WS-27771_C_CLO_20200720

115 MacKenan Drive | Cary, NC 27511
t: 919.469.3340 | f: 919.467.6008 | www.withersravenel.com | License No. C-0832
Asheville | Cary | Greensboro | Pittsboro | Raleigh | Wilmington
July 28, 2020
North Carolina Department of Public Safety Central Engineering Division 2020 Yonkers Road Raleigh, NC 27604
Attn: Mr. Brad C. Morris, P.E. RE: UST CLOSURE REPORT North Carolina Department of Public Safety
North Carolina Highway Patrol (NCSHP) Office One 10,000-Gallon Gasoline UST 650 Francis Street High Point, Guilford County, North Carolina Facility ID: 00-0-0000006763
WR Project Number: 06190975.00 Mr. Morris: WithersRavenel (WR) has completed underground storage tank (UST) closure as documented within the enclosed UST Closure Report for the above-referenced site. This report documents activities conducted at the facility in association with NCDPS Contract #C11275 issued by NCDPS on October
14, 2019.
During the UST system closure on July 13, 2020 by WR, soil samples were obtained beneath the base of the gasoline UST. Additionally, soil samples were obtained beneath the gasoline fuel lines, and beneath the locations of the former gasoline dispenser. None of the soil samples obtained from
beneath the USTs, fuel lines, or dispenser exhibited Total Petroleum Hydrocarbon concentrations that exceeded NCDEQ Action Levels. Accordingly, WR completed a UST-2A form for the site and
submitted the form to the NCDEQ UST Section Registration & Permitting Unit as required. A copy of the UST-2A form is included in this report. WR appreciates the opportunity to be of service to NCDPS. Should you have any questions regarding the attached, please contact us at 919-469-3340.
Sincerely,
WithersRavenel

Laura R. Elliott, P.G. Brian J. Bellis, P.G.
Project Manager Senior Hydrogeologist
WithersRavenel
Our People. Your Success.

Table of Contents

1. Site History and Characterization ........................................................................................... 1
1.1. UST Owner and Operator Information ..................................................................................... 1
1.2. Historical & Surrounding UST Information .............................................................................. 1
1.3. Non-UST Information .................................................................................................................... 2
1.4. Description of On-Site Testing of Soils .................................................................................... 2
1.5. Site Characteristics and Surrounding Property ....................................................................... 2
1.6. Initial Abatement Actions, Assessment Activities, and Corrective Actions ..................... 3
1.7. Preparations for UST Closures .................................................................................................... 3
1.8. UST Closure Procedures ............................................................................................................... 3
1.9. Tank Residuals, UST Disposal ..................................................................................................... 4
1.10. Initial Response Actions ................................................................................................................ 4
2. Site Investigation ........................................................................................................................ 5
2.1. Field Screening Techniques ......................................................................................................... 5
2.2. Soil Sampling Procedures ............................................................................................................. 5
2.3. Quality Control Measures ............................................................................................................ 5
2.4 Investigation Results ...................................................................................................................... 5
3. Conclusions and Recommendations....................................................................................... 6

WithersRavenel
Our People. Your Success.

FIGURES
Figure 1 General Location Map
Figure 2 Site Map
Figure 3 UST Closure Sample Locations with Laboratory Results
TABLES
Table B-1 Site History: UST/AST Systems & Other Release Information
Table B-3 Summary of Soil Analytical Results
APPENDICES
Appendix A Site Photographs
Appendix B Liquid Disposal Manifests
Appendix C Certificate of UST Disposal
Appendix D Laboratory Analytical Report & Chain-Of-Custody Records
Appendix E UST-3 (Notice of Intent: UST Permanent Closure or Change-in-Service)
Appendix F UST-2A (Site Investigation Reports)
WithersRavenel
Our People. Your Success.

NCSHP Facility ID #00-0-0000006763 WR Project No. 06190975.00 UST Closure Report July 2020 Page 1

1. SITE HISTORY AND CHARACTERIZATION
1.1. UST OWNER AND OPERATOR INFORMATION
The abatement action activities described in this report were conducted in association with NCDPS under the guidance of the NCDEQ UST Section. The UST system was owned and
operated by Crime Control and Public Safety (CC&PS); Division of State Highway Patrol.
The UST system removed from the site on July 13, 2020 included one fiberglass-coated steel 10,000-gallon (gal) gasoline tank, associated fuel delivery lines, and one dispenser. The northern-most building adjacent to the dispenser was also removed.
The table below summarizes UST information for all known or identified USTs relating to the site.
See the attached Table B-1 for additional information regarding the UST systems.

UST ID NO PRODUCT CAPACITY (GALLONS) DATE INSTALLED DATE REMOVED RELEASE DISCOVERED
1 Gasoline 2,000 Unknown 10/01/1992 YES
2 Gasoline 10,000 Unknown 10/01/1992 NO
3 Gasoline 10,000 10/07/1992 07/13/2020 NO

The site is located at 605 Francis Street, which is a commercial area on the southeast side of High
Point in Guilford County, NC (Figure 1). The property is currently owned by North Carolina State Highway Patrol and is currently operating as a North Carolina Division of Motor Vehicles (NC DMV) Office.
The site is adjoined to the south by a marketing agency and paper recycling facility, to the north
by I-85 Business / Highway 29 / Highway 70, to the west by wooded areas, and to the east by a
hotel and a television station. Public water is available in the area. Site photographs obtained during the UST system closure activities are included in Appendix A.

1.2. HISTORICAL & SURROUNDING UST INFORMATION
Based on information provided by the NCDEQ UST database and a February 14, 2012 NCDOT
Groundwater Sample Report and Request for Site Closure by the NCDOT, on October 1, 1992, a 10,000-gallon gasoline UST (UST-2) and a 2,000-gallon gasoline UST (UST-1) were removed from the North Carolina Highway Patrol facility at 650 Francis Street in High Point, Guilford County, North Carolina. Soil sampling indicated a release of gasoline had occurred from either the 2,000-gallon tank or the associated piping, or both. The amount of product released was unknown. The
two releases were assigned incident numbers #10801 and #10802. The UST database notes state that no free product was detected in the adjacent stream or monitoring wells, and that benzene was detected at concentrations greater than 10 times the surface water standard. Approximately
WithersRavenel
Our People. Your Success.

NCSHP Facility ID #00-0-0000006763 WR Project No. 06190975.00 UST Closure Report July 2020 Page 2

400 tons of contaminated soil was also removed at the time of tank closure in 1992 and disposed
of offsite.
A fiberglass-coated steel 10,000-gallon UST (UST-3) was installed on site after both UST-1 and UST-2 were removed from the site in October 1992. A Comprehensive Site Assessment (CSA) was performed in 1993, which included soil and groundwater investigation and subsequent
groundwater and surface water monitoring events by NCDOT. According to the NCDPS files, the
liquid contents of the UST-3 were removed by A&D Environmental on October 6, 2003; this is the
last known date that the UST was in use. The onsite monitoring wells were abandoned in 2012,
and the groundwater incidents were closed out in July 2012.

1.3. NON-UST INFORMATION
No aboveground storage tanks (ASTs) were present on the site during the UST Closure event.
1.4. DESCRIPTION OF ON-SITE TESTING OF SOILS
On July 13, 2020, samples of temporarily stockpiled soils that were excavated to remove the
10,000-gallon replacement UST (UST-3), installed in 1992, and associated fuel lines were field-
screened with a photoionization detector (PID) and inspected. All of the soils excavated from the UST tank area showed no indication of containing petroleum compounds. Therefore, these excavated soils were used to backfill the areas where the UST was removed. Samples of stockpiled soils were screened with the PID and were identified as Stockpile 1 through Stockpile 4.

