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Address, p C3a.x -3 City CiOJr zip 9 yX s'/ <br /> Phone No.( ao 9 ) �f.• <br /> Hauler Registration#(if hauled as hazardous)_/LC�Rl7 <br /> C. Tank/Piping Disposal Site: c' T <br /> Name Sc�'{/J1T2_Ee 5 7,etl_ P/IOJN16TS <br /> /vLA?OD MLSD�r! 13C�Q CityRg1)6& <br /> Address_ Ca?���X Zip L'J�r7SLZ <br /> Phone No.( 9/6 , .��— VV-10 <br /> EPA ID#(if transported to a permitted TSD facility) A4 <br /> 9. Is the sampling firm an independent third party from the contractor? YESr 2/ NO[] <br /> 9a. D scribe,in detail,how the soil and/or water sampl s)beneath the tank and pip', will be obtained: <br /> S4 [ES fxT.K7,CFrt "I ccKt So/ f.c® ,V 7_ <br /> 7 Cs!✓• T O o c 7 -✓F <br /> 10. Describe how the excavation will be backfilled with suitable material upon removal: <br /> /� /7F 7F, 1-7,7, .%TiwJ ®•--TWE 12,f /1/9 /V F -i e9 OF <br /> /3ockt:/CC 4//4( d£ oy,5cOFr!£<t Ts�f Six£ yi" Tf �X�fd�7o,� <br /> ff <br /> 11. andling <br /> GmtgG /LfbNC.e7o/�S, <br /> Hng of excavated soil: <br /> a)What material will be used to line the tank pit and cover the stockpile? <br /> C L Qfit cls &I-S 171C S//£z Z-u <br /> b)What will be the final destination of the excavated stockpile? <br /> Scq/C IS fC£ 41 j tTw/CC /,j£ 217vr_VSV ri, <br /> xGrf.so 7..r,✓ /F 00 7-/ /7 c c 6£ �it2oi�Cf a 2V 57 �i�'�pfA /4-7c-/Ci<< <br /> c)Contaminated Soil Hazardous Waste Hauler: <br /> Name l Hauler Registration# <br /> Address �(/ �p)< 7/7 � <br /> , Y/CO N CityZip <br /> t �QII// /c /L�� <br /> Phone No.( <br /> !�S('� �r¢)C 9Z S Cp 3 94 o ; 7 <br /> 12. What is the depth to groundwater? <br /> Describe the source of information: <br /> EH 23 046 (Revised 12/31/07) 5 <br />