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Sep 22 08 10:38a Reliable Petroleum 209-845-8953 p.5 <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[q�l <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES t'/N4[] <br /> 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> use the UST installation Application pages 4-8 as necessary for a timely plan review): <br /> ^Tr. r 4ua as {eSPA Gtii r�.Y btcc� l"�L�rr - � a5 0 <br /> _� ' �}�i/i f1t1�f.Rt�JrrrlSL'fs11z�r4 �al� IY�Su <br /> 4 ( (}tJ YE P✓ rLI;C[' � Y1L. 111 - Y"x� f <br /> 11r I ^l��l r73(, 'l/?!CiJJ'f' . 1 �F. l sem. <br /> 4. Description of equipment to be used(Attach drawingstblueprints as necessary): ;AI „ <br /> 5. All equipment is State certified or approved. 'YES NO [ <br /> 6. Decontamination Procedures: Af fy <br /> a. Will piping be decontaminated prior to removal? YES (] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name 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 /> e. Rinsate Hauler and permitted Treatment, Storage &Disposal Facility: <br /> Hauler Name 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: Allk <br /> b- Piping Hauler: <br /> Name Perone (_ } <br /> Address City Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone f_ <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 [ ] AM <br /> 9. Describe, in detail, haw the soil andfor water sample(s) beneath the piping or dispenser will be obtained:M <br /> 4- <br /> 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): Allk <br /> Name Hauler Registration# Phone <br /> Address City Zip <br /> b) If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />