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I <br />91 <br />10. <br />11. <br />b. Rinsate Ha 'er <br />Name___��_____.�� -- <br />Address <br />City State Zip <br />Phone No. }_ Hauler Registration # <br />C. TanklPipin= Hauler <br />Name -- <br />Address <br />Ciry t��t State CA Zip Zi <br />Phone No. ( is' 033— o33�n TInuler Registration #CAD BZSZ <br />d. Tank/Fiping Dispcsal Sit: <br />Name GW � _ �__---- <br />AddrAIC_LiI__ZPa <br />__:.�1:�12Cityt ,�,__.- _ State GA ZipPhonS' F.T'.� FD- #_ <br />e. Contaminated Soil Hazar :0u5 ti'+^ste :-tau?er <br />Name <br />Address— -- <br />_ _ State Zip <br />cityPhone No. (_ 1 i<fttuler Registration < # <br />Describe the method for purging and;b., ir•ert::%g of the tank(s). <br />QWI <br />Has ti:e aFplicant r:3v;ded the:i4tectier% limits ; .at wi!I t -e utiitz=d in the sugseste,i r;alti'sis? YES (J C ( <br />Describ ' tail ho.w fire soandior wdtc.r samples beneath tU ta;:k's i;iYert aril piping will be obtained. <br />einvc w �,�I <br />ao—_ Y r_� i � 17n6l Z- 4 e=T- _. 11i jAa, <br />I%. Describe hc%v the P.xcavadfja 'Wil! be backfulled w*10 suite,+e rn.:t:.rial l lrtf, sar: +, etc.; upon removal. <br />,� — 5 is-, 5 r^ `t w,G• <br />Page 5 <br />