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AUG-11-2008 08:50 From: p[� / To:2094683433 P.1/1 <br /> n L— .. Imo— � l� i4� �b`l la� 3 � <br /> �� C�D M6vhlt�� . <br /> UST SYSTEM RETROFIT OR REPAIR yd ZV& <br /> AUG 1 I Z*bmit minimum of 2 sets of plans &applications as originals will be retained r�t Leh Car Wash <br /> a.amjte Ave. <br /> 1. �01 r ewWWTy YES h{ NO [] i4ittcilli, to 55336 <br /> ENVIRONMENTAL <br /> y <br /> 2. Tsheet$ attached for all equipment to be installed YES NO [] <br /> D. 3. I Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> l/ use the UST Install 1Wn Application pages 4-8 as necassa jopittimely plan view) <br /> �Ltc <br /> O <br /> 4. Description of equipment to be used (Attach drawingsiblueprints as necessary): <br /> z4v— Mot e-5Ci <br /> 5. All equipment is State certified or approved. YES&NO [j <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 City Zip <br /> c. Describe method to be used for decontamination: <br /> d Describe how drisate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment. Storage& Disposal Facility: <br /> Hauler Name Phone() Hauler Reg# <br /> Address City Zip <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: <br /> Name Phone(____j <br /> Address City Zip <br /> Hauler Registration 9(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone( <br /> Address City Zip <br /> EPA ID#(if transported to a permitted TSD facility) <br /> 8 Is the sampling firm an independent third party from the contractor? YES [] NOH <br /> ] <br /> 9 Describe, in detail, how the soil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 10 Handling of excavated 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 />