
C)
Na)
C
N
N
N
00
U
C)U
C)U
N
N
C
N
�
N
N
N
C
�_
N
E
N
E
0
LC�
U
�
U
d
U
d)
N
CV
N
C
O
i2
C
i
Date
Incident
=
_
F0
=
coo
N
00
U
L
-C°
CL
4
L6
m
Sample ID
Collected
Source Area
Phase
d
>
D_
>o
o
>
o
N
m
m
u�)
w
o
N
N
z
c
H
CV
C'7
X
-1
w
TMW-1
01/27/23
1 UST-3
I LSA
2,290
4,830
4,830
2,190
2,190
65.9
63.8
26.5
528
79.5
244
268
27.4
88.4
32.8
181
<0.002
<0.00343
North Carolina 2L Groundwater Standard (µg/L)�
400
NS
700
NS
200
1
70
70
600
70
6
70
600
400
400
500
15
0.02
Gross Contamination Level (µg/L)2
NS
NS
NS
NS
NS
5,000
5,900
8,800
80,000
30,500
6,000
26,100
1 260,000
1 28,500
24,100
50,000
15,000
50
Notes:
1 = 15A North Carolina Administrative Code 2L Groundwater Standards (April 2022)
2 = Division of Waste Management Groundwater Quality Standards and Gross Contamination Levels for Groundwater (GCLs; October 2021)
Apart from VPH, only those compounds detected are shown.
Concentrations are reported in milligrams per kilogram (mg/kg).
Bold values exceed the North Caroline 2L Groundwater Standard.
LSA = Limited Site Assessment; MADEP = Massachusetts Department of Environmental Protection; VPH = Volatile Petroleum Hydrocarbons; NS = Not Specified; NA = Not Analyzed; BDL = Below Laboratory Detection Limit; J = Detected
concentration is an estimate between the laboratory detection limit and the reporting limit.
Table 5 (Page 1 of1)
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L
A
13
i -
G�y
J,
2F _
SITE \
'T
,i
USGS The National Map: National Boundaries Dataset, 3DEP Elevation
Program, Geographic Names, Information System, National Hydrography
Dataset, National Land Cover Database, National Structures Dataset, and
National Transportation Dataset; USGS Global Ecosystems; U.S. Census
Bureau TIGER/Line data; USFS Road Data; Natural Earth Data; U..S.
Department of State Humanitarian Information Unit; and NOAA National
Centers for Environmental Information, U.S. Coastal Relief Model. Data
refreshed August, 2021.
TITLE
n
o 2,000 4,000 SITE LOCATION MAP
NPROJECT
- SCALE IN FEET FORMER D's EXPRESS
223 CABARRUS AVENUE WEST
CONCORD, NORTH CAROLINA
U.S.G.S. QUADRANGLE MAP 14 2923 south Tryon street- suite 100
hart '• hickman Charlotte, North Carolina28203
CONCORD, NORTH CAROLINA 2019 w 704-586-0007 (p) 704-586-0373 (t)
SMARTER ENVIRONMENTAL SOLUTIONS License # C-1269 / # C-245 Geology
QUADRANGLE DATE: 2-1-23 REVISION NO: 0
7.5 MINUTE SERIES (TOPOGRAPHIC) JOB NO: HVS-001 FIGURE NO: 1

i
PAP
G
ZZ /
FORMER CANOPY
LEE'S LAUNDRY
(233 CABARRUS AVENUE W)
ASPHALT,
(�TMW-1 /
l / /
ASPHALT, v
\—UNDEVELOPED
FORMER D's EXPRESS
(223 CABARRUS AVENUE W)
LEGEND
SITE PROPERTY BOUNDARY
PARCEL LINE
LIMITS OF UST BASIN EXCAVATION
TEMPORARY MONITORING WELL
LOCATION
NOTES:
1. BASE DATA OBTAINED FROM CABARRUS COUNTY GIS,
2020.
8
APPROXIMATE
0 10
SCALE IN FEET
SAMPLE LOCATION MAP
20
112,IF`T FORMER D's EXPRESS
223 CABARRUS AVENUE WEST
CONCORD, NORTH CAROLINA
• 2923 South Tryon Street -Suite 100
hart h i c k m a n Charlotte, North Carolina 28203
704-586-0007(p)704-586-0373(f
SMARTER ENVIRONMENTAL SOLUTIONS License # C-1269 / #C-245 Geology
DATE: 2-1-23 REVISION NO. 0
JOB NO. HVS-001 FIGURE NO. 2

LEGEND
SOURCE PROPERTY BOUNDARY
PARCEL BOUNDARY LINE
OADJACENT PROPERTY OWNER
ID; SEE TABLE 2
NOTES:
1. AERIAL IMAGERY OBTAINED FROM NC ONEMAP, 2019.
2. PARCEL DATA OBTAINED FROM NC ONEMAP, 2023.
� N
0 250 500
SCALE IN FEET
nTLE
RECEPTOR SURVEY MAP
PRo E r
D'S EXPRESS
223 CABARRUS AVENUE
WEST CONCORD, NORTH CAROLINA
2923 South Tryon Street - Suite 100
hart '• hickman Charlotte, North Carolina28203
704-586-0007 (p) 704-586-0373 (f)
SMARTER ENVIRONMENTAL SOLUTIONS License # C-1269 / # C-245 Geology
DATE: 2-1-23 REVISION NO: 0
JOB NO. HVS-001 FIGURE NO: 3

Appendix A
IAA Soil Sampling Locations Maps
44
hart hickman
SMARTER ENVIRONMENTAL SOLUTIONS

i
PAP
G
FORMER CANOPY
LEE'S LAUNDRY
(233 CABARRUS AVENUE W)
ASPHALT,
ASPHALT,
• UST-1 B
• UST-2B
• UST-3C
�L-1 ` • U0T-2A
A
-0,L-2
A \ A
C • D-1>
e �
\—UNDEVELOPED
FORMER D's EXPRESS
(223 CABARRUS AVENUE W)
0
LEGEND
SITE PROPERTY BOUNDARY
PARCEL LINE
Q
POLE -MOUNTED TRANSFORMER
FD-1
DUMPSTER
P
PRODUCT LINE
FORMER UST LOCATION
— — — —
LIMITS OF UST BASIN EXCAVATION
•
SOIL SAMPLE LOCATION
NOTES:
1. BASE DATA OBTAINED FROM CABARRUS COUNTY GIS,
2020.
N\ 8
APPROXIMATE
0 10 20
SCALE IN FEET
SAMPLE LOCATION MAP
FORMER D's EXPRESS
223 CABARRUS AVENUE WEST
CONCORD, NORTH CAROLINA
• 2923 South Tryon Street -Suite 100
hart h i c k m a n Charlotte, North Carolina 28203
704-586-0007(p)704-586-0373(f
SMARTER ENVIRONMENTAL SOLUTIONS License # C-1269 / #C-245 Geology
DATE: 5-20-22 REVISION NO. 0
JOB NO. HVS-001 FIGURE NO. 3

Appendix B
Risk Classification and Land Use Form
44
hart hickman
SMARTER ENVIRONMENTAL SOLUTIONS

Limited Site Assessment Risk Classification and Land Use Form
Part I - Groundwater/Surface Water/Vapor Impacts
High Risk
1. Has the discharge or release contaminated any water supply well including any used
for non -drinking purposes?
The discharge or release has not resulted in known contaminated water wells in the site
area.
2. Is a water supply well used for drinking water located within 1,000 feet of the source
area of the discharge or release?
Water supply wells used for drinking water were not identified within 1, 000 ft of the
source area.
3. Is a water supply well used for any purpose (e.g., irrigation, washing cars, industrial
cooling water, filling swimming pools) located within 250 feet of the source area of the
release or discharge?
Water supply wells used for any purpose were not identified within 250 ft of the source
area.
4. Does groundwater within 500 feet of the source area of the discharge or release have
the potential for future use in that there is no other source of water supply other than the
groundwater?
The subject site and surrounding properties are served by the municipal water supply.
5. Do vapors from the discharge or release pose a threat of explosion because of
accumulation of the vapors in a confined space, or pose any other serious threat to public
health, public safety or the environment?
Vapors from the discharge or release do not pose a threat of explosion and do not pose a
serious threat to public health, public safety, or the environment.
6. Are there any other factors that would cause the discharge or release to pose an
imminent danger to public health, public safety, or the environment?
No other factors would cause the discharge or release to pose an imminent danger to
public health, public safety, or the environment.

Intermediate Risk
7. Is a surface water body located within 500 feet of the source area of the discharge or
release?
According to the USGS topographic map, no surface water bodies are located within 500
feet of the source area. The closest surface water body is an unnamed tributary of Irish
Buffalo Creek located approximately 1,490 ft west-northwest of the source area.
8. Is the source area of the discharge or release located within a designated wellhead
protection area as defined in 42 USC 300h-7(e)?
The source area is not located within a designated wellhead protection area.
9. Is the discharge or release located in the Coastal Plain physiographic region as
designated on a map entitled "Geology of North Carolina" published by the Department
in 1985? If yes, is the source area of the discharge or release located in an area in which
there is recharge to an unconfined or semi -confined deeper aquifer that is being used or
may be used as a source of drinking water?
The discharge or release is not located in the Coastal Plain physiographic region.
10. Do the levels of groundwater contamination for any contaminant exceed the gross
contamination levels established (see Table 3) by the Department?
Detected concentrations do not exceed gross contamination levels.
Part II - Land Use
Property Containing Source Area of Discharge or Release
1. Does the property contain one or more primary or secondary residences (permanent or
temporary)?
The property does not contain a primary or secondary residence.
2. Does the property contain a school, daycare center, hospital, playground, park,
recreation area, church, nursing home, or other place of public assembly?
The property does not contain a place of public assembly.
3. Does the property contain a commercial (e.g., retail, warehouse, office/business space,
etc.) or industrial (e.g., manufacturing, utilities, industrial research and development,
chemical/petroleum bulk storage, etc.) enterprise, an inactive commercial or industrial
enterprise, or is the land undeveloped?
The property currently contains an active a convenience store and grill.
2

4. Do children visit the property?
Children currently visit the property.
5. Is access to the property reliably restricted consistent with its use (e.g., by fences,
security personnel or both)?
Access to the property currently or in the future is not anticipated to be restricted.
6. Do pavement, buildings, or other structures cap the contaminated soil?
The area of the UST release is currently partially capped with asphalt and/or concrete.
7. What is the zoning status of the property?
The property is zoned as General Commercial District (C-2).
8. Is the use of the property likely to change in the next 20 years?
The use of the site property will likely remain commercial for the next 20 years.
Property Surrounding Source Area of Discharge or Release
The questions below pertain to the area within 1500 feet of the source area of the discharge or
release (excludes property containing source area of the release):
9. What is the distance from the source area of the release to the nearest primary or
secondary residence (permanent or temporary)?
The nearest residence is located approximately 190 ft east of the source area.
10. What is the distance from the source area of the release to the nearest school, daycare
center, hospital, playground, park, recreation area, church, nursing home or other place of
public assembly?
St. Andrews Living Center (a church) is located approximately 320 ft southwest of the
source area.
11. What is the zoning status of properties in the surrounding area?
The properties in the surrounding area are primarily zoned as General Commercial
District (C-2), Light Industrial District (I-1), Light Commercial Conditional District (C-
I -CD), and Residential Compact (RC).
12. Briefly characterize the use and activities of the land in the surrounding area.
The primary land use in the immediate vicinity of the site is commercial and residential.

Appendix C
Water Supply Well Survey Forms
19
hart hickman
SMARTER ENVIRONMENTAL SOLUTIONS

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name:
Phone -
Address of property receiving survey:
// r-&-e 9�eG ,Vkj
City: nC-VG ,rl County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply,upply well on this ro ert ? Yes No If "No" disregard remainin2 questioms and return survev
Name and address of owner(s) of property with water su2ply well: Name:
How man water supply wells are on your property'?
What is the well(s) used for? (check all that apply) Drinking , Irrigation , Swimming Pool
Water Livestock I Other (specify) . You do not use the Well
How many residences are connected to the well (list addresses below)?
How deep is the well(s)? Date well was installed'?
What is the casing depth of the well(s)?
What is the screen interval of the well(s)'?
Additional water supply well information:
r
Please return completed survey to Hart & Hickman, PC by _using one of the following methods:
1. Fax to [phone]
2 Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe ct harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Follow inh Information (to the bet of your knowledge)
Marne and telephone number of person completing the survey:
Name: �? , t.+i64kj
Phone -
Address of' property receiving sun'ey:
S 4ely- ,S? -cam- A/k,/
City: Cd►• County: ea
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property'? Yes No If "No" disre and remaining questions and returnsurvey
Name and address of owner(s) of property with water su 1 well: Name:
How many water supply wells are on your ro emtv'?
What is the well(s) used for'? (check all that apply) Drinking . Irrigation , Swimming Pool
Water Livestock Other (s ecify) . You do not use the Well
How many residences are connected to the well (list addresses below)'?
How de.. is the well sj? Date well was installed?
What is the msing depth of the well(s)?
What is the screen interval of the well(s)".
Additional water supply well information:
r
Please return completed survey to Han & Hickman. PC.bv using one of the following methods.
1. Fax to [phone]
?. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street. Suite 100
Charlotte, North Carolina 28203
3. Teie hone [phone]
4. E-mail to slibbe 'a harthi ckman. coin
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name:
Phone #:-
Address of property receiving survey:
r_e,ey- Alt/
City: &ICAW County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property'! Yes N If "No" disregard ramainir!g questions and return survey
Name and address of owner(s) of property with watersupply well. Name:
How many watersupply wells are on your ro eriv'?
What is the well(s) used for'? (check all that apply) Drinking , Irrigation . Swimming Pool
Water Livestock Other s eeif►') . You do not use the Well
How many residences are connected to the well list addresses below)?
How deep is the well(s)? Date well was installed?
What is the casin depth of the well(s)?
What is the screen interval of the well(s)'?
Additional water su l y well information:
Please return completed survey to Hart & Hickinan. PC by using one of the following methods:
1. Fax to 704) 586-0373
?. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street. Suite 100
Charlotte. North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe tharthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Followin; Information (to the bet of your knowledge)
?game and telephone number of person completing the survey:
Dame: s. G°4,4441
Phone ;%;: ( ) -
.Address of property receiving survey:
t '-? <44-P-
Citv: County-,bw►vu
What is the source of vour drinking water" Public Water / water Supply Well / Stream Intake / Other (please
explain below.)
Is there a water su Iv well on this pro ertr`' Yes do If "No" disregard remaining questions and return survev
Name and address of owner(s) of propeny with water su . •Iv well_ name: __
How many water su 1% "ells are on your rp erty?
What :s the well(s) used for'' (check all that apply) Drinking Irrigation Swimming Pool
Water Livestock . Other (s .eeiiv). You do not use the Well _
Hoy-v main residences are connected to the well I list addresses below)"
Ho\,\ dj:ep is the wellls)'.' Date well %,,-as installed''
�Vhat is the casin-• de})th of the ell(s)"
What is the screen interval of the "ell(s)"
Additional v\atersu Iv %yell information. _
r ' f
Pleaae return completed sun'ey to flart & Hickman. PC by usinv one of the lollowtmi methods:
1 Fax to (704) 586-03 73
1, Mail to Hart R Hickman. PC
Attn: Mr. Stephen Libbey
A923 South Tr on Street, Suite 100
Charlotte. North Carolina 2820
1e}..h��ne [phone]
4. F-mail to shbbeN tj! harthickman-com FT
If you have ane questions. please contact the consultant indicated above or Trudy Be\ erly ith the Moores\ ille UST
Section Office at (704) 6 3-1699,

