Laserfiche WebLink
UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) <br /> 1. She map enclosed YES[] NO[I <br /> 2 Manufacturer's spec sheets attached for all equipment to be installed YES[] NO[J <br /> 3. Description of work to be completed(If adding piping.UDC's,or other UST equipment,or performing tank top upgrade, <br /> Aise the UST Installation Application pages 4-8 as necessary for a timely plan nevi <br /> 4. of equipment two bre used(Attach drawnlbl <br /> gsueprints as necessary):w.caer, 5 1d )[ rre 'q , icr Pl s aro ria d Sl. A � { , <br /> 5. All equipment is State certified or approved. YES[] NO[j <br /> 6. Decontamination Procedures: <br /> a. Wig piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone) <br /> Address Cm,_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 /> - <br /> Hauler Name Phone <br /> Address L� Hauler Reg# <br /> City-Zip- <br /> Permitted <br /> ityLipPermitted 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 <br /> AddressPhone <br /> City Zp <br /> Hauler Registration S(rf hauled as hazardous) <br /> c. Piping Disposal She: <br /> Name Phone L� <br /> Address City Zp <br /> EPA IDS(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 Soh Hazardous Waste Hauler): <br /> Name Hauler Registration S Phone(_) <br /> Address <br /> City-Zip- <br /> b) <br /> ityZipb) If soil is not to be hauled, describe what will be done with it <br />