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C. TankfPiping Disposal Site: <br /> . & x, _ <br /> Addf,ss__ 3 i L t71. '_ . -f-� 1- <br /> -- a City ..�. t��__....Zip__,_ff F <br /> Phwic No. <br /> EPA til#(if transported to a permitted TSD facility)r <br /> 9. is the sampling firm an independent third party from the contractor (REQUIRED)? YEF,W NO(l <br /> 9a. Describe,in detail,hove the soil a for water sam le(s)beneath thgtank and piping will ba oDia lne d: +� <br /> OQAAA <br /> 10. Dec w t e sx nvafi n%rill be,bac filae 4 it suitable mater 1 uport removal <br /> If t <br /> ezd_ i4 1 A41� <br /> 11. ;iandlina p%sxcMe d soll: <br /> alat pyaterial will be use to ine the tan pit and cover the stockpile? �V <br /> ►+'tis y'!_.���"��-'yirr•.t� 1 <br /> by Vuj, will b e final sting Wlhe�je'�Tqy d sto ale1 . <br /> tefi old A CCS � 2n. ct t 3d5�7ss s �c) ontarnrnzited SoEI H zardcx�s Waste ul <br /> Name_,, �3f �L'Li. !:LF' <br /> l_J � t l �C Hauler Re�}lsfratlon#_.sC'.. .._..u., _ <br /> Address �Lc�� .� t 4 �' k city- <br /> -5, � <br /> Phone Humber 1 6 <br /> .'.a <br /> 12. Mat is the depth to groundwater? f 6twjux <br /> Describe the,source of information: <br /> 13. Are there any water wails on this parcel or adjacent properties? YES (J N ' <br /> LS DI STANCk TD TANKS;3 AP <br /> TYPE OF LVIiL ( } J A I <br /> Public VVeIE ft ll r <br /> Private VVeli <br /> trri anon atVa'il it. . . <br /> hhanitoriitd Well <br /> (.ether � fl- <br /> t <br /> 14. Will the tonk(n)ponding closure be.repiaced with an aboveground or underground storage tank(s)? � YES(j N4 <br /> 15. Indld wo the responsiNe party.to be billed for-additional EHD staff time expended beyond 3 hour minimum <br /> permit payment per tank, if ins:party designaled below is diff0ient than the permit applioarIL e.g. property <br /> owner,,the early must acknuwledgi this responsibility for the bailing by signature and date below. <br /> Name <br /> Cvt Sling -- <br /> Dy hone s her(_ a_ <br /> Lain— i PC 0 t - � -1- - <br /> Si, tura Title V Date <br />