FA-30244_49283_CA_UST-61_20231116

UST-61 24-Hour Release and UST Leak Reporting Form.
For Releases This form should be completed and submitted to the UST Section's regional office following a known or suspected release from
in NC an underground storage tank (UST) system. This form is required to be submitted within 24 hours of discovery of a known or suspected release
(DWM USE ONLY) Suspected Contamination? (Y/N) Facility ID Number Incident# Risk (H,l,L,U) Confirmed GW Contamination? (Y/N) ___ Date Leak Discovered Received On Received By Confirmed Soil Contamination ?(Y/N) ___ Comm/Non-Commercial? Reported by (circle one): Phone, Fax or Report Samples Taken?(Y/N) __ Reg/Non-regulated? Region Free Product? (Y/N) __ If Yes, State Greatest Thickness
INCIDENT DESCRIPTION Incident Name:
Address: I County:
City/Town: Zip Code: I Regional Office (circle one): Asheville, Mooresville, Fayetteville, Raleigh, Washington, Wilmington, Winston-Salem
Latitude (decimal degrees): Longitude (decimal degrees) : Obtained by: Briefly describe suspected or confirmed release: (including but not limited to: nature of release, date of release, amount OGPS of release, amount of free oroduct oresent and recoverv efforts, initial resoonses conducted, imoacts to receotors)□Topographic map
OGls Address matching
O0ther □unknown
Describe location:
HOW RELEASE WAS DISCOVERED (Release Code)
(Check one) □Release Detection Equipment or Methods Dvisual/Odor □Groundwater Contamination
ODuring UST Closure/Removal Dwater in Tank Dsurtace Water Contamination □Property Transfer Dwater Supply Well Contamination O0ther (specify)
SOURCE OF CONTAMINATION
Source of Release Cause of Release T�ee of Release Product T�ee Released
(Check primary source) (Check primary cause) (Check one) (Check primary product type released)
OTank □spill D Petroleum D Gasoline/ Diesel/ 0 DieselNeg. Oil □Piping □overfill D Non-Petroleum Kerosene Blend
D Dispenser D Corrosion OBoth D Heating Oil 0 Vegetable Oil 100%
D Submersible Turbine Pump D Physical/Mechanical D Other Petroleum OE10-E20
Location Products OE21-E84 D Delivery Problem Damage (Check one) D Metals D Install Problem OE85-E99 □spill Bucket D Other □Facility D Other lnorganics D Ethanol 100% Oother D Unknown □Residence D Other Organics OE01-E09 D Unknown O0ther
Definitions presented on reverse Definitions presented on reverse
Ownershie 1.Municipal 2. Military 3. Unknown 4. Private 5. Federal 6. County 7. State
Oeeration Tl£ee 1.Public Service 2. Agricultural 3. Residential 4. Education/Relig. 5. Industrial 6. Commercial 7. Mining
UST Form 61 (02/19) Page 1 of 2
49283 U - possible High
11/15/23 KEC
FAY
YN
YN
00-0-0000031525
CommReg
211 FAST MART
10827 HWY. 211 EAST MOORE
ABERDEEN 28315
35.116808 -79.388575
x
ARCGIS
NCDOT GeoTechnical revealed a 2021 DOT Preliminary Assessment that identified at least one soil sample
near the dispenser island area that exceeded the TPH action limit (24.1 mg/kg DRO)
X NCDOT
X X
X
X
X
FA-30244
IMPACT ON DRINKING WATER SUPPLIES
Water Supply Wells Affected? 1. Yes 2. No 3. Unknown
Number of Water Supply Wells Affected
Water Supply Wells Contaminated: (Include Users Names, Addresses and Phone Numbers. Attach additional sheet if necessary)
1.
2. 3.
UST SYSTEM OWNER
UST Owner/Company
Address
City I State Zip Code I Telephone Number
UST SYSTEM OPERATOR UST Operator/Company
Address
City I State Zip Code I Telephone Number
LANDOWNER AT LOCATION OF UST INCIDENT Landowner
Address
City I State Zip Code I Telephone Number
Draw Sketch of Area (showing two major road intersections) or Attach Map
Person Reporting Incident Company Telephone Number
Title Address Date
UST Form 61 (02/19) Page2 of2
Definitions of Sources Tank: means the tank that stores the product and is part of the underground storage tank system Piping: means the piping and connectors running from the tank or submersible turbine pump to the dispenser or other end-use equipment (Vent, vapor recovery, or fill lines are excluded.) Dispenser: includes the dispenser and the equipment used to connect the dispenser to the piping (e.g., a release from a suction pump or from components located above the shear valve) Submersible Turbine Pump (STP) Area includes the submersible turbine pump head (typically located in the tank sump), the line leak detector, and the piping that connects the submersible turbine pump to the tank Delivery Problem: identifies releases that occurred during product delivery to the tank. (Typical causes associated with this source are spills and overfills.) Other: serves as the option to use when the release source is known but does not fit into one of the preceding categories ( e.g., for releases from vent lines, vapor recovery lines, and fill lines) Unknown: identifies releases for which the source has not been determined Definitions of Causes Spill: use this cause when a spill occurs (e.g., when the delivery hose is disconnected from the tank fill pipe or when the nozzle is removed from the dispenser) Overfill: use when an overfill occurs (e.g., overfills may occur from the fill pipe at the tank or when the nozzle fails to shut off at the dispenser) Physical or Mechanical Damage: use for all types of physical or mechanical damage, except corrosion ( e.g., puncture of tank or piping, loose fittings, broken components, and components that have changed dimension) Corrosion: use when a metal tank, piping, or other component has a release due to corrosion ( e.g., for steel, corrosion takes the form of rust) Installation Problem: use when the problem is determined to have occurred specifically because the UST system was not installed properly Other: use this option when the cause is known but does not fit into one of the preceding categories (e.g., putting regulated substances into monitoring wells) Unknown: use when the cause has not been determined Point of Contact
Email
Email
Email
MCNEILL OIL COMPANY, INC.FRANK MCNEILL, JR.
[e-mail] P.O. BOX 396
ABERDEEN NC 28315 910-944-2329
DONALD E. GILLIS
P.O. BOX 535
ABERDEEN NC 28315
KEN CURRIE DWM/UST SECTION - FRO
11/16/2023
N
NC 211 H
WYEAST INDIANA AVE.0'35'
17.5'
70'
(ENGLISH)
70'

