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SAN ) O A Q U I N Environmental Health Department <br /> COUNTY <br /> C. Tank/Piping Disposal Site : <br /> Name Waste Management <br /> Address 35251 Skyline Rdpity Kettlemen City Zip 93239 <br /> Phone No. ( 866 909 -4458 <br /> EPA ID# ( if transported to a permitted TSD facility) CAT0006461 17 <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 /> Hand Auger <br /> 10 . Describe how the excavation will be backfilled with suitable material upon removal : <br /> 316' Pea Gravel or Approved Backfill for new uSTs <br /> 11 . Handling of excavated soil : <br /> a ) What material will be used to line the tank pit and cover the stockpile ? <br /> Type R filler fabric before new UST's installed <br /> b) What will be the final destination of the excavated stockpile? <br /> Republic Services Forward Inc & Austin Rd Landfills - 9999 S . Austin Rd Manteca, CA 95336 <br /> c) Contaminated Soil Hazardous Waste Hauler: <br /> Name Belshire Environmental Hauler Registration # CAR000183913 <br /> Address 25971 Towne Centre Dr City Lake Forest , CA Zip 92610 <br /> Phone Number ( 949 146M200 <br /> 12 . What is the depth to groundwater? 8ft ± Stantec Survey <br /> Describe the source of information : <br /> 13 . Are there any water wells on this parcel or adjacent properties ? YESX NO [ ] <br /> TYPE OF WELLS DISTANCE TO TANKS (S ) <br /> Public Well ft . <br /> Private Well ft . <br /> Irrigation Well ft . <br /> Monitoring Well 1 0 - 1 5 ft . <br /> Other ft . <br /> 14 . Will the tank(s) pending closure be replaced with an aboveground or underground storage tank (s ) ? YESD<] 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 pally 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 L . C . Services <br /> Mailing Address 3887 N . Valentine Ave . <br /> Day Phone NumberC559 ] 444 - 1730 <br /> 5of10 <br />