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SEP-3-2006 10: 17R FROM:MUP PETOOLEUM ENGINE 916 994 -1117 1:12094683433 P.2 <br /> 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[] NO�j <br /> 2. Manufacturers spec sheets attached for all equipment to be installed YES[W NO[] <br /> 3. Description of work to be completed(If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> use the UST Installation Application pages 4-B as necessary for a timelyplan review): <br /> Re o< T✓ -�X a <br /> 4. Desch Ion of equipment to be used(Attach drawings/blueprints as necessary): w D <br /> (4-1 Ti'r'es /Xlo�t c- FSoaoa <br /> 5. All equipment is State certified or approved. YES NfNO [] <br /> 6 Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? N YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone(_) <br /> Address City 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 Rlnsate Hauler and permitted Treatment, Storage& Disposal Facility: <br /> Hauler Name Phone(_) Hauler 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 /> NIS b. Piping Hauler: <br /> Name Phone( <br /> Address City Zip <br /> Hauler Registration N(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone(_) <br /> Address City Zip <br /> EPA ID*(If transported to a permitted TSD facility) <br /> N(/l B. Is the sampling firm an independent third party from the contractor? YES[ J NO[ ] <br /> N) 9. Describe, in detail, how the soil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> I/110. Handling of excavated soil(Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration S Phone(_) <br /> ( Address City Zip <br /> b) If soil Is not to be hauled, describe what will be done with it: <br /> 2 <br />