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02/20/2008 WED 15: 34 FAX 2094683433 SJC >rHD Stockton Sery Sta Eq Co 2004/008 <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[ NO[] <br /> 3. Description of work to be completed(if adding piping, UDC's,or other UST equipment, or performing tank top upgrade, <br /> use tUST Installation Application pages 4-8 as necessary for a timely Ian review <br /> 4. Description of equipment to be used(Attach drawings/bl a rints as necessary): <br /> + 4 <br /> 5. All equipment is State certified or approved. YES Who[] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES(] NO[] <br /> b. fdenlify contractor performin contamination: <br /> Narnz_ _ Phone(_) <br /> Address _ --- __City Zip <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> Y <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Phone(—) Hauler Reg# <br /> Address _ _,• _ City Zip <br /> Permitted Dtisposal Site <br /> 7. a. Describe the method that will be utilized to purge and/or inert the piping: <br /> b. Pip ir1g l�iatiler: <br /> Name _ _ ____Phone( ) <br /> Address_ City Zip <br /> Hauler Registration#(it hauled as hazardous) <br /> c. Piping Disposal Site; <br /> Name Phone <br /> _ Phone <br /> Address_ City Zip <br /> EPA lQ#(if transported to a permitted TSD facility) <br /> a. Is the sampling firm an independent third party from the contractor? YES[] NO() ld/,}- <br /> 9. describe, in detail,how the soil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handhng of excavated soil(Contaminated Soil Hazardous Waste Hauler): <br /> Name--- Hauler Registration# Phone{_) <br /> Address, --•�_ City Zip <br /> b)if soil is not to be hauled,describe what wolf be done with it: <br /> 2 <br />