Soil samples obtained from the base of the UST excavations (T-1, T-2, and T-3), below the product lines between the UST area and the gasoline dispenser (PL-1, PL-2, PL-3, PL-4, PL-5, and PL-6), and a sample below the gasoline dispenser (FP-1) were submitted to Pace Analytical Laboratories (Pace) for analysis of Total Petroleum Hydrocarbon (TPH) Gasoline-Range Organics (GRO) and
TPH Diesel-Range Organics (DRO) by Method 8015D/GRO and Method 8015C/DRO. None of
the TPH GRO or TPH DRO concentrations reported for these UST closure soil samples exceeded NCDEQ Action Levels, therefore no over-excavation of soils was conducted. The results of these analyses are included in the analytical laboratory report, which is provided in Appendix D.

1.5. SITE CHARACTERISTICS AND SURROUNDING PROPERTY
The site is located in a commercial area in the southeast portion of the City of High Point, which is located in the southwestern portion of Guilford County, North Carolina (Figure 1). The NC DMV Office onsite is in use, and the shed and canopy adjacent to the tank area are utilized for storage
by the NCDPS. The area surrounding the sheds and tank area to the south, west, and north are open grassy areas. The area to the east of the sheds and tank area is an asphalt parking lot for the NC DMV office. Site features, structures, UST system components and locations are depicted on Figure 2.
WithersRavenel
Our People. Your Success.

NCSHP Facility ID #00-0-0000006763 WR Project No. 06190975.00 UST Closure Report July 2020 Page 3

1.6. INITIAL ABATEMENT ACTIONS, ASSESSMENT ACTIVITIES, AND
CORRECTIVE ACTIONS
No initial abatement, assessment, or corrective action activities have been performed at the site to date, with the exception of those described herein. The UST closure assessment activities
conducted during July 13-14, 2020 are described in Sections 1 and 2 of this report.

1.7. PREPARATIONS FOR UST CLOSURES
• WR submitted the required GW/UST-3 (Notice of Intent: UST Permanent Closure or Change-in-Service) form to the Winston-Salem Region of the NCDEQ UST Section on June 11, 2020
(see Appendix E). • D. H. Griffin obtained the requisite permission to remove the UST from the City of High Point
Fire Marshal prior to and during closure activities on July 13, 2020. Approval for UST removals was given following testing of the oxygen and lower explosive limits of the atmosphere within the tank. • Residual fluids contained in the UST were removed by D.H. Griffin using a vacuum tanker truck prior to UST closure activities. A total of 92 gallons of liquid were pumped from the UST and associated fuel delivery lines. These residuals were disposed of at the D.H. Griffin Company,
Inc. facility in Greensboro, NC. Appendix B contains a copy of the disposal manifest. • Soil was removed (and stockpiled) from above the UST to expose the top of the tank and allow for the tank removal. Purging of vapors and reduction of oxygen content within the tanks was accomplished through the use of pressurized rinse water. Under supervision of the City of High Point Fire Marshal, the O2/LEL level within the tank was measured prior to its removal,
and extraction of the tank was not performed prior to approval by the fire marshal. • Soils that were excavated to remove the UST and associated fuel lines did not exhibit TPH
GRO or TPH DRO concentrations in excess of the Action Levels, and so were used to backfill the excavated areas along with clean fill obtained from local sources.
1.8. UST CLOSURE PROCEDURES
D.H. Griffin first removed the concrete overlying the UST to expose fill materials covering the UST.
Soils overlying the tank did not exhibited petroleum odor, and were screened as Stockpile samples (Stockpile 1 through Stockpile 4). For the purposes of tank removal, only those soils necessary to facilitate the removal of the tank were excavated from the side and end walls of the UST. Natural soils and soil samples beneath of the UST, fuel lines, and former fuel pump did not exhibit
petroleum odors or show signs of contamination by petroleum. The UST was removed from the subsurface of the site after having been cleared for removal by
the City of High Point Fire Marshal. The one 10,000-gallon UST was extracted using a track hoe
excavator. The condition of the tank upon removal from the subsurface is shown below:
WithersRavenel
Our People. Your Success.

NCSHP Facility ID #00-0-0000006763 WR Project No. 06190975.00 UST Closure Report July 2020 Page 4

UST ID Volume (gal) Use Condition 3 10,000 Gasoline Good. No obvious holes or pitting. The UST described above was removed from the site on July 13, 2020. The UST was transported to D. H. Griffin’s Facility in Greensboro, NC for disposal/destruction. Receipts for disposal/recycling of the tanks are included in Appendix C. The UST and product line excavation areas are illustrated on Figure 3. In association with closure of the UST on July 13, 2020, WR obtained samples of excavated fill soils that were stockpiled adjacent to the gasoline UST excavation and associated fuel lines for on-
site PID screening; these data are presented in Table B-3. As no obviously impacted soils were identified during the closure of the UST under the UST, no
soils were excavated from under the UST. On-site PID screening and visual inspection of
stockpiled soils adjacent to the UST excavations did not indicate the presence of petroleum contamination, and were therefore used to partially backfill the excavation. Clean soil fill obtained from a local source in Greensboro, NC, were brought to the site to complete the excavation backfill process.
1.9. TANK RESIDUALS, UST DISPOSAL
Information described in Section 1.8 and 1.10. A copy of the residual liquid disposal manifest is included in Appendix B, and the UST disposal manifest is included in Appendix C.
1.10. INITIAL RESPONSE ACTIONS
On-site screening of excavated soils beneath the UST did not identify concentrations of TPH GRO or TPH DRO that exceeded current NCDEQ UST Action Levels of 50 mg/kg and 100 mg/kg,
respectively. The dispenser, dispenser piping, and tank vent pipes were removed, and soils below the dispenser piping were sampled every 10 feet between the tank pit and the dispenser. A soil sample was also collected below the dispenser. On-site screening of excavated soils beneath dispenser and six soil samples below the dispenser piping did not identify concentrations of TPH GRO or TPH DRO that exceeded current NCDEQ UST Action Levels of 50 mg/kg and 100 mg/kg,
respectively. As requested by NCDPS, the northern-most shed was removed from the site, and the cement foundations, canopy, and southern-most building adjacent to the tank pit were left in place (see Photographs in Appendix A). Sampling locations beneath the concrete foundations and the former
gasoline dispenser were patched with concrete cement after sampling was conducted.

WithersRavenel
Our People. Your Success.

NCSHP Facility ID #00-0-0000006763 WR Project No. 06190975.00 UST Closure Report July 2020 Page 5

2. SITE INVESTIGATION
2.1. FIELD SCREENING TECHNIQUES
WR physically monitored the excavation of soil by randomly screening the soils as they were excavated. The samples were placed in clean, Zip-loc® bags and screened with a RAE Systems®
MiniRAE 3000™ PID for the presence of volatile organic vapors typical of petroleum
hydrocarbons. The PID is an industry-accepted screening device used to detect the presence of volatile organic vapors for contamination screening and health and safety reasons, but is not relied upon to determine specific levels of contamination.

2.2. SOIL SAMPLING PROCEDURES
In accordance with NCDEQ guidance for the closure of commercial UST systems, WR obtained
the requisite number of soil samples from approximately two feet into the natural soils beneath the former base of the dispenser location (FP-1), and three soil samples from two feet beneath the former centerline/midpoint of the registered gasoline UST. Additionally, WR collected six native soil samples from less than two feet beneath the gasoline fuel delivery lines at a frequency of every
ten feet of product line (PL-1 through PL-6).
All soil samples were collected either from the bucket of the excavator or through the use of a properly decontaminated hand auger. Each sample was field screened, and placed in laboratory-prepared containers including chemical preservatives required by laboratory methods. WR
personnel donned clean nitrile sampling gloves for each sample location. Following collection,
samples were placed on ice in a cooler and transported under proper chain-of-custody protocols via FedEx to the Pace facility in Mount Juliet, Tennessee. All samples were logged on chain-of-custody (COC) documents which included sample
identifications, sample date and times as well as requested analyses. Copies of the COCs are
included with laboratory reports in Appendix D.
2.3. QUALITY CONTROL MEASURES
Quality control measures were employed during this project and included use of clean sampling tools, laboratory-prepared sample bottle kits, calibrated field instruments, donning of clean sample
gloves during each sample collection and preparation effort and a use of third-party laboratories for analysis of soil samples obtained in association with completion of this project.
2.4 INVESTIGATION RESULTS
2.4.1 UST Closures
The analytical results for the 10 soil samples collected as described in Section 2.2 are summarized in Table B-3. The locations where these soil samples were collected are shown on Figure 3. None of the soil samples from beneath the removed UST, fuel lines/dispenser piping, or fuel dispenser
WithersRavenel
Our People. Your Success.

