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f"1Y-15-2009 06:49 Service Station Systems <br />M <br />5. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />Name <br />Address <br />c. Describe method to be used for decontamination: <br />N <br />YES (] NO [ J <br />Phone <br />City _ <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />408 938 8888 <br />Zip <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone (�) Hauler Reg# _ <br />Address City Zip <br />Permitted Disposal Site <br />6. a. Describe the method that will be utilized to purge and/or inert the piping: <br />b. Piping Hauler: <br />NamePhone <br />Address X66 F AnL,,.&Ca "$Cid City Zip a <br />Hauler Registration # (if hauled as hazardous) -s a-l(o <br />c. Piping Disposal Site: <br />Name��tA(lC (K,:rrd o�x 1 Phone CS lk) tk30 <br />Address 3504 14 AL Akf&& 9E- City L&LA�o- OA Zip i0a.1ZL. <br />EPA IM (if transported to a permitted TSD facility) CP t p6pa 8/j '7 6 <br />7. Is the sampling firm an independent third party from the contractor? YES[] NO [ ] <br />a. Identify sampling firm: <br />Name Phone(_) <br />Address City Zip <br />b. Identify laboratory performing analysis: <br />Name <br />Address <br />WITH <br />City <br />8. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />9. a. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name <br />Address <br />Hauler Registration # <br />City <br />b. If soil is not to be hauled, describe what will be done with it: <br />3 <br />Phone <br />Zip <br />Zip <br />TOTAL P.04 <br />