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A. J O A Q U[N Environmental Health Department <br /> c. Describe method to be used for decontamination: i <br /> i <br /> d. Describe how rinsate material will be stored onsite prior to rnanife ling offsite: <br /> j <br /> j e. Rinsate Hauler and permitted Treatment, Storage& Disposal Facility: <br /> j Hauler Name Phone Hauler Reg# <br /> 1 . <br /> Address City Zip <br /> Permitted Disposal Site <br /> i <br /> i <br /> 6. a. Describe the method that will be utilized to purge and/or inert the piping: <br /> b. Piping Hauler: <br /> Name?d MIDS `�t�D�rsN,�?t1 _..._ Phone' }V I Ts I f <br /> Address ��!� �j. �sv 3[ i City� e _ ZipUIT <br /> _ <br /> i Hauler Registration#(if hauled as hazardous) <br /> c. Pipin ispo al Site: <br /> I Name Phone <br /> . -_ <br /> Address 1�� t C' �\�(Jl City L�5_.A�i ZiF <br /> j EPA IDN(if transported to a permitted TSD facility)C � f <br /> 7. Is the sampling firm an independent third party from the contractor? YES, NO.[ .F <br /> I a. Identify, amp11 firm: <br /> Name C i t �`a t Phone( D_) p 4 `� C42 <br /> Address = Ar46'OA SS - City'T2miLc zip L Co c) <br /> b. Identify laboratory performing analysis: <br /> Name Phone(:jLC{COC }`�d"t� � <br /> i <br /> Address C YY1 YlE'C C .�� wy� City S� ip 2C� <br /> i <br /> 8. Describe, in detail, how the soil and/or water saople(s) beneath the piping or dispenser will be obtained: , <br /> f <br /> A ad <br /> t <br /> y <br /> 9. a. Handling of excavated soil(Contaminate Soil Hazardous Waste Hauler): <br /> NameLLLLC� i�rl,'yC>M YY edliauier Registration## Phone <br /> Address� �� V--\y e,r + City �WIRM' fD Zip s ! <br /> b, If soil is�not to ybe hauled, describe what,IwrI <br /> ill:be`done with it, <br /> � <br /> c�_i14l p I a cv- <br /> j <br /> 406 <br /> i <br />