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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 DQ <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES[] NO[4 <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 4-8 as necessary for a timely plan review): <br /> xeol lw a Turbine Sump Sensoltt for Diesel Product. <br /> 4. Description of equipment to be used(Attach drawingsiblueprints as necessary): <br /> ATA <br /> 5. All equipment is State certified or approved. YES[] NO[] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NO <br /> b. Identify contractor performing decontamination: <br /> Name Phone(_) <br /> Address City Zip <br /> G. 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 /> Hauler Name Phone(_) /hulerReg# <br /> Address C" Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge and/or inert the pipi <br /> b. Piping Hauler. <br /> Name t Phone <br /> Address City Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address CityZip <br /> EPA ID#(if transported to a permitted D facility) <br /> 8. Is the sampling firm an indepen tthird party from the contractor? YES[] NO[] <br /> 9. Describe,in detail,how the it and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handling of exc ated soil(Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone(_) <br /> Address I City Zip <br /> b) If if is not to be hauled,describe what will be don with it: <br />