NCSHP Facility ID #00-0-0000006763 WR Project No. 06190975.00 UST Closure Report July 2020 Page 6

exhibited concentrations of TPH GRO or TPH DRO that exceeded the Action Levels (see Table B-
3). On July 14, 2020, WR also prepared and submitted to NCDEQ a UST-2A Form that documents the removal of the UST systems from the site (see Appendix F).

3. CONCLUSIONS AND RECOMMENDATIONS

WR completed the removal of one registered commercial gasoline fuel UST and its associated fuel lines and dispensers on July 13, 2020. Conclusions regarding the UST system closures and the
results of laboratory testing of associated soil samples include the following:

• A combined total of 92 gallons of residual product and petroleum-contaminated water was removed from the UST and the associated fuel lines prior to their removal. These liquids were
transported and disposed of at the D. H. Griffin, Inc. facility in Greensboro, NC. • One gasoline UST (10,000-gal) was removed from the subsurface of the site on July 13, 2020.
The UST was found to be in good condition with no signs of pitting, holes or corrosion on their exterior surfaces. • No soils exhibited contamination by petroleum, and therefore no soils were removed from the site.
• The closure soil samples associated with the tank pit, fuel lines, and fuel pump areas that were were analyzed by Pace Analytical. The results of this testing did not identify concentrations of TPH GRO or TPH DRO that exceeded the current NCDEQ UST Section Action Levels.
• The former fuel dispenser, associated product lines, and one shed on the northern side of the
canopy area were removed from the site. Where soil sampling occurred beneath the cement pad, the area was patched with concrete cement on July 14, 2020.
• The former UST area was backfilled and properly compacted and graded with clean soil. Grass
seed and straw were placed over the entire work area upon completion of tank removal activities. We appreciate the opportunity to be of assistance to the NCDPS. Should you have any questions or comments regarding this report, please contact us at your convenience.
Sincerely,
WithersRavenel

Laura R. Elliott, P.G. Brian J. Bellis, P.G.
Project Manager Senior Hydrogeologist

WithersRavenel
Our People. Your Success.

FIGURES
JSC
LE
DRAWN BY:
10/07/19 06190975.00
1
SUBJECT SITE
±3.63 ACRES
SCALE:FIGURE NO.:
PROJECT NO.:DATE:APPROVED BY:
STATE HIGHWAY PATROL OFFICE
650 FRANCIS STREET
HIGH POINT, GUILFORD COUNTY, NC
GENERAL LOCATION MAP
WithersRavenel
Engineers | Planners | Surveyors
115 MacKenan Drive | Cary, NC 27511 | t: 919.469.3340 | license #: C-0832 |
www.withersravenel.com
1"=500 '
GRAPHIC SCALE
1 inch = 500 ft.
0 500250 1000
T-3
T-2
T-1
PL-1
PL-2
PL-3
PL-4
PL-5
PL-6
FP-1
LOCATION OF
10,000-GALLON UST-3
& ASSOCIATED PIPING
APPROXIMATE
FORMER UST
LOCATIONS
UST-1
UST-2
FUEL
DISPENSER
LOCATION
JSC
LRE
DRAWN BY:
1" = 20'
07/21/2020 06190975.00
2
SCALE:PAGE NO.:
PROJECT NO.:DATE:APPROVED BY:
WithersRavenel
Engineers | Planners | Surveyors
115 MacKenan Drive | Cary, NC 27511 | t: 919.469.3340 | license #: C-0832 |
www.withersravenel.com
NCSHP UST CLOSURE
SOIL SAMPLE LOCATIONS
650 FRANCIS STREET HIGH POINT, NC
LEGEND
NOTES:
1.) 2017 AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT.
GRAPHIC SCALE
1 inch = 20 ft.
0 2010 40
WithersRavenel
Our People. Your Success.

TABLES

UST IDNumberCurrent/LastContentsPreviousContentsCapacity(in gallons)ConstructionDetailsTankDimensions (diameter x length) (ft)Description ofAssociatedPiping & PumpsDate of TankInstallationStatus ofUSTWas release associated with UST System? (Y/N)1 Gasoline Gasoline 2,000 Unknown 5.33' x 12' Unknown Unknown Removed October 1, 1992Yes2 Gasoline Gasoline 10,000 Unknown 8' x 26'10'' Unknown Unknown Removed October 1, 1992No 3 Gasoline Gasoline 10,000Steel with Fiberglass Coating8' x 26'10''Steel and Fiberglass PipingOctober 7, 1992Removed July 13, 2020NoAST ID NumberCurrent/LastContentsPreviousContentsCapacity(in gallons)ConstructionDetailsTankDimensions (diameter x length) (ft)Description ofAssociatedPiping & PumpsDate of TankInstallationStatus ofASTWas release associated with UST System? (Y/N)NA NA NA NA NA NA NA NA NA NAIncidentNumberMaterialReleasedDateofRelease10801 & 10802 Gasoline UnknownNotes: UST = Underground Storage Tank AST = Aboveground Storage Tank Incidents #10801 & #10802Description of ReleaseNA = Not ApplicableTable B‐1Site History:  UST/AST System & Other Release InformationNC State Highway Patrol Office Petroleum products were detected upon removal of UST‐1 and associated piping in 1992. Petroleum compounds were detected in soil samples and monitoring wells collected from around UST‐1 and associated piping. Both incidents were closed out in July 2012.650 Francis StreetHigh Point, Guilford County, NCPage 1 of 1
Sample
ID
Depth 
Collected 
Below Ground 
Surface (feet)
PID Readings 
(ppm)
Date
Collected
Total Petroleum Hydrocarbons ‐ Gasoline Range OrganicsTotal Petroleum Hydrocarbons ‐ Diesel Range OrganicsT‐1 12 0.5 7/13/2020 <0.913 <4.84
T‐2 12 0.4 7/13/2020 <0.890 <0.996
T‐3 12 0.2 7/13/2020 <0.921 <1.02
PL‐1 3 0.8 7/13/2020 <1.11 <1.16
PL‐2 3 1.0 7/13/2020 <1.25 <1.20
PL‐3 3 0.3 7/13/2020 <1.19 <1.23
PL‐4 3 0.2 7/13/2020 <1.21 <1.21
PL‐5 2 13.8 7/13/2020 <0.900 <0.993
PL‐6 2 0.4 7/13/2020 <1.29 <1.28
FP‐1 3 8.8 7/13/2020 <.0994 1.62
Stockpile 1 4 0.0 7/13/2020 NA NA
Stockpile 2 8 0.1 7/13/2020 NA NA
Stockpile 3 8 0.0 7/13/2020 NA NA
Stockpile 4 8 0.0 7/13/2020 NA NA
50 100
Notes:
1)
2)
3)
NA
BRL
Result
Result = Result Exceeds State Action Level 
All results provided in mg/kg (milligrams per kilogram) or parts per million (ppm)
Laboratory results were provided by RedLab's mobile service onsite.
MSCC = Maximum Soil Contaminant Concentration
= Not Applicable or Not Analyzed by this Method
= Below Laboratory Reporting Limit
= Result Exceeds Laboratory Detection Limits
Analytical Method EPA Method 8015C
North Carolina State Action Level
TABLE B‐3
SUMMARY OF SOIL ANALYTICAL RESULTS
NC State Highway Patrol Office 
Incidents #10801 & #10802
650 Francis Street
High Point, Guilford County, NC
Page 1 of 1
WithersRavenel
Our People. Your Success.

APPENDIX A

SITE PHOTOGRAPHS

PHOTOGRAPHIC RECORD
Project: North Carolina Highway Patrol Office 650 Francis Street High Point, Guilford County, NC
WR Proj. No.: 06190975.00
Page 1 of 8
Frame No. 1

Description: View facing west adjacent to the UST area as cement cover was removed. Frame No. 2

Description: View facing northwest adjacent to the two sheds, cement pad, and canopy to the
north of the tank area.

