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SANI O n Q I I N Environmental Health Department <br /> V J F1 t,� U I - <br /> 4 <br /> COUNTY <br /> c. Tank/Piping Disposal Site : <br /> Name Republic Services Forward , Inc . j. IRONS F1 NTA HEp`CI H <br /> Address 999 S . Austin Road City. Manteca zip 158VARTMENT <br /> Phone No . ( 209 ) 982.4298 <br /> EPA ID# (if transported to a permitted TSD facility) Nonhazardous waste disposal facility. <br /> 9 . Is the sampling firm an independent third party from the contractor (REQUIRED) ? YES ]X] NO [ ] <br /> 9a . Describe , in detail , how the soil and/or water sample(s) beneath the tank and piping will be obtained : <br /> Samples will be taken using an excavator to extract samples from the bottom of the tank hole. <br /> Groundwater is not expected to be encountered during excavation ; however, if encountered , a grab water <br /> sample will be collected via disposable bailer. <br /> 10 . Describe how the excavation will be backfilled with suitable material upon removal : <br /> Tank hole will be backfilled partially with a five 5 foot layer of pea gravel covered by a layer of filter fabric <br /> with compacted dirt placed on top of the fabric to finished grade . <br /> 11 . Handling of excavated soil : <br /> a) What material will be used to line the tank pit and cover the stockpile? <br /> 10•mil Plastic <br /> b) What will be the final destination of the excavated stockpile? <br /> Republic Services Forward , Inc. <br /> c) Contaminated Soil Hazardous Waste Hauler: <br /> Name Belshire Environmental Services , Inc . Hauler Registration # 5019 <br /> Address 25971 Towne Center Drive city Foothill Ranch zip 92610 <br /> Phone Number ( 949 ) 460.5200 <br /> 12 . What is the depth to groundwater? < 63 Feet, Unknown <br /> Describe the source of information : Well destruction report, GeoTracker, 2005 <br /> 13 . Are there any water wells on this parcel or adjacent properties? YES [ ] NOX ] <br /> TYPE OF WELLS DISTANCE TO TANKS (S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft . <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tank(s) pending closure be replaced with an aboveground o underground orage tank(s) ? YES[X NO[ ] <br /> 15 . Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br /> permit payment per tank. If the party designated below is different than the permit applicant, e . g . property <br /> owner, the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name BP West Coast Products, LLC c/o Daryl Lee, Retail Compliance Coordinator <br /> Mailing Address PA . Box 6038 , Artesia, CA 90702 <br /> Day Phone Number ( 415 ) 902.5089 <br /> 5of10 <br />