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��r --� <br />Address s�-�� °5 < Pf"3t`ail C i I'fC City GlC�� Zip <br />Phone No.( , I // <br />Hauler Registration # (if hauled as hazardous) ' A <br />C. Tank/Piping Disposal Site: <br />Name <br />U <br />Address )Z/legilt.� kyys3 CiZip 953( <br />Phone No. z( t q ) Lt t 6 ' C �% 6 <br />EPA EM (if transported to a permitted TSD facility)—LA-11 .l ) <br />9. Is the sampling fine an independent third party from the contractor? YES JA NO [ <br />9a. Describe, in detail, how the soil and/or water sample(s) beneath the tank and piping will be obtained: <br />>! 11 �c der '' - t iW, )too .god cd In eeu, htuS� <br />ii�nls: tClver wii� o�um,lnum t�.,d I�QS�iI i'ArS Ort i e 1 <br />-�yeEti c1c� 1 rr,nlva0.� tkx n P '� <br />til) c; +5 y1 •uer i rA n Ji t i;ne MaM1 o/ rzld 1 �Alek u s el t�4�.V 01C Se' USi. <br />10. Describe how the excavation will be backfilled with suitable material upon removal &274-f e/3.'G art/ <br />..e - aey ai,-e4l <br />11. Handling of excavated soil: <br />a)J What material will be used to line the tank pit and cover the stockpile? <br />NCISA,c.- C�,Acl LCVr'c.fd 7 Si vt <br />%iG if Lv/ 1Lt qN [i tz [:nGl A /% /eW p0e:i`J,1 7/�4 tv/.:/z rt4� c" <br />b) What will be the final destination of the excavated sto&pile? <br />_IYlct UC.QtA 0.S E-xick.AM'� C�tRrl O.!1-Cjig('p�wa0 (ti� q'f4�1[+-ti-ti <br />IN ire-< LK..6'-d �s a4.$3 iT �iLc:-`:aw3 llik SLC !/ W'd �c '1 cs tI '--t- +Se %Y/r: nal,2MG. <br />c) Contaminated Soil Hazardous Waste Hauler: A ':kt65 .f J' .' x711 - l AC 66C Lfjl� l/7) l <br />Name '�Gt9" 1111��a CN0:'C �a&-Ao�3 LO Hauler Registration# <br />Address JIFCS yv ["if -('A kitc-P-6, City Zip C1-i3Ctj <br />Phone No. ( <br />—rt <br />i <br />What is the depth to groundwater? - <br />Describe the source of information: <br />EH 23 046 (Revised 12/31/07) <br />On r' cl-ly-56t"Alle4l q Drcoio <br />/ a <br />:,Cres ren ,yF,�[P DCri1--V-4 <br />oCC. J7 <br />Ot ^ DC'S f'/ac lrrJ .11J/ fl'A e -go 7ge 5•�6.K. <br />/U <br />iti';tidso� C<9 qsy� i"A 7 7 <br />5 <br />