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` CONTAMINATED SOIL DESCRIPTION FORM <br /> A SOIL SOURCE <br /> SOIL SOURCE LOCATION <br /> ADDRESS <br /> ENVIRONMENTAL CONSULTANT <br /> ADDRESS <br /> CONTACT PERSON/TELEPHONE <br /> B: HISTORICAL CHEMICALS USED: <br /> CHEMICAL USER/INDUSTRY SOURCE OF INFORMATION <br /> C: PREVIOUS SOIL INVESTIGATIONS <br /> ANY SITE/SOIL INVESTIGATIONS? YES NO <br /> LIST OF REPORTS: <br /> REPORT TITLES DATE PREPARED BY <br /> D: SOIL SAMPLING DATA <br /> SAMPLING COMPANYffiffiffi SAMPLING ffis NO.OF IN-SITU STOCKPILE SAMPLED _HOT SAMPLING DESIGNffiffiffiffiffi:� <br /> SAMPLER DATE SAMPLES YM Y•\N SOIL VOL SPOTS STRATIFIED RANDOM SYSTEMATIC <br /> -Additional representative sampling is required if soil has been added to stockpile since above-listed samples were collected <br /> E.. CERTIFICATION <br /> CALIF.REGISTERED GEOLOGIST/ENGINEER: <br /> Print Name <br /> I HAVE REVIEWED THE FOREGOING INFORMATION AND IT IS CORRECT TO THE BEST OF MY KNOWLEDGE SEAL <br /> Signature <br /> f:\docs\pravano\lac\soilcoo.frm <br /> 070690 <br />