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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[] <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES[] NO[] <br /> 3. Description of work to be completed(If adding piping, UDC's, or other UST equipment, or performing tank de, <br /> use the UST Installation Application pages 4-8 as necessary for a timely plan review): <br /> 4. Description of equipment to be used(Attach drawings/blueprints as necessary): <br /> 5. All equipment is Stateified or pproved. YES(] NO [] <br /> 8. Decontamination P cekV� <br /> a. Will piping be d ontd prior to removal? YE/( ) <br /> b. Identify contrac r pe decontamination: <br /> Name Address Zip <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifes' g offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage &Disp al Facility: <br /> Hauler Name Phon /Harg# <br /> Address CityZip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge p4d/or inert the piping: <br /> b. Piping Hauler: <br /> Name Phone( ) <br /> Address City Zip <br /> Hauler Registration#(if hauled as ha rdous) <br /> c. Piping Disposal Site: <br /> Name_ Phone(_) <br /> Address City Zip <br /> EPA ID#(if transported to a pe fitted TSD facility) <br /> 8. Is the sampling firm anInde endent third party from the contractor? YES (] NO[] <br /> 9. Describe, in detail, how a sail and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handling of exca ated soil (Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone(_) <br /> Address City Zip <br /> b) If soil is not to be hauled,describe what will be done with it: <br /> 2 <br />