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident :Same: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey.
Name: S C. bh••�
Phone #: ( )-
Address of property receiving survey:
2-0 �C� 5¢Yrr_f_
City: �dy County: s
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water Su�ll on this ro e�Yes No If --No" disregard remaining questions and return survey
Name and address of m� ner(s) of properN with water supply well: Name:
How many water,u i% wells are on your property:°
What is the well(s) used for'? (check all that apply) Drinking Irrigation Swimming Pool
'Water Livestock . Other s ecify) You do not use the 'Well —
How manv residences are connected to the vell I list addresses below)" _
How deep is the well(s)` Date well was installed`
What is the casing depth of the well(s)"
What is the screen inter,. al of the wel3(s)"
Additional skater su l� �vell infonnation:
f �
a
Please return completed surrey to Hart 8 Hickman. PC by using one of the Cllowing methods:
1. Fax to [phone]
�. Mail to Hart R Hickinan. PC
Attn: l`Ir. Stephen Libber
-)9-)3 South Tryon Street. Suite 100
Charlotte. 'North Carolina 38?03
3. Telephone [phone]
4. E-mail to slibbevia harthickman.com
If aou have any- questions. please contact the consultant indicated above or Trudy Be\ erly ith the vlooresville UST
Section Office at [phone],

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident dumber: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey
Name: 4IJ
Phone
Address of property receiving survey:
city. county CA
What is the source of your drinking water" Public water / water Supply Well / Stream Intake / Other (please
explain bellow)
Is there a water 3�t Ir well on this ro ert►'' �'es 1 If "No" disret=_ard remaining uestions and return sur�ev
Name and address of owners) of property with water supply well: dame;
Ho\c manv watersu l\ wells are on your property? _
What is the well(S) used for" (check all that apply) Drinking . Irrigation . Swimming Pool
'Water Livestock . Other specify) You do not use the Well
How manv residences are connected to the well Mist addresses below)''
How deep . is the well(s)? _ Date well was installed'-' —
What is the casine depth of thew ell(s)'.'
What is the screen inter,, al of the wellla•.'
Additional water stipph, well information:
Please return completed sui-•ey to Hart & Hickman. PC by __•_,ustng one of the rollowing methods:
I Fax to t 704) 586-0373 ---
'.\nail to Hart & Hickman. PC
Attn: Mr. Stephen Libbev
11)23 South Tryon Street. Suite IUO
Charlotte. North Carolina 28303
3 Telephone [phone]
4. E-mail to slibbew�a harthickman.com
If you have any questions- please contact the consultant indicated above or Trudy Be%erly ith the Mooresville CST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey*
Name: -! "6-1
Phone ( ) -
Address of property receiving survey:
City: County: 04
What is the source of vour drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
ex lain below)
Is there a water suppler' well on this pj2 erw. Yes NO IC -No" disreeard remaining questions and return sun ev
Name and address of mvner(s) of Eroperly with water su ply vvell: Name:
Hovv many water supply wells are on your property.? _
What is the %,,ell(s) used for? (check all that apply) Drinking Irrigation . S�6mming Pool
Water Livestock Other(specify) . You do not use the 'Well
How many residences are connected to the welt (list addresses below)?
How deep is the well[sF° Date well was installed''
What is the casing de th of the �\ell(s)''
What is the screen Interval of the \,\ ell(s):'
Additional �xater su tv well information:
Please return completed survey to Bart Hickman. PC b,, - -- -, using one of the following method;:
l FaX to [phone]
3. Mail to Hart & Hickman. PC
Aim: [\tr. Stephen Libbee
-I9?3 South Tryon Street- Suite IOU
Charlotte. North Carolina 28203
3 Telephone ('04) �86-0001
4. F-mail to slibbe%t,a► harthickman.com _._-_--
If you have any' questions- please contact the consultant indicated abo\ or Trud,, Bey erl.\ ith the Mooresv the L ST
Section Office at (-'04) 6h3-1699.

Water Supply 'Well Information Survey
(This line to be completed by Responsible Partv or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please ProNide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey
Name: 5"Jr --j
Phone T: ( 1 -
Address poff property receiving survey:
City. County:CA
What is the source of your drinking water'? Public bVater / )Xater Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property.'? Yes 1 , ' If --No" disregard remaining question,, and return sure%
Name and address of owner(,) of properiv with water suppIx well: Name -.-
How many water ;u Iv wells are on rt)ur rca eriyl? _
What is the welt(s) used for'? (check all that apply) Drinking . Irrigation .Swimming Pool
%'eater Livestock -Other (specify) You do not use the '�y ell _
How many residences are connected to the well (list addresses below)?
How deep is the well(s)•? Date well was installed'?
'hat is the casing depth of the uell(s)" _
What is the screen interval of the well(.$)?J
.additional w ater SURPIs we11 information:
-- ,
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to (704) �86-03 73
Mail to Hart R Hick -man. PC
�ttn: (Vtr, Stephen Libbe\
'9"3 South Trvon Street. Snite to()
Charlotte. Forth Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe�,,u harthickman.com ,
If you have any questions. please contact the consultant indicated above or Trud,,1sc\ erl\ w ith the Moores•.•ille UST
Section Office at (70-4) 66-1-16y9•

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name:: S
Phone #: ( ) -.
Address of property receiving survey:
[
C(:o
City: County:
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
explain below
Is there a water sup2ly well on this property? Yes 1;'o
If "No" disregard remainin uestions and return survey
Name and address of o%mer(s) of property. with water supply well: Name:
How many water sup2ly wells are on your property?
What is the well(s) used for" (check all that apply) Drinking , Irrigation . Swimming Pool
Water Livestock Other (spedy) You do not use the Well
How many residences are connected to the well (list addresses below)?
How deep is the well(s)" Date well was installed"
What is the casing depth of the well(s)?
What is the screen interval of the well(s)"
Additional water tippply well information:
Please return completed survey to Hart & Hickman- PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
?9-13 South Tryon Street. Suite 100
Charlotte. North Carolina 282103
3. Telephone [phone]
4. E-mail to slibbe aharthickman.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: < 1, 7;
Phone #: (-
Address of property receiving survey:
City: County:
What is the source of your drinking water" Public Water / Water Supply Well / Stream Intake / Other (please
explain below
Is there a water supply well on this property? Yes o If "No" disregard remaining questions and return survey
Name and address of owner(s). of propeny with water sup2ly well. Name:
How many water supply wells are on your property?
What is the well(s) used for" (check all that apply) Drinking . Irrigation Swimming Pool
Water Livestock . Other (specify) You do not use the Well
How manv residences are connected to the well (list addresses below)?
How deep is the w°ell(s)? Date well was installed?
What is the casing depth of the well(s)?
What is the screen internal of the well(s)'.
Additional watersupply well information:
Please return completed survey to Hart & Hickman. PC by LiSina one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
2923 South Trvon Street. Suite 100
Charlotte_ North Carolina 282103
3_ Telephone [phone]
4. E-mail to slibbev(u harthickman,com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name. S 44
Phone t?: ( ] -
Address of property receiving survey:
City: / County:
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water su ply well on this property'? Yes 1io If "No" disregard remaining questions and return survey
Name and address of owner(s) of property with water supplwell; Name:
How many water supply wells are on your property?
What is the well(s) used for? (check all that apply) Drinking . Irrigation . Swimming Pool
Water Livestock . Other s ecifv) You do not use the 'Well
How- many residences are connected to the well list addresses below)"
How deep is the well(s)? Date well was installed'?
What is the casing depth of the well(s)"
What is the screen interval of the well(s)"
Additional water supply well information:
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
"9?3 South Trvon Street. Suite 100
Charlotte. North Carolina 28203
3. Telephone (704) 5S6-0007
4. E-mail to slibbev ci harthickman.com
If you have any questions, please contact the consultant indicated above or Trudv Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey,
(This line to be completed by Responsible Party or their representative)
Incident '.lumber: 48472 Incident Fame: Former D's Express, Concord, NC
Please Provide the Following, Information (to the bet of your knowledge)
Name and telephone number of person completing the surrey:
Name: 5-- wSc,
Phone 4: ( ) - -
Address of property receiving survey:
City: County:
What is the source of your drinkinL, water? Public �Vater / IvVater Supply d9'ell / Stream Intake / Other (please
explain below
Is there a water supply well on this property'? 1es•(.'o If --No" disregard remainina questions and return survey
Name and address of ow•nerts) of ro err.. with ,vater';U221V well: Name:
Hovv many water su 1% wells are on vour ropetly"'
What is the well(s) used for? (check all that apply) Drinking . Irrigation Swimming Pool
is ater Livestock Other (s ecif►) l ou do not use the Well
How manv residences are connected to the well (list addresses belo\\
Hove deep is the well[s)'? Date well was installed'.)
What is the casing depth of the
What is the screen interval of the ellts)" �J
Additional eater su h \,\'ell information: _
eo
r W•} r
Please return completed survey to kart & Hickman. PC b�, _usin= one of the folloW1112 methods:
1. Fax to [phone]
�. %Tail to Hart & Hickman. PC
Attn: Mr. Stephen Libbev
19", South Tryon Street. Suite 100
Charlotte. North Carolina 28 01)
3. Telephone ('704) 5S6-0007
4. E-mail to slibbeti;uharthickman.com
It you have anv question;_ please contact the consultant indicated above ur Trudy Bz\ erl% ith the MooresN ille UST
Section Office at (104) 66-1699.

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident dame: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone
number of person completing the survey':
?dame: T (- ft ,,
Phone ( )
.Address of property recei\ ing survey:
City: County:
What is the source of your drinkinU water" Public Water / Water Supple 'well / Stream Intake / Other (please
explain below
Is there a water supply well on this property'? YeS . o If -No" disreaard remainIM, questions and return survey
Name and address of owner(s) of property with water supply Nell: Name:
How many water supply wells are on your }ro eFIV:'
What is the well(s) used for? (check all that apply) Drinking . Irrigation _ Swimming Pool
'Water Livestock . Other (s eriLv) You do not use the Well _
Ho\A many residences are connected to the well ( list addresses below')"
Hoy,,' deep is the \%ellt-j' Date well was installed''
What is the casing depth of the wells)"- - -
What is the screen interval of the \\ell(s)''
.Additional w ater supply well information:
if
F
Please return completed sun eV to Hart LK, Hickman. P.t,b,� using one of the following methods:
1. Fax to (704) s86-03-73
�. N,,lail to Hart & Hickman. PC
Attn: Mr. Stephen Libber'
2923 South Tryon Street. Suite 100
Charlotte. North Carolina
Telephone (704) 5S6-000-7
4. E-mail to slibbe,,'u harthickman.com
It you have any question>. please contact the consultant indicated above t)r 1'rudy Beverly ith the ylooresN ille UST
Section Office at (-04) 663-1699,

V ater Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident !lumber: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telcphone number of person completing the surrey:
Name- G/0"
Phone;;-. 1 I - -
Address of property receiving survey:
city: county:
What is the source of your drinkinu water? Public Water- / LA'ater Supply Well / Stream Intake / Other (please
e-x7ain below)
Is there a water+u lr well on this ro ertv'' Aes ,'o If No disreearti remaininv questions and return sun•ev
Name and address of owner(s) of roerty with eater su pl� well: \ame:
How many .rater iupply wells are on your property?
What is the well(s) used for'? (check all that apple) Drinking Irrigation Swimming Pool
Water Livestock Other (specify) You do not use the Well
How man- residences are connected to the well List addresses belo�\
Hoy, deep is the wells)'.' Date ,vell was installed''
What is the casing depth of the welll s)" _
What is the screen internal of the well(s)?
Additional %� ater su l► w ell information.
Please return completed sun tV to Hart & Hickman. PC' by using one of the fnitowing methods:
1. Fax to (70 1) 386-0373 --
Mail to Hart R Hickman. PC
.Attn: 'Mr. Stephen Libber•
293 South Tryon Street. Suite l(-)0
Charlotte. North Carolina -'8-U3
3. Tele hone ('04) 586-0007
�. E-mail to slibbey,u harthickman.com _
If you have am' questions. please contact the consultant indicated above or -rude Be\ erl\ �,� ith the y[oores 'ille UST
Section Office at ('04) 663-1699.

Water Supple Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the sun•ey:
Name: $ (,`d
Phone: ( ) - 7
Address of property receiving survey:
City: � l_d County: W
What is the source of vour drinking water'' Public Water / dVater Supply dVell / Stream Intake / Other (please
explain below)
Is there a water %upply well on this propeny2 �/_ if - No" disregard remainin uestions and return sur ev
Name and address of ownerts) of propem, with water sv lv well; 'game:
How many watersupply wells are on tiour proarty? J
What is the xell(.$) used for'? (check all that apply) Drinking . Irrigation . Swimming Pool
°Water Livestock _ Other (5 ecifti) You do not use the NN ell _
Ho\,,\ mangy• residences are connected to the well.( list addresses belo��
How die.p is the well(sy! Date well was installed?
'Xinat is the casing depth of the well(sy' 4 �.
What is the screen interval of the %NelIis)-'
Additional w ater supply well information:
Please return completed survey to Hart & Hickman. DC b,� __ _using one of the tollowin-) method,,:
1. Fax to (704) �86-0373
�. ?Flail to Hart & Hiclarian. PC
Atuz: Mr. Stephen Libbey
292; South Tn•on Street. Suite 100
Charlotte. \orth Carolina 28203
3. Tele hone (704) �86-C)00'
q. E-mail to slibbe\'U harthicktnan.com
If you have any questions. please contact the consultant indicated above or Trudy Be%erly with the Nloores� ille UST
Section Office at (�04) 663-1699.

