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Sep,?3 2008 10:01AM S#Ser Construction 951-788-7089 p.2 <br />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 YES [. NO ( ) <br />2. Manufacturer's spec sheets attached for all equipment to be installedYES WNFO <br />3. Description of work to be completed (if adiding piping, UDC's, or other UST equipment, or <br />performing tank top upgrade <br />use the UST installation Application pages 4-8 as necessary for a time <br />�.rwr c7 i6, f,rl� IY plan review): <br />4. Description oequipment to be used (Attach drawingsiblueprints as necessary): <br />5. All equipment is State certified or approved. YES P"O [ <br />6. Decontamination Procedures: <br />a. WIII piping be decontaminated prior to removal? YES [ j NO W,— <br />b. Identify contractor performing decontamination: <br />Name Phone( <br />Address City Zip <br />c. Describe method to be used for decontamination: <br />--- &�%+3.-- <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />9.11,44 <br />e. Rlnsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name ii..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 />,a /�- <br />b. Piping Hauler: <br />Name__. .dL,- /.O-- Phone �a <br />Address City Zip <br />Hauler Registratlon # (if hauled as hazardous) <br />c. Piping Disposal Site. <br />Name._.. _.._ /J�%4-- 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 I I <br />S. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />ry ZA= <br />10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # Phone <br />Address City Zip <br />b) If soil is not tq be, hauled, describe what will be done with it: <br />2 <br />