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SAN J O A Q U I N Environmental Health Department <br /> COUNTY -- <br /> c, Tank/Piping Disposal Site : <br /> Name Waste Management Azusa Landfill <br /> Address 1501 Gladstone St . city Azusa Zip 91702 <br /> PhoneNo . ( 626 ) 334 - 0719 <br /> EPA ID# (if transported to a permitted TSD facility) Handler I D : 4CAD0 0 90 0 7 62 6 <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 /> 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 <br /> 10 . Describe how the excavation will be backfilled with suitable material upon removal : <br /> Tank will be filled with lean concrete once certified clean <br /> 11 . Handling of excavated soil : <br /> a) What material N ilJAbe used to line the tank pit and cover the stockpile? <br /> b) What will be t fi�aI 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 ( 9 4 9 ) 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 [x] 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 ea 10 ' ft. <br /> Other None ft , <br /> 14 . Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s) ? YES[)J 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 )) 626 - 0325 <br /> 5of10 <br />