MO-28112_47377_G_NORR_20201124

November 24, 2020

Sam's Mart, Inc
7935 Council Place, #200
Matthews, NC 28105
Attention: Adnan Jazairi

Re: Notice of Regulatory Requirements
15A NCAC 2L .0405
Risk-based Assessment and Corrective
Action for Petroleum Underground Storage
Tanks

Sams Mart 80
8325 Old Statesville Rd
Charlotte, NC
Incident Number: 47377

Mr. Jazairi:

The UST Closure Report form received by the UST Section, Division of Waste Management, Mooresville Regional
Office on October 30, 2020, confirms a release or discharge from a petroleum underground storage tank (UST) system
at the above-referenced location. The report indicates that soil contamination exceeds or equals the 10 mg/kg total
petroleum hydrocarbons (TPH) screening limit (or exceeds the lower of the residential or soil-to-groundwater
maximum soil contaminant concentrations (MSCCs) established in Title 15A NCAC 2L .0411) and/or that
groundwater contamination exceeds the standards or interim standards established in Title 15A NCAC 2L.0202.

Therefore, the responsible party must comply with the assessment and reporting requirements of Title 15A NCAC 2L
.0405, which includes the preparation and submittal of a Limited Site Assessment (LSA) Report, in accordance with
the rule and the most recent version of the Guidelines for Assessment and Corrective Action for UST Releases, within
120 days of discovery of the release. The Limited Site Assessment (LSA) report outline and requirements can be
found online at: http://portal.ncdenr.org/web/wm/ust/guidance; the LSA investigation and report must follow these
specifications.

Because a release or discharge has been confirmed, a Licensed Geologist or a Professional Engineer, certified by the
State of North Carolina, is required to prepare and certify all reports submitted to the Department in accordance with
Title 15A NCAC 2L .0103(e), and 2L .0111(b).

Please note that before you sell, transfer, or request a “No Further Action” determination for a property that has not
been remediated to below “unrestricted use” standards, you must file a Notice of Residual Petroleum ("Notice") with
the Register of Deeds in the county where the property is located (NCGS 143B-279.9 and 143B-279.11).

Failure to comply with the State's rules in the manner and time specified may result in the assessment of civil penalties
and/or the use of other enforcement mechanisms.

If you have any questions regarding trust fund eligibility or reimbursement from the Commercial or Noncommercial
Leaking Petroleum Underground Storage Tank Cleanup Funds, please contact the UST Section Trust Fund Branch at
[phone]. If you have any questions regarding the actions that must be taken or the rules mentioned in this
letter, please contact me at the address or telephone number listed below.

Sincerely,

Daniel Bowser, PG
Hydrogeologist
UST Section, Division of Waste Management, NCDEQ
Mooresville Regional Office
[phone]

cc via email: Mike Stanforth, PE, ECEA
Shawna Caldwell, LUESA- Mecklenburg County Health Department