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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 R NO [ ] <br />2. Manufacturer's spec sheets attached for all equipment to be installed YES.VkO [ ] <br />3. <br />4. <br />Description of equi ment to be used (Attach dr_ay✓ings/blu pri is as necessary): <br />?CO2C� UZ5 ��NitOnvra� 7lJ��Jf' mewIj 1-0 <br />All equipment is State certified or approved. YES [ ] NO ( ] <br />6. econtamination Procedures: <br />Will piping be decontaminated prior to removal? YES [ ] NO[] <br />b. ntity contractor performing decontamination: <br />Na a Phone( <br />City <br />c. Describe 'Ret hod to be used for decontamination: <br />d. Describe how rins a material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permn ed Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( 1 <br />7. a. Describe the method that will be utiliz to purge and/or inert the piping: <br />b. Piping Hauler: <br />Name <br />Hauler Registration # (if hauled as <br />c. Piping Disposal Site: <br />Name <br />EPA ID# (if transported to a permitted TSD facility) <br />Is the sampling firm an independent third party from the contractor. <br />Describe, in detail, how the soil and/or water sample(s) beneath the <br />10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # <br />Address City <br />b) If soil is not to be hauled, describe what will be done with it: <br />2 <br />City <br />_ Phone <br />Phone ( <br />Reg# <br />Zip <br />Zip <br />Zip <br />[] No(] <br />l or dispenser will be obtained: <br />Zip <br />