PHOTOGRAPHIC RECORD
Project: North Carolina Highway Patrol Office 650 Francis Street High Point, Guilford County, NC
WR Proj. No.: 06190975.00
Page 2 of 8

Frame No. 3

Description: View facing west as USTs are uncovered and vacuum truck began to remove remaining liquids. Frame No. 4

Description: View of dispenser footing after dispenser was removed.

PHOTOGRAPHIC RECORD
Project: North Carolina Highway Patrol Office 650 Francis Street High Point, Guilford County, NC
WR Proj. No.: 06190975.00
Page 3 of 8
Frame No. 5

Description: View facing north as tank was uncovered. Frame No. 6

Description: Tank 1 removal on July 13, 2020.

PHOTOGRAPHIC RECORD
Project: North Carolina Highway Patrol Office 650 Francis Street High Point, Guilford County, NC
WR Proj. No.: 06190975.00
Page 4 of 8
Frame No. 7

Description: View of base of 10,000-gallon UST. No holes or pitting observed. Tank was steel with fiberglass outer coating. Frame No. 8

Description: View facing north from tank area as product lines were uncovered and removed.

PHOTOGRAPHIC RECORD
Project: North Carolina Highway Patrol Office 650 Francis Street High Point, Guilford County, NC
WR Proj. No.: 06190975.00
Page 5 of 8
Frame No. 9

Description: View facing north of sampling locations below product lines under cement pad. Frame No. 10

Description: View of backfilling in tank area.

PHOTOGRAPHIC RECORD
Project: North Carolina Highway Patrol Office 650 Francis Street High Point, Guilford County, NC
WR Proj. No.: 06190975.00
Page 6 of 8
Frame No. 11

Description: View facing south of jackhammer removing cement pad in product line sampling location. Frame No. 12

Description: View of UST loaded on trailer for offsite disposal.

PHOTOGRAPHIC RECORD
Project: North Carolina Highway Patrol Office 650 Francis Street High Point, Guilford County, NC
WR Proj. No.: 06190975.00
Page 7 of 8
Frame No. 13

Description: View facing south after northern-most shed was removed. Frame No. 14

Description: View of sampling area beneath former gasoline dispenser.

PHOTOGRAPHIC RECORD
Project: North Carolina Highway Patrol Office 650 Francis Street High Point, Guilford County, NC
WR Proj. No.: 06190975.00
Page 8 of 8
Frame No. 15

Description: Concrete cement patching conducted on cement pad where sampling was conducted.
Frame No. 16

Description: Former tank area after backfill, compaction, and grading were completed. Grass seed and straw applied to all disturbed areas of grassy area.

WithersRavenel
Our People. Your Success.

APPENDIX B

LIQUID DISPOSAL MANIFESTS

WithersRavenel
Our People. Your Success.

APPENDIX C

CERTIFICATE OF UST DISPOSAL
WithersRavenel
Our People. Your Success.

