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v V <br /> C. Tank/Piping Disposal Site: <br /> Name West Coast Equipment <br /> Address P. O. Box 2368 City Turlock, CA Zip 95381 <br /> Phone No.( 800 )441-8544 <br /> EPA ID#(if transported to a permitted TSD facility) N/A <br /> 9. Is the sampling firm an independent third party from the contractor (REQUIRED)? YES NO[] <br /> 9a. Describe,in detail,how the soil and/or water sample(s)beneaththe tank and piping will be obtained: <br /> Soil sample will be collected with the backhoe and soil sam ler from sail bucket <br /> 10. Describe how the excavation will be backfilled with suitable material upon removal: <br /> Self compacting clean fill material will be imported to replace the'volume"of the UST. Soil excavated <br /> during remQval will he Placed narK into me eXcaysition <br /> 11. Handling of excavated soil: <br /> a)What material will be used to line the tank pit and cover the stockpile? <br /> 4 MFI plastirn vi e <br /> b)What will be the final destination of the excavated stockpile? <br /> Backfill the excavation if soil samples appear"clean" or"non-detect' However, soil may be stockpiled <br /> on-site if obvious contamination is noted (for later haul-off and disposal). <br /> c)Contaminated Soil Hazardous Waste Hauler. <br /> Name L& B Environmental Hauler Registration# 3946 <br /> Address 4460 South Highway 99 City Stockton, CA Zip 95215 <br /> Phone Number( ) <br /> 12. What is the depth to groundwater? 10 to 15 feet' data from nearby wells and investigations. <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] NON <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well 500 ft. <br /> Private Well 500 ft. <br /> Irri ation Well <1,000 ft. <br /> Monition Well 400 ft. <br /> Other NA ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)? YES[] NON <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 Louis Levand Trust, Et. al. c/o Ms. Paula Levand <br /> Mailing Address 24692 Sand Wedge Lane, Valencia, CA 91355 <br /> Day Phone Number( 661 ) 904-2133 <br /> Trustee <br /> Signature Title Date <br /> EH 23 046 (Revised S/I/t 1) 5 <br />