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07/17/2008 08:24 2@J&38 ENVIRONMENT LTH PAGE 03/07 <br /> UST 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 installed YES WINO[] <br /> 3. Description of work to be completed (if addino piping, UDC's,or other UST equipment, or performing tank top upgrade, <br /> us the UST Installation Applic tion pages 4-8 as a ssa for a timet plan review); <br /> TS AJ <br /> 4 Description of equipment to be use testa d wi s/blueprints s necessary): <br /> a <br /> 5. All equipment is State certified or approved- YES RINO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO[] <br /> b. Identify contractor perfgrming decant * tion: <br /> Name Phoned^) <br /> Address City Zip <br /> c. Describe method to be used for d to inatiom <br /> d. Describe how rinsate material will be stored onsit prior to manifesting offsite' <br /> e. Rinsate Hauler and permitted Treatment, Storage & D' pos <br /> Pal Facility: <br /> Hauler Name one Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site JjE <br /> 7. a. Describe the method that will be util ed to purge al/or inert the piping: <br /> b, Piping Hauler: <br /> Name Phone(� <br /> Address City Zip <br /> Hauler Registration #(if hauled as ous) <br /> c. piping Disposal Site,. Phone( <br /> Name <br /> Ad d ress 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 w4er samples)beneath the piping or dispenser will be obtained: <br /> lot <br /> 10. Handling of excavated soil (Cont i ted Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone (___j <br /> Address City Zip _ <br /> b) If soil is not to be hauled,describe what will be done with it: <br /> 2 <br />