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i <br />Describe the method that will be utilized to purge and/or inert the <br />Tank/Plpfng Hauler: <br />Name ELY.- <br />Y.-. ` \ <br />Address �„� fAf!" d,JfJ� CityZip 3U2— <br />Hauler <br />U2 -- <br />is , : Registration # Of hauled :: hazardous) <br />! 1.. <br />Tank/Piping Disposal Site: <br />Name —_ <br />Address city zip L <br />Phone Noy Sf D - <br />EPA ID# (if transported to a permitted TSD facility) C h D Q D q G 3a2 <br />Is the sampling firm an independent third party from the contractor? YESN NO I] <br />9a. Describe, in detall, how the soil andlor water sample(s) beneath the tank and piping will be obtained: <br />10. Describe how the excavation will be backfilled with suitable material upon removal: <br />11. <br />a) What material will be used to line the tank pit and cover the stockpile? <br />�t ► .�� ► i i. >, �. _1 <br />r <br />b) What will be the final destination of the excavated stockpile? T. $• 0. <br />S %k 1 �s it of\ S� <br />c) Contaminated Soil Hazardous WasW Hauler. <br />Hauler Registration <br />Address 1 : r,. �......►. .�... r, irr M ,. <br />•al is 1: o. <br />EH 23 046 (Revised 10118188) Page 5 <br />