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12/02/2008 14:41 FAX 9163712540 BZMAINT 002 <br /> 0 0 <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(]/ <br /> 2. Manufacturer's spec sheets attached for all equipment to be InatalledYES[] NO[0-/ <br /> 3. Description of work to be complete pages in piping,necessary for a timely plaer UST reequipment, or performing tank top upgrade. <br /> use the UST installation App <br /> 4. Description of equipment to be used(Attach drawings/blueprints as necessary): <br /> 5. All equipment is State certified or approved. YES[] NO[] <br /> B, Decontamtnatlon Procedures: I(✓ YES[] NO[t <br /> a. wil piping be decontaminated prior to removal? r <br /> b. Identify contractor performing decontamination: Phone(_) <br /> Name City_ ,Zip <br /> Address <br /> c. Describe method to be used for decontamination: <br /> d. Describe how Mnsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,StoraPgleo&DI(s al Facility: Hauler Regg� <br /> Hauler Name City ZiP <br /> Address <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: Phone <br /> Name CityZ'p <br /> Address <br /> Hauler Registration#(it hauled as hazardous) <br /> c. Piping Disposal Site: Phone(� <br /> Name City�.�--Zip <br /> Address ermitted TSD facility) <br /> EPA ID#(if transported to a p <br /> g. Is the sampling firm an independent third party <br /> from the contractor? YES[] NO[] <br /> g. Describe,In detail, how the soil and/or wat r sample(s) beneath the piping or dispenser will be obtained: <br /> N <br /> 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Haul . <br /> Hauler Registration uler): Phone (..� <br /> Name <br /> Cl <br /> Zip <br /> Address <br /> b) If soil is not to be hauled,describe what will be done with it: <br /> 2 <br />