Laserfiche WebLink
09/26/2008 FRI 16:47 FAX 2094683433 SJC HHD 2003/007 <br /> `/ 1400, <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed YEAS[.)v NO[] <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YE8 N0[] <br /> 3. Description of work to be completed(If adding piping, UDC's, or other UST equipment,or performing tank top upgrade, <br /> `use the�TQ\stallatigq Application pages 4-8 as necessary for a timely plan review): <br /> � <br /> 11 i ICIYY e\hA <br /> 4. Description of equipment to be used(Attach drawings/blueprints as necessary): <br /> 5. All equipment is Stale certified or approved. S ] NO[] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> NamePhone(_) <br /> Address City Zip <br /> c. Describe method t e used for decontamination: <br /> d. Describe how rinsata)rnaterial will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler a d permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name Phone(_) Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal S e <br /> 7. a. Describe the metho that will be utilized to purge and/or inert the piping: <br /> b. Piping Hauler: <br /> Name Phone(_) <br /> Address City Zip <br /> Hauler Registratio if(if hauled as hazardous) <br /> c. Piping Disposal Site <br /> Name Phone( <br /> Address CityZip <br /> EPA ID#(if transport to a permitted TSD facility) <br /> 8. Is the sampling fir an independent third party from the contractor? YES[] NO(] <br /> 9. Describe, in detail,h w thesoil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handling of excavat d soil(Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone(_) <br /> Address City Zip <br /> b)If soil is not to be iled,describe what will be done with it: <br /> 2 <br />