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% ..� <br />Address ° t ?`+C Ci ^3,,t <br />a?3`r � c +�e'�[�i:�dt;,c_ ri 1c�Cl zip <br />Phone No.( 2t e <br />Hauler Registration # (if hauled as hazardous) <br />C. Tank/Piping Disposal Site: <br />Name `N l C`y-sAA- (..,ami' 1pif\ti rt <br />Address )Z/-1 �S 1Cgplt;i 2C��ttL'Sl City-7k., <br />ity l 1cleZip-TJ r <br />clK . Zip <br />Phone No.0 t i ) [1 10 � ' cin t <br />EPA ID# (if transported to a permitted TSD facility) Cf,A 1 Z 31 <br />9. Is the sampling firm an independent third party from the contractor? YES M NO [ ] <br />9a. �escribe, in detail, how the soil and/or water sample(s) beneath the tank and piping will be obtained: <br />,Y Jt ` - - Yi is 1 PC!- d � Y Ai rlc, �r G' Uf.' u l d IRL" it) etla btzi , <br />�ta7 uvea wi-1 In l\,A.\itium DI'Sii or) i e vAh <br />.•'s: Cx\it1 \ C clow R- QY_' f ` 'e.,s;f` a%f'Af�,d <br />C.l) e.,+ Fine :,.a. I rsi t l wAic/ "IlePt•s e,r<Zf/� tar-Sa>i( UST, <br />10. Describe how the excavation will be backfilled with suitable material upon removal: &-+)Ole s eiSe rr<ssd -4y 149 o r , i <br />t UC.t }es�•J/fepi <br />++t `l 1 1 jj77 D(om�-�- 11 <br />Y'J A,�V„1. m� ..•.11 4�f— —•11 r'(A \e,i�TY\ 1YY\Iti/iitC'(.t t1FCd:\7'177 1AU rlt U'1\iLl CA•CAI::\ <br />11 <br />12. <br />Handling of excavated soil: <br />a) What material will be used to line the tank pit and cover the stockpile? <br />teal etk SL- i 1 S v,; i U <br />mil <br />Tate pp,! :NSF /I2'r Oe (++ted cknJ w,/) OAe:tjj,);- ,,d <br />b) What will be the final destination of the excavated stocipile? <br />kxtcleA ill I I (- <br />4 <br />res <br />l.Vc:se, ��Sc'/ :S e 551 /7ws L1/k1�� i ett;ll be ci)spoSe�f ZliaSte !�1<n.zy'e,xe.tf <br />c) Contaminated Soil Hazardous Waste Hauler: A ekt 55 S� �c „dl ; )� C &C bob �V1 l/7 ) <br />/ <br />Name (`aCU” v fill l lc - `%off �u �dL c{c `3 i/cu Hauler Registration # C -1J c cl tJ t i <br />Address ��CS C�rL'Jll LLnC RCl. City Zip Crrj 3Cc <br />Phone No. ( ZC G <br />What is the depth to groundwater?d Ck� / rCCt 1 T6 N W/t lLarf �'i i SC L <br />Describe the source of information: <br />anQe.r� �u��11e� ry9o;;ny prco;ou� b�yz.g <br />IFTe'v/,prt <br />" luny clJe clr�',ge,ue �el,-ineQ> <br />bCA <br />/Z` ✓)e <eSfc <br />Lv,`r\ci�5ot- C,� <br />EH 23 046 (Revised 12/31/07) 5 <br />k -e*;& <br />_td 25 -7t1 -4,1W 69.J 992 S, 6.32- <br />83-s� -Av <br />