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Mar 26 08 12:05p Sandra Barnhart 2098458586 p.2 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of pians&applications as originals will be retained by 2HO) <br /> 1. Site map enclosed YES j] NO[] <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES 0 NO j] <br /> 3. Description of work to be completed(If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> se th I UST.Installation Application pages 4-&a necessary for a timely pian r viewj: <br /> ovl c 9 " <br /> �� V-Cki v-1 V , "l -- C)' �1 �d ` � �q e Cr�'�V �-#-O� C �ji SCK{ <br /> 4. Description of equipment to be used(Att, h drawingstblueprints as tiecessar� l_�N ,L{ 't ��'� 1`k <br /> c�. Y'? nlasr ^tL� — -� t <br /> QI,ITitC �-(Z`r� �'so3�:�'�`'� T' v-i'iror 8So3sJ�r„rT; prvPTw D-Yinq P5v3 9-/� !c sed -td rej,--zke+ <br /> 5- All equipment is State certified or approved, YES W NO <br /> B. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NOT] <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 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. Descrit:e 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 ID#Cif transported to a permitted TSD facility) <br /> 8. Is the sampling firm an independent third party from the contractor? YES[] NO I J <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 Zig <br /> b)If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />