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lil <br />5. Decontarninadon Procedures: <br />a. Will piping be decontaminated prior to removed? <br />b. Identify contractor performing decontamination: <br />Name <br />Address <br />c. Describe method to be used for decontamination: <br />1:1 <br />YES (I No(] OCT 18 2016 <br />ONTO] ►IA 114,211 <br />city z9EPARTMENT <br />y <br />ar 11 M -370M f <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: ENVIRONMENTAL HEALTH <br />EALTH <br />PERM ITspE,-s a <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone Hauler Reg# <br />Address City Zip <br />Permitted Disposal Site <br />6. a, Describe the method that will be utilized to purge and/or inert the piping: <br />b. Piping Hauler: <br />Name Phone (_____a <br />Address City Zip <br />Hauler Registration 0 (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone <br />Address city Zip <br />EPA ID# (if transported to a permitted TSD facility) <br />7. Is the sampling firm an independent third party from the contractor? YES (] NO [ I <br />a. Identify sampling firm: <br />Name Phone(_a <br />Address city Zip <br />b. Identify laboratory performing analysis: <br />Name Phone <br />Address City Zip <br />8. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained.- <br />9. <br />btained: <br />9. a. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # Phone 1—) <br />Address City Zip <br />b. If soil is not to be hauled. describe what will be done with it: <br />4 <br />Received Time Apr. 13, 2017 2:30PM No. 1250 <br />