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04/06/2007 09:12 2094684.33 EHD PAGE 04 <br />RPr 05 07 03:07a Elite 1v ConLractO. s Ira 2034616342 P.2 <br />y Jj V <br />JU <br />UST SYSTEM i <br />(submit minimum of 2 sets of plans a <br />1. sire map enclosed YES (] N044_� <br />2 Man r s spec sheets attached for aU equip - <br />3. Descd work to be completed (it addin-41 PiPir <br />use Raga' as n <br />ROF T OR REPAIR r lI ��r', �•r ` <br />;ations as originaiss ma be retained by Eli C7} <br />be instagodYE5 ( ) NO ) <br />K: s, or other UST equipment, or pertoffning tank top upgrade, <br />pry fo► a limy p)an r 'i9"%1 _ /, , ;,, <br />1'd ZirE919t,60Z DUI 5J04QeJ4U00 nI a4113 e8s:60 Lo al jdd <br />u <br />j --2blb�"44, t nt5 as 'e4, <br />�qurp e t fawvr <br />Descri ion of <br />I <br />n( <br />/ $ I <br />1rit itJred YDS (j O <br />5. <br />AN eq rpmeis�SCate or5p/proGved. <br />1r� <br />`? G ' <br />Decontamination proudures= too YES(] NUL I <br />prior <br />a tif1�p pipirigiie detontamineled p 1 <br />1I (L <br />b. idemifycordradorperforraingdecontaminatiom <br />Name city ____—-�P.•--- <br />Adelmss <br />C, Desaibe method to be used for decontamination <br />d, Describe how finale maledat will be stored prior to rnanifesfrng Oft te: <br />i <br />o. Abssata Hauler and pes+e itled-rmatrnent, Sto b Dapasat � Y' <br />oneL--) Hxr{Er Recce_ <br />t t Nam a City _ Zlp� <br />_ <br />Address <br />permitted Disposal site j . <br />7, <br />a. Describe the me@md that wilt be utilized lu purge and/or inert the pining- <br />I <br />, <br />b, piping HaulerPhone,( 1 - - <br />Nair" .... _.. city—. Lp <br />Address <br />F1aUIsr Registrstfon (t (rf hauled as hazardotrs) <br />C. piping Disposal Site. Phone ( ) <br />Name Cityy Zip <br />Address <br />EpA [Dell {if transport to a permitted TSD faa I ) <br />g. <br />Is the sampling firm an independent BriRt party Dm the contraclor7 YES [) ND L T <br />Describe. in detail. how the soil andrar water pk'(s) beneath the piping or dispenser -ill be obtained' <br />g. <br />10. <br />ifanding of excavated _o (Con aminated Sad I aza,,o Waste "Ager}- Phone <br />uler Registratiaa i_ ___� <br />_ <br />Name City zip - <br />Andress <br />b) If sod is not to be h:Wed. describe what wiV done with it <br />2 <br />I <br />1'd ZirE919t,60Z DUI 5J04QeJ4U00 nI a4113 e8s:60 Lo al jdd <br />