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name:
Phone #:-
Address of prop erty receiving survey:
City: County:
What is the source of your drinking water" Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water Sup-DISup-DIV well on this property'? Yes i " If "No" disregard remaining questions and return survey
Name and address of owner s) of property with water supply well: Name:
How -many water qupply wells are on your ro ert ?
What is the well(s) used for9 (check all that apply) Drinking Irrigation , Swimming Pool
Water Livestock . Other (specify) . You do not use the Well
How many residences are connected to the well ( list addresses below}'?
How de.de.ep is the well(s)? Date well was installed"
What is the casin depth of the well(s)?
What is the screen interval of the well(s)"
Additional water supply well information:
OF r
Please return completed survey to Hart 8 Hickman. PC by using one of the following methods:
1, Fax to [phone]
�. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
?923 South Tryon Street. Suite 100
Charlotte. North Carolina 38203
3. Telephone [phone]
4. E-mail to slibbeygharthickman.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Naive and telephone number of person completing the survey:
Name: Se.bh�
Phone #:-
Address of property receiving survey:
oa. b cz ?vs Aje .
City: County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property'? Yes If "No" disregard remainingguesLions and return survey
Name and address of owner(s) of property with water supply well; Name:
How many water supply wells are on your property'?
What is the well(s) used for'? (check all that apply) Drinking , Irrigation . Swimming Pool
Water Livestock Other (specify) . You do not use the Well
How manv residences are connected to the well (list addresses below)?
How deep is the well(s)" Date well was installed'?
What is the casing depth of the well(s)'?
What is the screen interval of the well(s)?
Additional water supply well information:
Please return completed survey to Hart & Hickman, PC by using one of the following methods:
1. Fax to [phone]
2. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street. Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe uharthickman.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: G6b�
Phone 4
Address of property receiving survey:
I t
City: County: .
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water SUPply well on this property"? Yes No If "No" disregard remaining questions and return survey
Name and address of owners) of propem with water supply %yell_ "same:
How many water su ly wells are on your ro erty?
What is the Well(S) used for? (check all that apply") Drinking Irrigation _ Swimming Pool
Water Livestock ..Other (specify) You do not use the Well
How many residences are connected to the well Ihst addresses belo%\ )"
Ho,x deep is the wellis)? Date_well was installed"
What is the casing depth of the \\ ell[ s)?
What is the screen inters al of the "ellts)''
Additional water su 1\ well information:
Please return completed sun"e,� to Hart E Hickman. PC by __. ___using one or the followin-, methods:
l Fax to [phone]
'_- Mall to Hart & Hickman" PC
.attn: Mr_ Stephen Libbev
'9_13 South Trvon Street- Suite 100
Charlotte. N'orth Carolina 28203
Tcic iiv uc (�vrtj �01�-VVv�
�. F-mail to slibbey a harthicknnan com
It you have any questions. please contact the consultant indicated above or Trudy Bey erl, \\ ith the yloores\ ille UST
Section Office at (704) f h_-1h99_

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name:
Phone #:-
Address of pro erty receiving survey
2 3 3 �a b ct�•S Gc,�
City:
County;
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
Is there a water suvoly well on this properry'? Yes CNN If "No" disre and remaining questions and return
Name and address of owner(s) of propene+ with water supply well; Name:
How many water &!jpply wells are on your property?
What is the well(s) used for'? (check all that apply) Drinking , Irrigation , Swimming Pool
Water Livestock . Other (specify) You do not use the Well
How many residences are connected to the well (list addresses below)-?
How deep is the well(s)'?
What is the casing depth of the well(s)?
What is the screen interval of the well(s)'?
Additional water sunoly well information:
Date well was installed'?
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
2, Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
-�913 South Tryon Street. Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4_ E-mail to slibbeytiz harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone],

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: �a 4
Phone -
Address of property receiving Airvcy:
z 3,t e 60rw-c Ale. w
County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property'? Yes 6-0 If "No" disregard remaining questions and return survey
Name and address of owner(s) of property with water supply well; Name:
How many water supply wells are on your property?
What is the well(s) used for'? (check all that apply) Drinking Irrigation , Swimming Pool
Water Livestock , Other (specify) . You do not use the Well
How many residences are connected to the well (list addresses below)'?
How deep is the well(s)'? Date well was installed"
What is the casing depth of the well(s)?
What is the screen interval of the well(s)'?
Additional water supply well information:
r
Please return completed survey to Hart & Hickman, PC by using one of the following methods:
1. Fax to [phone]
2. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbey a harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of ►-our knowledge)
Name and telephone number of person completing the survey:
Name: Se.bh�
Phone #:-
Address of property receiving sun'ey:
Z3 8 6a6a2.vs 4je. k)
City: County: rg
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below
Is there a water supply well on this ro ert '? Yes I' If "No" disregard remaining questions and return survey.
Name and address of owner(s). of properiy with water su lv well, Name:
How many water supply wells are on your property'!
What is the well(s) used for'? (check all that apply) Drinking , Irrigation , Swimming Pool
Water Livestock Other (specify) You do not use the Well
How Many residences are connected to the well list addresses below)'.. _
How deep is the well(s)'? Date well was installed'?
What is the casing depth of the well(.)?
What is the screen interval of the well(s)"
Additional water supply well information:
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
?- Mail to Hart & Hickman. PC
Attn: Mr, Stephen Libbey
2923 South Tryon Street. Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe it harthickman.com
If you have any questions_ please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone]-

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name:
Phone #: ( ) -
Address of pro rry receiving survey:
2 Y/ C 6 �m s rc1
City: County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this propert '? Yes No If "No" disregard remaininE questions and return survey
Name and address of owner(s) of property with water supply well; Name:
How many water supply wells are on your property'?
What is the well(s) used for'? (check all that apply) Drinking , Irrigation , Swimming Pool
Water Livestock Other (specify) You do not use the Well
How manv residences are connected to the well (list addresses below)?
How de is the well s)? Date well was installed'? _
What is the casing depth of the welI(s)?
What is the screen interval of the welI(s)"
Additional water supply well information:
Ad i
Please return completed survey to Hart & Hickman, PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
?923 South Tryon Street. Suite 100
Charlotte_ North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbey Ldharthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone]-

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: �S,.-09y,Lj
Phone #: ( ) - -
Address of property receiving survey:
2,41& /1c. tt)
City:oem County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a watersupply well on this property'? Yes If "No" disregard rem-ainiqg Suestions and return survey
Name and address of owner(s) of property with water 5upply well; Name:
How many water supply wells are on your property?
What is the well(s) used for'? (check all that apply) Drinking . Irrigation , Swimming Pool
Water Livestock . Other (specify) . You do not use the Well
How many residences are connected to the well (list addresses below).'
How deep is the well(s)'? Date well was installed'?
What is the casino depth of the well(s)?
What is the screen interval of the wellw'?
Additional water su22ly well information:
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
2. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street. Suite 100
Charlotte. North Carolina 28203
3. Telephone [phone]
4. E-mail to shbbe [e harthickman.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: <--L- 6dwj
Phone =: ( ) -
Address of property receiving sure-ey:
����c ��=►�/ s
City County:
What is the source of your drinking water" Public Water /'Nater Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property? Yes �a If --No" disrefaard remaining uestions and return sun-ev
Name and address of owner(s) ofprap�*rty with water supplt �-,yell: lame:
How many water su l%- wells are on your rra erty? _
What is the welt(s) used for? (check all that apply) Drinking _ Irrigation Swimming Pool
Water Livestock ..Other (specify) You do not use the Well
How main residences are connected to the %\-ell (list addresses below'}'
How deep is the w'ell(s)". Date well was installed?
`Xhat is the casing depth of the
What is the screen interval of the lls)?
Additional water su l% %-,,ell information:
Please return completed survey to Hart Hickman, PC b� ___using one of the following methods:
1. Fax to [phone]
Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbev
'9'3 South Tryon Street. Suite I(M
Charlotte. North Carolina 28203
icic 1lulic % "*I..011-GC"u
-l. E-mail to slibbe\ a harthiclman.com
If you have any. questions. please Contact the consultant indicated abo%e or Trudy Bev erl\ w Nth the Mooresv ille UST .
Section Office at I701) 6(,3-1699. -

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Fame: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey;:
Name:
Phone -
Address of property receiving survey:
City: County:
What is the source of your drinking water" Public !rater / water Supply Well / Stream Intake / Other (please
explain below)
Is there a water su ly v,ell on this property" Yes o If --NO" disregard remaminL, questions and return survey
Name and address of owner(s) of properi4 with water supply- well; Name:
How many water su h wells are on. yourprop-erty?
What is the �tiell(s) used for? (check all that apply) Drinking Irrigation _ Swimming Pool
Water Livestock Other s e.city) You do not use the Well
How mane residences are connected to the Well list addresses beiov"Y'
Hopi deep is the well(s):' Date well was installed'' _
What is the casing depth of the well(s)"
What is the screen interval of the well(s)?
.Additional kyater su h: %yell information:
A,e-LPI,b 4.R� -
Please return completed sure\ to Hart & Hickman. PC b� ___using one of the folloWing methods:
1. Fax to [phone]
�. [ail to Hart & Hickman. PC
Attn: %-Irv. Stephen Libber
'9"3 South Tr -on Street_ Suite 10H
Charlotte- North Carolina 28203
cic ionic j?0-+i 0„-vvv'
4 F-mail to slibbe\- :i harthickman.com
If you have any questions- please contact the consultant indicated ahm e or Trudy Beverly v, tth the yloores\ ille UST
Section Office at (704) 603- l h99,

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of pour knowledge)
Naive and telephone number of person completing the survey:
Name: 5;096A.1
Phone #:-
Address of properly receiving survey:
24; 7 0% bones /le. Ge%
City:
County:
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
Is there a water.qUpply well on this roe ? Yes no2 If "No" disregard remaining questions and return
Name and address of owners) of property with water su 1 well: Name:
How many water supply wells are on your rn: ertY.'
What is the well(s) used for'? (check all that apply) Drinking , Irrigation . Swimming Pool
Water Livestock Other. s ecify You do not use the Well
How many residences are connected to the well (list addresses below)?
How deep is the well(s)? Date well was installed`?
What is the casing depth of the well(s)?
What is the screen interval of the wells)?
Additional water supply well information:
Please return completed survey to Hart & Hickman, PC by using one of the following methods:
1. Fax to [phone]
2. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street. Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbeyk-harihickntan.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name:
Phone #:-
Address of property receiving survey:
/& i Vec i-e S W
City: County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below
Is there a water supply well on this property? Yes 1 < . If "No" disregard remaining questions and return survey
Name and address of owner(s) of ra erty with water supply well: Name:
How many water supply wells are on your property'?
What is the well(s) used for'? (check all that apply) Drinking . Irrigation Swimming Pool
Water Livestock Other (s ecily) . You do not use the Well
How many residences are connected to the well (list addresses below)?
How deep is the well(s)? Date well was installed'?
What is the casing depth of the well(s)?
What is the screen interval of the well(s)'?
Additional water supply well information:
Please return completed survey to Hart & Hickman. PC by ,using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman, PC
Attn: Mr_ Stephen Libbey
2923 South Tryon Street. Suite 100
Charlotte. North Carolina 28203
3. Telephone [phone]
4. E-mail to siibbev it harthickman.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:.
Name: �, L I.� Strj
Phone #:-
Address of property receiving survey:
101 Vec A-,e -5"/
City:
County:
What is the source of your drinking water" Public Water / Water Supply Well / Stream Intake / Other (please
explain belowl
Is there a water suvoly well on this property'? Yes If "No" disre and remaining questions and return
Name and address of owner(s) of property with water su lv well: Name:
How many water supplv wells are on your property'?
What is the well(s) used for'? (check all that apply) Drinking . Irrigation . Swimming Pool
Water Livestock _ Other s eeifv) You do not use the Well
How manv residences are connected to the well (list addresses below)'?
How deep is the well(s)'?
What is the casino depth of the well(s)'?
What is the screen interval of the well(
Additional water s.upply well information:
..
Date well was installed?
Please return completed survey to Hart & Hickman PC by using one of the following methods:
1. Fax to
[phone]
?. Mail to
Hart & Hickman_ PC
Attn: Mr. Stephen Libbey
?9')3 South Tryon Street. Suite 100
Charlotte, North Carolina 28?03
3. Telephone
704) 586-0007
4. E-mail to
slibbev{ri harthiclanan.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: S, 416j st y
Phone #:-
Address of property receiving survey:
PR Vec /tc S W
City: County:
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this ro ert? Yes /Ao If "No" disregard remainin uestions and return survey
Name and address of owner(s) of property with water sugly well: Name:
How many water supply wells are on your property'?
What is the well(s) used for'? (check all that apply) Drinking , Irrigation , Swimming Pool
Water Livestock Other (s ecifv) You do not use the Well
How many residences are connected to the well (list addresses below)'?
How deep is the well(s)? Date well was installed'?
What is the casing depth of the well(s)'?
What is the screen interval of the well(s)'?
Additional water supply well information:
Please return completed survey to Hart & Hickman, PC b using one of the following methods.:.
1. Fax to [phone]
2. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbey ci.harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: s 416
Phone #: ( -
Address of property receiving survey:
22- Cpt.--ea /j-. Sr..,�
City: �� County:
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
ex lain below)
Is there a water su2ply well on this property'? Yes f<o If "No" disregard remaining questions and return survey
Name and address of owner(s) of property with water supply well; Name:
How many water supply wells are on your ro ert?
What is the well(s) used for'? (check all that apply) Drinking , Irrigation , Swimming Pool
Water Livestock Other (specify) You do not use the Well
How many residences are connected to the well (list addresses below)?
How deep is the well(s)? Date well was installed?
What is the casing depth of the well(s)?
What is the screen interval of the well(s)?
Additional water supply well information;
Please return completed survey to Han & Hickman. PC by using one of the following methods:
1. Fax to [phone]
2. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe a,harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: 54b5e-1
Phone #: ( ) - -
Address of property receiving survey:
zo
City: Arov emd County: _
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property'? Yes / . 'o) If "No" disregard remaininE quesfions and return survey
Name and address of owner(s) of property with water supply well; Name:
How many water supply wells are on your property?
What is the well(s) used for? (check all that apply) Drinking Irrigation . Swimming Pool
Water Livestock Other (specify) You do not use the Well
How many residences are connected to the well (list addresses below)'?
How deep is the well(s)? Date well was installed'?
What is the casing depth of the well(s)'?
What is the screen interval of the well(s)'?
Additional water supply well information:
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
2. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe gharthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: z Lb64- 1
Phone 9:.( ) - -
Address of property receiving survey:
-3 o � n,,K by-. S: DJ
City: County:
What is the source of vour drinking water'? Public Water / Water Supply Well / Stream intake / Other (please
explain below)
Is there a water supply well on this ry eriv.':' Yes/0 If "No" disretrard remaining questions and return survey
Name and address of owner(s) of property with water supply well; 'dame:
How many water supply wells are on.your property?
What is the well(s) used for'? (check all that apply) Drinking . Irrigation . Swimming Pool
Water Livestock . Other (specify) . You do not use the Well
How manv residences are connected to the well (list addresses below)?
How deep is the well(s)" Date well was installed'?
What is the casing depth of the well(s)'?
What is the screen interval of the well(s)'.1
.Additional water supplv well information:
1'
Please return completed sun•ev to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
?923 South Tr -von Street. Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbeyCy harthickman.com
If you have anv questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name:
Phone 4:-
Address of property receiving survey:
3 4r
City: County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below
Is there a water su ly well on this property" Yes f5oIf "No" disrz�ard remainingquestions and return stm ev
Name and address of owners) of property with water supply well: 'lame:
How many water supply wells are on your ro ert►t?
What is the well(s) used for? (check all that apply) Drinking , Irrigation . Swimming Pool
Water Livestock _ Other (specify) . You do not use the Well
How many residences are connected to the well (list addresses below)'?
How deep is the well(s)? Date well was installed?
What is the casing dej2th of the Aell(s)''
What is the screen interval of the well(s)?
Additional water supply well information_
Please return completed survey to Hart & Hickman, PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
19?3 South Tryon Street_ Suite 100
Charlotte. North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbev a harthickman.com
If you have anv questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express. Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: s. Lr%7�jt••!
Phone #:
Address of property receiving survey:
City: d County:
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
explain below
Is there a water supply well on this ra erf ? Yes o If "No" disrc card remaining uestions and returnsurvey
Name and address of owner(s) of ro erty with waters I well: Name:
How many water supply wells are on your "ro erty?
What is the well(s) used for? (check all that apply) Drinking , Irrigation . Swimming Pool
Water Livestock _ Other (specify) You do not use the Well
How many residences are connected to the well (list addresses below)?
How de..- -is the well(s)'? Date well was installed'?
What is the casing depth of the well(s)?
What is the screen interval of the well(s)?
Additional water supply well information:
.Sme
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to 704) 586-0373
?. Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
39?'3 South Tryon Street. Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbev et harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: 7'
Phone 7: ( ) -
Address of property receiving survey:
City: 61 � cAr�County: �y
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property'? Yes No j If -'No" disregard remaining questions and return survey
Name and address of owner(s) of property with water supply well; Name:
How many water supply wells are on. our property'?
What is the well(s) used for'? (check all that apply) Drinking , Irrigation . Swimming Pool
Water Livestock , Other (specify) . You do not use the Well
How manv residences are connected to the well list addresses below)'?
How deep is the well(s)'? Date well was installed'?
What is the casing depth of the well(s)'?
What is the screen interval of the well(s)"
Additional water supply well information:
�� :�" e
Please return completed survey to Hart & Hickman, PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street_ Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe aharthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone],

