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SAN ,J 0 A QU ! N Environmental Health Department <br /> i 0) Li <br /> KKEIVED <br /> c. Describe method to be used for decontamination : <br /> MAY 0 9 2018 <br /> d . Describe how rinsate material will be stored onsite prior to manifesting offsite :ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> e . Rinsate Hauler and permitted Treatment , Storage & Disposal Facility : <br /> Hauler Name Phone (.) Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> P <br /> 6 . a . Describe the method that will be utilized to purge and/or inert the pipings. <br /> Ih� zvt ` V c1wI <br /> b . Piping Hauler : i Re tvc (� �I �` eY)j �u j Ple+ ce (1 S ; <br /> c`sSh' e1Qd � � '✓ � �� <br /> Name i kwtvAv, Q-� 44 2, Ru,,O& Phone 21 ) csj ,7 - 3 11 <br /> Address I Q LV\ wAPl� L, j e City , �n L% � rte` Zip C,#- 0 'd � 6 <br /> Hauler Registration # (if hauled as hazardous ) I <br /> c . Piping Disposal Site : i I � ► cJ % M <br /> Name j 11xj�t CA vii is Dov D Phone g! -L) LO 7 <br /> Address 1 e7 f kN /' l- Q wt w1 e-t . GI Lt ( City 76 f� 'ZtL Zip C 14J, 50 <br /> EPA ID# (if transported to a permitted TSD facility) C 1 "7 i & / 90ho 044(% © 0 3SLjLj3V <br /> 7 . Is the sampling firm an independent third party from the contractor? YES [tom NO [ <br /> a . Identify sampling firm : <br /> Name Ci" 1 5fe [ � Gec) 10 k 52fy' iGePhone 1 (a ) %1 1 Z <br /> Address ' f�'�l9-iolaw� pt iU j City SQLt c�ri1 e.� �� Zip <br /> b . Identify laboratory performing .analysis : <br /> Name u 'n &v' I6: l cgr � -vf � � S Phone ( 53G ) 33ccf - SS ? S <br /> Address 2gC> 0 03c> a6c) ^ Book) Vic S' O ; •) c 3" City SC%k (' fLuhzedZip SCu <br /> 8 . Describe , in detail , how the soil and/or water sample ( s ) beneath the piping or dispenser will be obtained : <br /> 04') C- tC I) Pb JbSeA X04 ar 50uK21211 Ci; c% L ]- lo -� PS 1�Q j �ov't <br /> col t ec ec&y '` PI <br /> 9 . a . Handling of excavated soil ( Contaminated Soil Hazardous Waste Hauler) : <br /> Name Ammer on Uje4 ul �e,94 Hauler Registration # '� 74c� Phone <br /> Address , C� t�Z� 3"la i City Q42-1 11 Zip �'�S <br /> b . If soil is not to be hauled , describe what will be done with it: <br /> 4of6 <br />