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S {� N j O j� Q f I N Environmental Health Department <br /> H J`I `HI I' <br /> c. Describe method to be used for decontamination: <br /> RECEIVED <br /> MAY 092018 <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite.ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> e. Rinsate Hauler and permitted Treatment, Storage& Disposal Facility: <br /> Hauler Name Phone ( ) Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> 6. a. Describe the method that will be utilized to purge and/or inert the piping: <br /> --3 yo ' <br /> car ->� '� ��e %c9 w(C. Ct��`►n t /4�'iPy w�' <br /> ( <br /> b. Piping Hauler: 2WiZL'Ct� �l ���� ik,I p &CeA iQA S3- 81WKIo,,& <br /> ikrc 0,A4A4 9- R rPhone e& \1 .�w '�"sl� <br /> Name �Qt1 wl fu✓ ��tq JJ • <br /> ( _) 4"17-3(� I <br /> Address IQI% E. 14-o"N Bei- L%wHe City S',-uzip­C-4- Jd16 <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: N14 wit/ r(J-T 114 S'tTeA <br /> Name i �•v cti uy. C, rev Phone 1-17 7 3//1 <br /> Address It? 16 }q w1 wt e-t l-4 _j t City Qn G Vii{._ Zip i -%Sd1 Il <br /> EPA ID# (if transported to a permitted TSD facility) 01'75 J A,? /9006 MWA0000 3.3g43f <br /> 7. Is the sampling firm an independent third party from the contractor? YES [y/ NO [] <br /> a. Identify sampling firm: 1 <br /> Name U'j 5ee << 6260 SF.(,V',LeS Phone I(e) -112 - 36-7b <br /> Address 'q[?t City SctCrc��len�o Zip__S S�O(OL( <br /> b. Identify laboratory performing analysis: <br /> Name Sin �- &V- [G: r,:�-1-v (�'S Phone (530) 30`4- 5S7S <br /> Address 2a Sb City Sc:(_v1c m e,;4, Zip q S C(:,t <br /> .8. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br /> OkIC-. '}arty- Rr(spvte4� /,K'Q4-k\ 55 <br /> 12b Cc 11 PLL ,-1 j S JQ <br /> h�� <br /> L. cl., y crt6 50; f 4 <br /> LO [1 ec f 5ce-m p)-t <br /> 9. a. Handlingof excavated soil (Contaminated Soil Hazardous Waste Hauler): <br /> Name A-M 44,f Lc.A LAA11e4 tve,-S�e Hauler Registration# �-7`LI( Phone (;V q) G(' - t 5� <br /> Address f27 3`�0 i City QqA 1 Zip <br /> b. If soil is not to be hauled, describe what will be done with it: <br /> 4of6 <br />