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: S Gbb�
Phone -
Address of property receiving survey:
City: ; ¢ County: �& &
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake ! Other (please
explain below)
Is there a water su 1 well on this property? Yes N o If "No" disre and remaining questions and return survey
Name and address of owners of property with water supply well; Name:
How many water supply wells are on your property?
What is the well(s) used for'? (check all that apply) Drinking . Irrigation . Swimming Pool
Water Livestock . Other (specify) _ You do not use the Well
How Many residences are connected to the well list addresses below)?
How deep is the tvell[S}'? Date well was installed?
What is the casing depth of the well(s)?
What is the screen interval of the well(s)?
Additional water supply well inforInationig
r
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe aharthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
?Name: 5: 4LS�
Phone #: ( ) - -
Address of property receiving survey:
21 sv�
City: �r County: (27&fir
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this ra eni '? Yes No ` If "No" disregard remaining uestinns and return sun e�
Name and address of owner(s) of property with water supply well; Name:
How many water supply wells are on your property?
What is the well(s) used for? (check all that apply) Drinking Irrigation Swimming Pool
Water Livestock . Other (specify) You do not use the Well
How many residences are connected to the well ( list addresses below)'?
How deep is the well(s)'? Date well was installed'?
What is the casing depth of the well(s)"
What is the screen interval of the well(s)'?
Additional water sup2lv well info ration:
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman_ PC
Attn: Mr. Stephen Libbey
2923 South Trvon Street, Suite 100
Charlotte. North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe caharthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: S, h 5
Phone -
Address of property receiving survey:
,2_r pa d 4ve SVJ
City: ( �, County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property? Yes N o J If "No" disregard remaining question-, and return survey
Name and address of ❑wner(s) of property with water supply well, '.name:
How many water supply wells are on your ry ert '?
What is the well(s) used for'? (check all that apply) Drinking Irrigation . Swimming Pool
Water Livestock Other. (specify) You do not use the Well
How many residences are connected to the well (list addresses below)'?
How deaj2 is the well(s)'? Date well was installed'?
What is the casin.- depth of the well(s)*?
What is the screen interval of the well(s)?
Additional water supply well information:
Please return completed survey to Hart & Hickman, PC by _using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe rr harthickman,com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the FolIowing Information (to the bet of your knowledge)
Name and telephgrte number of person completing the survey:
Name: 'Lob"
Lo
Phone #: ( ) - -
Address of property receiving survey:
City: L:@ .1 � County:
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
ex lain below).
Is there a water supply well on this ro ert ? Yes No If "No" disre¢ard remainirt questions and return survey
Name and address of owners) of pLoperty with water supply well: Name:
How many water supply wells are on your property?
What is the well(s) used for'? (check all that apply) Drinking . Irrigation . Swimming Pool
Water Livestock Other (s eclfv) You do not use the Well
How manv residences are connected to the well list addresses below)?
How deep is the well(s)? Date well was installed?
What is the casing depth of the well(s)?
What is the screen interval of the we11(s)?
Additional water supply well inilos ation:
Please return completed survey to -Hart &Hickman. PC by _using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
21923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbevaharthickman.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
NVame: 5; le 1,
Phone -
Address of property receiving survey:
3 1 Po,- cc 4ve- SL4J
City:jCounty: y�,y
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below).
Is there a water supply well on thisproperty'? Yes Nn If "No" disre and remaining questions and return survey
Name and address of owner(s) of property with water su . I well; Name:
How many water supply wells are on your property'?
What is the well(s) used for'? (check all that apply) Drinking , Irrigation Swimming Pool
Water Livestock Other (s ecifv) You do not use the Well
How many residences are connected to the well (list addresses below)'?
How deep is the well(s)'? Date well was installed"
What is the casing de th of the well(s)'?
What is the screen interval of the well(s)?
Additional water supply well information:
119
Please return completed survey to Hart & Hickman, PC by using one of the following methods:
1. Fax to [phone]
2. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street_ Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe ct.harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: 4bbdL7
Phone #:-
Address of property receiving survey:
3(o t t4e. Sw
City: County: ei 4,V�lt
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
explain below
Is there a water supp.ly well on this. roe '? Yes / o If "No" disregard remaining questions and return survey
Name and address of owner(s) of property with water supply well; Name:
How many water supply. wells are on your property'?
What is the well(s) used for? (check all that apply) Drinking , Irrigation . Swimming Pool
Water Livestock Other (specify) , You do not use the Well
How many residences are connected to the well (list addresses below)?
How deep is the well(s)'? Date well was installed'?
What is the casino depth of the well(s)'?
What is the screen interval of the well(s)?
Additional water su2ply well information:
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
2. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe ii harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name -I 5.
Phone ( -
Address of property receiving survey:
/Y V�l�� Sf. Sul
City: "',-1 County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property? Yes o) If "No" disregard remaining questions and return surve
Name and address of owner(s) of propea with water supply well; Name:
How many water supply wells are on your 2 ert?
What is the well(s) used for? (check all that apply) Drinking , Irrigation , Swimming Pool
Water Livestock . Other s ecifv You do not use the Well
How manv residences are connected to the well list addresses below)?
How deep is the welI(s)? Date well was installed?
What is the casino depth of the well(s)?
What is the screen interval of the well(s)?
Additional water supply well information:
Please return completed survey to Hart & Hickman, PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
'9?3 South Tryon Street. Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbeviaharthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knov
Marne and telephone number of person completing the survey
dame:
Phone: -
Address of property receiving survey:
1$ V/ Ilkj Sf. su-,�
City:
County;
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
exulain below)
Is there a water Supply well on this
Name and address of owner(s) of
Yes k'No ) If "No"
with water sunply well: Name:
ining questions and return
How many water supply wells are on your property'! —
What is the well(s) used for? .(check all that apply) Drinking , . Irrigation . Swimming Pool
Water Livestock Other 8 ecif l) You do not use the Well
How manv residences are connected to the well (list addresses below)'?
How deep is the well(s)'?
What is the casing depth of the well(s)'?
What is the screen interval of the well(s)'?
Additional water suppiy well information:
Date well was installed'?
Please return completed survey to Hart & Hickman PC by using one of the following methods:
1. Fax to [phone]
Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Tel hone 704) 586-0007
4. E-mail to slibbey(gharthiekman.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone];

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the I- olln« in- Information (to the bet of . our knr)F+ledge)
Name and telephone number of person completing the survey:
Name: rj. �•��y
Phone -
Address of property receiving survey:
Va��
City:
County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
Is there a water supply well on this
Name and address of owners) of
y? Yes , o ] If "No" disregard
with water supply well, Name: _
and return
How many water supply wells are on your property!
What is the weIl(s) used for" (check all that apply) Drinking , Irrigation . Swimming Pool
Water Livestock . Other (5 eeiLy) . You do not use the Well
How many residences are connected to the well list addresses below)?
How deep is the well(s)''
What is the casing depth of the well(s)`
What is the screen interval of the w•ell(s)"
Additional water supply well information:
Date well was installed'?
Please return completed survey to Hart & Hickman PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart &Hickman, PC
Attn: Mr. Stephen Libbey
-1913 South Tryon Street. Suite 100
Charlotte, North Carolina 28203
3, Telephone [phone]
4. E-mail to slibbey(u_harthickman.com
if you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey
Name: S 4t,t ►7
Phone g: ( } -
Address of property receiving survey:
2,7, vq(ley S, Sup
City 19 County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)-
Is there a water supply well on this roe ? Yes :'o) If "No" disregard remainin uestions and return survey
Name and address of owner(s) of property with water supely well: Name:
How many water supply wells are on your ro ert ''
What is the well(s) used for? (check all that apply) Drinking , Irrigation , Swimming Pool
Water Livestock Other s eeifv . You do not use the Well _
How many residences are connected to the well list addresses below)?
How deep is the well(s)? Date well was installed'?
What is the easing depth of the well(s)'?
What is the screen interval of the well(s)-'
Additional water supply well information:
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
_'9?3 South Tryon Street. Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbeyuharthickman.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name- —j. Ca{�
Phone:-, t t� -
Address of property receiving survey:
2 S V kc, S�, Sub
City: r � County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below) ,
Is there a water supply well on this property'? Yes o If "No" disregard remaining questions and return survey
Name and address of owner(s) of propea with water supply well; Name:
How many water supply wells are on your property'?
What is the well(s) used for" (check all that apply) Drinking Irrigation , Swimming Pool
Water Livestock . Other (s ecifv) , You do not use the Well
How many residences are connected to the well (list addresses below)'?
How deep is the well(s)'? Date well was installed"
What is the casing depth of the well(s)'?
What is the screen interval of the well(s)"
Additional water supply well information:
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
19?3 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbey aharthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Follo►►ing Information (to the bet of your know
Name and telephone number of person completing the survey:
name: 5 44
Phone n ( l -
Address of property receiving survey:
M Vq(1el Sf- Sub
City�_M/ County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
Is there a water supply well on this property'? Yes o)If "No" disregard remaining uestions and return
Name and address of owner(s) of property,with water supply well; Name.. -
How many water supply wells are on your propen '.'
What is the well(s) used for'? [check all that apply) Drinking , Irrigation , Swimming Pool.
Water Livestock . Other s ecif► You do not use the Well
How many residences are connected to the well (list addresses below)?
How deep is the well(s)? Date well was installed'?
What is the casing depth of the well(s)'?
What is the screen interval of the well(s)?
Additional water su lv well information: _.
Please return completed survey to Hart & Hickman PC by using one of the following methods:
1. Fax to [phone]
?. Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
29-13 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe ' u harthickman.com
If you have any questions. please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone],

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knov
Name and telephone number of person completing the survey
Name: S 46ft7
Phone x: ( 1 - -
Address of property receiving survey:
// 1!�n ld S^f Srt�
City:� County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water suonly well on this
Name and address of owner(O of
Yes i` i o ) If "No"
with water suovly well: Name:
and return
How many water su [y wells are on your
What is the well(s) used for'? (check all that apply) Drinking , Irrigation , Swimming Pool
Water Livestock Other s eeifv) , You do not use the Well
How many residences are connected to the well (list addresses below)"
How dee2 is the well sl7
What is the casing depth of the well(sl`
What is the screen interval of the well(s)?
Additional water suvoly well information:
Date well was installed"
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1. Fax to [phone]
?_ Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
?9?3 South Tryon Street. Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbey(cz harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: S 46 i .k7
Phone -
Address of property receiving survey:
l 7 4�old 97, .S"J
City: County --
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
explain below)
Is there a water supply well on this property'? Yes ,'o If "No" disregard rentaining questions and return survey
Name and address of owner(s) of property with water su [y well: Name:
How many water.supely wells are on your' ro pert
What is the well(s) used for'? (check all that apply) Drinking , Irrigation Swimming Pool
Water Livestock . Other specify) You do not use the Well
How many residences are connected to the well (.list addresses below)?
How deep is the welt(s)" Date well was installed?
What is the casing depth of the well(s)"
What is the screen interval of the well(s]''
Additional water suopIy well information-
Please return completed survey to Hart & Hickman. PC by usintr one of the following methods:
1. Fax to [phone]
2. Mail to Hart & Hickman. PC
Attn: Mr. Stephen Libbey
2923 South Tryon Street, Suite 100
Charlotte, North Carolina 28203
3. Telephone [phone]
4. E-mail to slibbe ccharthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone],

