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May 09 02 12:18p RV e IIty/Co�nnttractors Inc 2094616342 P.1 <br />MAY 0 9 2008(��dff <br />�� <br />Mar 10 08 10:8�ER <br />}te YA <br />IvContractors Inc 2034616342 C`p.1 <br />'Tallu <br />SYSTEM RETROFIT OR REPAIRNP <br />J Submit minimum of 2 sets of plans & applieahons as originals wilt be retained by EHD) <br />AJC j Site map enclosed YESt) NO [ ) <br />2. Manufacturer's spec sheets attached for all equipment to be installed YES I NO <br />3_ Description of work to be completed (if adding piping, UDC s. or other UST equipment, or performing tank top upgrade, \ ,(Q <br />us"he UST Installation Application pages I" as necessary for a timely pian review): R �^ � J. •7/d <br />Ni" lemir-s, <br />sc <br />4. Deription of equipment to be used (Attach drawings/blueprints as necessary): <br />�ie <br />5. All equipment is State certified or approved. YES[] NO j) <br />6. Decontamination Procedures: <br />a. Witt piping be decontaminated prior to removal? YES(] NO ( I <br />b. Identity contractor performing decontamination: <br />Name Phone(` ) <br />Address _ City Zip <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage ,& Disposal Facility <br />Hauler Name Phone(_ } Hauler Reg#€ <br />Addmess Cly zip <br />Permitted Disposal Site <br />7. a, Describe the method that will be rdifized to purge andlor inert the piping: <br />b. Piping Hauler. <br />Name Phone I I <br />Address Char 4P <br />Hauler Registration # (if hauled as hazardous) <br />c_ Piping Disposal Site: <br />Name Phone U <br />Address City Zip <br />EPA EM (rf transported to a permitted TSD facility) <br />&. Is the sampling firm an independent third party from the contractor? YES [ J NO[] <br />Describe, in detail, how the soil and/or water sample(s) beneath the piping or dspenserwitl be obtained: <br />10. Handling of -excavated sol# (Contaminated Soil Hazardous Waste Harper): <br />Name Hauler Registration #1 Phone <br />Address City 7jp <br />h) If soil is not to be hauled, describe what will be done with it <br />SZO/SZ0VI Al a4TT2 --- QHa OrS £0£89t60Z xva SS:VT THJ 8002/TZ/£0 <br />