FA-1015_19070_G_RRA_20230601

NCDEQ UNDERGROUND STORAGE TANK SECTION
RISK, RANK, AND ABATEMENT RATING FORM
Incident Name:Food Lion Distribution Center 4 Region:
2023.06.01 Ranked By:
Note: a new ranking form must be completed whenever site conditions may have changed, or at least once every 5 years
SECTION I. Initial Risk Classification (Check all that apply)
1. High Risk
All UST and Non-UST Petroleum Releases
A.
Commercial UST, Noncommercial Motor Fuel UST, and Non-UST Petroleum Releases Only
G.
Noncommercial UST Releases Only (including Noncommercial Farm or Residential Motor Fuel USTs)
H.
I.
2. Intermediate Risk (Commercial UST and Non-UST Releases Only)
A.
B.
D.
E.
3. Low Risk
A.X
In the Coastal Plain Physiographic Province (as designated on a map entitled Geologic Map of North Carolina published by
the Department in 1985), the source area of a confirmed release is located where there is recharge to an unconfined or
semi-confined deeper aquifer which the Department determines is being used or may be used as a source of drinking
no source of water supply other than the groundwater;
confirmed release;
dibromide, benzene and the aliphatic and aromatic carbon fraction classes) exceed 50 percent of the solubility of the
contaminant at 25 degrees Celsius or 1,000 times the groundwater quality standard or interim standard established in 15A
SCORE
19070
1,000 times the federal drinking water standard set out in 40 CFR 141(these levels have also been termed “gross
contamination levels”).
A low risk classification means that the risk posed by a release does not meet any of the high or intermediate risk criteria
or, based on site-specific information received by the Department, the release does not pose a significant risk.
L85D
An existing water supply well, including one used for non-drinking purposes, has been contaminated by any UST release or
any non-UST petroleum release;
responsible party for the release; or
contaminant concentration exceeds the applicable surface water quality standard and criteria found in 15A NCAC 2B .0200
by a factor of 10;
UST/200 Rev 2018-05_P Pg 1 of 4
SECTION II. Risk Classification (Assign points as applicable)
1. EMERGENCY HAZARD ASSESSMENT E - FLAG
Complete form with letter "E" assigned to final rating. Once Emergency is abated, a new rating must be prepared.
2. EXPOSURE ASSESSMENT
Groundwater
A. Impacted Water Supplies
Public Supply Wells (each well can only be counted once)
x 600 =
Private Supply Wells (each well can only be counted once)
x 200 =
x 75 =
Public or Private Wells below 2L .0202 Standards (each well can only be counted once)
x 100 =
B. Threat to Uncontaminated Drinking Water Supplies
Public Supply Wells (each well can only be counted once)
x 40 =
x 10 =
Private Supply Wells (each well can only be counted once)
x 20 =
x 10 =
x 5 =
C. Proximity of Wells to Permitted USTs (PIB Information Check - No Points)
*
*
Surface Water
:
:
Incident #
Section II.2: Surface Water (cont.)
A. Land Use (Choose soil cleanup level. Apply points only if soil contamination exceeds requirement.)
19070
:
TO
T
A
L
CO
U
N
T
(Flag if true, leave blank if no emergency is apparent.)
x
PO
I
N
T
S
TO
T
A
L
NCAC 2L groundwater quality standards. 600 pts ea.
NCAC 2L groundwater quality standards. 200 pts ea.
75 pts ea.
groundwater quality standards. 100 pts ea.
PO
I
N
T
S
UST or non-UST plume edge, or 100 feet of other noncommercial UST plume edge; plume edge is
motor fuel UST or non-UST plume edge, or 100 and 150 feet of other noncommercial UST plume
noncommercial motor fuel UST or non-UST plume edge, or 150 ft of othernoncommercial UST plume
motor fuel UST or non-UST plume edge and wells are threatened or threat is currently unknown. 10
motor fuel UST or non-UST plume edge; or wells located within 1000 ft but threat to wells is
Check after
notifying PIB:
1. Violation of Class HQW, ORW, WS-I, WS-II, or SA surface water quality standards as a result of
groundwater discharge. 10 pts total.
No Risk Data Soil to GW Residential Ind/Comm
UST/200 Rev 2018-05_P Pg 2 of 4
X :5
:
:
B. Proximity of Protected Waters to Permitted USTs (PIB Information Check - No Points)
*
Air Quality
A. Vapor Phase Exposure
3. HYDROGEOLOGY and LITHOLOGY
A. Bedrock
B. Vertical Contaminant Migration
C. Horizontal Contaminant Migration
4. ENVIRONMENTAL VULNERABILITY ASSESSMENT
A. Existing Groundwater Quality - Worst-Case Monitor or Supply Well (assign only one)
B. Predominant Contamination Type
5. CONTAMINANT SOURCE ABATEMENT (from Section III)
A. Rank Contributions from Section III: Source Abatement Assignment (automated)
:0
:50
SECTION II. Release Ranking
Incident #
SECTION III. Source Abatement Assignment (Assign Letter)
1. Abated or Unabated Contaminant Source
(20 pts)
(20 pts)
(0 pts)
(5 pts)
(5 pts)
(10 pts)
(50 pts)
OR
OR
OR
OR
OR
WS-II or SA is located within 500' of a permitted UST.
Check after
notifying PIB:
Data or observations indicate that no discharge points or aquifer discontinuities exist between the
discharge, release, or known extent of contamination and the nearest down-gradient drinking water
surface. 10 pts total.
vaults, etc.) but levels are below 20% of the lower explosive limit. 5 pts total.
explosive limit and health concern levels. 20 pts total.
19070
85
exposure concentration. 10 pts total.
exposure concentration. 5 pts total.(5 pts)
(10 pts)
UST/200 Rev 2018-05_P Pg 3 of 4
A. Emergency Situation
Total: Risk, Rank, and Abatement Score
(Use Risk letter from Section I, total of all Rank points from Section II, and Abatement letter from Section III. Transfer final score to Page 1)
D
D
UST Systems remain in operation and continue to discharge into the environment.
Assign Letter "A". (+100 points added to Rank.)
The UST release has been abated; however, contaminated soil continues to release product or contaminants
into the environment. Assign Letter "D". (+50 points added to Rank in Section II.5.)
The UST release has been abated and contaminated soil has been removed or remediated.
Assign Letter "R". (No points added to Rank in Section II.5.)
An Emergency condition must be immediately abated. Assign letter "E" (and see Section II.1).
L85D
UST/200 Rev 2018-05_P Pg 4 of 4