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone number of person completing the survey:
Name: 5, 4,6
Phone =: ( a
Address of property receiving survey:
City: County:
What is the source of your drinking water'? Public Water / Water Supply Well / Stream Intake / Other (please
explain below
Is there a water supply well on this roe '? Yes o) If "No" disregard remaining questions and return survey
Name and address of owner(s) of property with water suppyly well: Name. -
How many water supply wells are on our' ro ert?
What is the well(s) used for'? (check all that apply) Drinking , Irrigation Swimming Pool
Water Livestock . Other s ecifv . You do not use the Well
How many residences are connected to the well (list addresses below)?
How deep.is the well(s)? Date well was installed"
What is the casing depth of the well(s)'?
What is the screen interval of the well(s)'?
Additional water supply well information:
Please return completed survey to Hart & Hickman. PC by using one of the following methods:
1, Fax to [phone]
?. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
19?3 South Tryon Street, Suite 100
Charlotte, North Carolina ?8203
3. Telephone [phone]
4. E-mail to shbbev a harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Water Supply Well Information Survey
(This line to be completed by Responsible Party or their representative)
Incident Number: 48472 Incident Name: Former D's Express, Concord, NC
Please Provide the Following Information (to the bet of your knowledge)
Name and telephone. number of person completing the survey:
,Name:
Phone Y: ( } -
Address of property receiving survey:
city. County:
What is the source of your drinking water? Public Water / Water Supply Well / Stream Intake / Other (please
explain below
Is there a water supply$upply well on this prope"? Yes Co If "No" disregard remaining questions and return survey
Name and address of owner(s) of propeny with water supplwell, Name:
How many water supply wells are on our' roe ?
What is the well(s) used for'? (check all that apply) Drinking , Irrigation , Swimming Pool
Water Livestock Other (specify) . You do not use the Well
How many residences are connected to the well list addresses below)?
How deep is the well(s)'? Date well was installed'?
What is the casing depth of the well(s)'?
What is the screen interval of the well(s)"
Additional water supply well information:
Please return completed survey to Hart 8: Hickman, PC by _using one of the following methods:
1. Fax to 704) 586-0373
?. Mail to Hart & Hickman, PC
Attn: Mr. Stephen Libbey
?923 South Tryon Street, Suite 100
Charlotte, North Carolina 218203
3. Telephone [phone]
4. E-mail to slibbev!it harthickman.com
If you have any questions, please contact the consultant indicated above or Trudy Beverly with the Mooresville UST
Section Office at [phone].

Appendix D
Boring Log, Well Completion Record, and Low -Flow Form
19
hart hickman
SMARTER ENVIRONMENTAL SOLUTIONS

14
hart hickman
Client: Hidden Valley Solutions
Project:
WELL LOG
Well No. TMW-1
Former D's Express (HVS-001)
SMARTER ENVIRONMENTAL SOLUTIONS
Address: 223 Cabarrus Ave. W., Concord NC
Page: 1 of 1
Drilling Start Date: 1/27/23
Boring Depth (ft): 13.0
Well Depth (ft): 13.0
Drilling End Date: 1/27/23
Boring Diameter (in): 2.25
Well Diameter (in): 1.0
Drilling Company: GEX
Sampling Method(s):
Screen Slot (in): 0.010
Drilling Method: Direct Push
DTW During Drilling (ft):
Riser Material: Sch 40 PVC
Drilling Equipment: Geoprobe 7822DT
DTW After Drilling (ft): 6.06
Screen Material: Sch 40 PVC Slotted
Driller: David Hall
Top of Casing Elev. (ft):
Seal Material(s): Bent. Chips
Logged By: Thomas Vaughan
Location (X,Y):
Filter Pack: Sand Pack
COLLECT
MEASURE
$
}
J
w
WOO
z
www
J
wa
N
Q
N3
$
d
p
SOIL/ROCK VISUAL DESCRIPTION
n
E
a
0
H
p
0
J
U
O
)
m
0 0
�'_ '✓
(0') Gravel/Fill
0.0
J
-^;-ER
(15) Silty SAND (SM); medium dense, moist, brown
0.0
0.0
5
5
69.1
(6.5') Poorly graded SAND (SP); loose, wet, black, strong odor
259.4
10
959.1
10
71.4
(12') SILT (ML); few clay, stiff, wet, greenish -gray
(12.5') SILT (ML); some clay, hard, wet, gray and brown, with PWR
(13') Boring terminated, DPT Refusal
15 15
NOTES: Hole precleared to 5 ft bgs on 1/27/23 using hand auger.
generated using GroundLogs.onlfne

Stabilization Criteria
hart hackman
Primary: Secondary:
pH +/- 0.1 unit DO +/- 0.2 mg/L
Job No: HVS-001
SMARTER ENVIRONMENTAL SOLUTIONS
S. Cond. +/- 5% ORP +/- 20 mV
LOW -FLOW GROUNDWATER
Turb. +/- 10% (<10 NTUs for metals)
Well ID: TMW-1
Water Level: slight or stable
SAMPLING RECORD
drawdown during purging
Well Location: Concord, NC
Facility Name:
Date: 1/27/23
Top of Casing Elevation (ft msl):
Casing Material: PVC Volume of Water Per Well Volume:
gallons
Total Well Depth (ft bgs): 13
Depth to Water (ft bgs ): 6.03
Well Diameter:
1-inch
Sampling Personnel: THV
I Screen Interval (ft bgs): 3
- 13
Type of Pump: Peristaltic
Tubing Material: Polyethylene
Pump/Tubing set at:
11 ft
Weather Conditions: Sunny 40s
NOTES: Begin low -flow at 11:35
Removed 3.0 gallons during development
GROUNDWATER SAMPLING PARAMETERS
Water Volume
Pumping DO Temp.
S. Cond. pH
ORP Turbidity
Time Level Pumped
Rate m /I f-C-1
S/cm
mV NTU
11:50 6.99 2250 mL
150 mL/min 0.45 15.1
881.0 6.18
-36.4 138.00
11:55 7.03 3000
0.37 15.0
879.0 6.17
-54.4 98.10
12:00 7.08 3750
0.22 15.4
855.0 6.16
-63.9 35.00
12:05 7.10 4500
0.21 15.6
860.0 6.17
-50.7 23.20
12:10 7.14 5250
0.30 15.9
861.0 6.17
-50.4 20.00
12:15 7.16 6000
0.16 16.1
860.0 6.16
-34.1 12.90
12:20 7.19 6750
0.14 16.0
860.0 6.16
-31.2 9.63
Other Sample Parameters:
Sampled at: 12:20
Parameters taken with:
YSI Pro Plus, Hanna
Sample Delivered to: Waypoint
by THV
at
1/27/23
Field Filtration: ®Yes e No
If yes, which sample parameters were field filtered:
Sample Parameter Containers (Types, Number of Containers, Preservatives): 6200 VOCs via x3 40 mL VOAs (w/HCI); VPH via x3 40 mL VOAs
(w/HCI); 504.1 EDB via x3 40 mL VOAs (w/Na2S203); 6010 lead via x1 250 mL plastic jar.
"S:\BBB Master Templates\Forms - 2022 Forms\Low Flow Groundwater Sampling Form.pdf' Stabilization criteria guidelines from the EPA SESD Operating
Last Updated: 2/1412022 Procedure for Groundwater Sampling, dated April 26, 2017.

Appendix E
Laboratory Analytical Report
44
hart hickman
SMARTER ENVIRONMENTAL SOLUTIONS

Waypointo
ANALYTICAL
2/7/2023
Hart & Hickman (Charlotte)
Steve Libbey
2923 South Tryon St. Ste 100
Charlotte, NC, 28203
Ref: Analytical Testing
Lab Report Number: 23-027-0022
Client Project Description: HVS-001
Dear Steve Libbey:
449 5pringbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointanalytical.com
Waypoint Analytical, LLC (Charlotte) received sample(s) on 1/27/2023 for the analyses presented in the
following report.
The above referenced project has been analyzed per your instructions. The analyses were performed in
accordance with the applicable analytical method.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters were performed in accordance with guidelines established by the USEPA (including 40 CFR 136
Method Update Rule May 2021) unless otherwise indicated.
Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as -
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report.
Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
a'-1
Angela D Overcash
Senior Project Manager
Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
Page 1 of 22

0
Waypoint.
ANALYTICAL
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointana lyti ca Isom
Certification Summary
Laboratory ID: WP CNC: Waypoint Analytical Carolina, Inc. (C), Charlotte, NC
State
Program
Lab ID
Expiration Date
North Carolina
State Program
37735
07/31/2023
North Carolina
State Program
402
12/31/2023
South Carolina
State Program
99012
07/31/2023
South Carolina
State Program
99012
12/31/2022
Laboratory ID: WP MTN: Waypoint Analytical, LLC., Memphis, TN
State
Program
Lab ID
Expiration Date
Alabama
State Program
40750
02/28/2023
Arkansas
State Program
88-0650
02/07/2023
California
State Program
2904
06/30/2023
Florida
State Program
- NELAP
E871157
06/30/2023
Georgia
State Program
C044
02/18/2023
Georgia
State Program
04015
06/30/2023
Illinois
State Program
- NELAP
200078
10/10/2023
Kentucky
State Program
80215
06/30/2023
Kentucky
State Program
KY90047
12/31/2023
Louisiana
State Program
- NELAP
LA037
12/31/2023
Louisiana
State Program
- NELAP
04015
06/30/2023
Mississippi
State Program
MS
02/11/2023
North Carolina
State Program
47701
07/31/2023
North Carolina
State Program
415
12/31/2023
Pennsylvania
State Program
- NELAP
68-03195
05/31/2023
South Carolina
State Program
84002
06/30/2023
Tennessee
State Program
02027
11/14/2025
Texas
State Program
- NELAP
T104704180
09/30/2023
Virginia
State Program
00106
06/30/2023
Virginia
State Program
- NELAP
460181
09/14/2023
Page 1 of 1 00016/23-027-0022
Page 2 of 22

Waypoint. (2) 449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
ANALYTICAL www.waypointana lyti ca I som
Sample Summary Table
Report Number: 23-027-0022
Client Project Description: HVS-001
Lab No Client Sample ID Matrix Date Collected Date Received Method Lab ID
98536
TMW-1
Aqueous
01/27/2023
12:20
01/27/2023
14:50
98536
TMW-1
Aqueous
01/27/2023
12:20
01/27/2023
14:50 6010D WP MTN
WP MTN - Memphis, TN: Waypoint Analytical - TN, Memphis, TN
Page 3 of 22

Waypoint (D 449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
ANALYTICAL www.waypointanalytica l.com
Summary of Detected Analytes
Project: HVS-001
Report Number: 23-027-0022
Client Sample ID Lab Sample ID
Method Parameters Result Units Report Limit Analyzed Qualifiers
TMW-1
V 98536
6200E
Benzene
65.9
pg/L
5.00
02/01/2023
07:47
6200E
n-Butylbenzene
63.8
Ng/L
5.00
02/01/2023
07:47
6200E
sec -Butyl benzene
26.5
pg/L
5.00
02/01/2023
07:47
6200E
Ethylbenzene
528
Ng/L
5.00
02/01/2023
07:47
6200E
Isopropyl benzene
79.5
pg/L
5.00
02/01/2023
07:47
6200E
Naphthalene
244
Ng/L
10.0
02/01/2023
07:47
6200E
n-Propylbenzene
268
pg/L
5.00
02/01/2023
07:47
6200E
Toluene
27.4
Ng/L
5.00
02/01/2023
07:47
6200E
1,2,4-Trimethylbenzene
88.4
pg/L
5.00
02/01/2023
07:47
6200E
1,3,5-Trimethylbenzene
32.8
Ng/L
5.00
02/01/2023
07:47
6200E
o-Xylene
21.1
pg/L
5.00
02/01/2023
07:47
6200E
m,p-Xylene
160
Ng/L
10.0
02/01/2023
07:47
6200E
Xylene (Total)
181
pg/L
5.00
02/01/2023
07:47
MADEP-VPH
Aliphatic C5-C8
2290
pg/L
115
01/30/2023
11:10
MADEP-VPH
Aliphatic C9-Cl2
4830
iag/L
258
01/30/2023
11:10
MADEP-VPH
Aromatic C9-C10
2190
Ng/L
40.2
01/30/2023
11:10
Page 4 of 22

Waypointo
ANALYTICAL
Client: Hart & Hickman (Charlotte)
Project: HVS-001
Lab Report Number: 23-027-0022
Date: 2/7/2023
449 5pringbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointanalytical.com
CASE NARRATIVE
Volatile Organic Compounds - GUMS Method 6200B
Analyte: 2-Butanone
QC Batch No: V29384/V29383
Relative Percent Difference (RPD) for the duplicate analysis was outside of the allowable QC limits.
Analyte: 4-Methyl-2-pentanone
QC Batch No: V29384/V29383
Relative Percent Difference (RPD) for the duplicate analysis was outside of the allowable QC limits.
Analyte: Acetone
QC Batch No: V29384/V29383
Relative Percent Difference (RPD) for the duplicate analysis was outside of the allowable QC limits.
Page 5 of 22

WavDdibnto
ANALYTICAL
01102
Hart & Hickman (Charlotte)
Steve Libbey
2923 South Tryon St. Ste 100
Charlotte , NC 28203
Project HVS-001
Information :
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointana lyti ca Isom
Report Date : 02/07/2023
Received : 01/27/2023
Report Number : 23-027-0022 REPOR T OF A NA L YSIS
Lab No : 98536 Matrix: Aqueous
Sample ID: TMW-1 Sampled: 1/27/2023 12:20
Test Results Units MDL MQL DF Date / Time By Analytical
Analyzed Method
Lead <0.002 mg/L 0.002 0.006 1 02/07/23 05:04 TJS 6010D
Qualifiers/ DF Dilution Factor
Definitions
MQL Method Quantitation Limit
Page 6 of 22

