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S. a. D%cribe the method.that will be utilized to purge and/or inert the <br />b. Tank/ Piping Hauler: <br />NameMQQ 10M ® MT11-10 IImo- i�'�j�Cr�.5 (� <br />Address 295 T,)P'�: 4f City �11C1�i1( ZIP �I 01 <br />Phone No.( ) 239 _ G9 3 <br />Hauler Registration # (if hauled as hazardous) CAD 9 8 Z 030 1-73 <br />C. Tank/Piping Disposal Site: <br />N <br />0 <br />Address 255 v TCS ^ �,71�j City <br />Phone No.(�) G,3J -13g3 <br />EPA ID# (if transported to a permitted TSD facility) CAD ®Qq <br />9. Is the sampling firm an independent third party from the contractor? <br />9a. Describe, in detail, how the soil end/or water sample(s) beneath the tank <br />1.0. <br />YES *,-- NO [ <br />ipinQ will be obtained: <br />Describe how the excavation will be backfilled with suitable material upon removal: <br />MA <br />Handling of excavated soil: <br />a) What material will be used to line the tank pit and cover the stockpile? <br />b) What will be the final destination of the excavated stockpile? <br />. Xr. <br />c) Contaminated Soil Hazardous Waste Hauler: (' �....,,,y <br />4 <br />Name _ 1 leYr R gistra ion #` <br />Address j/ �J►&kcity Z <br />in �`n�i c <br />r C� <br />Phone No. ( l9 t3 0 <br />EH 23 046 (Revised 10/16/03) Page 5 <br />