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SAN. 10 A Q U IN /" \ Environmental Health Department 1 <br /> ---COUNTY— <br /> c. <br /> _--COUNTY c. Describe me hod t be used for decontamination: 6222017 <br /> �ALTH <br /> d. Describe w rinsate aterial will be stored onsite prior to anife ting offsite: riTi2 N T <br /> e. Rinsate auler and per tted Treatment, Storage & Di posal F cility: <br /> Hauler ame Phone ( ) Hauler Re # <br /> Addres ity Zip <br /> Permit ed Disposal Site <br /> 6. a. Desc be the method that will be utilized to purge and/ r inert th piping: <br /> b. Pipi g Hauler: <br /> Na Phone ) <br /> Add ess Cit Zip <br /> Ha ler Registration # (if hauled as hazardous) <br /> c. Pip ng Disposal Site: <br /> Na a Phone ) <br /> Ad ress Cit Zip <br /> E ID# (if transported to a permitte TSD facilit ) <br /> 7. Is the ampling firm an independent third arty from he contractor ES [] NO [ <br /> a. Id ntify sampling firm: <br /> Name Phone( ) <br /> A dress City Zip <br /> b. Identify laboratory performing analysis: <br /> N me Phone )) <br /> A dress City Zip <br /> 8. Describe, in detail, how the soil and/or water am le(s) beneath t ie pipin or dispenser will be obtai ed: <br /> 9. a. H ndling of excavated soil (Contaminated S it Hazardous Wste Ha er): <br /> N me Hau Registration# Phone ( ) <br /> A dress City Zip <br /> b. If oil is not to be hauled, describe what wil a done with it: <br /> 4 of 6 <br />