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`M01 U <br /> c. Tank(Piping Disposal Site: <br /> Narne 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 /> will <br /> 9a. Soill same le will,how the soil l be collected witor water h the backhoeea and samthe <br /> ler from oil bucket <br /> 10. <br /> obtained: <br /> 10. Describe how the excavation will be backfilled with suitable material upon removal: <br /> Self-com actin clean fill mater al will be im orted to re lace the"volume"of the UST. Soil excavated <br /> 11. Handling of excavated soil: <br /> a)Whatmaterial will be used to line the tank pit and cover the stockpile? <br /> it /v' <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 /> Conon-tite if obvious contamination is aminated Soil <br /> (for later haul-off and disposal), <br /> c) aminated Soil Haza dous Waste Hauler, <br /> Name L& B Environmental Hauler Registration# 3946 <br /> Address 4460 South Highway 99 City Stockton, CA Zip 95215 <br /> Phone Number( 1 <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 [j NO[)] <br /> TYPE OF WEMAft. <br /> Public Well <br /> Private Well <br /> Irrigation Well <br /> Monitorin We <br /> Other <br /> 14. Nhll the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[] N%] <br /> 15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br /> permitpayment 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 <br /> Title Date <br /> EH 23 046 (Revised 8/1/11) 5 <br />