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Address <br /> Phone No( Cary Zip Sit " <br /> Hauler Registration#(if hauled as hazardous) ' S A S L 3 � 3 <br /> J C'C a <br /> 1JicL.9�zr) �✓�� �.��, <br /> C. Tank/Piping Disposal Site: eo CoX •5-2 9 <br /> Name _ 1(£ T� 7-0 <br /> " <br /> �/` _ _ /lit? i/'iq>� 0-eF-I) vp <br /> Address 9 442S�� 12r�._e..,6ry � C �ri�,zC�r�✓gal <br /> Phone <br /> EPA ID#(if transported to a permitted TSD facility) ` -� i �iVTiKf�/'7�i Tf <br /> 9. is the sampling firm an independent third party from the contractor? YES <br /> 4.ga. Describe,in detail,how the soil and/or water sample(s)be eath the t - NO[J <br /> !!'! GAS £ S' lank and 'ping will be obtained: <br /> ..!Yj <br /> 10. Describe how the excavation will be backfilled with suitable material upon removal.- <br /> 11. <br /> emoval:11. Handling of excavated soil: <br /> a)What material will be used to line the tank pit and cover the stockpile? <br /> b)What will be the final destination of the excavat stockpile? /i— <br /> •: � 1 l�z/rG G � 1�/S�f�� �F <br /> c)Contaminated Soil Hazardous Waste Hauler: <br /> Name <br /> Saufer Registration# <br /> Address �- � j2e;�,j p _ <br /> City ` � <br /> Phone No.{ ) � �� <br /> 12. What is the depth to groundwater? � ) <br /> Describe the source of information: 6�/(! <br /> l � - �I � i I'll <br /> EH 23 046 (Devised 1201/07) <br /> 5 <br />