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UST SYSTEM `~ <br /> (Submit minimum of 2 sets of plans&RE17 ROFIT OR REPq►R <br /> 1- Site map enclosed YES[] NOf) ppbO�as originate will be retained by EHD) <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES[] NO[] <br /> 3. Description of work to be completed(If addtn <br /> use the UST Installab 8 as n <br /> icataUDC's or other UST <br /> n es 4-8 as n ry for a time equipment, or performing tank top upgrade, <br /> _ �N P n re ;ew): <br /> 4. Desc n of equipment t b u (Attach ra- <br /> gs/b ue rints as necessary): <br /> � n <br /> 5. All equipment is State certified or approved. YES[I NO[] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Phoney) <br /> Address cityLp <br /> C. Describe method to be used for decontamination: <br /> d. Describe taw rinsate material will be stored onsite prbr to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Phone( Haub Reg# <br /> Address City zip <br /> Permitted 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 Phone y, <br /> Address City Zip <br /> Hauler Registration S(d hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone(_) <br /> Address City Zip <br /> EPA lD#(d transported to a permitted TSD facility) <br /> 8. Is the sampling firm an independent third party from the contractoo 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 Soil Hazardous Waste Hauler): <br /> Name Hauler Registration 8 Phone <br /> Address City Zip <br /> b) If soil is not to be hauled,describe what will be done with it <br /> 2 <br />