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5 of 10 <br />Environmental Health Department <br />c. Tank/Piping Disposal Site: <br />Name_________________________________________________________________________________ <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 [ ] <br />9a. Describe, in detail, how the soil and/or water sample(s) beneath the tank and piping will be obtained: <br />_____________________________________________________________________________________________ <br />_____________________________________________________________________________________________ <br />10. Describe how the excavation will be backfilled with suitable material upon removal: <br />_____________________________________________________________________________________________ <br />_____________________________________________________________________________________________ <br />11. Handling of excavated soil: <br />a) What material will be used to line the tank pit and cover the stockpile? <br />_____________________________________________________________________________________________ <br />b) What will be the final destination of the excavated stockpile? <br />_____________________________________________________________________________________________ <br />c) Contaminated Soil Hazardous Waste Hauler: <br />Name__________________________________________________ Hauler Registration #____________________ <br />Address___________________________________________ City______________________ Zip_______________ <br />Phone Number (__________)______________________________________________________________________ <br />12. What is the depth to groundwater? __________________________________________________________________ <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties?YES [ ] NO [ ] <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[ ] 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 _______________________________________________________________________________ <br />Mailing Address _______________________________________________________________________ <br />Day Phone Number (__________)_________________________________________________________ <br />Following excavation activities, two samples from base of each tank pit, up to 4 stockpiles samples from excavated soil, up to 4 soil samples from removed piping areas, and rinseate sampling will be obtained by ENGEO. <br />Place previously excavated pea gravel and soil overburden, import and place 3/4" crushed gravel for backfill, place geotextile fabric on top of gravel, importClass II recycled AB (6" thick section). <br />Innovative Construction Solutions <br />575 Anton Blvd Suite 850, Costa Mesa, CA 92626 <br />893-6366714 <br />Visqueen underneath layered with straw wattles and another layer of weighted Visqueen will be used. <br />Excavated material will be used to backfill the tank pit post-removal, assuming material is clean. <br />Forward Landfill <br />9999 S. Austin Rd Manteca 95336 <br />209 235-9623 <br />CAL000190080 <br />ECTI <br />7275 National Dr. Suite C Livermore 94550 <br />060424550498GI <br />800 644-7773 <br />-19.0 - 23.5 Spring 2025 ESJ GW Monitoring report <br />If soil comes back Haz we will take to WM Kettleman Hills <br />*Tanks & Piping will be certified clean, Non-HW.