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RECEIVED <br /> C. Tank/Piping Disposal Site: SEP 15 7.015 <br /> Name West Coast Equipment Company EENII 11IRI nNMENTAL <br /> WI=pI rU r1Cp8RT4ACNT <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 [3 NO [] <br /> 9a. Describe, in detail, how the soil and/or water sample(s) beneath the tank and piping will be obtained: <br /> Soil samples will be collected from backhoe bucked using a metric soil sampler and clean stainless steel <br /> Fn(i-q of each slpp\ie Will h,= rovered with teflon sh,=f=t-,, r,.Apppd anri qPAIPrJ with tqpt <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 exavated during <br /> removal w 11 he placed back into excavation Poly shapting will sepPrate soil from backfill is soil appears impacted. <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 sheeting if necessary. <br /> b)What will be the final destination of the excavated stockpile? <br /> Excavated soil will be used for backfill. If significantly impacted soil may be stockpiled on-site pending <br /> characterization for proper disposal <br /> c) Contaminated Soil Hazardous Waste Hauler: <br /> Name L & B Environmental, Inc. Hauler Registration# 3946 <br /> Address 4460 South Highway 99 City Stockton, CA zip 95215 <br /> Phone Number( 209 932-0606 <br /> 12. What is the depth to groundwater? 40 feet, based upon montioring wells in general vicinity. <br /> Describe the source of information: <br /> 13. Are there any water wells on this parcel or adjacent properties? YES [] NO [] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well 1000 ft. <br /> Private Well >2,000 ft. <br /> Irrigation Well >2,000 ft <br /> Monitoring Well 50 ft. <br /> Other NA ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? YES[] NO[A <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 City of Stockton <br /> Mailing Address 22 East Weber Avenue, Room 301, Stockton, CA 95202 <br /> Day P 'ne Number( (2 9) )937-8374 <br /> `` Assistant Engineer <br /> Sig Title at <br /> ._,tiLU-r 1 N �0.j Ll <br /> EH 23 046 (Revised 07/17!14) 5 <br />