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E003/003 <br /> 08/05/2008 TUE 17: 13 FAX <br /> 07/02/2008 WED 15106 FAX 203433 SJC SHD 21005/005 <br /> X003/004 <br /> 07/e2/2008 WED 12: 13 FAX <br /> 07/02/2008 WED 11:58 FAX 209 3433 STC aHP 9003/1104 <br /> .i .. _....__.. ............. ... _.. .._.__.........._........_..._......_..._.................................._....._.__._........_............... <br /> _.....__.."'"__-.....-_... ......._..__.._...... <br /> ' UST SYSTEM RETROFIT OR REPAIR //� <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by EH I fie"V:S YD <br /> 1 <br /> �. <br /> T. Site map enclosed YES NO[J <br /> i <br /> i 2. Manufacturer's spec sheets attached for all equipment to be instadedYES�kNO[) <br /> 3. Description of work to be completed(If adding piping, UDCs,or other UST equipment or performing tank top upgrade. <br /> use the UST Installation Application pages 4-8 as necessary for a time y plan r view): <br /> S G / �21je4 6s- <br /> c — �e <br /> ! 4. Description of a uipgI�nent to be used(A ch drawih s/bl eparits as necessary): <br /> q ✓fii2 Sr�✓/r.�a obv <br /> Ii Ile—dna—d�Ll--�xZ-" . �i ,t t - --- <br /> i ` .7p�Gker ✓e' &Ieez r-T- VVrEW$7(I7L Sqi: _�A_ W:Tn Moat.61�{ �/'Y.3?o -L'20 <br /> I! 5. Ali equipment is Slate certified or approved. YES NO(I 5/V ya. <br /> j 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 City fp <br /> c. Describe method to be used for decontamination: <br /> d.,Describ6 ioW.AnSat6::materiWWII' 'stb <br /> be onsilaprlor to,maniPesting offsite -- <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Phone(__) Hauler Reg# <br /> zip— <br /> Address city <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 /> Name Phone( <br /> Addressty.� _.....___.._.._Zi.P.. _._...._....... <br /> NauterRegistration#(If hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone(_) <br /> Address City 71p <br /> EPA ID#(If transported to a permitted TSD facility) <br /> a. is the sampling firm an independent third party from the contractor? YES U NO[) <br /> 1 9. Describe,in detail,how the soil andforwater sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handling 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 will be done with it: <br /> .. .2 <br /> .. <br />