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Jan 28 08 04: 06p Eli*+ Iv Contractors Inc 209461 ;42 _ P. 1 <br /> Mau—, UST SYSTM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans b applications as originals vnU be retained by END) <br /> 7. Site map enclosed YES[] NO[] <br /> 2 hlanufacturet's speesheets attached for an egtdpment to be installed YES[j NO <br /> () 3. Description of Nark to be completed(1f afi piping.L1DC's,w other 115T equipment,w performing tank top upgtad� <br /> use the UST Installation Applwatan pages a.t ac noY�gV 10,a <br /> wa tirrety elan review): (�q <br /> n [¢. -[ '.n' ',Lyn. �� '. 'Y 't d / et <br /> 4. Descdplion�or. pmeht to be'u ;(Aftq tlrrSwn is ass <br /> • �, star aaao c e dMAM� <br /> fl) )At <br /> 5. Ab equipment is State cegr7ied or approved. YES f) NO[j <br /> 6. DaemUminalion Procedures: <br /> S_ a.Vtbl piping be decontaminated prior to remoras? YES[] NO[1 <br /> J a) <br /> LFL_iFj ¢ ui b.�nKycouractorperformitgdecontamination: <br /> o w� Name <br /> ` , N .r_ AddressCity Lp <br /> —_ a: <br /> Lim rA uj <br /> i c Describe method to be used for decontamination: . <br /> LT < c <br /> ,J� —r u d.Describe howrinsalematenaiNsYbesloredonsile rrorf0 <br /> ( p" martarti@seng ol6le: <br /> ui <br /> e. Ri wabe Haulwand permnled TreatmW Storage 8 Disposal t=eeny <br /> Hauer Mame Phone( 1. Ffauter Reg#. <br /> Address City 27p <br /> Per Tkw Disposal She <br /> 7. a.Describe the method lief will be rtif¢ed to purge and/or Vert the piping: <br /> b.Piping Hauer. <br /> Name Phare( <br /> Add,'ess Cify 411Hauler Rewsmoon S(dhauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name - Phone C_) <br /> Address Cly Zip <br /> EPA IDff(dbanspoded to permitted?8D fad6ly) <br /> 9. Is the sarnpiing firm an independent third party nom the Contractor?YES[1 NO[j <br /> 9. Describe,in decal,how the soil andifar water sIxoP s)bength the p*V ord ispenser will be obpitted: <br /> 70. Handling of excavated Doi(Cordam'stated'SM Huwdars Waste Hauled: <br /> Name HaukrRegis4eSont Phone( .. 1 <br /> Address City zip <br /> - <br /> b)If sod is not to be hauled,describe what Coli be done with it <br /> 2 <br />