Laserfiche WebLink
C, Tank/Piping Disposal Site: <br /> Name �`�1M 5 �Ct(C-ity' / ��aa <br /> Address ��d 0 0 aw-o ro- �� City 87 oo'on Zip <br /> Phone No.( ao q ) q ,3 `"q.-78 <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 M NO[] <br /> 9a. Describe,in detail,how the soil and/or water sample(s)beneath the tank and piping will be obtained: <br /> Two feet and six feet per permit requirements <br /> 10. Describe how the excavation will be backfilled with suitable material upon removal: <br /> Backfill tank excavation with pea gravel not more than (1/2) inch in diameter <br /> and crusbed rock not more than 314 inch in cross sectional Tneasurement, <br /> 11. Handling of excavated soil: <br /> a)What niate''"l will be used to line the tank pit and cover the stockpile? <br /> i `ARIL Black_pl.a stick vri.th .s.and. bates <br /> b)What will be the final destination of the excavated stockpile? <br /> Forward, Inc Manteca, Ca Unless the labs come back other_wj.-,P <br /> c)Contaminated Soil Hazardous Waste Hauler: <br /> Name United Pumping Service, Inc Hauler Registration# 063 <br /> Address 14000 E. Valley Blvd. city Industry Zip 91746 <br /> Phone Number( 626 ) 961-9326 <br /> 12. What Is the depth to groundwater? Typ i r a 1 1;�' nr rni r s 30-40 fj- 'h q!-, <br /> Describe the source ofinformation: <br /> Based on GeoTracker data from an off--site property <br /> locatedapproximately 0 .5 miles south of the UST. <br /> 13. Are there any water wells on this parcel or adjacent'properties? YES [] K <br /> TYPE OF WELLS DISTANCE TO TANKS(S) <br /> Public Well ft. <br /> Private Well ft. <br /> Irrigation Well ft. <br /> Monitoring Well ft. <br /> Other ft. <br /> 14. Will the tank(s)pending closure be replaced with an aboveground or underground storage tank(s)? YES[] NCR] <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 <br /> t must acknowledge this responsibility for the billing by signature and date below. <br /> Name t�itilLc�.. <br /> Mailing Address IYOV0 E, [A&f.lC47-V OF Jr-J34.5' 7 -V4 <br /> Ph ne Nu bar "IJ ) <br /> t -1 �-� <br /> Signature Title Date <br /> EH 23 046 (Revised 10/30/12) 5 <br />