COMPLIANCE INFO_2008-2012 - Laserfiche WebLink

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UST SYSTEM RETROFIT OR REPAIR (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) 1. Site map enclosed YESX NO[] 2. Manufacturer's spec sheets attached for all equipment to be installed YES X NO[] 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application pXes 4-8 as necessary for a timely plan review): v6E7)Ek_R06T — EUK-�_AN�—I S�_��k—EL6—(—u vc� —gip UQ=204-17 4. Description of equipment tobe used (Attach drawings/blueprints as necessary): — -- 200? PLO!,1 itL i ff/_— C� RG S&7v/ O/Z SOS f•�ARlsr 5. All equipment is State certified or approved. YES[] NO [] 6. Decontamination Procedures: a. Will piping be decontaminated prior to removal? YES[] NO[] I`] A- b. Identify contractor performing decontamination: Name ------------------------Phone(---)------------------- ---------- Address-------- ------------------- City-----------Zip ------- c. Describe method to be used for decontamination: d. Describe how rinsate material will be stored onsite prior to manifesting offsite: ------------------------------------------------------------------ e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: Hauler Name---------_----Phone(—)-------Hauler Reg#---_--- Address----------- City--------Zip------ Permitted Disposal Site_ __—_—_----_------------------------ 7. a. Describe the method that will be utilized to purge and/or inert the piping: b. --------------------------------------- Piping Hauler: Phone (---)----------------- Name--------- -------------City--------- Zip —------- Address-------- - Hauler Registration#(if hauled as hazardous)--_----_------- c. Piping Disposal Site: Name----------------------------Phone(---)------------- Address------------------------------City------------ZAP-------- EPA ID#(if transported to a permitted TSD facility)------------ 8. Is the sampling firm an independent third party from the contractor? YES[] NO [] l A- 9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): Name----------_------ Hauler Registration# _-- Phone Address------------------------City----------------Zip---------- b) If soil is not to be hauled,describe what will be done with it: 2