Waypoint. 0 449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
ANALYTICAL www.waypointanalytical.com
01102
Hart & Hickman (Charlotte) Project HVS-001
Steve Libbey Report Date : 02/07/2023
2923 South Tryon St. Ste 100 Information : Received : 01/27/2023
Charlotte , NC 28203
Report Number : 23-027-0022 REPOR T OF A NA L YSIS
Lab No : 98536
Matrix: Aqueous
Sample ID: TMW-1
Sampled: 1/27/2023 12:20
Analytical Method: 6200B
Prep Batch(es):
V29383 01/31/23 14:00
Prep Method: 6200 PT
Test
Results
Units
MDL MQL
DF
Date / Time
By
Analytical
Analyzed
Batch
Acetone
<100
N9/L
100
10
02/01/23 07:47
MSA
V29384
Benzene
65.9
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
Bromobenzene
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
Bromochloromethane
<10.0
u9/L
10.0
10
02/01/23 07:47
MSA
V29384
Bromodichloromethane
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
Bromoform
<50.0
u9/L
50.0
10
02/01/23 07:47
MSA
V29384
Bromomethane
<10.0
N9/L
10.0
10
02/01/23 07:47
MSA
V29384
n-Butylbenzene
63.8
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
sec -Butyl benzene
26.5
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
tert-Butyl benzene
<20.0
u9/L
20.0
10
02/01/23 07:47
MSA
V29384
Carbon Tetrachloride
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
Chlorobenzene
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
Chlorodibromomethane
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
Chloroethane
<10.0
u9/L
10.0
10
02/01/23 07:47
MSA
V29384
Chloroform
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
Chloromethane
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
2-Chlorotoluene
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
4-Chlorotoluene
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
Di -Isopropyl Ether (DIPE)
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,2-Dibromo-3-Chloropropane
<20.0
u9/L
20.0
10
02/01/23 07:47
MSA
V29384
Dibromomethane
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,2-Dichlorobenzene
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
Qualifiers/ DF Dilution Factor
MQL
Method Quantitation Limit
Definitions
Page 7 of 22

Waypoint. 0 449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
ANALYTICAL www.waypointanalytical.com
01102
Hart & Hickman (Charlotte) Project HVS-001
Steve Libbey Report Date : 02/07/2023
2923 South Tryon St. Ste 100 Information : Received : 01/27/2023
Charlotte , NC 28203
Report Number : 23-027-0022
REPORT OF ANAL YSIS
Lab No : 98536 Matrix: Aqueous
Sample ID: TMW-1 Sampled: 1/27/2023 12:20
Analytical Method: 6200B Prep Batch(es): V29383 01/31/23 14:00
Prep Method: 6200 PT
Test Results Units MDL MQL DF Date / Time By Analytical
Analyzed Batch
1,3-Dichlorobenzene
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,4-Dichlorobenzene
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
Dichlorodifluoromethane
<50.0
N9/L
50.0
10
02/01/23 07:47
MSA
V29384
1,1-Dichloroethane
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,2-Dichloroethane
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,1-Dichloroethene
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
cis- 1,2-Dich loroethene
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
trans- 1.2-Dichloroethene
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,2-Dichloropropane
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,3-Dichloropropane
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
2,2-Dichloropropane
<20.0
N9/L
20.0
10
02/01/23 07:47
MSA
V29384
1,1-Dichloropropene
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
cis- 1,3-Dich loropropene
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
trans-1,3-Dichloropropene
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
Ethanol
<2000
N9/L
2000
10
02/01/23 07:47
MSA
V29384
Ethylbenzene
528
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
Hexachlorobutadiene
<30.0
N9/L
30.0
10
02/01/23 07:47
MSA
V29384
2-Hexanone
<10.0
u9/L
10.0
10
02/01/23 07:47
MSA
V29384
Isopropyl benzene
79.5
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
4-Isopropyl toluene
<5.00
u9/L
5.00
10
02/01/23 07:47
MSA
V29384
Methyl Ethyl Ketone (MEK)
<50.0
N9/L
50.0
10
02/01/23 07:47
MSA
V29384
Methyl tert-butyl ether (MTBE)
<10.0
u9/L
10.0
10
02/01/23 07:47
MSA
V29384
Qualifiers/ DF Dilution Factor
MQL
Method Quantitation Limit
Definitions
Page 8 of 22

Waypoint. 0 449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
ANALYTICAL www.waypointanalytical.com
01102
Hart & Hickman (Charlotte) Project HVS-001
Steve Libbey Report Date : 02/07/2023
2923 South Tryon St. Ste 100 Information : Received : 01/27/2023
Charlotte , NC 28203
Report Number : 23-027-0022 REPOR T OF A NA L YSIS
Lab No : 98536
Matrix: Aqueous
Sample ID: TMW-1
Sampled:
1/27/2023
12:20
Analytical Method: 6200B
Prep Batch(es):
V29383 01/31/23 14:00
Prep Method: 6200 PT
Test
Results
Units
MDL MQL
DF
Date / Time
By
Analytical
Analyzed
Batch
4-Methyl-2-Pentanone
<10.0
N9/L
10.0
10
02/01/23 07:47
MSA
V29384
Methylene Chloride
<20.0
pg/L
20.0
10
02/01/23 07:47
MSA
V29384
Naphthalene
244
N9/L
10.0
10
02/01/23 07:47
MSA
V29384
n-Propylbenzene
268
pg/L
5.00
10
02/01/23 07:47
MSA
V29384
Styrene
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,1,1,2-Tetrachloroethane
<5.00
pg/L
5.00
10
02/01/23 07:47
MSA
V29384
1,1,2,2-Tetrachloroethane
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
Tetrachloroethene
<5.00
pg/L
5.00
10
02/01/23 07:47
MSA
V29384
Toluene
27.4
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,2,3-Trichlorobenzene
<5.00
pg/L
5.00
10
02/01/23 07:47
MSA
V29384
1,2,4-Trichlorobenzene
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,1,1-Trichloroethane
<5.00
pg/L
5.00
10
02/01/23 07:47
MSA
V29384
1,1,2-Trichloroethane
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
Trichloroethene
<5.00
pg/L
5.00
10
02/01/23 07:47
MSA
V29384
Trichlorofluoromethane
<5.00
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,2,3-Trichloropropane
<5.00
pg/L
5.00
10
02/01/23 07:47
MSA
V29384
1,2,4-Trimethyl benzene
88.4
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
1,3,5-Trimethyl benzene
32.8
pg/L
5.00
10
02/01/23 07:47
MSA
V29384
Vinyl Acetate
<50.0
N9/L
50.0
10
02/01/23 07:47
MSA
V29384
Vinyl Chloride
<5.00
pg/L
5.00
10
02/01/23 07:47
MSA
V29384
o-Xylene
21.1
N9/L
5.00
10
02/01/23 07:47
MSA
V29384
m,p-Xylene
160
pg/L
10.0
10
02/01/23 07:47
MSA
V29384
Qualifiers/ DF Dilution Factor
MQL
Method Quantitation Limit
Definitions
Page 9 of 22

WavDdibnto
ANALYTICAL
01102
Hart & Hickman (Charlotte)
Steve Libbey
2923 South Tryon St. Ste 100
Charlotte , NC 28203
Project HVS-001
Information :
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointana lyti ca Isom
Report Date : 02/07/2023
Received : 01/27/2023
Report Number : 23-027-0022
REPOR T OF A NA L YSIS
Lab No : 98536
Matrix: Aqueous
Sample ID: TMW-1
Sampled: 1/27/2023
12:20
Analytical Method: 6200B
Prep Batch(es):
V29383 01/31/23 14:00
Prep Method: 6200 PT
Test
Results
Units
MDL MQL
DF Date / Time By
Analytical
Analyzed
Batch
Xylene (Total)
181
Ng/L
5.00
10 02/01/23 07:47
V29384
Surrogate: 4-Bromofluorobenzene
95.4
Limits: 70-130%
10 02/01/23 07:47 MSA
V29384
Surrogate: Dibromofluoromethane
98.6
Limits: 70-130%
10 02/01/23 07:47 MSA
V29384
Surrogate: 1,2-Dichloroethane - d4
94.0
Limits: 70-130%
10 02/01/23 07:47 MSA
V29384
Surrogate: Toluene-d8
98.4
Limits: 70-130%
10 02/01/23 07:47 MSA
V29384
Analytical Method: EPA-504.1
Prep Batch(es):
V29336 02/01/23 10:23
Prep Method: EPA-504.1(PREP)
Test
Results
Units
MDL MQL
DF Date / Time By
Analytical
Analyzed
Batch
1,2-Dibromoethane
<0.00343
ug/L
0.00343 0.0208
1 02/01/2316:56 AMP
V29367
Qualifiers/ DF Dilution Factor
Definitions
MQL Method Quantitation Limit
Page 10 of 22

WavDdibnto
ANALYTICAL
01102
Hart & Hickman (Charlotte)
Steve Libbey
2923 South Tryon St. Ste 100
Charlotte , NC 28203
Project HVS-001
Information :
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointana lyti ca Isom
Report Date : 02/07/2023
Received : 01/27/2023
Report Number : 23-027-0022
Lab No : 98536
Sample ID: TMW-1
REPOR T OF A NA L YSIS
Matrix: Aqueous
Sampled: 1/27/2023 12:20
Analytical Method: MADEP-VPH
Prep Batch(es):
V29268
01/30/23 08:00
Prep Method: MAVPH (Prep)
Test
Results Units
MDL
MQL
DF Date / Time By
Analytical
Analyzed
Batch
Aliphatic C5-C8
2290 Ng/L
115
500
10 01/30/23 11:10 TBL
V29269
Aliphatic C9-C12
4830 ug/L
258
500
10 01/30/23 11:10 TBL
V29269
Aromatic C9-C10
2190 Ng/L
40.2
500
10 01/30/23 11:10 TBL
V29269
Surrogate: 2,5-Dibromotoluene (FID)
81.5
Limits:
70-130%
10 01/30/23 11:10 TBL
MADEP-VPH
Surrogate: 2,5-Dibromotoluene (PID)
77.9
Limits:
70-130%
10 01/30/23 11:10 TBL
MADEP-VPH
Qualifiers/ DF Dilution Factor
Definitions
MQL Method Quantitation Limit
Page 11 of 22

•
Waypoint,
449 Springbrook Rd, Ch
Charlotte, NC 28217
Main 704.529.6364
ANALYTICAL
www.waypoi ntana lytica l.com
Quality Control Data
Client ID: Hart & Hickman (Charlotte)
Project Description: HVS-001
Report No: 23-027-0022
QC Prep: L661691
QC Analytical Batch(es): L662400
QC Prep Batch Method: 3005A
Analysis Method: 6010D
Analysis Description: Metals Analysis
Lab Reagent Blank
LRB-L661691
Matrix: AQU
Associated Lab Samples: 98536
Blank MDL
MQL Analyzed
Parameter Units
Result
Lead mg/L
<0.002 0.002
0.006 02/07/23 04:44
Laboratory Control Sample
LCS-L661691
Spike
LCS LCS %Rec % Rec
Parameter Units
Conc.
Result Limits
Lead mg/L
0.100
0.105 105 80-120
Matrix Spike & Matrix Spike Duplicate
G 54267-MS-L661691 G 54267-MSD-L661691
MS Spike
MSD MS Result MSD MS MSD %Rec Max
Parameter Units
Result Conc.
Spike Result %Rec %Rec Limits RPD RPD
Conc.
Lead mg/L
< 0.002 0.100
0.100 0.113 0.113 113 113 75-125 0.0 20.0
Post Digestion Spike
G 54267-PDS-L661691
PDS
% Analyzed
Parameter Units
Result
Recovery
Lead mg/L
0.269
108 02/07/23 05:30
Date: 02/07/2023 05:05 PM Page 1 of 9
Page 12 of 22

Waypointo
ANALYTICAL
Client ID: Hart & Hickman (Charlotte)
Project Description: HVS-001
Report No: 23-027-0022
QC Prep: V29383
QC Prep Batch Method: 6200 PT
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointanalytical.com
Quality Control Data
QC Analytical Batch(es): V29384
Analysis Method: 6200B
Analysis Description: Volatile Organic Compounds - GC/MS
Lab Reagent Blank LRB-V29383 Matrix: AQU
Associated Lab Samples: 98536
Blank MQL Analyzed % % Rec
Parameter Units Result Recovery Limits
Acetone
pg/L
< 10.0
10.0
02/01/23 01:15
Benzene
pg/L
< 0.500
0.500
02/01/23 01:15
Bromobenzene
pg/L
< 0.500
0.500
02/01/23 01:15
Bromochloromethane
pg/L
< 1.00
1.00
02/01/23 01:15
Bromodichloromethane
pg/L
< 0.500
0.500
02/01/23 01:15
Bromoform
Ng/L
< 5.00
5.00
02/01/23 01:15
Bromomethane
pg/L
< 1.00
1.00
02/01/23 01:15
n-Butylbenzene
pg/L
< 0.500
0.500
02/01/23 01:15
sec -Butyl benzene
pg/L
< 0.500
0.500
02/01/23 01:15
tert-Butyl benzene
pg/L
< 2.00
2.00
02/01/23 01:15
Carbon Tetrachloride
pg/L
< 0.500
0.500
02/01/23 01:15
Chlorobenzene
pg/L
< 0.500
0.500
02/01/23 01:15
Chlorodibromomethane
pg/L
< 0.500
0.500
02/01/23 01:15
Chloroethane
pg/L
< 1.00
1.00
02/01/23 01:15
Chloroform
pg/L
< 0.500
0.500
02/01/23 01:15
Chloromethane
pg/L
< 0.500
0.500
02/01/23 01:15
2-Chlorotoluene
pg/L
< 0.500
0.500
02/01/23 01:15
4-Chlorotoluene
pg/L
< 0.500
0.500
02/01/23 01:15
Di -Isopropyl Ether(DIPE)
pg/L
< 0.500
0.500
02/01/23 01:15
1,2-Dibromo-3-Chloropropane
pg/L
< 2.00
2.00
02/01/23 01:15
Dibromomethane
pg/L
< 0.500
0.500
02/01/23 01:15
1,2-Dichlorobenzene
pg/L
< 0.500
0.500
02/01/23 01:15
1,3-Dichlorobenzene
pg/L
< 0.500
0.500
02/01/23 01:15
1,4-Dichlorobenzene
pg/L
< 0.500
0.500
02/01/23 01:15
Dichlorodifluoromethane
Ng/L
< 5.00
5.00
02/01/23 01:15
1,1-Dichloroethane
pg/L
< 0.500
0.500
02/01/23 01:15
1,2-Dichloroethane
pg/L
< 0.500
0.500
02/01/23 01:15
Date: 02/07/2023 05:05 PM
Page 2 of 9
Page 13 of 22

