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Mar 05 08 12:33p Elite Iv Contractors Inc 2094616342 p.l <br />' ; 1 M <br />1'�t?'�i � ; °�/5 f G`J� _ � /--� : // %it - lam' lC�� `>�l G�l� . ✓�1'�L`��",. 1. <br />n } L/ <br />ire t��1,2�.; { UST SYSTEM RETROFIT OR REPAIR°���%�� <br />.Itl (Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) <br />J <br />1. Site map enclosed YES[] NO MAR - 5 2008 <br />2 Manufacturer's spec sheets attached for all equipment to be installed YES [] N ENVIRONMENT HEALTH <br />3. Description of work to be completed if addingUDC's, or 3 er U <br />PERMIT/SERVICES <br />( +_ piping. equipment, or performing tank top upgrade, <br />use the UST Installation Application pages 4-8 as n ry for a <br />ti <br />plan r view): <br />1 iG ' i : l • U%lc ��Li GrS �C /�,. 7/lit'c' , LL. L ✓�/ 7�� <br />lillu <br />PCI <br />clltii/I ,c,ucuC C+�iI1'tLCrtAA <br />/����Cc<��cr�h._( G'4�C� L�t4. equipment tole used (Attach drawings/b epnhts as necessary): <br />- F 1.Y1 <br />1 <br />,1�s, .15 <br />J911) al I <br />5. AA equipment is State certified or approv ES [] NO [] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated rior to removal? YES [ ] NO[] <br />b. Identify contractor performi decontamination: <br />Name Phone(_ <br />Address city -zip <br />c. Describe meth be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting onsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility. <br />Hauler Name Phone(_, Hauler Reg# <br />Address Cly 2;p <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 />•IlV <br />Address <br />Phone <br />Hauler Registration # (if hauled as hazardous) City Zip <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. Handing of excavated soil (Contaminated Soil Hazardous Waste Hauler); <br />Name Hauler Regisbation <br />Address # Phone (--1 <br />City Zip <br />b) If sol is not to be hauled, descnbe what will be done with it <br />