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. Apr 05 07 09:07a Elit^ Iv Contractors Inc 209461F942 p.2 <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[] NOS 4- <br />/ <br />2. Manufact is spec sheets attached for all equipment to be installed YES (] NO [ J <br />3. Descri oon work to be completed (If addir q piping, UDC's, or other UST equipment, or performing tank top upgrade, <br />use t 'Don <br />pages 4a8 as necessjary for a UWly Agan rer j r�r�! <br />4- <br />5. All equipment is State certified or approved. YES [ ] NO [I <br />6. Decontamination Procedures: <br />a_ Will piping be decontaminated prior to removal? YES[] N <br />OLI <br />b. Identify contractor performing decontamination: <br />Phone() <br />Name city Zip <br />Address _. <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 Haulier and pennitted Treatment, Storage & Disposal Facility: <br />Hauler Name Ohone(C __J Hauler Reg# <br />Address city zip <br />— <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 />Phone <br />Name city Zip .. .. <br />Address <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone (___j <br />Address City Zrp <br />EPA ID# (if transported to a permitted TSD facility) <br />8_ is the sampling firm an independent third party from the contractor? YES [ ] NO[] <br />g. Describe, in detail, how the soil and/or water sampie(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 />