Waypointo
ANALYTICAL
Client ID: Hart & Hickman (Charlotte)
Project Description: HVS-001
Report No: 23-027-0022
QC Prep: V29383
QC Prep Batch Method: 6200 PT
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointanalytical.com
Quality Control Data
QC Analytical Batch(es): V29384
Analysis Method: 6200B
Analysis Description: Volatile Organic Compounds - GC/MS
Lab Reagent Blank LRB-V29383 Matrix: AQU
Associated Lab Samples: 98536
Blank MQL Analyzed % % Rec
Parameter Units Result Recovery Limits
1,1-Dichloroethene
pg/L
< 0.500
0.500
02/01/23 01:15
cis-1,2-Dichloroethene
pg/L
< 0.500
0.500
02/01/23 01:15
trans-1,2-Dichloroethene
pg/L
< 0.500
0.500
02/01/23 01:15
1,2-Dichloropropane
pg/L
< 0.500
0.500
02/01/23 01:15
1,3-Dichloropropane
pg/L
< 0.500
0.500
02/01/23 01:15
2,2-Dichloropropane
pg/L
< 2.00
2.00
02/01/23 01:15
1,1-Dichloropropene
pg/L
< 0.500
0.500
02/01/23 01:15
cis-1,3-Dichloropropene
pg/L
< 0.500
0.500
02/01/23 01:15
trans-1,3-Dichloropropene
pg/L
< 0.500
0.500
02/01/23 01:15
Ethanol
pg/L
< 200
200
02/01/23 01:15
Ethylbenzene
pg/L
< 0.500
0.500
02/01/23 01:15
Hexachlorobutadiene
pg/L
< 3.00
3.00
02/01/23 01:15
2-Hexanone
pg/L
< 1.00
1.00
02/01/23 01:15
Isopropyl benzene
pg/L
< 0.500
0.500
02/01/23 01:15
4-Isopropyl toluene
pg/L
< 0.500
0.500
02/01/23 01:15
Methyl Ethyl Ketone (MEK)
pg/L
< 5.00
5.00
02/01/23 01:15
Methyl tert-butyl ether (MTBE)
pg/L
< 1.00
1.00
02/01/23 01:15
4-M ethyl-2-Pentanone
pg/L
< 1.00
1.00
02/01/23 01:15
Methylene Chloride
pg/L
< 2.00
2.00
02/01/23 01:15
Naphthalene
pg/L
< 1.00
1.00
02/01/23 01:15
n-Propylbenzene
pg/L
< 0.500
0.500
02/01/23 01:15
Styrene
pg/L
< 0.500
0.500
02/01/23 01:15
1,1,1,2-Tetrachloroethane
pg/L
< 0.500
0.500
02/01/23 01:15
1,1,2,2-Tetrachloroethane
pg/L
< 0.500
0.500
02/01/23 01:15
Tetrachloroethene
pg/L
< 0.500
0.500
02/01/23 01:15
Toluene
pg/L
< 0.500
0.500
02/01/23 01:15
1,2,3-Trichlorobenzene
pg/L
< 0.500
0.500
02/01/23 01:15
Date: 02/07/2023 05:05 PM
Page 3 of 9
Page 14 of 22

Waypointo
ANALYTICAL
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointanalytical.com
Quality Control Data
Client ID:
Hart & Hickman (Charlotte)
Project Description:
HVS-001
Report No:
23-027-0022
QC Prep:
V29383
QC Analytical Batch(es): V29384
QC Prep Batch Method:
6200 PT
Analysis
Method:
6200B
Analysis
Description:
Volatile Organic Compounds - GC/MS
Lab Reagent Blank
LRB-V29383
Matrix: AQU
Associated Lab Samples:
98536
Blank
MQL
Analyzed
%
% Rec
Parameter
Units
Result
Recovery
Limits
1,2,4-Trichlorobenzene
pg/L
< 0.500
0.500
02/01/23 01:15
1,1,1-Trichloroethane
pg/L
< 0.500
0.500
02/01/23 01:15
1,1,2-Trichloroethane
pg/L
< 0.500
0.500
02/01/23 01:15
Trichloroethene
pg/L
< 0.500
0.500
02/01/23 01:15
Trichlorofluoromethane
pg/L
< 0.500
0.500
02/01/23 01:15
1,2,3-Trichloropropane
pg/L
< 0.500
0.500
02/01/23 01:15
1,2,4-Trimethyl benzene
pg/L
< 0.500
0.500
02/01/23 01:15
1,3,5-Trimethyl benzene
pg/L
< 0.500
0.500
02/01/23 01:15
Vinyl Acetate
pg/L
< 5.00
5.00
02/01/23 01:15
Vinyl Chloride
pg/L
< 0.500
0.500
02/01/23 01:15
o-Xylene
pg/L
< 0.500
0.500
02/01/23 01:15
m,p-Xylene
pg/L
< 1.00
1.00
02/01/23 01:15
4-Bromofluorobenzene (S)
02/01/23 01:15
96.4
70-130
Dibromofluoromethane (S)
02/01/23 01:15
90.0
70-130
1,2-Dichloroethane - d4 (S)
02/01/23 01:15
84.0
70-130
Toluene-d8(S)
02/01/23 01:15
103
70-130
Laboratory Control Sample & LCSD
LCS-V29383
LCSD-V29383
Spike
LCS
LCSD
LCS LCSD
% Rec
Parameter
Units
Conc.
Result
Result
%Rec % Rec
Limits
RPD
Max
RPD
Acetone
pg/L
40.0
55.3
43.6
138 109
40-160
23.6*
20.0
Benzene
pg/L
20.0
20.3
18.8
102 94.0
70-130
7.6
20.0
Bromobenzene
pg/L
20.0
18.1
17.8
90.5 89.0
70-130
1.6
20.0
Bromochloromethane
pg/L
20.0
21.1
18.8
106 94.0
70-130
11.5
20.0
Bromodichloromethane
pg/L
20.0
21.1
18.8
106 94.0
70-130
11.5
20.0
Bromoform
pg/L
20.0
21.7
20.9
109 105
70-130
3.7
20.0
* QC Fail Date: 02/07/2023 05:05 PM Page 4 of 9
Page 15 of 22

Waypointo
ANALYTICAL
Client ID: Hart & Hickman (Charlotte)
Project Description: HVS-001
Report No: 23-027-0022
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointanalytical.com
Quality Control Data
QC Prep: V29383 QC Analytical Batch(es): V29384
QC Prep Batch Method: 6200 PT Analysis Method: 6200B
Analysis Description: Volatile Organic Compounds - GC/MS
Laboratory Control Sample & LCSD LCS-V29383 LCSD-V29383
Parameter
Units
Spike
Conc.
LCS
Result
LCSD
Result
LCS
%Rec
LCSD
% Rec
% Rec
Limits
RPD
Max
RPD
Bromomethane
pg/L
20.0
16.4
15.9
82.0
79.5
60-140
3.0
20.0
n-Butylbenzene
pg/L
20.0
18.8
19.0
94.0
95.0
70-130
1.0
20.0
sec -Butyl benzene
pg/L
20.0
19.2
19.3
96.0
96.5
70-130
0.5
20.0
tert-Butyl benzene
pg/L
20.0
19.0
19.3
95.0
96.5
70-130
1.5
20.0
Carbon Tetrachloride
pg/L
20.0
22.3
20.4
112
102
70-130
8.8
20.0
Chlorobenzene
pg/L
20.0
20.1
19.8
101
99.0
70-130
1.5
20.0
Chlorodibromomethane
pg/L
20.0
20.8
21.1
104
106
70-130
1.4
20.0
Chloroethane
pg/L
20.0
22.0
20.1
110
101
60-140
9.0
20.0
Chloroform
pg/L
20.0
20.7
19.4
104
97.0
70-130
6.4
20.0
Chloromethane
pg/L
20.0
20.3
18.3
102
91.5
60-140
10.3
20.0
2-Chlorotoluene
pg/L
20.0
18.9
18.6
94.5
93.0
70-130
1.6
20.0
4-Chlorotoluene
pg/L
20.0
18.8
19.5
94.0
97.5
70-130
3.6
20.0
Di -Isopropyl Ether (DIPE)
pg/L
20.0
21.9
20.3
110
102
70-130
7.5
20.0
1,2-Dibromo-3-Chloropropane
pg/L
20.0
21.5
19.5
108
97.5
70-130
9.7
20.0
Dibromomethane
pg/L
20.0
19.1
18.1
95.5
90.5
70-130
5.3
20.0
1,2-Dichlorobenzene
pg/L
20.0
19.8
20.4
99.0
102
70-130
2.9
20.0
1,3-Dichlorobenzene
pg/L
20.0
20.3
19.8
102
99.0
70-130
2.4
20.0
1,4-Dichlorobenzene
pg/L
20.0
19.9
19.9
99.5
99.5
70-130
0.0
20.0
Dichlorodifluoromethane
pg/L
20.0
19.5
21.5
97.5
108
60-140
9.7
20.0
1,1-Dichloroethane
pg/L
20.0
21.0
19.7
105
98.5
70-130
6.3
20.0
1,2-Dichloroethane
pg/L
20.0
19.3
17.8
96.5
89.0
70-130
8.0
20.0
1,1-Dichloroethene
pg/L
20.0
19.9
18.8
99.5
94.0
70-130
5.6
20.0
cis-1,2-Dichloroethene
pg/L
20.0
19.8
19.5
99.0
97.5
70-130
1.5
20.0
trans-1,2-Dichloroethene
pg/L
20.0
20.1
18.5
101
92.5
70-130
8.2
20.0
1,2-Dichloropropane
pg/L
20.0
20.7
19.0
104
95.0
70-130
8.5
20.0
1,3-Dichloropropane
pg/L
20.0
19.9
18.2
99.5
91.0
70-130
8.9
20.0
Date: 02/07/2023 05:05 PM Page 5 of 9
Page 16 of 22

Waypointo
ANALYTICAL
Client ID: Hart & Hickman (Charlotte)
Project Description: HVS-001
Report No: 23-027-0022
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointanalytical.com
Quality Control Data
QC Prep: V29383 QC Analytical Batch(es): V29384
QC Prep Batch Method: 6200 PT Analysis Method: 6200B
Analysis Description: Volatile Organic Compounds - GC/MS
Laboratory Control Sample & LCSD LCS-V29383 LCSD-V29383
Parameter
Units
Spike
Conc.
LCS
Result
LCSD
Result
LCS
%Rec
LCSD
% Rec
% Rec
Limits
RPD
Max
RPD
2,2-Dichloropropane
pg/L
20.0
19.0
17.5
95.0
87.5
70-130
8.2
20.0
1,1-Dichloropropene
pg/L
20.0
22.1
20.1
111
101
70-130
9.4
20.0
cis-1,3-Dichloropropene
pg/L
20.0
20.7
20.0
104
100
70-130
3.4
20.0
trans-1,3-Dichloropropene
pg/L
20.0
20.3
18.8
102
94.0
70-130
7.6
20.0
Ethanol
pg/L
500
592
543
118
109
60-140
8.6
20.0
Ethylbenzene
pg/L
20.0
19.2
19.1
96.0
95.5
70-130
0.5
20.0
Hexachlorobutadiene
pg/L
20.0
21.3
21.4
107
107
70-130
0.4
20.0
2-Hexanone
pg/L
20.0
19.7
16.7
98.5
83.5
60-140
16.4
20.0
Isopropyl benzene
pg/L
20.0
19.1
19.8
95.5
99.0
70-130
3.5
20.0
4-Isopropyl toluene
pg/L
20.0
19.5
20.0
97.5
100
70-130
2.5
20.0
Methyl Ethyl Ketone (MEK)
pg/L
20.0
23.9
18.2
120
91.0
60-140
27.0*
20.0
Methyl tert-butyl ether (MTBE)
pg/L
20.0
20.5
18.1
103
90.5
70-130
12.4
20.0
4-Methyl-2-Pentanone
pg/L
20.0
20.0
15.8
100
79.0
60-140
23.4*
20.0
Methylene Chloride
pg/L
20.0
19.1
17.7
95.5
88.5
70-130
7.6
20.0
Naphthalene
pg/L
20.0
18.9
17.7
94.5
88.5
70-130
6.5
20.0
n-Propylbenzene
pg/L
20.0
18.9
19.3
94.5
96.5
70-130
2.0
20.0
Styrene
pg/L
20.0
20.2
20.2
101
101
70-130
0.0
20.0
1,1,1,2-Tetrachloroethane
pg/L
20.0
19.9
20.1
99.5
101
70-130
1.0
20.0
1,1,2,2-Tetrachloroethane
pg/L
20.0
19.6
18.0
98.0
90.0
70-130
8.5
20.0
Tetrachloroethene
pg/L
20.0
20.4
20.4
102
102
70-130
0.0
20.0
Toluene
pg/L
20.0
20.1
19.0
101
95.0
70-130
5.6
20.0
1,2,3-Trichlorobenzene
pg/L
20.0
20.4
20.1
102
101
70-130
1.4
20.0
1,2,4-Trichlorobenzene
pg/L
20.0
20.4
19.5
102
97.5
70-130
4.5
20.0
1,1,1-Trichloroethane
pg/L
20.0
20.5
19.1
103
95.5
70-130
7.0
20.0
1,1,2-Trichloroethane
pg/L
20.0
21.3
18.8
107
94.0
70-130
12.4
20.0
Trichloroethene
pg/L
20.0
20.4
19.8
102
99.0
70-130
2.9
20.0
* QC Fail Date: 02/07/2023 05:05 PM Page 6 of 9
Page 17 of 22

Waypointo
ANALYTICAL
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointanalytical.com
Quality Control Data
Client ID:
Hart & Hickman (Charlotte)
Project Description:
HVS-001
Report No:
23-027-0022
QC Prep:
V29383
QC Analytical Batch(es): V29384
QC Prep Batch Method:
6200 PT
Analysis
Method:
6200B
Analysis
Description:
Volatile Organic Compounds - GC/MS
Laboratory Control Sample
& LCSD
LCS-V29383
LCSD-V29383
Spike
LCS
LCSD
LCS
LCSD
% Rec
Parameter
Units
Conc.
Result
Result
%Rec
% Rec
Limits
RPD
Max
RPD
Trichlorofluoromethane
pg/L
20.0
21.3
19.8
107
99.0
60-140
7.2
20.0
1,2,3-Trichloropropane
pg/L
20.0
18.1
16.7
90.5
83.5
70-130
8.0
20.0
1,2,4-Trimethyl benzene
pg/L
20.0
19.1
19.0
95.5
95.0
70-130
0.5
20.0
1,3,5-Trimethylbenzene
pg/L
20.0
19.4
19.8
97.0
99.0
70-130
2.0
20.0
Vinyl Acetate
pg/L
20.0
20.1
18.6
101
93.0
60-140
7.7
20.0
Vinyl Chloride
pg/L
20.0
22.3
20.2
112
101
60-140
9.8
20.0
o-Xylene
pg/L
20.0
19.2
18.9
96.0
94.5
70-130
1.5
20.0
m,p-Xylene
pg/L
40.0
40.3
39.7
101
99.2
70-130
1.5
20.0
4-Bromofluorobenzene (S)
94.8
98.2
70-130
Dibromofluoromethane (S)
106
99.0
70-130
1,2-Dichloroethane - d4 (S)
97.4
92.0
70-130
Toluene-d8(S)
102
101
70-130
Date: 02/07/2023 05:05 PM Page 7 of 9
Page 18 of 22

