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Feb 11 08 12:18p Elite Iv Contractors Inc 209461-442 p.l <br />UST SYSTEM RETROF OR REP <br />ft <br />(Submit minimum of 2 sets of plans & applications as originals will b ih <br />U�� <br />l J 1. Site map enclosed YES [ ] NO [ ] FEB 1 1 2008 <br />2. Manufacturers spec sheets attached for all equipment to be installed YES NO <br />�[] ,'. [ONV!RONf�1EP EALTh <br />3. Description of vvcrk to be crr Pfeted if ad incr^ "^^J �_.... f►,se_LLc= ... —2E !� S, <br />use the UST Installatin Ap lication pages .4 8 <br />b` ' <br />fl Cil/ �`lu C %C -1t fez rC <br />4. DSescriphon of equipment to be used (Attach dr <br />-�' / -c, / <br />5. A e uiomen�is State ertiiied or aoorovee3. YE <br />as necessary ror i� i <br />iii I' 4 ( j <br />awings/blueprints as <br />/.. -, /-') 0c/A <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />plan review): <br />upgrade, <br />YES [ ] NO(] <br />Address / _ City Zip <br />c. Describe method to be used for decontaTi ation: <br />i <br />d. Describe how rinsate material It be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility.- <br />Hauler <br />acility:Hauler Name Phone( Hauler Reg# <br />Address City Zip <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge and/or inert the piping: <br />b. Piping Hauler: <br />Name Phone ( ) <br />Address City Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone <br />Address City. Zip <br />EPA ID# (if transported to a permitted TSD facility) <br />8_ Is the sampling firm an independent third party from the contractor? YES ( ] NO [ ] <br />9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration X Phone ( ) <br />Address City Zip <br />b) If soil is not to be hauled, describe what will be done with it: <br />2 <br />Mk <br />