APPENDIX D

LABORATORY ANALYTICAL REPORT
& CHAIN OF CUSTODY RECORDS

ANALYTICAL REPORT
July 20, 2020
Withers & Ravenel Eng. - Standard
Sample Delivery Group:L1239841
Samples Received:07/15/2020
Project Number:06190975
Description:NCSHP UST Closure
Report To:Laura Elliott
115 MacKenan Drive
Cary, NC 27511
Entire Report Reviewed By:
July 20, 2020
[Preliminary Report]
Heather J Wagner
Project Manager
Results relate only to the items tested or calibrated and are reported as rounded values. This test report shall not be reproduced, except in full, without written approval of the laboratory. Where applicable, sampling conducted by Pace Analytical National is performed per guidance provided in laboratory standard operating procedures ENV-SOP-MTJL-0067 and ENV-SOP-MTJL-0068. Where sampling conducted by the customer, results relate to the accuracy of the information provided, and as the samples are received.
12065 Lebanon Rd Mount Juliet, TN 37122 615-758-5858 800-767-5859 www.pacenational.com
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 1 of 23
July 20, 2020
Heather J Wagner
Project Manager
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 1 of 23
ONE LAB. NATIONWIDE.TABLE OF CONTENTS
Cp: Cover Page 1
Tc: Table of Contents 2
Ss: Sample Summary 3
Cn: Case Narrative 5
Sr: Sample Results 6
T-1 L1239841-01 6
T-2 L1239841-02 7
T-3 L1239841-03 8
PL-1 L1239841-04 9
PL-2 L1239841-05 10
PL-3 L1239841-06 11
PL-4 L1239841-07 12
PL-5 L1239841-08 13
PL-6 L1239841-09 14
FP-1 L1239841-10 15
Qc: Quality Control Summary 16
Total Solids by Method 2540 G-2011 16
Volatile Organic Compounds (GC) by Method 8015D/GRO 18
Semi-Volatile Organic Compounds (GC) by Method 8015C 19
Gl: Glossary of Terms 21
Al: Accreditations & Locations 22
Sc: Sample Chain of Custody 23
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 2 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 2 of 23
ONE LAB. NATIONWIDE.SAMPLE SUMMARY
Collected by Collected date/time Received date/time
T-1 L1239841-01 Solid Laura Elliott 07/13/20 11:40 07/15/20 08:30
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Total Solids by Method 2540 G-2011 WG1510899 1 07/17/20 23:10 07/17/20 23:18 MT Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO WG1510991 25 07/13/20 11:40 07/18/20 03:56 ACG Mt. Juliet, TN
Semi-Volatile Organic Compounds (GC) by Method 8015C WG1509774 5 07/16/20 09:29 07/18/20 13:48 JN Mt. Juliet, TN
Collected by Collected date/time Received date/time
T-2 L1239841-02 Solid Laura Elliott 07/13/20 11:45 07/15/20 08:30
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Total Solids by Method 2540 G-2011 WG1510899 1 07/17/20 23:10 07/17/20 23:18 MT Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO WG1510991 25 07/13/20 11:45 07/18/20 04:18 ACG Mt. Juliet, TN
Semi-Volatile Organic Compounds (GC) by Method 8015C WG1509774 1 07/16/20 09:29 07/18/20 09:07 JN Mt. Juliet, TN
Collected by Collected date/time Received date/time
T-3 L1239841-03 Solid Laura Elliott 07/13/20 11:50 07/15/20 08:30
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Total Solids by Method 2540 G-2011 WG1510899 1 07/17/20 23:10 07/17/20 23:18 MT Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO WG1510991 25 07/13/20 11:50 07/18/20 04:40 ACG Mt. Juliet, TN
Semi-Volatile Organic Compounds (GC) by Method 8015C WG1509774 1 07/16/20 09:29 07/18/20 09:27 JN Mt. Juliet, TN
Collected by Collected date/time Received date/time
PL-1 L1239841-04 Solid Laura Elliott 07/13/20 12:00 07/15/20 08:30
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Total Solids by Method 2540 G-2011 WG1510899 1 07/17/20 23:10 07/17/20 23:18 MT Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO WG1510991 25 07/13/20 12:00 07/18/20 05:03 ACG Mt. Juliet, TN
Semi-Volatile Organic Compounds (GC) by Method 8015C WG1509774 1 07/16/20 09:29 07/18/20 10:38 JN Mt. Juliet, TN
Collected by Collected date/time Received date/time
PL-2 L1239841-05 Solid Laura Elliott 07/13/20 12:05 07/15/20 08:30
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Total Solids by Method 2540 G-2011 WG1510899 1 07/17/20 23:10 07/17/20 23:18 MT Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO WG1510991 25 07/13/20 12:05 07/18/20 05:25 ACG Mt. Juliet, TN
Semi-Volatile Organic Compounds (GC) by Method 8015C WG1509774 1 07/16/20 09:29 07/18/20 10:52 JN Mt. Juliet, TN
Collected by Collected date/time Received date/time
PL-3 L1239841-06 Solid Laura Elliott 07/13/20 12:10 07/15/20 08:30
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Total Solids by Method 2540 G-2011 WG1510899 1 07/17/20 23:10 07/17/20 23:18 MT Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO WG1510991 25 07/13/20 12:10 07/18/20 05:47 ACG Mt. Juliet, TN
Semi-Volatile Organic Compounds (GC) by Method 8015C WG1509774 1 07/16/20 09:29 07/18/20 11:54 JN Mt. Juliet, TN
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 3 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 3 of 23
ONE LAB. NATIONWIDE.SAMPLE SUMMARY
Collected by Collected date/time Received date/time
PL-4 L1239841-07 Solid Laura Elliott 07/13/20 12:15 07/15/20 08:30
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Total Solids by Method 2540 G-2011 WG1510899 1 07/17/20 23:10 07/17/20 23:18 MT Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO WG1510991 25 07/13/20 12:15 07/18/20 06:09 ACG Mt. Juliet, TN
Semi-Volatile Organic Compounds (GC) by Method 8015C WG1510491 1 07/16/20 21:04 07/19/20 06:36 JN Mt. Juliet, TN
Collected by Collected date/time Received date/time
PL-5 L1239841-08 Solid Laura Elliott 07/13/20 15:30 07/15/20 08:30
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Total Solids by Method 2540 G-2011 WG1510899 1 07/17/20 23:10 07/17/20 23:18 MT Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO WG1510991 26.5 07/13/20 15:30 07/18/20 06:32 ACG Mt. Juliet, TN
Semi-Volatile Organic Compounds (GC) by Method 8015C WG1510491 1 07/16/20 21:04 07/19/20 06:50 JN Mt. Juliet, TN
Collected by Collected date/time Received date/time
PL-6 L1239841-09 Solid Laura Elliott 07/13/20 16:50 07/15/20 08:30
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Total Solids by Method 2540 G-2011 WG1510900 1 07/17/20 22:59 07/17/20 23:07 KDW Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO WG1510991 25.8 07/13/20 16:50 07/18/20 06:54 ACG Mt. Juliet, TN
Semi-Volatile Organic Compounds (GC) by Method 8015C WG1510491 1 07/16/20 21:04 07/19/20 07:08 JN Mt. Juliet, TN
Collected by Collected date/time Received date/time
FP-1 L1239841-10 Solid Laura Elliott 07/14/20 08:30 07/15/20 08:30
Method Batch Dilution Preparation Analysis Analyst Location
date/time date/time
Total Solids by Method 2540 G-2011 WG1510900 1 07/17/20 22:59 07/17/20 23:07 KDW Mt. Juliet, TN
Volatile Organic Compounds (GC) by Method 8015D/GRO WG1510991 25 07/14/20 08:30 07/18/20 07:16 ACG Mt. Juliet, TN
Semi-Volatile Organic Compounds (GC) by Method 8015C WG1510491 1 07/16/20 21:04 07/19/20 07:26 JN Mt. Juliet, TN
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 4 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 4 of 23
ONE LAB. NATIONWIDE.CASE NARRATIVE
All sample aliquots were received at the correct temperature, in the proper containers, with the
appropriate preservatives, and within method specified holding times, unless qualified or notated within
the report. Where applicable, all MDL (LOD) and RDL (LOQ) values reported for environmental samples
have been corrected for the dilution factor used in the analysis. All Method and Batch Quality Control
are within established criteria except where addressed in this case narrative, a non-conformance form
or properly qualified within the sample results. By my digital signature below, I affirm to the best of my
knowledge, all problems/anomalies observed by the laboratory as having the potential to affect the
quality of the data have been identified by the laboratory, and no information or data have been
knowingly withheld that would affect the quality of the data.
[Preliminary Report]
Heather J Wagner
Project Manager
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 5 of 23
Heather J Wagner
Project Manager
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 5 of 23
ONE LAB. NATIONWIDE.SAMPLE RESULTS - 01
L1239841
T-1
Collected date/time: 07/13/20 11:40
Total Solids by Method 2540 G-2011
Result Qualifier Dilution Analysis Batch
Analyte %date / time
Total Solids 79.5 1 07/17/2020 23:18 WG1510899
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 0.913 4.20 25 07/18/2020 03:56 WG1510991
(S) a,a,a-Trifluorotoluene(FID)99.7 77.0-120 07/18/2020 03:56 WG1510991
Semi-Volatile Organic Compounds (GC) by Method 8015C
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) High Fraction U 4.84 25.2 5 07/18/2020 13:48 WG1509774
(S) o-Terphenyl 74.5 18.0-148 07/18/2020 13:48 WG1509774
Sample Narrative:
L1239841-01 WG1509774: Cannot run at lower dilution due to viscosity of extract
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 6 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 6 of 23
ONE LAB. NATIONWIDE.SAMPLE RESULTS - 02
L1239841
T-2
Collected date/time: 07/13/20 11:45
Total Solids by Method 2540 G-2011
Result Qualifier Dilution Analysis Batch
Analyte %date / time
Total Solids 77.2 1 07/17/2020 23:18 WG1510899
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 0.890 4.10 25 07/18/2020 04:18 WG1510991
(S) a,a,a-Trifluorotoluene(FID)99.1 77.0-120 07/18/2020 04:18 WG1510991
Semi-Volatile Organic Compounds (GC) by Method 8015C
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) High Fraction U 0.996 5.18 1 07/18/2020 09:07 WG1509774
(S) o-Terphenyl 72.6 18.0-148 07/18/2020 09:07 WG1509774
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 7 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 7 of 23
ONE LAB. NATIONWIDE.SAMPLE RESULTS - 03
L1239841
T-3
Collected date/time: 07/13/20 11:50
Total Solids by Method 2540 G-2011
Result Qualifier Dilution Analysis Batch
Analyte %date / time
Total Solids 75.6 1 07/17/2020 23:18 WG1510899
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 0.921 4.24 25 07/18/2020 04:40 WG1510991
(S) a,a,a-Trifluorotoluene(FID)98.4 77.0-120 07/18/2020 04:40 WG1510991
Semi-Volatile Organic Compounds (GC) by Method 8015C
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) High Fraction U 1.02 5.29 1 07/18/2020 09:27 WG1509774
(S) o-Terphenyl 76.2 18.0-148 07/18/2020 09:27 WG1509774
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 8 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 8 of 23
ONE LAB. NATIONWIDE.SAMPLE RESULTS - 04
L1239841
PL-1
Collected date/time: 07/13/20 12:00
Total Solids by Method 2540 G-2011
Result Qualifier Dilution Analysis Batch
Analyte %date / time
Total Solids 66.4 1 07/17/2020 23:18 WG1510899
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 1.11 5.12 25 07/18/2020 05:03 WG1510991
(S) a,a,a-Trifluorotoluene(FID)98.6 77.0-120 07/18/2020 05:03 WG1510991
Semi-Volatile Organic Compounds (GC) by Method 8015C
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) High Fraction U 1.16 6.02 1 07/18/2020 10:38 WG1509774
(S) o-Terphenyl 75.0 18.0-148 07/18/2020 10:38 WG1509774
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 9 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 9 of 23
ONE LAB. NATIONWIDE.SAMPLE RESULTS - 05
L1239841
PL-2
Collected date/time: 07/13/20 12:05
Total Solids by Method 2540 G-2011
Result Qualifier Dilution Analysis Batch
Analyte %date / time
Total Solids 64.3 1 07/17/2020 23:18 WG1510899
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 1.25 5.77 25 07/18/2020 05:25 WG1510991
(S) a,a,a-Trifluorotoluene(FID)99.6 77.0-120 07/18/2020 05:25 WG1510991
Semi-Volatile Organic Compounds (GC) by Method 8015C
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) High Fraction U 1.20 6.22 1 07/18/2020 10:52 WG1509774
(S) o-Terphenyl 72.0 18.0-148 07/18/2020 10:52 WG1509774
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 10 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 10 of 23
ONE LAB. NATIONWIDE.SAMPLE RESULTS - 06
L1239841
PL-3
Collected date/time: 07/13/20 12:10
Total Solids by Method 2540 G-2011
Result Qualifier Dilution Analysis Batch
Analyte %date / time
Total Solids 62.6 1 07/17/2020 23:18 WG1510899
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 1.19 5.50 25 07/18/2020 05:47 WG1510991
(S) a,a,a-Trifluorotoluene(FID)99.2 77.0-120 07/18/2020 05:47 WG1510991
Semi-Volatile Organic Compounds (GC) by Method 8015C
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) High Fraction U 1.23 6.39 1 07/18/2020 11:54 WG1509774
(S) o-Terphenyl 75.5 18.0-148 07/18/2020 11:54 WG1509774
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 11 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 11 of 23
ONE LAB. NATIONWIDE.SAMPLE RESULTS - 07
L1239841
PL-4
Collected date/time: 07/13/20 12:15
Total Solids by Method 2540 G-2011
Result Qualifier Dilution Analysis Batch
Analyte %date / time
Total Solids 63.4 1 07/17/2020 23:18 WG1510899
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 1.21 5.55 25 07/18/2020 06:09 WG1510991
(S) a,a,a-Trifluorotoluene(FID)99.5 77.0-120 07/18/2020 06:09 WG1510991
Semi-Volatile Organic Compounds (GC) by Method 8015C
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) High Fraction U 1.21 6.31 1 07/19/2020 06:36 WG1510491
