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L <br />C. Tank/Piping Disposal Site: <br />Republic Services Vasco Road Landfill <br />Address 4001 North Vasco Road City Livermoore <br />Phone No.( 925 ) 447-0491 <br />EPA ID# (if transported to a permitted TSD facility) CAL000390596 <br />9. Is the sampling firm an independent third party from the contractor (REQUIRED)? YES [ I NO [ ] <br />9a. Describe, in detail, how the soil and/or water sample(s) beneath the tank and piping will be obtained: <br />Once tank and piping is removed samples will be taken by Apex Envirotech Inc. 3 samples from beneath 12,000 gallon UST. Samples will <br />ha takan h—eath nmchirt lima vent linea and disnensers every 20 lineal feet. 2 samoles every 50 cubic vards of stockpile for landfill profiling will be collected. <br />10. Describe how the excavation will be backfilled with suitable material upon removal: <br />Backfill with either 1/2 pea gravel or 3/4 inch crushed rock. Backfill will be placed in 12" lifts. Backfill will be compacted to comply with the Uniform <br />Building Code Appendeix Chapter 70. <br />11. Handling of excavated soil: <br />a) What material will be used to line the tank pit and cover the stockpile? <br />Plastic <br />b) What will be the final destination of the excavated stockpile? <br />Waste Managment - Kettleman Hills Hazardous Waste Facility 35251 Skyline Road, Kettleman City, CA 93239 <br />c) Contaminated Soil Hazardous Waste Hauler: <br />Name Fremouw Enviornmental Hauler Registration # 3544 <br />Address 6940 Tremont Road City Dixon Zip 95620 <br />Phone Number (__sop ) 559-3274 <br />12. What is the depth to groundwater? 60 feet. Provided by Elianna Floriido, EHST Environmental Health Specialist <br />Describe the source of information: <br />13. Are there any water wells on this parcel or adjacent properties? YES [] NO [� <br />TYPE OF WELLS <br />DISTANCE TO TANKS(S) <br />Public Well <br />ft. <br />Private Well <br />ft. <br />Irrigation Well <br />ft. <br />Monitoring Well <br />ft. <br />Other <br />ft. <br />14. Will the tank(s) pending closure be replaced with an aboveground or underground storage tank(s)? <br />15. Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour minimum <br />permit payment per tank. If the party designated below is different than the permit applicant, e.g. property <br />owner, the party must acknowledge this responsibility for the billing by signature and date below. <br />Name B&T Service Station Contractors <br />Mailing Address 630 South Frontage Road <br />Day Phone Number ( 805 929-8944 ext 1002 <br />A- <br />1 094- AIIA� Project Coordinator 10/5/2017 <br />Sign re Title Date <br />EH 23 046 (Revised 7/26/2016) $ <br />YES[ ] NO[,] <br />