REMOVAL 2011 CLOSURE IN PLACE - Laserfiche WebLink

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C. Tank/Piping Disposal Site: Name Not applicable Address City Zip Phone No.( ) EPA ID#(if transported to a permitted TSD facility) 9. Is the sampling firm an independent third party from the contractor (REQUIRED)? YES NO[] 9a. Describe, in detail, how the soil and/or water sample(s)beneath the tank and piping will be o twined: The soil from the side o1 the tank will be excavated using a backhoe to the base of the tank at 4 feet. A PSt technician will then use a hand auger rd drill 45 degrees at the base of the tank to obtain the soll underneath the tank. Two borings will be complete are on each end of the UST. 10. Describe how the excavation will be backfilled with suitable material upon removal: Stockpiled material will be covered with Visqueen. There will be no tank pit as it is an abandon'in place. 11. Handling of excavated soil: \ a)What material will be used to line the tank pit and cover the stockpile? Stockpiled material will be covered with Visqueen. There will be no tank pit as it is an abandon in place. b)What will be the final destination of the excavated stockpile? Pending analyses-Soil will be removed to a suitable landfill c)Contaminated Soil Hazardous Waste Hauler: Name Pending Analyses Hauler Registration# Address City Zip Phone Number( ) 12. What is the depth to groundwater? 50 t0 60 fe Describe the source of information: According to GeoTrac r,there are monitodng wells east of the property. The reports state that groundwater is between 50 to 60 feel. 13. Are there any water wells on this parcel or adjacent properties? YES V NO[] TYPE OF WELLS` DISTANCE TO TANKS(S) Public Well ft, Private Weir ft. Irri ation;Well {}. Monitoring Well 171 ft. Other ft. 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[] NO[W] 15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum permit payment per tank. If the party designated below is different than the permit applicant, e.g. property owner, the party must acknowledge this responsibility for the billing by signature and date below. Name Mr. Frank POSS, PSI Mailing Addres'4703 Tidewater Avenue, Suite B, Oakland, CA 94601 yPho tuber(51 )434-9200 -Department Manager 10/20/11 Signature- _ Title Date EH 23 046 (Revised 411111) 5