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Dec 10 08 02: 03p Eli Iv Contractors Inc 209461 -42 p. 3 <br /> 4F ou-)UU [� <br /> 12-11-US <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&apprieations as originals vall be retained by EHD) <br /> 1. Site map enctosed YES❑ NO[y <br /> 2 Manuf ulutefs spec sheets attached foray equipment to be installed YFSI[ NO[) <br /> 3. Description ofworkto be completed(Irad_ ding piping,UDC's,or other USTequipment <br /> use a UST Insfaltation plication or performing tank top upgrade. <br /> ` pages 4-8 a;nary for a timely n revi <br /> e <br /> 4, (� <br /> Description of equipm 1 to be used Att tlrawingsrblurIIi��e ..dry � � hCPAO b1f <br /> 5_ M equipment isShatCYceA ed or approved YFS[]•p U <br /> 6. Decontamination Procedures: <br /> a.V144 piping be decontaminated prior to removal? YES(1. NO Cl <br /> b. Iderdify contractorperforming decordamination: <br /> Name <br /> hDnAddress P <br /> city <br /> Zip <br /> r- Desarbe method to be used for decantamroatiore <br /> d_Describe how rirtsate maledW wal be stored onsite prior to manikstitg offsite_ <br /> e. Rinsate Hauler and perm ted Tr_atmAnt,Storage&Disp=l PaGW <br /> Hauler Name <br /> Address PhOnc(__) Hauler Rep# <br /> Permitted pisposat 5de Cdy f'p <br /> 7. a. Describe the method that vnll be uhS¢ed fo purge andlor mert the piping' <br /> b.Piping Haulor. <br /> Name <br /> Address Phone <br /> Mauler Regi>dntion t'(d hauled as hamrdous) Cdy - 22p <br /> Q Piping Disposal Sde: <br /> Name <br /> Address Phone L_j <br /> EPA,'...44poilvo In a Penr died 75D fadity) City. zp <br /> 8_ Is the sampfctg firm an independent Ihid party from the contractor?YES[] NO[] <br /> 9. Describe,in detaa,how the SOO and/or water samples)beneath the piping or dispenser will be obtained: <br /> 10. ceding of ft=Vated sa(Contaminaled'Soa Hazardous Waste Ha(ger): <br /> Address Hauler Regisbabon C Phone <br /> �dY Tip <br /> b)if soli is not to be hauled, describe what will be done with it <br /> 2 <br />