(S) o-Terphenyl 57.8 18.0-148 07/19/2020 06:36 WG1510491
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 12 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 12 of 23
ONE LAB. NATIONWIDE.SAMPLE RESULTS - 08
L1239841
PL-5
Collected date/time: 07/13/20 15:30
Total Solids by Method 2540 G-2011
Result Qualifier Dilution Analysis Batch
Analyte %date / time
Total Solids 77.4 1 07/17/2020 23:18 WG1510899
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 0.900 4.15 26.5 07/18/2020 06:32 WG1510991
(S) a,a,a-Trifluorotoluene(FID)98.8 77.0-120 07/18/2020 06:32 WG1510991
Semi-Volatile Organic Compounds (GC) by Method 8015C
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) High Fraction U 0.993 5.17 1 07/19/2020 06:50 WG1510491
(S) o-Terphenyl 53.5 18.0-148 07/19/2020 06:50 WG1510491
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 13 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 13 of 23
ONE LAB. NATIONWIDE.SAMPLE RESULTS - 09
L1239841
PL-6
Collected date/time: 07/13/20 16:50
Total Solids by Method 2540 G-2011
Result Qualifier Dilution Analysis Batch
Analyte %date / time
Total Solids 60.3 1 07/17/2020 23:07 WG1510900
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 1.29 5.93 25.8 07/18/2020 06:54 WG1510991
(S) a,a,a-Trifluorotoluene(FID)99.9 77.0-120 07/18/2020 06:54 WG1510991
Semi-Volatile Organic Compounds (GC) by Method 8015C
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) High Fraction U 1.28 6.63 1 07/19/2020 07:08 WG1510491
(S) o-Terphenyl 63.7 18.0-148 07/19/2020 07:08 WG1510491
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 14 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 14 of 23
ONE LAB. NATIONWIDE.SAMPLE RESULTS - 10
L1239841
FP-1
Collected date/time: 07/14/20 08:30
Total Solids by Method 2540 G-2011
Result Qualifier Dilution Analysis Batch
Analyte %date / time
Total Solids 72.6 1 07/17/2020 23:07 WG1510900
Volatile Organic Compounds (GC) by Method 8015D/GRO
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) Low Fraction U 0.994 4.58 25 07/18/2020 07:16 WG1510991
(S) a,a,a-Trifluorotoluene(FID)98.7 77.0-120 07/18/2020 07:16 WG1510991
Semi-Volatile Organic Compounds (GC) by Method 8015C
Result (dry)Qualifier MDL (dry)RDL (dry)Dilution Analysis Batch
Analyte mg/kg mg/kg mg/kg date / time
TPH (GC/FID) High Fraction 1.62 J 1.06 5.51 1 07/19/2020 07:26 WG1510491
(S) o-Terphenyl 70.5 18.0-148 07/19/2020 07:26 WG1510491
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 15 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 15 of 23
ONE LAB. NATIONWIDE.QUALITY CONTROL SUMMARYWG1510899
Total Solids by Method 2540 G-2011 L1239841-01,02,03,04,05,06,07,08
Method Blank (MB)
(MB) R3550771-1 07/17/20 23:18
MB Result MB Qualifier MB MDL MB RDL
Analyte %%%
Total Solids 0.00100
L1239841-01 Original Sample (OS) • Duplicate (DUP)
(OS) L1239841-01 07/17/20 23:18 • (DUP) R3550771-3 07/17/20 23:18
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyte %%%%
Total Solids 79.5 80.1 1 0.722 10
Laboratory Control Sample (LCS)
(LCS) R3550771-2 07/17/20 23:18
Spike Amount LCS Result LCS Rec.Rec. Limits LCS Qualifier
Analyte %%%%
Total Solids 50.0 50.0 100 85.0-115
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 16 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 16 of 23
ONE LAB. NATIONWIDE.QUALITY CONTROL SUMMARYWG1510900
Total Solids by Method 2540 G-2011 L1239841-09,10
Method Blank (MB)
(MB) R3550733-1 07/17/20 23:07
MB Result MB Qualifier MB MDL MB RDL
Analyte %%%
Total Solids 0.000
L1239859-04 Original Sample (OS) • Duplicate (DUP)
(OS) L1239859-04 07/17/20 23:07 • (DUP) R3550733-3 07/17/20 23:07
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyte %%%%
Total Solids 82.7 84.3 1 2.00 10
Laboratory Control Sample (LCS)
(LCS) R3550733-2 07/17/20 23:07
Spike Amount LCS Result LCS Rec.Rec. Limits LCS Qualifier
Analyte %%%%
Total Solids 50.0 50.0 100 85.0-115
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 17 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 17 of 23
ONE LAB. NATIONWIDE.QUALITY CONTROL SUMMARYWG1510991
Volatile Organic Compounds (GC) by Method 8015D/GRO L1239841-01,02,03,04,05,06,07,08,09,10
Method Blank (MB)
(MB) R3550936-3 07/18/20 01:42
MB Result MB Qualifier MB MDL MB RDL
Analyte mg/kg mg/kg mg/kg
TPH (GC/FID) Low Fraction U 0.0217 0.100
(S)
a,a,a-Trifluorotoluene(FID)100 77.0-120
Laboratory Control Sample (LCS)
(LCS) R3550936-2 07/18/20 00:58
Spike Amount LCS Result LCS Rec.Rec. Limits LCS Qualifier
Analyte mg/kg mg/kg %%
TPH (GC/FID) Low Fraction 5.50 6.05 110 72.0-127
(S)
a,a,a-Trifluorotoluene(FID) 105 77.0-120
L1239841-01 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1239841-01 07/18/20 03:56 • (MS) R3550936-4 07/18/20 11:03 • (MSD) R3550936-5 07/18/20 11:25
Spike Amount
(dry)
Original Result
(dry)MS Result (dry)MSD Result
(dry)MS Rec.MSD Rec.Dilution Rec. Limits MS Qualifier MSD Qualifier RPD RPD Limits
Analyte mg/kg mg/kg mg/kg mg/kg %%%%%
TPH (GC/FID) Low Fraction 142 U 94.2 95.7 66.5 67.6 25 10.0-151 1.59 28
(S)
a,a,a-Trifluorotoluene(FID) 100 100 77.0-120
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 18 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 18 of 23
ONE LAB. NATIONWIDE.QUALITY CONTROL SUMMARYWG1509774
Semi-Volatile Organic Compounds (GC) by Method 8015C L1239841-01,02,03,04,05,06
Method Blank (MB)
(MB) R3550900-1 07/18/20 07:27
MB Result MB Qualifier MB MDL MB RDL
Analyte mg/kg mg/kg mg/kg
TPH (GC/FID) High Fraction U 0.769 4.00
(S) o-Terphenyl 78.4 18.0-148
Laboratory Control Sample (LCS)
(LCS) R3550900-2 07/18/20 07:41
Spike Amount LCS Result LCS Rec.Rec. Limits LCS Qualifier
Analyte mg/kg mg/kg %%
TPH (GC/FID) High Fraction 50.0 41.2 82.4 50.0-150
(S) o-Terphenyl 109 18.0-148
L1239841-02 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1239841-02 07/18/20 09:07 • (MS) R3550900-3 07/18/20 08:21 • (MSD) R3550900-4 07/18/20 08:40
Spike Amount
(dry)
Original Result
(dry)MS Result (dry)MSD Result
(dry)MS Rec.MSD Rec.Dilution Rec. Limits MS Qualifier MSD Qualifier RPD RPD Limits
Analyte mg/kg mg/kg mg/kg mg/kg %%%%%
TPH (GC/FID) High Fraction 64.3 U 51.5 52.2 80.1 81.4 1 50.0-150 1.25 20
(S) o-Terphenyl 84.6 87.3 18.0-148
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 19 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 19 of 23
ONE LAB. NATIONWIDE.QUALITY CONTROL SUMMARYWG1510491
Semi-Volatile Organic Compounds (GC) by Method 8015C L1239841-07,08,09,10
Method Blank (MB)
(MB) R3550631-1 07/17/20 14:29
MB Result MB Qualifier MB MDL MB RDL
Analyte mg/kg mg/kg mg/kg
TPH (GC/FID) High Fraction U 0.769 4.00
(S) o-Terphenyl 80.0 18.0-148
Laboratory Control Sample (LCS)
(LCS) R3550631-2 07/17/20 14:41
Spike Amount LCS Result LCS Rec.Rec. Limits LCS Qualifier
Analyte mg/kg mg/kg %%
TPH (GC/FID) High Fraction 50.0 38.9 77.8 50.0-150
(S) o-Terphenyl 84.7 18.0-148
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 20 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 20 of 23
ONE LAB. NATIONWIDE.GLOSSARY OF TERMS
Guide to Reading and Understanding Your Laboratory Report
The information below is designed to better explain the various terms used in your report of analytical results from the Laboratory. This is not
intended as a comprehensive explanation, and if you have additional questions please contact your project representative.
Results Disclaimer - Information that may be provided by the customer, and contained within this report, include Permit Limits, Project Name,
Sample ID, Sample Matrix, Sample Preservation, Field Blanks, Field Spikes, Field Duplicates, On-Site Data, Sampling Collection Dates/Times, and
Sampling Location. Results relate to the accuracy of this information provided, and as the samples are received.
Abbreviations and Definitions
(dry)Results are reported based on the dry weight of the sample. [this will only be present on a dry report basis for soils].
MDL Method Detection Limit.
MDL (dry)Method Detection Limit.
RDL Reported Detection Limit.
RDL (dry)Reported Detection Limit.
Rec.Recovery.
RPD Relative Percent Difference.
SDG Sample Delivery Group.
(S)
Surrogate (Surrogate Standard) - Analytes added to every blank, sample, Laboratory Control Sample/Duplicate and
Matrix Spike/Duplicate; used to evaluate analytical efficiency by measuring recovery. Surrogates are not expected to be
detected in all environmental media.
U Not detected at the Reporting Limit (or MDL where applicable).
Analyte The name of the particular compound or analysis performed. Some Analyses and Methods will have multiple analytes
reported.
Dilution
If the sample matrix contains an interfering material, the sample preparation volume or weight values differ from the
standard, or if concentrations of analytes in the sample are higher than the highest limit of concentration that the
laboratory can accurately report, the sample may be diluted for analysis. If a value different than 1 is used in this field, the
result reported has already been corrected for this factor.
Limits
These are the target % recovery ranges or % difference value that the laboratory has historically determined as normal
for the method and analyte being reported. Successful QC Sample analysis will target all analytes recovered or
duplicated within these ranges.
Original Sample The non-spiked sample in the prep batch used to determine the Relative Percent Difference (RPD) from a quality control
sample. The Original Sample may not be included within the reported SDG.
Qualifier
This column provides a letter and/or number designation that corresponds to additional information concerning the result
reported. If a Qualifier is present, a definition per Qualifier is provided within the Glossary and Definitions page and
potentially a discussion of possible implications of the Qualifier in the Case Narrative if applicable.
Result
The actual analytical final result (corrected for any sample specific characteristics) reported for your sample. If there was
no measurable result returned for a specific analyte, the result in this column may state “ND” (Not Detected) or “BDL”
(Below Detectable Levels). The information in the results column should always be accompanied by either an MDL
(Method Detection Limit) or RDL (Reporting Detection Limit) that defines the lowest value that the laboratory could detect
or report for this analyte.
Uncertainty
(Radiochemistry)Confidence level of 2 sigma.
Case Narrative (Cn)
A brief discussion about the included sample results, including a discussion of any non-conformances to protocol
observed either at sample receipt by the laboratory from the field or during the analytical process. If present, there will
be a section in the Case Narrative to discuss the meaning of any data qualifiers used in the report.
Quality Control
Summary (Qc)
This section of the report includes the results of the laboratory quality control analyses required by procedure or
analytical methods to assist in evaluating the validity of the results reported for your samples. These analyses are not
being performed on your samples typically, but on laboratory generated material.
Sample Chain of
Custody (Sc)
This is the document created in the field when your samples were initially collected. This is used to verify the time and
date of collection, the person collecting the samples, and the analyses that the laboratory is requested to perform. This
chain of custody also documents all persons (excluding commercial shippers) that have had control or possession of the
samples from the time of collection until delivery to the laboratory for analysis.
Sample Results (Sr)
This section of your report will provide the results of all testing performed on your samples. These results are provided
by sample ID and are separated by the analyses performed on each sample. The header line of each analysis section for
each sample will provide the name and method number for the analysis reported.
Sample Summary (Ss)This section of the Analytical Report defines the specific analyses performed for each sample ID, including the dates and
times of preparation and/or analysis.
Qualifier Description
J The identification of the analyte is acceptable; the reported value is an estimate.
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 21 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 21 of 23
ONE LAB. NATIONWIDE.
Pace National is the only environmental laboratory accredited/certified to support your work nationwide from one location. One phone call, one point of contact, one laboratory. No other lab is as
accessible or prepared to handle your needs throughout the country. Our capacity and capability from our single location laboratory is comparable to the collective totals of the network
laboratories in our industry. The most significant benefit to our one location design is the design of our laboratory campus. The model is conducive to accelerated productivity, decreasing
turn-around time, and preventing cross contamination, thus protecting sample integrity. Our focus on premium quality and prompt service allows us to be YOUR LAB OF CHOICE.
* Not all certifications held by the laboratory are applicable to the results reported in the attached report.
* Accreditation is only applicable to the test methods specified on each scope of accreditation held by Pace National.

