Laserfiche WebLink
Nov 04 2011 9: 01AM LASERJET FAX P. 3 <br /> M TankiPtping Disposal Site: <br /> Marne <br /> Address City Zip <br /> Phone No.( D <br /> EPA D#(if transpodied to a permitted TSD f ) <br /> 9. Is the sampling flan an Independent third party from the contractor (REQUIRED)? YESW Not] <br /> 93. Describe,in detal,haw the 1� ser��le(sp beneath the tank and piping will Ian obtained:: <br /> dW6 <br /> 10. DescrIbe hoar the eatoavatlon will be bac dk d with suitable material upon l: <br /> L N t r• W STT! TEAF;d y r CdAleAt.Z2oov. <br /> Al tWSA Elfw <br /> 11. Handling of excavated so: <br /> a)What MWAM will be used W Ins the tank pit and oover the stockpile?' <br /> b)What vdll be the:tinton of the excavetled stockpile? <br /> c)t ontamineted Sal Hamdous Waste Hauler. <br /> Name �[MnrE f pe i �7IV�(^ ► Reg) on# <br /> AddnM �j10 �thI3C1 C{'�Svt}�°lo7 city �,J,titlSd✓ C& Zip <br /> Number t -77 <br /> 12. Whet b the depth to grounthode? "71 <br /> DOSCrbe the sanrce of hdormation:®M:f t r� MWt. <br /> 13. Aro theca any water wells an this parcel or adocent propertles? YES'r NQ t] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public&OR ft Nle <br /> Private Wel <br /> lainallon Wel it (V4 <br /> MonitoringWell (0® it. <br /> Othff IL N4 <br /> 14. Wil the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)? YES(] <br /> 15. Indicate the re9lowsible party to be billed for additional EMD staff time expend beyond 3 hour minirnum <br /> Permit payment per tank If ttte party designated below is different than the permit applicant,e.g.property <br /> owner the party must scluw*edga this nsuity for IIIc billing by signature and dabs below. <br /> Name At Wf* 1 NC, <br /> MallingAddrns LSZS /VF�mp} �llc Or -4 3s0 SRf C.A tS'��i3 <br /> Day Pone Number( <br /> �wc 1�i, rrci r <br /> S. re3 ' Title `' <br /> EH 23 t346 (Rovised$/1111) 5 <br />