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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)CAC002665350 <br /> 9. Is the sampling firm an independent third party from the contractor (REQUIRED)? YES l NO [] <br /> r <br /> 9a. Describe, in detail, how the soil and/or water sample(s)beneath the tank and piping will be obtained: f <br /> The soil from the side of the lank will be excavated using a backhoe to the base of the tank at 4 feet. A PSI technician will then use a hand auger and drill 45 degrees a e bash of <br /> the lank to obtain the soil underneath the lank. Two berings will be complete one on each end of the UST. <br /> 10. Describe how the excavation will be backfilled with suitable material upon removal: <br /> Stockpiled material will be covered with Visqueen. 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 Visqueen. There will be no tank pit as it is an abando/place. <br /> b)What will be the final destination of the excavated stockpile? <br /> Forward Landfill <br /> c) Contamin Soil Hazardous Waste Hauler: <br /> Nam nding Analyses <br /> uler Registrati # <br /> ddress City Zip <br /> Phone Number( ) <br /> 12. What is the depth to groundwater? 50 to 60 feet <br /> escribe the source of information: , <br /> According to GeaTracker,there are monitoring wells east of the r e reports state that groundwater is between 5010 66 feel <br /> J <br /> 13. Are there a es. YESONO <br /> TYPE OF WELLS DISTANCE TO TANKS(S) ``✓{ <br /> Public Well ft. O/ El'A/ I <br /> Private Well ft. <br /> Irrigation W ft. <br /> Monitori Well 171 ft. <br /> Other ft. <br /> 14. Will the tanks)/pendingure be replaced with an aboveground or underground storage tank(s)? YES[] NO[a15. Indicate the resy to be billed for additional EHD staff time expended beyond 3 hour minimum <br /> permit paymenthe party designated below is different than the permit applicant, e.g. property <br /> owner,the partwledge this responsibility for the billing bysignature and date below. <br /> Name Mr, Fr , PSI <br /> Mailing Ad 3 Tidewater Avenue, Suite B, Oakland, CA 94601 <br /> Pho N (5 0 34-9200 <br /> Department Manager 10/20/11 <br /> Signat r Title Date <br /> EH 23 046 (Revised 8/t/11) 5 <br />