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Aug 24 06 08:07a Elite Iv Contractors Inc 2094616'42 UST SYSTEM RETROFIT OR REPAIR (Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) 1. Site map enclosed YESX NO[] 2. Manufacturer's spec sheets attached for all equipment to be installed YES;P�NO[] p.2 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application pages 4-8 as necessary for a timely plan review): j C, c' -re « !L ; ,� �� c r- T s a f A- r,N. -e v o N L C -� /b ; � 'e 1. i., t� e % c� i. p •rte � e 4. Description of equipment to be used (Attach drawings/blueprints as necessary): C s A -e Tc r- v- 2 b e r o ,-/ C- / o, A e �� S 5. All equipment is State certified or approved. YESX NO [ ] 6. Decontamination Procedures: a. Will piping be decontaminated prior to removal? b. Identify contractor performing decontamination: Name Address c. Describe method to be used for decontamination: YES [I NO, Phone _ City d. Describe how rinsate material will be stored onsite prior to manifesting offsite: e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name Phone) Address Permitted Disposal Site 7. a. Describe the method that will be utilized to purge and/or inert the piping: b. Piping Hader: Name Address Hauler Registration # (if hauled as hazardous c. Piping Disposal Site: Name _ Address EPA ID# (if transported to a permitted TSD facility Hauler Reg# City Zip Zip _ Phone (__) City Zip _ Phone City 8. Is the sampling firm an independent third party from the contractor? YES f ] NO[) 9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): Name Hauler Registration #_ Address City b) If soil is not to be hauled, describe what will be done with it: 2 Phone U Zip