Appendices Appendix A Report Formats 67 – 1. Site Check Report 68 2. Notice of Intent: UST Permanent Closure or Change-in-Service Form (UST-3) 73 3. 24-Hour Release and UST Leak Reporting Form (UST-61) 75 4. 20-Day Report 78 5. UST Closure Report (following UST-12 format) and Site Investigation Report for Permanent Closure or Change-in-Service of UST (UST2A or UST-2B) 82 6. Initial Abatement Action (Site Check, UST Closure with UST-2 Form, Excavation, Post-Excavation Soil Contamination Assessment) Report 89 Appendix B Reporting Tables 98 – 1. Table B-1 Site History UST/AST System and Other Release Information 99 – 2. Table B-2: Site History UST/AST Owner/Operator and Other Responsible Party – Information 100 3. Table B-3: Summary of Soil Sampling Results 101 4. Table B-4: Summary of Groundwater and Surface Water Sampling Results 102 5. Table B-5: Private/Public Water Supply Well and Other Receptor Information 103 6. B-6: Property Owners/ Occupants 104 7. Table B-7: Monitoring and Remediation Well Construction Information 105 8. Table B-8A: NAPL Recovery Information 106 9. B-8B: Cumulative Volume of NAPL Recovered from Site 106 10. Table B-9: Current and Historical Groundwater Elevation and FP Thickness 107 Appendix C UST Systems: Regulated or Not Regulated under 15A NCAC 2N 108 – Appendix D Collecting Soil Samples 111 – Appendix E Disposal of Contaminated Soil and Groundwater 112 – Appendix F Guidelines Pertaining to Contaminant Sources other than USTs 118 –
Appendices Appendix A – Report Formats 67 1. Site Check Report 68 2. Notice of Intent: UST Permanent Closure or Change-in-Service Form (UST-3) 73 3. 24-Hour Release and UST Leak Reporting Form (UST-61) 75 4. 20-Day Report 78 5. UST Closure Report (following UST-12 format) and Site Investigation Report for Permanent Closure or Change-in-Service of UST (UST2A or UST-2B) 82 6. Initial Abatement Action (Site Check, UST Closure with UST-2 Form, Excavation, Post-Excavation Soil Contamination Assessment) Report 89 Appendix B – Reporting Tables 98 1. Table B-1 Site History – UST/AST System and Other Release Information 99 2. Table B-2: Site History – UST/AST Owner/Operator and Other Responsible Party Information 100 3. Table B-3: Summary of Soil Sampling Results 101 4. Table B-4: Summary of Groundwater and Surface Water Sampling Results 102 5. Table B-5: Private/Public Water Supply Well and Other Receptor Information 103 6. B-6: Property Owners/ Occupants 104 7. Table B-7: Monitoring and Remediation Well Construction Information 105 8. Table B-8A: NAPL Recovery Information 106 9. B-8B: Cumulative Volume of NAPL Recovered from Site 106 10. Table B-9: Current and Historical Groundwater Elevation and FP Thickness 107 Appendix C – UST Systems: Regulated or Not Regulated under 15A NCAC 2N 108 Appendix D – Collecting Soil Samples 111 Appendix E – Disposal of Contaminated Soil and Groundwater 112 Appendix F – Guidelines Pertaining to Contaminant Sources other than USTs 118
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