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Address InT-k� City r�c{�TB� ZipCZ_!�_ZQti5 <br /> Phone No.( ZOC( ) 4+L" — = <br /> Hauler Registration#(if hauled as hazardous) t.L L� <br /> C. Tank/Pip<Disposal Site• <br /> Name —S <br /> , �Tt7�, p LY n <br /> wZKl ?7�A ��l ,r <br /> Address ZS may�7 74. t l i wl CityaMCIc^t- j Zip l�Zd.\ <br /> Phone No. 2y-8333 <br /> EPA ID#(if transported to a permitted TSD facility) <br /> 9. Is the sampling firm an independent third party from the contractor? YES M NO[] <br /> 9a. Describe,in d il,how and/or the oil I w r samples)beneath the tank and piping will be obtained: <br /> r '�zL'x�� <br /> 10. Describe how the excavation will be backfilled with suitable material upon removal: <br /> IL Handling of excavated soil: <br /> a)What material will be used to line the tank pit and cover the stockpile? <br /> l-4 /A- <br /> b)What will be the final destination of the excavated stockpile? <br /> u�aR� tha�DRu� f �L1.r. .J 14A,,tr� <fA, 5 3 <br /> c)Contaminated Soil Hazardous Waste Hauler: <br /> Name Hauler Registration# <br /> Address City M Ah(-T-e-C Zipt� <br /> Phone No.((50 <br /> 12. What is the depth to groundwater? tk R)C f OkZA) <br /> Describe the source of information: <br /> EH'23 046 (Revised 12/31/07) 5 <br />