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MO-29309_48472_CA_LSA_20230622_Phase I LSA
hart hickman SMARTER ENVIRONMENTAL SOLUTIONS 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 SMARTER ENVIRONMENTAL SOLUTIONS 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 (704) 712-0844 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 SMARTER ENVIRONMENTAL SOLUTIONS 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 i hart '` hickman https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/14VS-001_PhaselLSA 2021'122.doc SMARTER ENVIRONMENTAL SOLUTIONS 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 ii hart _%_ hickman https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/HVS-001_PhaselLSA 2021'122.doc SMARTER ENVIRONMENTAL SOLUTIONS 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. 1 hart'` hickman https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/14VS-001_PhaseILSA_202J 2.doc SMARTER ENVIRONMENTAL SOLUTIONS 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. 2 hart'` hickman https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/14VS-001_PhaseILSA_202J 2.doc SMARTER ENVIRONMENTAL SOLUTIONS 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. 3 hart'` hickman https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/14VS-001_PhaseILSA_202J 2.doc SMARTER ENVIRONMENTAL SOLUTIONS 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. 4 ha'` rthickman https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/14VS-001_PhaseILSA_202*2.doc SMARTER ENVIRONMENTAL SOLUTIONS 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. 5 hart'` hickman https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/14VS-001_PhaseILSA_202J 2.doc SMARTER ENVIRONMENTAL SOLUTIONS 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. 6 hart'` hickman https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/14VS-001_PhaseILSA_202J 2.doc SMARTER ENVIRONMENTAL SOLUTIONS 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. 7 hart'` hickman https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/14VS-001_PhaseILSA_202J 2.doc SMARTER ENVIRONMENTAL SOLUTIONS 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. 8 hart'` hickman https://harthick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/14VS-001_PhaseILSA_202J 2.doc SMARTER ENVIRONMENTAL SOLUTIONS 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) 6/22/2023 hick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/Tables/Tables.xls Hart &Hickman, Pl. 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) 2/10/2023 hick.sharepointcom/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/Tables/Tables 2%/2023 Hart IX HZCk1YtUYl, PC 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) 2/90/2023 hick.sharepoint.com/sites/MasterFiles-1/Shared Documents/AAA-Master Projects/Hidden Valley Solutions (HVS)/Phase I LSA/Tables/Tables ! Hart IX Hickman, 1. 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 (704) 586-0373 2 Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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 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 (704) 586-0373 ?. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street. Suite 100 Charlotte, North Carolina 28203 3. Teie hone (704) 586-0007 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 (704) 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 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 (704) 586-0007 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 (704) 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 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 (704) 586-0007 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 (704) 586-0373 �. 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 (704) 586-0007 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 (704) 663-4699, 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 (704) 586-0007 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 (704) 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: -! "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 (704) 586-0373 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 (704) 536-0007 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 (704) 586-0373 ?. Mail to Hart & Hickman. PC Attn: Mr. Stephen Libbey ?9-13 South Tryon Street. Suite 100 Charlotte. North Carolina 282103 3. Telephone (704) 586-0007 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 (704) 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: < 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 (704) 586-0373 ?. Mail to Hart & Hickman. PC Attn: Mr. Stephen Libbey 2923 South Trvon Street. Suite 100 Charlotte_ North Carolina 282103 3_ Telephone (704) 586-0007 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 (704) 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. 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 (704) 556-0373 ?. 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 (704) 663-1699. 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 (704) 586-0373 �. %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 (704) 586-0373 �. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey ?923 South Tryon Street. Suite 100 Charlotte. North Carolina 38203 3. Telephone (704) 586-0007 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 (704) 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) 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 (704) 586-0373 2. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street. Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 536-0373 '_- 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 (704) 586-0373 2, Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey -�913 South Tryon Street. Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: �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 (704) 586-0373 2. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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 ►-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 (704) 586-0373 ?- Mail to Hart & Hickman. PC Attn: Mr, Stephen Libbey 2923 South Tryon Street. Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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 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 (704) 586-0373 ?. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey ?923 South Tryon Street. Suite 100 Charlotte_ North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: �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 (704) 586-0373 2. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street. Suite 100 Charlotte. North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: <--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 (704) 536-0373 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 (704) 386-0373 �. [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 (704) 586-0373 2. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street. Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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 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 (704) 586-0373 ?. Mail to Hart & Hickman, PC Attn: Mr_ Stephen Libbey 2923 South Tryon Street. Suite 100 Charlotte. North Carolina 28203 3. Telephone 704) 586-0007 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 (704) 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: �, 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 (704) 586-0373 ?. 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 (704) 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: 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 (704) 586-0373 2. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 586-0373 2. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 586-0373 2. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 586-0373 ?. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey ?923 South Tr -von Street. Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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 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 (704) 586-0373 ?. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 19?3 South Tryon Street_ Suite 100 Charlotte. North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 586-0007 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 (704) 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: 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 (704) 586-0373 ?. Mail to Hart & Hickman. PC Attn: Mr. Stephen Libbey 2923 South Tryon Street_ Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 586-0373 ?. Mail to Hart & Hickman. PC Attn: Mr. Stephen Libbey 2923 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 586-0373 ?. Mail to Hart & Hickman_ PC Attn: Mr. Stephen Libbey 2923 South Trvon Street, Suite 100 Charlotte. North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 586-0373 ?. Mail to Hart & Hickman. PC Attn: Mr. Stephen Libbey 2923 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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 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 (704) 586-0373 ?. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 21923 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 586-0373 2. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street_ Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 586-0373 2. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 2923 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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 -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 (704) 586-0373 ?. Mail to Hart & Hickman. PC Attn: Mr. Stephen Libbey '9?3 South Tryon Street. Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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 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 (704) 586-0373 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 (704) 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 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 (704) 586-0373 ?. Mail to Hart &Hickman, PC Attn: Mr. Stephen Libbey -1913 South Tryon Street. Suite 100 Charlotte, North Carolina 28203 3, Telephone 704) 586-0007 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 (704) 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: 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 (704) 586-0373 ?. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey _'9?3 South Tryon Street. Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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- —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 (704) 586-0373 ?. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 19?3 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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 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 (704) 586-0373 ?. Mail to Hart & Hickman. PC Attn: Mr. Stephen Libbey 29-13 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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 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 (704) 586-0373 ?_ Mail to Hart & Hickman. PC Attn: Mr. Stephen Libbey ?9?3 South Tryon Street. Suite 100 Charlotte, North Carolina 28203 3. Telephone (704) 586-0007 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 (704) 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: 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 (704) 586-0373 2. Mail to Hart & Hickman. PC Attn: Mr. Stephen Libbey 2923 South Tryon Street, Suite 100 Charlotte, North Carolina 28203 3. Telephone 704) 586-0007 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 (704) 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: 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 (704) 586-0373 ?. Mail to Hart & Hickman, PC Attn: Mr. Stephen Libbey 19?3 South Tryon Street, Suite 100 Charlotte, North Carolina ?8203 3. Telephone (704) 586-0007 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 (704) 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 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 704) 586-0007 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 (704) 663-1699. 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 7041529-63fi4 • Fax: 7041525-0405 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 <slibbey@harthickman.com> Sent: Tuesday, July 11, 2023 12:14 PM To: Beverly, Trudy <trudy.beverly@deq.nc.gov> 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: 704-302-4404 m.10 From: Beverly, Trudy <trudy.beverly@deg.nc.gov> Sent: Friday, June 23, 2023 7:34 AM To: Steve Libbey <slibbey@harthickman.com> 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 <slibbey@harthickman.com> 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.