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3a►' ti/ <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 N NO [ <br />9a. Describe, in detail, how the soil and/or water sample(s) beneath the tank and piping will be obtained: <br />Soil sample will be collected with the backhoe and soil sampler from soil bucket <br />10. Describe how the excavation will be backfilled with suitable material upon removal. - <br />Self -compacting, <br />emoval:Self compacting clean fill material will be imported to replace the "volume" of the UST. Soil excavated <br />during removal will be placed back into the excavation <br />11. Handling of excavated soil: <br />a) What material will be used to line the tank pit and cover the stockpile? <br />4 mil plastic ahQe1ing/visqueen <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 ( 1 ) - ` � 2_ <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 [) NO [ <br />14 <br />15. <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />500 <br />ft. <br />Private Well <br />500 <br />ft. <br />Irrigation Well <br /><1,000 <br />ft. <br />Monitoring Well <br />400 <br />ft. <br />Other <br />NA <br />ft. <br />Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ) NON <br />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 Levand Family Trust Go Paula Levand <br />Mailing Address <br />24692 Sand Wedge Lane, Velencia, CA 91355 <br />DayPh a Number ( 661 )_ 904-2133 <br />Signature <br />Title Date <br />%'GC5 <br />EH 23 046 (Revised 8/11/11) 5 <br />