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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 [I NO[)p <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES DYNO[] <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 /> /5 —ZZ04&A V' �AR S ✓S/JJc' <br /> 4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br /> L S`7 12�?, S�i�✓SiJI? <br /> 5. All equipment is State certified or approved. YES WNO[] <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 Cl Zip <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate material it La nsite prior to manifesting offsite: <br /> e. Rinsate Hauler permitted Treatment, Storage& Disposal Facility: <br /> Hauler N Phone( _Hauler Reg# <br /> Add s City _Zip <br /> rmitted 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 O <br /> Address ity Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone(_) <br /> Address City Zip <br /> EPA ID#(if transported to a permitted T c ) <br /> 8. Is the sampling firm an independe party from the contractor? YES [ ] NO [] <br /> 9. Describe, in detail, how the soil d/or water sample(s) beneath the piping or dispenser will be obtained. <br /> % Handling of ex(Xcaed oil (Contaminated Soil Hazardous Waste Hauler): <br /> Name _Hauler Registration# Phone (_) <br /> Address City Zip <br /> b) If it is not to be hauled, describe what will be done with it: <br /> 2 <br /> coo 1B 'IUKHNNI)HIAN8 JJV,L TTOTS999T6 %Vd 99:9T 900Z/90/TT <br />