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c. Tank/Piping Disposal Site: <br /> Name Not applicable <br /> Address City Zip <br /> Phone No.( ) <br /> EPA ID#(if transported to a permitted TSD facility)C'AC002678515 <br /> 9. Is the sampling firm an independent third party from the contractor (REQUIRED)? YESQ NO[] <br /> 9a. Describe,in detail,how the soil and/or water sample(s)beneath the tank and piping will be obtained: <br /> Thaaptken <br /> MOM@ of In$lenkwi6 MO=Vatedeanpa ba*; W thObay of ba tank b4IaaL A Pal IecMlcien pill bMass a hand aup«and dra 45 dapry afire asaaa <br /> IM IaNr to ablain Ne aoa W Wmaab IM lank Two bamga wtll b mmplba mn on aeU and of be UST. <br /> 10. Describe how the excavation will be backfilled with suitable material upon removal: <br /> Stockpiled material will be covered with Vlsqueen There will be no tank pit as it is an abandon in place <br /> 11. Handling of excavated soil: <br /> a)What material will be used to line the tank pit and cover the stockpile? <br /> Stockpiled material will be covered with Visgueen There will be no tank pit as It Is an abandon in place <br /> b)What will be the final destination of the excavated stockpile? <br /> fenrsd,,MW <br /> c)Contaminated Soil Hazardous Waste Hauler. <br /> Name Al Chem Disposal 2914 <br /> Hauler Registration# <br /> Address 21 Great Oaks city San Jose ZIP 95119 <br /> Phone Number(408 1499-5274 <br /> 12. what is the depth to groundwater? 50 to 60 feet <br /> Describe the source of information: <br /> AGONrp b GadTnckx,ban ero monibdrgweh.wdUm Omea7.ilw rapaM slab uM9lourlewebr isbeMan 50 b W kret <br /> 13. Are there any water wells on this parcel or adjacent properties? YESaNO[) <br /> TYPE OF WELLS DISTANCE TO TANKS($) <br /> Public Well kkll 77 MMMM tt,�I <br /> fE. <br /> Private Well a_ OCT 2 6 2011 <br /> Irrigation Well ft. SAl4JOAL,I-iN COUlti;v <br /> . <br /> Monitoring Well 171 ry ttfdViRONMCNTAL. <br /> Other ry <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)? YES[] NO( <br /> 15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different than the permit applicant, e.g. property <br /> owner,the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name Mr. Frank Poss, PSI <br /> _MgWotg' ddr Tidewater Avenue, Suite B, Oakland, CA 94601 <br /> Day P one umber 5.1 _ 434-9200 <br /> Department Manager 10/20/11 <br /> SignatureTitle Date <br /> EH23046 (Revisedli/l/11) 5 <br />