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Tank'Piping Dis-,sal Sate: <br />Name West Coast Equipment <br />Address P. O. Box 2368 Cay Tudoek. CA ZD 95381 <br />Phone No.l 800 ) 441-8544 <br />EPA ID# (if transported to a permitted TSD facility) NIA <br />9. Is th_ sampling firm an rAe.--ndent third Darty from the contractor (REQUIRED I? YES Pc NO i ] <br />9a- Describe, in ci_tail, how the sal andloc water samo _jsj b_n_ath the tank and p arg'sF__' be obtained: <br />Soil sample will be collected with the backhoe and sail sampler from soil bucket <br />10. Describe how the excavaC n uil< be backfilled with suaable mat-ral upon removes: <br />Self -compacting, clean FII material will be imported to replace the 'volume' of the UST. Soil excavated <br />6 rrinn ramnval will he nlaced hack into the Pxc.avatinn- <br />11. Handling oiexcavatedso-3- <br />a) 'Pinat <br />o3 <br />a)'Pfnat materia wll be used to Lne the tank p":1 and cover the stoc p:'._? <br />a mil plastic snaettnq'wsaueen <br />b)'Pirat will be ti a fna destinaEon of th_ excavated stc-cko_e? <br />Backfill the excavation if soil samples appear "clean' or 'non -detect _ However. soil may be stockpiled <br />on-site if obvious contamination is noted (for later haul -off and disposal). <br />cj Contaminated Soil Hazard•:,js Waste Hauler. <br />Name L_& B Environmental Hauler Registration f0 3946 <br />Address 4460 South Highv:ay 99 City Stockton, CA Zo 95215 <br />Phone Number <br />12. What is the depth to groundwater? 10 to 15 feet; data from nearby wells and investigations. <br />Describe the source of informaton: <br />13. Are th_r_ any water wells on this part or ad .-cent properE_s? YES [ ] NOW <br />TYPE OF YELLS <br />DISTANCE TO TANKS(S) <br />j� <br />Pubtic'.Yeli <br />-- 500 <br />ft. <br />++I <br />Private Well <br />I 500 <br />ft. <br />irrigation Well <br /><1,000 <br />ft. <br />Monitoring Well <br />406.4 <br />ft._ <br />Other <br />NA <br />ft. <br />14. Will the tank4,s1 pending closure be replaced Wth an aboveground or underground stcrag_ tan%(s)? YES[ ] N454 <br />15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br />ermil Dazyment per tank. if the party designated belrrar is different than the permit act+"cant, e.g. property <br />aimer, the party must acknowledge this reso-xtaibility for the bW ng by s:,gnature and date below. <br />Name Louis Levand Trust, Et. al. clo fats. Paula Levand <br />Mailino Address 24692 Sand Wedge Lane. Valencia. CA 91355 <br />Day �one NLjr. =_ (ss1 <br />904-2133 <br />Trustee <br />Ia12+u46 (RAkcd5ri-ll1 i <br />