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Jun 11 02 03: 46p Elite Iv Contractors Inc 2094616342 p. 2 <br /> rip Y�5 aml Fel <br /> 1� UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) <br /> y 1. Site map enclosed YES& NO[] <br /> 2 Manufacturer's spec sheets attached for all equipment to be installed YES 0 NO[) <br /> 3. Des-cription of work tc be. mpleted-�f addinc,pi rg.-UE6'ror-other UST equipment, or performi. ^.S tank top upgrade, <br /> the UST Installation Application pages• as necessary for a timely plan revi14hl 1111W ;-4)e <br /> ew): <br /> i��^, 1 rtiil fi Q (K' s[n tblu tall i(1 '"(i li7 fit 4 �zY (�l'iuse7. <br /> 4. notion o gwpment to be: A a drawrngs/blue n as ne <br /> q ti IS ` . #--BSL e ! etc i . <br /> a # <br /> s c e �r �eP i t2 t par i-s <br /> uNA,'!' P I All uipmenCis tate CerCrfied or apptaved. YES NO [j <br /> CVP <br /> - 1E t \� �e Q5 c�ls;b e �r 4jlc QMj)Va( C-C CAr_l cUs� e.t> i5 <br /> �nf Deeo mmati n Prosed res: <br /> a. Will piping be decontaminated prior to removal? YES[] NO[) <br /> b. Identify contractor performing decontamination: <br /> �u1rY1Q4 Name 1, <br /> 11 Phone(_ <br /> v' Address City Zip <br /> c. Describe method to be used for decontamination: <br /> d. Describe Crow rinsate material will be stored onsite prior o manifesting offsite: <br /> V <br /> e. Rinsate Hauler and permitted Treatment,Storage isposal Facility: <br /> Hauler Name Ph (� - Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge d/or inert the piping: <br /> b. Piping Hauler. <br /> Name Phone <br /> Address CityZip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address City Zip <br /> EPA ID#(rf transported to a permitted TSD fa city) <br /> 8_ Is the sampling firm an independent third pa from the contractor? YES[) NO[I <br /> 9. Describe, in detail,how the soil and/or water ample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handing of excavated sod(Contaminated Si Pit Hazardous Waste Hauler): <br /> Name Ha&Ar Registration# Phone( ) <br /> Address City Zip <br /> b) If soil is not to be hauled,describe what r be done with it: <br /> 2 <br />