MO-29309_48472_CA_UST-3_20220405_Notice of Intent UST Permanent Closure‐Change in Service

UST-3 Notice of Intent:
UST Permanent Closure or Change -in -Service
STATE USE ONLY
Return completed form to:
The DWM Regional Office located in the area where the facility is located. Also send a copy to the Central Office in Raleigh. 1.D• #
SEE MAP ON THE BACK OF THIS FORM FOR THE CENTRAL AND REGIONAL OFFICE ADDRESSES. Date Received
INSTRUCTIONS (READ THIS
Complete and return a UST-3 form at least thirty (30) days prior to closure or change -in-service activities.
Completed UST closure or change -in-service site assessment reports, along with a copy of the UST-2A and/or 26 forms, should be submitted
to the appropriate Division of Waste Management (DWM; Regional Office within thirty (30) days following closure activities. The UST-2 form
should also be submitted to the Central Office in Raleigh so that the status of the tanks may be changed to permanently closed and your
tank fee account can be closed out. Note: Tank fees may be due for unregistered tanks.
UST closure and change -in-service site assessments must be completed in accordance with the latest version of the Guidelines for Site
Checks, Tank Closure and Initial Response. The guidelines can be obtained at htt s:Ifde .nc. ovlabouUdivisions/waste-mans g mentlust.
Note: To close tanks in place you must obtain prior approval from the DWM Regional office located in the region where the facility is located.
You must make sure that USTs removed from your property are disposed of properly. When choosing a closure contractor, ask where the
tank(s) will be taken for disposal. Usually, USTs are cleaned and cut up for scrap metal. This is dangerous work and must be performed
by a qualified company. Tanks disposed of illegally in fields or other dumpsites can leak petroleum products and sludge into the environment.
If your tanks are disposed of improperly, you could be held responsible for the cleanup of any environmental damage that occurs.
(.OWNERSHIP OF TANKS II. LOCATION.
Owner Name (Corporation, Individual, Public Agency, or Other Entity) Facility Name or Company
Hidden Valley Solullons LLC D's Ex Tess
Street Address Facility ID # (If known)
11211 Hyde Pointe Ct 00-0-0000007440
City
County
Charlotte
Mecklenburg
State
Zip Code
NC
28262
Phone Number
Email
478-250-1135
hiddenvalleysofutions@gf
Name:
Yannick Tuwamo
Street Address
223 Cabarrus Ave W
Clty County Zip Code
Concord Cabarrus 28025
Phone Number
III. CONTACT PERSONNEL
Company Name: Job Title:
Hidden Valley Solutions LLC Owner
IV. TANK REP
1. Contact local fire marshal. 5.
2. Plan entire closure event.
3. Conduct Site Soil Assessment. 6.
4. If removing tanks or closing in place, refer to
API Publication 2015 Cleaning Petroleum 7
Storage Tanks and 1604 Removal and
Disposal of Used Underground Petroleum
Storage Tanks.
Contractor Name:
Tony Disher
Address:
1702 Vargrave Street
Primary Consultant N
Steve Libbey, PG
Tank ID No.
Size in Gal
1
10000
2
6000
3
6000
)VAL., CLOSURE IN PLACE. CHANGE -
Provide a sketch locating piping, tanks and
soil sampling locations.
Submit a closure report in the format of UST-
12 (including the form UST-2) within thirty
(30) days following the site investigation.
If a release from the tanks has occurred, the
site assessment portion of the tank closure
must be conducted under the supervision of
V. WORK TO BE PERFORMED BY
Contractor Company Name:
EVO Corp.
Phone Number:
7120844
a P.E. or L.G., with all closure site assessment
reports bearing the signature and seal of the
P.E. or L.G. If a release has not occurred, the
supervision, signature or seal of a P.E. or L.G.
is not required.
8. Keep closure records for three (3) years.
State: Zip Code:
NC 27107
Primary Consultant Company Name:
Hart & Hickman
VI. TANKS SCHEDULED FOR CLOSURE OR CHANGE-IN»SE
Gasoline, Gas Mix
Gasoline, Gas Mix
Gasoline, Gas Mix
Phone No:
336-725-5844
Consultant Phone No:
704-302-4404
Closure I Chan e-In•5ervice
Removal I Abandonment in Place' I New Contents Stored
Prior written approval to abandon a tank in place must be received from a DWM Regional Office.
VII. OWNER OR OWNER'S AUTHORIZED REPRESENTATIVE
Has a release from a UST system occurred at this location? ❑ Yes ❑ No ® Unknown
I understand that I can be held responsible for environmental damage resulting from the improper disposal of my USTs.
Print name and official title: Steve Libbey/Project Manager
Signature Date Signed SCHEDULED REM�OLATE Notify your DWM Regional Office
48 hours before this date if
�� 9 scheduled removal date changes

