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Nov 02 07 08: 29a Elite Iv Contractors Inc 209461663342 p. 2 <br /> (�tfN' Tl^cc�-lie (�enrp/ <br /> 2� - A 7 <br /> UST SYSTEM RETROFIT OR REPAIR +O Pk�lh 1` <br /> (Submit minimum of 2 sets of pians&applications as originals will be retained by EHD) y5 <br /> 1. Site map enclosed YES[] NO[I <br /> 2 Manufacturers spec sheets attached for all equipment to be installed YES[] NO[] <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-a as necessary for a tirnety plan review): <br /> �e-Pln er{� txrQ Leak 1 ¢Fw4or c , � 2cnincc� bncQ Lc�. � r<:�cr <br /> 4_ Description of equipment to be used, drawurgs/blueprints as necessary): <br /> n c^Icss Lb rr� LF t 4e t w �R * t)7t� <br /> �[lhn � n `2(XYl Lzat tl..k lar S(z ii Rr]3 i�� O D'c��— <br /> 5. Al equipment is State certified or approved. YES[] NO[] <br /> 6. Decontamination Procedures: <br /> a_AMU piping be decontaminated prior to removal? YES[] NO [] <br /> b. Identify contractorperfonning decontamination: <br /> Name Phone( <br /> Address Cly Zp <br /> c- Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manleslmg offsite: <br /> e. Bicisate 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 ufiT¢ed to purge and/or inert the piping: <br /> b. Piping Hauler. <br /> Name Phone <br /> Aridness Cly Zip <br /> Hauler Registration S(d hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone�) <br /> Address Cly Zip <br /> EPA IDS(if transported to a permitted TSD facility) <br /> a_ Is the sampling firm an independent third party from the contractor? YES[] NO[I <br /> 9. Describe, in detail,how the soil and/or water sample(s)beneath the piping or dispenserwill be obtained: <br /> 10. Handing of excavated soil(Cmdaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration S Phone <br /> Address City Zip <br /> b) If soil is not to be hauled, describe what will be done with it <br /> 2 <br />