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92555 17888 Line 0169 pm. 03-28-2016 6/10 <br /> N��V <br /> 5. Decontamination 9vmcwdmrem <br /> o. Will pipingbwdecontaminated prior to removal? YES[} NO �&A � � 7D^� <br /> b. Identify contractor performing MAR � �~'° <br /> Name Phone <br /> Address city Lip <br /> c Describe method tobaused for doconbaminadion� <br /> � ' <br /> d. Describe how dmmatematerial will bmstored onsite prior tomanifesting offsite: <br /> e. Rimmate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name Phone HaulerReg# <br /> Address city Zip <br /> Permitted Disposal Site <br /> 0. o. Describe the method that will beutilized hmpurge and/or inert the piping: <br /> b. Piping Hauler: <br /> Mame Phone <br /> Address city Zip <br /> Hauler Registration#(if hauled as hazard us) <br /> o. Piping Disposal Site: <br /> Name Phone <br /> Address city Zip <br /> cty <br /> 7. Is the sampling finn an independent third party um the contractor? YES NO[] <br /> e. Identify sampling firm: <br /> Name Phone( <br /> Address city ZiA_______ <br /> b. Identify laboratory performing analysis: <br /> Nome Phone <br /> Address City Zip______ <br /> B. Describe, in detail, how the soil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> W. a. Handling of excavated soil(Contaminated Soil Hazardous Waste Hau|er): <br /> Name Hauler Registration# Phone <br /> Address city Zio_______ <br /> b. If soil is not to be houled,describe what will be done with it: <br /> 3 <br />