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08106/2008 WED 14: 54 FAX _ ®0.0.3/005 <br /> ...... ......I ............... <br /> 07/02/2008 WED 15: 06 FAX 20 3433 SJC BED 12005/005 <br /> 07/92/2008 WED 12: 13 FAX 20031004 <br /> 0003/004 <br /> 07/02/2008 WED L1258 VAX 209 '3433 GTC BHP <br /> ---------- <br /> UST SYSTEM RETROFIT OR REPAIR <br /> d a.U <br /> (Submft minimum of 2 sets of plans&applications as originals will be retaine byFH <br /> 1. Site map enclosed yes/k No <br /> 2. Manufacturer's spec sheets attached for all equipment to be lnstsllec[YES�NO <br /> ( N <br /> 3. Description of work to be completed(It adding piping, UDC's,or other UST equipment,or performing I tank top upgrade, <br /> use the UST Installation Application pages 48 as necessary for a timely pie <br /> . ......................... <br /> � <br /> 4-- Description of equi 2 of to b-e-used jA PcFj dr-aw-Ing-stblyeprints as necessary) <br /> f;Ze 0022� <br /> —.gfj^%e— 5,04-Am JaL-e <br /> ��jrO�144LeVIelez zwexmrAL &P56eV WiTH �U 0a EW 7914 317o-4 2-o <br /> 5. A equipment is State certified or approve NO(] <br /> 'S SN'4' <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES() NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone( <br /> Address Cin,("—) <br /> Describe method to be used for decontamination: <br /> .......... <br /> dA ...... -------- <br /> -D ON 011 00pel-guslits prior o. manifesti. <br /> .....................-................ .... ..... --- . <br /> ............... ------ <br /> .................... <br /> a. Rinsate Hauler and permitted Treatment.Storage&Disposal Facility: <br /> Hauler Name Phone( ) Hauler Reg# <br /> Address City_7lip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge and/or inert the piping: <br /> b. Piping Hauler: <br /> Nama Phone( <br /> Address <br /> -'ArWjr RagjjtrjVjon#(if hauled as hazardous), <br /> c, Piping Disposal Site: <br /> Name 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[] <br /> 9. Describe,in detall, how the soft and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handling of excavated soil(Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Reflistration#_Phone <br /> Address city—Zip <br /> b)If soil is not to be hauled,describe what Will be done with it: <br /> 2 <br />