State Accreditations
Alabama 40660 Nebraska NE-OS-15-05
Alaska 17-026 Nevada TN-03-2002-34
Arizona AZ0612 New Hampshire 2975
Arkansas 88-0469 New Jersey–NELAP TN002
California 2932 New Mexico ¹n/a
Colorado TN00003 New York 11742
Connecticut PH-0197 North Carolina Env375
Florida E87487 North Carolina ¹DW21704
Georgia NELAP North Carolina ³41
Georgia ¹923 North Dakota R-140
Idaho TN00003 Ohio–VAP CL0069
Illinois 200008 Oklahoma 9915
Indiana C-TN-01 Oregon TN200002
Iowa 364 Pennsylvania 68-02979
Kansas E-10277 Rhode Island LAO00356
Kentucky ¹ ⁶90010 South Carolina 84004
Kentucky ²16 South Dakota n/a
Louisiana AI30792 Tennessee ¹ ⁴2006
Louisiana ¹LA180010 Texas T104704245-18-15
Maine TN0002 Texas ⁵LAB0152
Maryland 324 Utah TN00003
Massachusetts M-TN003 Vermont VT2006
Michigan 9958 Virginia 460132
Minnesota 047-999-395 Washington C847
Mississippi TN00003 West Virginia 233
Missouri 340 Wisconsin 9980939910
Montana CERT0086 Wyoming A2LA

