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MAR-07-2008 03:44PM FROM- • +9255517895 . T-481 P.003/003 F-999 <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 /> I <br /> 2. Manuf> cturers spec sheets attached for all equipment to be InstalledYES g NO[] <br /> 3. Description of work to be completed(If addma plplitg, 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 /> 4. Descrl n of equipment ro be used(Attac(1 awingulblucprinty as ne sary): <br /> \l�� �. a Gu».�..aCtcu <br /> I � <br /> 5. All aqufpment Is Slate certified or approved. YES[] NO [] <br /> 6. Deeoetamination Procedures: <br /> a. WI(I piping be decontaminated prior to removal? YES[] NOW <br /> b. Ideinlify contractor performing decontamination: <br /> Nah1e_.- Phone( ) <br /> Address City .,.Zip <br /> c. D:The method to be used for decontamination: <br /> I <br /> d. D,�cThee now Ansate material will be stored onsite prior to manifesting offsite, <br /> ll�� <br /> I <br /> a. Rini Hauler and permitted Treatment,Storage&Disposal Facility: 13 <br /> Ha luler Name Phone(_ 1 Hauler Reg# <br /> Address Choy <br /> Permitted Disposal Site <br /> 7, a. Describe the method that will be utilized to purge and/or Inert the piping: <br /> b. Piping HauTW <br /> Name^ M * Phone(�) <br /> Address City. Zip <br /> Hauler Registration p(if hauled as hazardous) <br /> C. Piping Disposal Site' <br /> Name Phone(__-,_) <br /> Address �— City Zip <br /> EPA 1Di(If transported to a permitted TSD facility) <br /> a. Is the sampling firm an independent third parry from the contractor? YES[] NO r% <br /> 9. Des foe,in tail,how the sojl.. for water ssmple(s)beneath the piping or dispenser will be obtained: <br /> Dy _ <br /> ;S -C <br /> 10. Hariding of excavated loll(Contaminated Soil Hazardous Waste Hauler): �b <br /> IN Hauler Registration N Phone(_.__) <br /> Adoress City. zip <br /> b)If sail Is not to be hauled,describe what will be done with it: Ib� <br />