Beverly, Trudy
From: Strauss, Ruth
Sent: Thursday, April 7, 2022 9:15 AM
To: Beverly, Trudy
Subject: RE: [External] D's Express NOI; Concord, NC - UST-3
Thanks Trudy!
Ruth Strauss :L.G.
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UST 9 Detim. Dii isiurn ofW3!;te NIME5MMt
North Carolina D-p rtment of F wif mtnetit al Quality
- 919. 707.8299 (Offtc5 & Fax)
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From: Beverly, Trudy <[e-mail]>
Sent: Wednesday, April 6, 2022 6:45 AM
To: Steve Libbey <[e-mail]>; Osman, Hassan <[e-mail]>; Randolph, Wayne
<[e-mail]>; Strauss, Ruth <[e-mail]>
Cc: Taraban, Ron <[e-mail]>
Subject: RE: [External] D's Express NOI; Concord, NC - UST-3
Thank you Steve.
Ruth, Wayne, & Osman - Please see the attached UST-3 for D's Express located at 223 Cabarrus Avenue West, Concord,
Cabarrus County (Facility ID 00-0-0000007440). Tanks are scheduled to be removed on May 9tn
Trudy
Trudy Beverly, L.G.
Hydrogeologist, Division of Waste Management
e:,eo:--fD,EQ North Carolina Department of Environmental Quality
r n h "�"�,�,�• UST Section, Mooresville Regional Office
704.235.2182 (Office)
Trudy. B everlykncdenr. 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: https://deq.nc.gov/about/divisions/waste-management/ust
Branch's Above Ground Storage Tanks Website Address: hitps://deg.nc.gov/about/divisions/waste-management/ust/ast-proeram
INTERACTIVE MAPS WITH DWM SITES AND PERMITTED FACILITIES:
httns://deo.nc. eov/about/divisions/waste-manaeement/waste-manaeement-rules-data/waste-manaeement-eis-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):
htips://deq.ne.gov/about/divisions/waste-management/laserfiche
Document Submittal & UST File Names for Laserfiche Policies:
httys:Hflles.nc.aov/nedea/Waste%2OManaeement/DWM/UST[WhatsNew/Final-Electronic-Document-Submittal-Policy.odf
htips://files.nc. gov/ncdeq/Waste%2OManagement/D WMiUST/Corrective%2OAction/UST%20file%20names%20for%2OLaserfiche.docx

From: Steve Libbey[mailto:[e-mail]]
Sent: Tuesday, April 5, 2022 6:25 PM
To: Beverly, Trudy <[e-mail]>
Subject: [External] D's Express NOI; Concord, NC
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Hi Trudy, the Notice of Intent (UST-3) for D's Express is attached. I was as able to move it to May 91n
Thanks,
Steve
Stephen Libbey, PG, Project Manager
Hart &Hickman, PC
2923 S Tryon Street, Suite 100 • Charlotte, NC 28203
Direct:704-887-4606 Mobile:[phone]
www.harthickman.com I 0