Third Party Federal Accreditations
A2LA – ISO 17025 1461.01 AIHA-LAP,LLC EMLAP 100789
A2LA – ISO 17025 ⁵1461.02 DOD 1461.01
Canada 1461.01 USDA P330-15-00234
EPA–Crypto TN00003
ACCREDITATIONS & LOCATIONS

¹ Drinking Water ² Underground Storage Tanks ³ Aquatic Toxicity ⁴ Chemical/Microbiological ⁵ Mold ⁶ Wastewater n/a Accreditation not applicable

Our Locations
Pace National has sixty-four client support centers that provide sample pickup and/or the delivery of sampling supplies. If you would like assistance from one of our support offices, please contactour main office. Pace National performs all testing at our central laboratory.
1 Cp
2Tc
3Ss
4Cn
5Sr
6Qc
7Gl
8Al
9Sc
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 15:39 22 of 23
ACCOUNT:PROJECT:SDG:DATE/TIME:PAGE:
Withers & Ravenel Eng. - Standard 06190975 L1239841 07/20/20 19:12 22 of 23
WithersRavenel
Our People. Your Success.

APPENDIX E

UST-3
(NOTICE OF INTENT: UST PERMANENT
CLOSURE OR CHANGE-IN-SERVICE)

UST-3 Notice of Intent: UST Permanent Closure or Change-in-Service
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. SEE MAP ON THE BACK OF THIS FORM FOR THE CENTRAL AND REGIONAL OFFICE ADDRESSES.
STATE USE ONLY
I.D. #_____________________
Date Received______________
INSTRUCTIONS (READ THIS FIRST)
Complete and return a UST-3 form at least thirty (30) days prior to closure or change-in-service activities. If a Professional Engineer (P.E.) or a Licensed Geologist (L.G.) provides supervision for closure or change-in-service site assessment activities and signs and seals all closure reports then at least a five (5) working days’ notice is acceptable.
Completed UST closure or change-in-service site assessment reports, along with a copy of the UST-2A and/or 2B 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 https://deq.nc.gov/about/divisions/waste-management/ust. 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.
I.OWNERSHIP OF TANKS II. LOCATION
Owner Name (Corporation, Individual, Public Agency, or Other Entity) CC&PS, Div. of State Hwy Patrol Facility Name or Company Div. of State Hwy Patrol
Street Address 1300 Blue Ridge Road Facility ID # (If known) 00-0-0000006763
City Raleigh County Wake Street Address 650 Francis Street
State NC Zip Code 27607-3903 City High Point County Guilford Zip Code 27263
Phone Number 919-324-1240 Email [e-mail] Phone Number 324-1240
III.CONTACT PERSONNEL
Name: Laura Elliott Company Name: WithersRavenel, Inc. Job Title: Project Geologist Phone Number: 238-0422IV. TANK REMOVAL, CLOSURE IN PLACE, CHANGE-IN SERVICE
1. Contact local fire marshal.
2. Plan entire closure event.
3. Conduct Site Soil Assessment.
4.If removing tanks or closing in place, refer toAPI Publication 2015 Cleaning PetroleumStorage Tanks and 1604 Removal andDisposal of Used Underground PetroleumStorage Tanks.
5.Provide a sketch locating piping, tanks andsoil sampling locations.
6.Submit a closure report in the format of UST-12 (including the form UST-2) within thirty(30)days following the site investigation.
7.If a release from the tanks has occurred, thesite assessment portion of the tank closuremust be conducted under the supervision of
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.
V. WORK TO BE PERFORMED BY
Contractor Name: Eric McManus Contractor Company Name: D. H. Griffin
Address: 4716 Hilltop Road Greensboro State: NC Zip Code: 27407 Phone No: 336-214-9012
Primary Consultant Name: Laura Elliott Primary Consultant Company Name: WithersRavenel, Inc. Consultant Phone No: 919-238-0422
VI. TANKS SCHEDULED FOR CLOSURE OR CHANGE-IN-SERVICE
Tank ID No. Size in Gallons Last Contents
Proposed Activity
Closure Change-In-Service Removal Abandonment in Place * New Contents Stored
1 10000 Gasoline, Gas Mix
*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: Laura Elliott, Project Geologist and Consultant for NC Department of Public Safety
Signature Date Signed 06.11.2020 SCHEDULED REMOVAL DATE 07.13.2020 Notify your DWM Regional Office 48 hours before this date if scheduled removal date changes
UST-3 Rev 3/2020

WithersRavenel
Our People. Your Success.

APPENDIX F

UST-2A
(SITE INVESTIGATION REPORT)

UST-2A Site Investigation Report for Permanent Closure or Change-in-Service of REGISTERED UST
Return completed form to: NC DEQ / DWM / UST SECTION 1646 MAIL SERVICE CENTER RALEIGH, NC 27699-1646 ATTN: REGISTRATION & PERMITTING
phone [phone] fax [phone] http://www.wastenotnc.org/
STATE USE ONLY: Facility ID # 00-0-0000006763
Date Received
INSTRUCTIONS (READ THIS FIRST)
1.UST permanent closure or change in service must be completed in accordance with the latest version of the Guidelines for Site Checks, TankClosure and Initial Response and Abatement. The guidelines can be obtained at http://deq.nc.gov/about/divisions/waste-management/waste-management-permit-guidance/underground-storage-tanks-section.
2. Permanent closure: Complete all sections of this form.
3. Change-in-service: Where a UST system will be converted from storing a regulated substance to a non-regulated substance, complete sections I, II,III, IV, and VI
4. For more than 5 registered UST systems, attach additional forms as needed
5.Tank Fee Refund: An annual tank fee may be refunded for a tank for which a tank fee was not required. An owner or operator must submita written request and include: (1) contact information, (2) federal identification # or SSN, and (3) a copy of UST-2 form. The annual tankfee will be prorated based on the date of permanent closure.
6. UNREGISTERED USTs use Form UST-2B
I. OWNERSHIP OF TANKS II. LOCATION OF TANKS
Owner Name (Corporation, Individual, Public Agency, or Other Entity) CC&PS; Div. of State Hwy Patrol Facility Name or Company Div. of State Hwy Patrol
Street Address 1300 Blue Ridge Road Facility ID # (If known) 00-0-0000006763
City Raleigh County Wake Street Address 650 Francis StreetState NC Zip Code 27607-3903 City High Point County Guilford Zip Code 27263
Phone Number 919-324-1240 (Brad Morris, NC DPS)Phone Number 919-324-1240
III. CONTACT PERSONNEL
Contact for Facility: Brad Morris, PE
Job Title: Senior Project Mgr Phone #: [phone]
Closure Contractor Name: Eric McManus Closure Contractor Company: D.H. Griffin Address: Greensboro, NC Phone # [phone]
Primary Consultant Name: Laura Elliott, PG Primary Consultant Company: WithersRavenel, Inc.Address: Greensboro, NC Phone # [phone]
IV. UST INFORMATION FOR REGISTERED UST SYSTEMSUNREGISTERED USTs use Form UST-2B V. EXCAVATION CONDITION
Tank ID No. Size in Gallons Last Contents Last Use Date
Permanent Close Date Method of Permanent Closure: Indicate REMOVED or enter fill material, such as foam/ concrete/ sand
Change-in-Service Date
Water in excavation Free product
Notable odor or visible soil contamination
Yes No Yes No Yes No
1 10000 Gasoline, G NA 07/13/20 Removed 07/13/20
VI. CERTIFICATION
I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true accurate and complete.
Print name and official title of owner or owner’s authorized representative Laura Elliott, Consultant for NC Dept. of Public Safety
Signature Date Signed 07/14/20
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY, DIVISION OF WASTE MANAGEMENT, UST SECTION 1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646 PHONE [phone] FAX [phone] http://www.wastenotnc.org/ 1/2016