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Address f D C)o�X 3J 7 City 4 zip s� <br /> PhoneNo.(_2 O aj <br /> t� C+fJ9�AS23 e <br /> Hauler Registration N(if hauled as hazardous) //�� / cc ".2-/ <br /> 0/c c.t,Z� L a///iiC4tJsrrEN 7'C aF ildiGtf <br /> c. Tank/Piping Disposal Site:: l70 CO;< .5-2 X/ '41 ", 9,die <br /> NameSCT1 GLK nrG/L� 2ed(!C715 <br /> r/ <br /> Address /Z,0d 0 G/ 41-5 --n aJ iVd )'-1 oU.9 Zip_s7�Z <br /> Phone No.( 9i� , !4 -/(f/Q <br /> EPA HHIifrran p ry) Ci9CO2j 1�'fS rA-D9 <br /> ( sported to a permitted TSD facili L S L 3 <br /> 9. Is the sampling first an independent third party from the contractor? YES/, NO[) <br /> 9a. Describe,in detail,how the soi and/or water sampl9 beneath the tank and ' 'ng will be obtained: <br /> i✓'/ LLS r c £ T £ t' s!'I/n! /Y�i?!r9 <br /> G , CE .rCc <br /> _ h/ me A o.'- <br /> 10. <br /> 10. Describe how the excavation will be backfilled with suitable material upon removal: <br /> 11. Handling ofexcavatedsoil: <br /> a)What material will be used to line the tank pit and cover the stockpile? <br /> 6" -;;V! l 'Ozefc�/r <br /> b)What will be the final destination of the excavated stockpile? T/£ <br /> Cpry Ti/.'r'/i�„^77£/ /� ✓)�GISO<✓ ij S£% C//'on/ Y/�C CG+QJ���..✓��vd <br /> c)Contaminated Soil Hazardous Waste Hauler. <br /> Name <br /> Address, ` nJA� %U19City_L� Hauler Reglstratlon M �S <br /> /"®�J/c �/7t�/(� y/Zy��- <br /> Phone No. <br /> 12. What is the depth to groundwater? _ r 776 ,�� G/ Ty ©� s�t✓/ /� <br /> Describe the source of information: - / - —7-- <br /> EH 23 046 (Revised 12/31/07) 5 <br />