WS-2442_3329_G_RRA_20170327

NCDEQ UNDERGROUND STORAGE TANK SECTION
RISK, RANK, AND ABATEMENT RATING FORM
Incident Name:James Residence, Walter Region:
3/27/2017 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 Farm UST, and Non-UST Petroleum Releases Only
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.
D.
E.
3. Low Risk
A.x
Low
SCORE
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.
L211D
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
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
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
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)
x 600 =0
Private Supply Wells (each well can only be counted once)
x 200 =0
x 75 =0
Public or Private Wells below 2L .0202 Standards (each well can only be counted once)
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
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
2. Free product or sheen discovered on surface waters as a result of groundwater discharge. 5 pts total.
CO
U
N
T
3329
(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. 200 pts ea.
75 pts ea.
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 :5
10 :
15 :
Air Quality
A. Vapor Phase Exposure
20 :
5 :
3. HYDROGEOLOGY and LITHOLOGY
A. Bedrock
20 :20
B. Vertical Contaminant Migration
10 :10
C. Horizontal Contaminant Migration
5 :
4. ENVIRONMENTAL VULNERABILITY ASSESSMENT
A. Existing Groundwater Quality - Worst-Case Monitor or Supply Well (assign only one)
5 :
20 :
40 :40
80 :
B. Predominant Contamination Type
20 :20
0 :
5. CONTAMINANT SOURCE ABATEMENT (from Section III)
A. Rank Contributions from Section III: Source Abatement Assignment (automated)
100 :
50 :50
SECTION II. Release Ranking
3329
4. Free product is present. 80 pts total.
OR
1. Low boiling-point petroleum productes (gasoline, aviation fuel). 20 pts total.
2. High boiling-point petroleum products (fuel oil, kerosene, diesel fuel, etc). 0 pts.
OR
OR
OR
OR
PO
I
N
T
S
:
211
2. 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.
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
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
100 :A
50 :D
D
OR
D. Contaminant Sources Abated
SECTION III. Source Abatement Assignment D
SECTION IV. Risk, Rank, and Abatement Score
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)
50
E" (and see Section II.1).
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.)
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.)
0
L211D
3329
UST/200 Rev 2016-08_P Pg 4 of 4