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III. <br />_ lei 91, <br />5. Decontamination Procedures: OCT 18 2016 <br />a. Will piping be decontaminated prior to removal? YES [ 1 NO[] <br />b. Identify contractor performing decontamination: <br />Name Phone (�EMVMQWENjAL HEALTH <br />Address City zREPARTMENT <br />c. Describe method to be used for decontamination: <br />� J <br />d. Describe how rinsate material will be stored onslte prior to manifesting offsite: ENVIRONMENTAL HEALTH <br />E IDSERA <br />e. <br />Rinsate Hauler and permitted Treatment, Storage & Disposal f=acility: <br />Hauler Name Phone L___j 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( <br />Address City — . _ ... - - Zip <br />Hauler Registration p (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Nine 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 [ j <br />a. Identify sampling firm: <br />Name Phone(.____a <br />Address City Zip <br />b. Identify laboratory performing analysis: <br />Name Phone L� <br />Address City Zip <br />8. Describe, in detail, how the $oil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />9. a. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler) - <br />Name Hauler Registration # Phone �) <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 />