Laserfiche WebLink
Mar 10 08 10:01a Elite Iv Contractors Inc 20946 12 P.1 <br />a PIC/ L <br />�ST SYSTEM RETROFIT OR REPAIR <br />Submit minimum of 2 sets of plans & applications as originals wilt be retained by EHD) <br />site map enclosed YES [I NO [I <br />!1 0 2_ Manufacturers spec sheets attached for all equipment to be installed YES [ ] NO <br />3_ Description of work to be completed (If adding piping, UDC's, or other UST, of uipment, or performing tank top upgrade, <br />u he UST Installation Application pages 4$ as necessary for a time lan review): fa <br />Vis }� / vG <br />^J L <br />4. Description of equipment to be used (Attach drawings/bkfeprints as necessary): <br />Ic-X- 1E I <br />`ciao <br />5. All equipment is State certified or approve5/YES [] NO[] <br />0 <br />Decontamination Procedures: <br />a. Will piping be decontaminated <br />b. Identify contractor performin <br />Name <br />Address <br />to removal? <br />c- Describe method jdbe used for decontamination: <br />YES[] NO[] <br />ione{`� <br />City Zip <br />d. Descri"w rinsate materiat will be stored onsite prior to manifesting offsite: <br />e. 4nsate Hauler and pennJitted Treatment, Storage & Disposal Facility: <br />/ Phone Hauler Reg# <br />Hauler Name ( � <br />Address <br />City Lp <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge andlor inert the piping: <br />b. Piping Hauler: <br />Phone <br />Name (_) <br />Address City Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone <br />Address city <br />EPA ID# Cd transported to a permitted TSD facility) <br />8. Is the sampling firm an independent third party from the contractor? YES [ I NO [ I <br />Zip <br />S. 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 # Phone U <br />Address Cityzip <br />b) If soil is not to be hauled, describe what will be done with it: <br />2 <br />