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SAN JOAQUIN <br />—COUNTY ----- <br />4 Tank/PiV Disposal Site: <br />Name Potrero Hills Landfill <br />3675 Potrero Hills Lane <br />Phone No.( 707 ) 432-4627 <br />EPA ID# (if transported to a permitted TSD <br />Environmental Health Department <br />city Suisun City <br />N/A -Non-Hazardous <br />9. Is the sampling firm an independent third party from the contractor (REQUIRED)? <br />94585 <br />9a. Describe, in detail, how the soil and/or water samples) beneath the tank and piping will be obtained: <br />Soil samples will be taken from the bucket of the excavator and placed into laboratory provided containers <br />and lagged on chain of custody and plarPri on ire for delivery to lah Water samnlas will he collected using a bailer <br />and placed into laboratory provided containers and logged on a chain of custody and placed on ice for delivery to lab. <br />10. Describe how the excavation will be backfilled with suitable material upon removal: <br />Backfill will be performed by Tracy Grading and Paving. A backfill certificate has been provided and <br />11. Handling of excavated soil: <br />a)) What material will be used to line the tank pit and cover the stockpile? <br />No new tanks will be installed so no liner Is proposed. 6 mil visqueen sheeting will be used <br />to cover soil stockpile. <br />b) What will be the final destination of the excavated stockpile? <br />Proposed disposal site for non -hazardous impacted soil will be Recology Hay Road Landfill. AA <br />Proposed disposal for hazardous impacted soil will be Kettleman Hills Landfill. <br />c) Contaminated Soil Hazardous Waste Hauler: <br />Name Naman Trucking Hauler Registration # 5164 <br />Address 411 Acacia St.,�Unit B City Tracy Zip 95376 <br />Phone Number( 209 ) 321-0319 <br />12. What is the depth to groundwater? "8' BGS <br />Describe the source of information: Recent grading and excavating activities near to the tank location. <br />13. Are there any water wells on this parcel or adjacent properties? YES [) NO[ ] <br />*See included map showing <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />8 448 ft. <br />Private Well <br />N/A ft, <br />Irrigation Well <br />N/A ft. <br />MonitoringWell <br />1330 ft. <br />Other <br />N/A ft• <br />well <br />locations. <br />14. Will the tanks) pending closure be replaced with an aboveground or underground storage tank(s)? YES[ ] NO[)Q <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. propert <br />y <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name Costera Waste & Environmental, Inc. <br />Mailing Address 14 EI Vaquero Rancho Santa Margarita CA 92688 <br />Day Phone Number ( 415 ) 533-0112 <br />9 <br />of10 <br />