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u � <br /> _. TonklPiping Disprsal Sate: <br /> Name 'Jest Coast Equipment <br /> Address P.0-Box 2368 City Turipek CA Zip_15381 <br /> Phone No-( 800 )•tA1�544 <br /> EPA 1D#(if transported to a permitted TSD facility) NIA <br /> 5. Is Ina sampling firm an adapsndamt third party frarl the contractor (REOUIREO)? YES NO f] <br /> 9a_ Describe•in detail,how the sod andiar water samde(s)beneath the tank and pipng A. be obtained: <br /> Soil sample will be collected with the backhoe and soil sampler from sari bucket _ <br /> to Describe how the excavabon wig be backfilled with sv lable metrral upon removal: <br /> Self-compacting clean 511 material will be imported to replace iha'volume,of the UST.Soil excavated <br /> _during r al will be pl""rl hack IDID 111 <br /> If- Handling of excavated so> <br /> a)Vint material w9l be used to fine the tank p1 and oover the slcokpde? <br /> 4 ml, plastic a <br /> b)SYnat will be the fins:destination of the excavated slockc•-__? <br /> Backfill the excavation if soil samples appear"clean'or'non-de--ct" However. soil may be stockpiled <br /> on-site if obvious contamination is noted(for later haul-of and disposal). <br /> c)Contaminated Soil Hazardous Waste Hauler <br /> Name L 8 B Environmental Hauler Registration ti3946 <br /> Address 4460 South Highway 99 Cly Stockton.CA Sal 95215 <br /> phone Number I } <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 adacent properties? YES (] NO(t] <br /> TYPE OF WELLS I DISTANCE TO TANKStSJ <br /> Public wall I 5O0 H. <br /> Private Well ' 500 5. <br /> Inioalian Well I <1'000 it. <br /> Monitoring Well 400 h. <br /> DthEr <br /> i 4. Will the tank{s)pending closure he replaced with an aboveground or underground starag=tank(sy? YES(] NO?] <br /> i5_ Indicate the reser Bible party too-billed for additional EHD staff time expended beyond 3 Fsur minimum <br /> peril payment per tank. If the party designated beluu is different than the peril app cant,e.g.property <br /> Owner,the party must acknowledge this responsibility for the bMr.g by sgnature Wd date below. <br /> Name Louis Levand Trust,Et_al.oro Nis.Paula Levand <br /> ),failing Address 24692 Sand Wedge Lane.Valencia.CA 91355 <br /> Day P DrieNgirnbarf 661 904-2133 <br /> Trustee <br /> Sfgnafure Title Da!_ <br /> Eli231A6 (Revixd3AMI 5 <br />