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SA ^� I (� A (� { A+ Environmental Health Department <br />�F—i- IC O X111 N! T Y-----1 - <br />9 <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone U Hauler Reg# _ <br />Address City Zip <br />Permitted Disposal Site <br />6. a. Describe the method that will be utilized to purge and/or inert the piping: <br />b. Piping Hauler: <br />Name Phone L� <br />Address City Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone (� <br />Address City Zip <br />EPA ID# (if transported to a permitted TSD facility) <br />7. Is the sampling firm an independent third party from the contractor? YES [ ] NO [ ] <br />a. Identify sampling firm: <br />Name Phone( <br />Address City Zip <br />b. Identify laboratory performing analysis: <br />Name Phone �) <br />Address City Zip <br />8. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />9. a. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # Phone <br />Address City Zip <br />b. If soil is not to be hauled, describe what will be done with it: <br />4 of 6 <br />