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SANJ O A Q U I N Environmental Health Department <br /> COUNTY <br /> c. Tank/Piping Disposal Site : <br /> Name Not applicable , Tank and Piping Closed in Place <br /> Address City Zip <br /> Phone No. ( ) <br /> EPA ID# (if transported to a permitted TSD facility) <br /> 9. Is the sampling firm an independent third party from the contractor (REQUIRED) ? YES [ ] NO [ x ] <br /> 9a . Describe , in detail , how the soil and/or water sample(s) beneath the tank and piping will be obtained : <br /> One boring will be done on east and west side of tank and a soil sample will be taken <br /> at 14 and 16 ' for each boring . Soil samples will be collected from underneath the piping using an angle <br /> boring at 4 locations along the 84 ' piping run . <br /> 10 . Describe how the excavation will be backfilled with suitable material upon removal : <br /> Tank and piping to be closed in place will be filled with lean concrete once certified clean <br /> There will be no excavation during this closure in place . Barings will generate a void , the <br /> Borings will be backfilled with neat cement . Soils will be drummed and transported under manifest . <br /> 11 . Handling of excavated soil : <br /> a) What material wil) be used to line the tank pit and cover the stockpile? <br /> N / A <br /> b) What will be th�A I destination of the excavated stockpile? <br /> c) Contaminated Soil Hazardous Waste Hauler: Soil boring waste expected to be Non — Haz <br /> Name Belshire Env . Services , Inc . Hauler Registration # <br /> Address 25971 Towne Center Dr . city Foothill Rancl2ip 92610 <br /> Phone Number ( 949 ) 460 - 5200 <br /> 12 . What is the depth to groundwater? Approximately 9 to 11 feet , nearby groundwater wells <br /> Describe the source of information : <br /> 13 . Are there any water wells on this parcel or adjacent properties? YES [A NO [ ] <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well None ft, <br /> Private Well None ft <br /> Irrigation Well None ft , <br /> Monitoring Well 3 each ft. 10 ' <br /> Other ft . <br /> 14 . Will the tank(s) pending closure be replaced with an aboveground or underground storage 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 Wanye Perry Inc <br /> Mailing Address 8281 Commonwealth Ave , Buena Park , CA 90621 <br /> Day Phone Number L11.4 )) 826 - 0325 <br /> 5of10 <br />