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07/02/2008 WED 12: 13 FAX 0003/004 <br /> 07/02/2008 WED 11: 58 FAX 20 3433 SSC FHD • 3003/004 <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 installedYES?kNO[J <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 page-8 as necessary for ai���l�r view): <br /> e- Taft DF <br /> 4. Description of equi ment to be used(A ch drawings/bl eprints as necessary): <br /> �frGl � <br /> jL . �i�ns r (Lc�u f rc � n g— 5 o-v-e <br /> 5. All equipment is State certified or approved. YES'A NO[] <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 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: <br /> b. Piping Hauler: <br /> Name Phone( <br /> ---- -- _ <br /> Address <br /> Hauler Registration#(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 detail,how the soil 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 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 />