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Jan 13 03 01 : 32P Elite iv Contractors Inc 2094616342 <br /> 'AN 1 4 <br /> UST SYS-MM <br /> RETROFIT OR REPAIR <br /> , <br /> (Si;bQ minimum oft sets of plans&applications as a. *ats M111 be ret COUNI) <br /> MENTAL <br /> 1� Site map endused YES fj NO[I HEAL-r EPART EN-1- <br /> f <br /> 2 Manufau-_vrers spec sheets attached for all equipmunt to be installed YES[INO[] <br /> 3Dasc:dption of work to be completed(if 2gnq N-ing,UDC s,or other UST rqLfipmeM Ot-psrformirU tank bp upgrade, <br /> use the UST lr;staltaflon App1ic;W,,;n pages 4-8 as neDes;_-ary for a timely plan review)' <br /> 4. Dcswiption of equipment to he used(Attach dra[winq5Jblueprirjf_-�nC!=sSaDr)- <br /> ;,)o..I,, r­f- .0,)W <br /> )0 LLILL/11), <br /> 5- AD aqriiprnent is Scare certified or approved- YES NO <br /> B. Decontamination PMC4vdums- <br /> a- V"I➢Piping be decontaminated print t,5 removal? YES[I NC) [] <br /> b. ldendfY coritacturperforming deconL3miriatiDn: <br /> Narne <br /> Adarnss city 7ip <br /> c- Describt method to be used for de=n1-,niaatbn.- <br /> d- De--c be h9w dMate mXerial mrill be stared ctn_-ite,prior to xnanffezting olfsiW <br /> e. RillsmItO I-Wuller-wd perwiUed TmatmM S16mge&Disposw Faaafff_ <br /> Hauffer Mame More( Haulm-r Reg# <br /> Address Ci!Y_zjP_ <br /> PL-rmnnd Dis;o-,al site <br /> 7- 2-DescFbe the method that will be ut&md to purge ancYar inert the Piping, <br /> LL Piping liaulm: <br /> Name Phone, <br /> Addmss City- 2�p <br /> C. piping Di:p=al Ske- <br /> Name phone <br /> Add <br /> M= Tip <br /> EFAM#ff transported to a permitted TSD bc3k*)— <br /> B. Is the samphng firm an indepanderit ffijro"from the ConLraclor?ym-S[I NO[I <br /> 9. Dasarkoe-,in olctall•h0wthe soil be-neafh the piping orclispeascrwAR be obtained- <br /> =waste HaLiler): <br /> Name Hauler Rvgis:irat an 0 Phone <br /> Address: C4—zip <br /> — <br /> 0) if soil is;not W be Niuled,do;gibewhat wilt be done%ilh it <br />