•
Waypoint,
449 Springbrook Rd, Ch
Charlotte, NC 28217
Main 704.529.6364
ANALYTICAL
www.waypoi ntana lytica l.com
Quality
Control Data
Client ID: Hart & Hickman (Charlotte)
Project Description: HVS-001
Report No: 23-027-0022
QC Prep: V29336
QC Analytical Batch(es): V29367
QC Prep Batch Method: EPA-504.1(PREP)
Analysis Method:
EPA-504.1
Analysis Description:
EDB and DBCP by Microextraction GC/ECD
Lab Reagent Blank
LRB-V29336
Matrix: AQU
Associated Lab Samples: 98536
Blank MDL
MQL
Analyzed
Parameter Units
Result
1,2-Dibromoethane pg/L <0.00330 0.00330
0.0200
02/01/23 12:01
Laboratory Control Sample & LCSD
LCS-V29336 LCSD-V29336
Spike
LCS LCSD
LCS LCSD % Rec
Parameter Units
Conc.
Result Result
%Rec % Rec Limits RPD
Max
RPD
1,2-Dibromoethane pg/L
0.250
0.300 0.300
120 120 70-130 0.0
20.0
Duplicate
V 98373-DUP-V29336
Result DUP
RPD Max RPD
Analyzed
Parameter Units
Result
1,2-Dibromoethane pg/L < 0.0207 <0.0207
0.0 20.0
02/01/23 14:19
Matrix Spike
V 98372-MS-V29336
MS Spike
MSD MS Result
MSD MS %Rec
Max
Parameter Units
Result Conc.
Spike
Result %Rec Limits
RPD
Conc.
1,2-Dibromoethane pg/L < 0.00338 0.256
0.267
104 70-130
Date: 02/07/2023 05:05 PM Page 8 of 9
Page 19 of 22

Waypointo
ANALYTICAL
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointanalytical.com
Quality Control Data
Client ID: Hart & Hickman (Charlotte)
Project Description: HVS-001
Report No: 23-027-0022
QC Prep: V29268
QC Analytical Batch(es): V29269
QC Prep Batch Method: MAVPH (Prep)
Analysis Method:
MADEP-VPH
Analysis Description:
Massachusetts VPH
Lab Reagent Blank
LRB-V29268
Matrix: AQU
Associated Lab Samples: 98536
Blank MDL
MQL
Analyzed
%
% Rec
Parameter Units
Result
Recovery
Limits
Aliphatic C5-C8 pg/L
<11.5
11.5
50.0
01/30/23 09:59
Aliphatic C9-C12 pg/L
<25.8
25.8
50.0
01/30/23 09:59
Aromatic C9-C10 pg/L
<4.02
4.02
50.0
01/30/23 09:59
2,5-Dibromotoluene (FID)(S)
01/30/23 09:59
83.9
70-130
2,5-Dibromotoluene (PID)(S)
01/30/23 09:59
82.2
70-130
Laboratory Control Sample & LCSD
LCS-V29268
LCSD-V29268
Spike
LCS LCSD
LCS LCSD
% Rec
Parameter Units
Conc.
Result Result
%Rec % Rec
Limits
RPD
Max
RPD
Aliphatic C5-C8 pg/L
300
264 264
88.0 88.0
70-130
0.0
50.0
Aliphatic C9-C12 pg/L
300
362 372
121 124
70-130
2.7
50.0
Aromatic C9-C10 pg/L
100
106 108
106 108
70-130
1.8
50.0
2,5-Dibromotoluene (FID) (S)
85.5 78.1
70-130
2,5-Dibromotoluene (PID) (S)
78.6 77.0
70-130
Date: 02/07/2023 05:05 PM Page 9 of 9
Page 20 of 22

WayPAoint.
NALYTICAL
449 Springbrook Rd, Charlotte, NC 28217
Main 704.529.6364
www.waypointanalytical.com
Shipment Receipt Form
Customer Number: 01102
Customer Name: Hart & Hickman (Charlotte)
Report Number: 23-027-0022
Shipping Method
0 Fed Ex 0 US Postal # Lab
0 UPS 0 Client 0 Courier
0 Other:
Thermometer ID:
IRT-15 2AC
Shipping container/cooler uncompromised?
CO,) Yes
0 No
Number of coolers/boxes received
F
Custody seals intact on shipping container/cooler?
0 Yes
0 No
# Not Present
Custody seals intact on sample bottles?
0 Yes
0 No
# Not Present
Chain of Custody (COC) present?
# Yes
0 No
COC agrees with sample Iabel(s)?
# Yes
0 No
COC properly completed
# Yes
0 No
Samples in proper containers?
U Yes
0 No
Sample containers intact?
0 Yes
0 No
Sufficient sample volume for indicated test(s)?
U Yes
0 No
All samples received within holding time?
# Yes
0 No
Cooler temperature in compliance?
0 Yes
0 No
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
U Yes
0 No
Water - Sample containers properly preserved
0 Yes
0 No
0 N/A
Water - VOA vials free of headspace
0 Yes
0 No
N/A
Trip Blanks received with VOAs
0 Yes
0 No
N/A
Soil VOA method 5035 — compliance criteria met
F_ High concentration container (48 hr)
F_ High concentration pre -weighed (methanol -14 d)
Special precautions or instructions included?
Comments:
0 Yes 0 No U N/A
F Low concentration EnCore samplers (48 hr)
Low conc pre -weighed vials (Sod Bis -14 d)
0Yes ONo
Signature: Asia Blakeborough
Date & Time: 01/27/2023 16:23:18
Page 21 of 22

0
CHAIN OF CUSTODY RECORD
Waypoint,
(
NO NIA
ANALYTICAL
PAGE OF QUOTE * TOENSURE PROPER BILLING: _
� '�
Samples INTACT upon arrival?
Project Name:. �
Received IN ICE?
449 Springbrook Road • Charlotte, NC 28217
Phone [phone]fi4 • Fax: [phone]
Short Hold Analysis (Yes) jHoJ UST Project: es (Noy
PROPER PRESERVATIVES indicated?
i. I
"Please ATTACH any project specific reporting (QC LEVEL 1 11 Ill IVj
Received WITHIN HOLDING TIMES?
K _
Client Company Name: �7 r rx
Report TolContact Name: 23/c- L '
provisions an r QC Requirement
p G�.�v��" �' �.
CUSTODY SEALS INTACT?
VOLATILES reed W10UT HEAOSPACE7
X
K
r- v , nypice To,
Reporting Address: 5, 1 r tr©1'+ rX s ROPER CaNTAIN 5 u ed? _
- + Address: �CJ �� nS P P v� ! .�.- r 1 L �a..�... ^�
TEMP: Therm IR� Observed 4,LL"C ICorr.�_°C
Phone: �' - ax (Yes)(N01 Purchase Order No./Billing Reference TO BE FILLED Ills BY CLIENTISAMPLING PERSONNEL
1 Email Address: 5L 1 yz &I h ��"� I C fi� - 5 Y Requested Due Date J 1 flay J 2 Days J 3 Days J 4 Days 5 Days
EDD Type: PDFX Excel X Other "Working Days" J &9 Days 3 Standard 16 days J Rush Work Must Be Certification: NC SC
y Pre Approved Other NIA
Site Location Name: �1 rh ;, �� Al v!� Samples received after 15:00 will be processed next business day.
Site Location Physical Address: Turnaround time is based on business days, excluding weekends and holidays. Water Chlorinated: YES_ NO_
,1 {SEE REVERSE FOR TERMS 8 CONDITIONS REGARDING SERVICES
I] / r :.• -V W I MC p/ rY� RENDERED BY WAYPOINT ANALYTICAL, LLC TO CLIENT] Samples feed Upon Collection: YES—NQ_
CLIENT
SAMPLE DESCRIPTION
DATE
COLLECTED
TIME
COLLECTED
MILITARY
MATRIX
(SOIL,
WATER, OR
SAMPLE CONTAINER
PRESERVA-QLI
TIVES
ANALYSIS REQUESTED
`� s r+ REMARKS
ID NO.
-TYPE
HOURS
SLUDGE)
SEE BELOW
NO"
SIZE
Ix I x I I I
IJill11111l1 III 1111111110111111111111111111�11In 23-027-W22
! I I! II III I!1 III i1 II 11111111 JIM 0,1?022�23
Halt & Hickman 1Chariortel 15 21
HVS-001
COPIES03
PRESS DOWN FIRMLY - 2
Sampler's Signature - ` ,'� Sampled By (Print Dame) _ �1 � r =- ' k Affiliation ,
Upon relinquishing, this Chain of Custody is your authorization for Waypoint Analytical to proceed with the analyses as requested above. Any changes must be Slta Arrival Time:
submitted in writing to the Waypoint Anal al Project Manager. There will be charges for any changes after analyses have been Initialized.
Relinquished By (Signature) Received By (Signature) Date MililaryNcrurs Additional Comments: . Sim Departure Tlnw;
Relinquished By: [Signature) Receid By: (SignBlure) Date Field Tech Fee:
Relirm­hed By lS,nnaturel Mileage:
McMcd of Shipment: NOTE? ALL SAMPLE COOLERS SHOULD BE TAPED SHUT WITH CUSTODY SEALS FOR TRANSPORTATION TO THE LABORATORY. /CDC Gr6up No. ( .
SAMPLES ARE NOT ACCEPTED AND VERIFIED AGAINST COC UNTIL RECEIVED AT THE LABORATORY.
ZI Fed Ex J UPS Hand -delivered J Waypoinl Analytcal Field Service J Dlher
NPDES: UST: GROUNDWATER• DRINKING WATER: SOLWASTE: RCRA: BRWNFLD LANDFILL OTHER -
NC
❑-JSIC JNC USC aNC USC lNC ❑SC ❑NC ❑SC ❑NC JSC UNC ❑SC ❑NC JSC JNC JSC
❑ I J ❑ I
LiID Cl J ❑ u ORIGINAL
'CONTAINER TYPE CODES: A = Amber C = Clear G= Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Organics Analysis (Zero Heed Space)
Page 22 of 22

Beverly, Trudy
From: Beverly, Trudy
Sent: Tuesday, July 11, 2023 12:19 PM
To: Steve Libbey
Subject: RE: [External] Former D's Express; Incident No. 48472
Good Afternoon Steve,
It's going to be next week. I'm on leave Thursday and Friday this week.
Have a great day,
Trudy
Trudy Beverly, L.G.
Hydrogeologist, Division of Waste Management
_ North Carolina Department of Environmental Quality
Leparin•en[U L.- ' m tal oua" UST Section, Mooresville Regional Office
704.235.2182 (Office)
Trudy.BeverlyAdec nc.gov
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Office Mailing Address:
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Branch's Underground Storage Tanks Website Address: hops://deq.nc.gov/about/divisions/waste-management/ust
Branch's Above Ground Storage Tanks Website Address: hops://deg.nc.gov/about/divisions/waste-management/ust/ast-program
INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES:
ht_pt s://deg.nc.gov/about/divisions/waste-management/waste-management-rules-data/waste-management-gis-mans
File Review Procedures:
https://deq.nc. gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office
ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche):
https: //dea.nc. gov/about/divisions/waste-management/laserfiche
Document Submittal & UST File Names for Laserfiche Policies:
https:Hfiles.nc.gov/ncdea[Waste%20Management/DWM/UST/W hatsNew/Final-Electronic-Document-Submittal-Policy.pdf
https:Hfiles.nc.gov/ncdeq/Waste%20Management/DWM/UST/Corrective%2OAction/UST%20fi le%20names%20for%2OLaserfiche.docx
From: Steve Libbey <[e-mail]>
Sent: Tuesday, July 11, 2023 12:14 PM
To: Beverly, Trudy <[e-mail]>
Subject: RE: [External] Former D's Express; Incident No. 48472
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Hi Trudy, the client asked me about this report today. When do you think you will have time to review this report?
Thanks,
Steve
Stephen Libbey, PG, Project Manager
Hart & Hickman, PC
2923 S Tryon Street, Suite 100 • Charlotte, NC 28203

Direct: 704-887-4606
www.harthickman.co
• Mobile: [phone]
m.10
From: Beverly, Trudy <[e-mail]>
Sent: Friday, June 23, 2023 7:34 AM
To: Steve Libbey <[e-mail]>
Subject: RE: [External] Former D's Express; Incident No. 48472
Received.
Trudy
S, A�5
Ileya'rinxnS o7 6nm'onmrnw lal 4
Trudy Beverly, L.G.
Hydrogeologist, Division of Waste Management
North Carolina Department of Environmental Quality
UST Section, Mooresville Regional Office
704.235.2182 (Office)
Trudy.Beverlykdeq.nc.. og_v
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Office Mailing Address:
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Branch's Underground Storage Tanks Website Address: https:Hdeq.nc.gov/about/divisions/waste-management/ust
Branch's Above Ground Storage Tanks Website Address: hit2s://deq.nc.gov/about/divisions/waste-management/ust/ast-program
INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES:
hops://deg.nc.wov/about/divisions/waste-management/waste-management-rules-data/waste-mana eg ment- ig s=maps
File Review Procedures:
hops: //deq.nc. gov/about/divisions/waste-management/ust/file-review-procedures#mooresville-regional-office
ONLINE ACCESS TO UST SECTION DOCUMENTS (Laserfiche):
hops://deq.nc. gov/about/divisions/waste-management/laserfiche
Document Submittal & UST File Names for Laserfiche Policies:
https://files.nc.¢ov/ncdeg/Waste%2OManagement/D WMIUST/W hatsNew/Final-Electronic-Document-Submittal-Policv.pdf
https:Hfiles.nc.gov/ncdeq/Waste%20Management/DWM/UST/Corrective%2OAction/UST%20file°/a20names°/`20for%2OLaserfiche.docx
From: Steve Libbey <[e-mail]>
Sent: Thursday, June 22, 2023 4:17 PM
To: Beverly, Trudy <trudy.beverly@deg. nc.gov>
Subject: [External] Former D's Express; Incident No. 48472
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Hi Trudy, a Phase I LSA for this site is attached.
Please call me if you have any questions.
Thanks,
Steve
Stephen Libbey, PG, Project Manager

Hart & Hickman, PC
2923 S Tryon Street, Suite 100
Direct:704-887-4606 Mobile:
www.harthickman.com I 0
• Charlotte, NC 28203
704-302-4404
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.