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Aug 15 2008 12: 58PM Slunaker Construction 951 -788-7089 P. 1 <br /> 06/15/2008 FRI 12c22 FAX 2094 433 SJC BHD 002/003 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by END) <br /> 1. Site map enclosed YES NO(j <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES{j NO <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 far a timely plan review): , <br /> l o 's <br /> 4. Description of equi ment to be used(Attach ing blueprint s necessary): ` <br /> b � ow t/" � efc�r resc5 r� s e.H 5 0!' �e�eyamT l <br /> 5. All equipment is State certified or approved. YES[rj NO[j <br /> 5. 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 /> a Describe method to be used for decontamination: <br /> d. Describe how rinsate 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( ) <br /> Address City Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone( <br /> Address City zip_ <br /> EPA[DO(If transported to a permitted TSO facility) <br /> 8. Is the sampling firm an independent third party from the contractor?YES{J NO[) <br /> 9. Describe,in detail, how the soil and/or water sample(s)beneath the piping or dispenserwill 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 />