P229-B18
P229-B17P229-B16
P229-B15
P229-B14
P229-B13
P229-B12
P229-B11
P229-B10
P229-B9
P229-B8
P229-B7
P229-B5
P229-B6
P229-B3
P229-B2
P229-B4
P229-B1

20478R5709
APPROXIMATE BORING LOCATION
AREA OF INVESTIGATION

ABERDEEN, NORTH CAROLINA
10827 NC 211 HWY
R-5709 - PARCEL 229
ANALYTICAL RESULTS MAP
FIGUREJOB NUMBER
BY:
CHECKED DATE: DATE: BY:
PREPARED
LMM HPC 310/15/21 10/15/21
P229-B1 2-4
4-6
<0.2
<0.17
<0.08
<0.07
P229-B2 4-6
8-10 <0.15 <0.06
P229-B3 2-4
6-8 <0.15
<0.07
<0.06
P229-B4 2-4
6-8 <0.15
<0.07
<0.06
P229-B5 2-4
6-8
<0.2
<0.12
P229-B6 2-4
8-10 <0.12 <0.05
<0.15 <0.1
<0.17
<0.17
0.05
4.4
<0.15 0.9
P229-B7 0-2
6-8 <0.12 <0.05
<0.15 0.4
P229-B8 2-4
8-10 <0.12 <0.05
<0.12 0.1
P229-B9 0-2
4-6 <0.14
24.1
2-4
6-8 <0.17 <0.07
2-4
4-6 <0.17 <0.07
<0.17
2-4
6-8 <0.08
<0.22
<0.6
<0.3
P229-B10
<0.3 <0.15
P229-B11
<0.07
P229-B12 <0.2
<0.09
2-4
6-8 <0.09
<0.08
2-4
6-8 <0.05
<0.19
2-4
4-6 <0.08<0.2
<0.08
2-4
4-6
<0.17
2-4
6-8 <0.08
<0.22
<0.2
<0.09
0-2
4-6 <0.07
<0.17
P229-B13
<0.2
<0.22
P229-B14
<0.4
<0.12
P229-B15
<0.2
P229-B16 <0.17
0.18
0.08
P229-B17
P229-B18 <0.17
0.5
BOLD CONCENTRATION EXCEEDS RESPECTIVE STATE ACTION LEVEL
DRO STATE ACTION LEVEL = 100 mg/kg
GRO STATE ACTION LEVEL = 50 mg/kg
DRO=DIESEL RANGE ORGANICS
GRO=GASOLINE RANGE ORGANICS
CONCENTRATIONS SHOWN IN MILLIGRAMS PER KILOGRAM (mg/kg)
DEPTHS SHOWN IN FEET BELOW GROUND SURFACE
1S
MTLFIRE STATION
S
CONC
CONC1SFBUS1SFBUS
MTL CAN
AT
M1S
M
TL BUSGAZEBO
DI
MTLCONCS
SS
CONC
CONC
CONCCONCCONCCONCSSS 1SFBUS1SMTLBUS
24" RCP
24" RCPDI
DI
DI
DB 546 PG 837
229EIPEIP
187
10
X70 ST
R5709-8
EXISTING R/WEXISTING R/WEXISTING R/WEXISTING R/WEIP
8
4123
473.73
4134472.78
4142468.75
U/G TANKS
HOUSE
WELL
LP
LP
LP
LP
LP
LP
JP
LP
206
207 212213217
222
223
SIG
SIG
LT
LT
LT
LT
LT
SIGLTW/LT
LT
LT
W/LT
SIG W/LTW/LTTT
H
H
T
T
T
T
H
H
S6 FO6 FO
12 FO
12 FO
48 FO
48 FO
EOIEOIEOI
WOODS
WOODS 228MTRMTRMTRCONC
FIRE DEPART
MENT, INC.
CRESTLINE VOLUNTEER
DB 1120 PG 409
DB 3896 PG 540
THO
MAS KOLTUN
CHARLES R. GILLIS
AND
DONALD E. GILLIS
DB 2679 PG 63 CHARLES R. GILLISANDDONALD E. GILLISDB 2679 PG 63TO
WN OF ABERDEEN
TO
WN OF ABERDEEN 107109
110 2GI-A15"
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
Boring Depth GRO DRO
F
C
C
F
C
C
C
C
C
F
FCCCC
F
C
C
C