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TY <br /> �j <br /> (�II€ Environmental Health Department <br /> IN <br /> COUNTY- <br /> 71 1 <br /> c. Describe method to b used for decontamination: <br /> !'f <br /> a <br /> d. Describe how rinsate m terial will be stored onsite prior to manifesting offsite: a �-�- <br /> :, � ; ` T <br /> "spa� ^�.�z����i. �� { Q� <br /> e. Rinsate Hauler and pe fitted Treatment,Storage&Disposal Facility: <br /> Hauler Name A] Phone{�) Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> 6. a. Describe the method th 4 jNiII be utilized to purge and/or inert the piping: <br /> b. Piping Hauler: %A <br /> Name l ' Phone( _) <br /> Address City Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name AJ 1A 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[] <br /> a. Identify sampling firm: <br /> Name Phone(�� <br /> Address City Zip <br /> b. identify laboratory performing analysis: <br /> Name Phone(� <br /> Address City Zip <br /> 8. Describe,in detail, sail and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> All - <br /> 9. <br /> a. Handling of epxga ed 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 /> 4of6 <br />