WS-5015_17048_G_RRA_20230302

NCDEQ UNDERGROUND STORAGE TANK SECTION
RISK, RANK, AND ABATEMENT RATING FORM
Incident Name:NCDOT-Elkin Region:LIncident Number:17048 County:SCORE 152Date:3/2/2023 Ranked By:D
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.
B.
C.
D.
E.
F.
G.
Noncommercial UST Releases Only (including Noncommercial Gasoline or Diesel Farm USTs)
H.
I.
2. Intermediate Risk (Commercial UST and Non-UST Releases Only)
A.
B.

C.
D.

E.
A.x
A water supply well not used for drinking water is located within 250 feet of the source area of a confirmed release; or
The groundwater within 500 feet of the source area of a confirmed release has the potential for future use in that there is
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
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.
any non-UST petroleum release;
responsible party for the release; or
by a factor of 10;
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
L
UST/200 Rev 2016-08_P Pg 1 of 4
Incident # 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)
0 x 600 =0
Private Supply Wells (each well can only be counted once)
0 x 200 =0
0 x 75 =0
Public or Private Wells below 2L .0202 Standards (each well can only be counted once)
0 x 100 =0
B. Threat to Uncontaminated Drinking Water Supplies
Public Supply Wells (each well can only be counted once)
v
Private Supply Wells (each well can only be counted once)
Surface Water
NCAC 2L groundwater quality standards. 200 pts ea.
75 pts ea.
TO
T
A
L
CO
U
N
T
x
PO
I
N
T
S
=
17048
(Flag if true, leave blank if no emergency is apparent.)
2. Free product or sheen discovered on surface waters as a result of groundwater discharge. 5 pts total.
edge, or 100 feet of noncommercial UST plume edge; plume edge is within radius of influence of
UST plume edge, or 100 and 150 feet of noncommercial UST plume edge; or threat is reasonably
UST plume edge and wells are threatened or threat is currently unknown. 10 pts ea.
UST plume edge; or wells located within 1000 ft but threat to wells is reasonably known; or an
UST/200 Rev 2016-08_P Pg 2 of 4
Incident #
Section II.2: Surface Water (cont.)
A. Land Use (Choose soil cleanup level. Apply points only if soil contamination exceeds requirement.)
5 :
10 :10
15 :
Air Quality
A. Vapor Phase Exposure
20 :
5 :
3. HYDROGEOLOGY and LITHOLOGY
A. Bedrock
20 :20
10 :10
5 :
- Worst-Case Monitor or Supply Well (assign only one)
5 :
20 :
40 :40
80 :
20 :20
0 :
(from Section III)
(automated)
100 :
50 :502. Abatement letter "D" assigned due to a contaminated soil source remaining. 50 pts total.
concentration. 5 pts total.
no risk-based data is available. 15 pts total.
and health concern levels. 20 pts total.
but levels are below 20% of the lower explosive limit. 5 pts total.
Contamination is located in, on, or within five (5) feet of bedrock. 20 pts total.
surface. 10 pts total.
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 supply. 5 pts total.
TO
T
A
L
17048
OR
OR
OR
OR
OR
PO
I
N
T
S
:
2. High boiling-point petroleum products (fuel oil, kerosene, diesel fuel, etc). 0 pts.
No Risk Data Soil to GW Residential Ind/Comm
UST/200 Rev 2016-08_P Pg 3 of 4
Incident # SECTION III. Source Abatement Assignment (Assign Letter)
1. Abated or Unabated Contaminant Source
A. Emergency Situation E
0
OR
B. Active UST System 100 :A

OR
C. Residual Soil Contamination 50 :D
D
OR
D. Contaminant Sources Abated R

SECTION III. Source Abatement Assignment D
SECTION IV. Risk, Rank, and Abatement Score
Total: Risk, Rank, and Abatement Score L 152 D
(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)
17048
Assign Letter "R". (No points added to Rank in Section II.5.)
x
An Emergency condition must be immediately abated. Assign letter "E" (and see Section II.1).
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 relase product or contaminants
into the environment. Assign Letter "D". (+50 points added to Rank in Section II.5.)
UST/200 Rev 2016-08_P Pg 4 of 4