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• <br />E <br />Address At) Q X, 3 j City 4�ek�21 Zip S <br />Phone No (2 0 07 1" 2 _C6 $��f <br />Hauler Registration # (if hauled as hazardous)--:!! / ��s / CG _ � A 5' 3 5�3 <br />"', ? " ,FSS// <br />U/cc.9-,z0 R,iv/ ,tet. T -¢c JGFeeklle rs <br />C. Tank/Piping Disposal Site: PC QBir e-4 • <br />Go.Jc>(£T� ry. g 7'O La <br />Name__pO/�sail¢�Z� /�;9(s ��tr �//'i�t1s) 2_oKF�tlV,p <br />Address <br />PhoneNo.( aCdf�Cy�- <br />EPA ID#(if transported to a permitted TSD facili -/ 0 -7 <br />9. Is the sampling firm an independent third party from the contractor? YES4 NO [ J <br />9a. <br />IM <br />Describe how the excavation will be backfilled with suitable material upon removal: <br />ll. Handling of excavated soil: <br />a) What material will be used to line the tank pit and cover the stockpile? <br />What will be the final destination of the excavated stockpile? ��� %/'� <br />n .'e / _ <br />5-1z C <br />c) Contaminated Soil Hazardous Waste Hauler: �r <br />Name: .�'��iC� sit%��//ZQ<l% !�G <br />ay Hauler Registration <br />Address City_ <br />/' <br />Phone No. ( �a �) 653 <br />L / Cd T. T. <br />12. What is the depth to groundwater? to _—� <br />Describe the source of information: � <br />EH 23 046 (Revised 17!31/07) 5 <br />) 7-r! <br />