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Sunday, June 15, 2008 8:08 AM HMC- Henderson Maint Co(209)465-4988 p.03 <br /> 06/03/2008 TUE 15.47 FAX 209, 433 SJC EHO 2005/005 <br /> Monday,June 02,2008 3:35 PM HMC• Henderson Mairit Co(209)465-4988 p.02 <br /> 06/02/2000 MON 171:29 PAU 2090' 433 SJC ZHD ®002/002 <br /> US It SYSTEM RETROFIT OR REI-AIR <br /> (Submit mi►dnturn of 2 cels of plans &applications as originals will be retained by EHO) <br /> 1. Site map en losed YES [) NO(] <br /> 2, Manufacturer's spec shoots altachsd for all equipment to be instaliod VE.Ss O NO I) <br /> 3. Description o(wn(W to tae completed(lf s din piping. UDC'v,or other UST Cquipment,or performing tank top upgrade, <br /> use(he UST Installation Application pages 4-tt as necessary for a timely plan review): <br /> Ii 87 1_t_1) _.. <br /> 4. oseriphon of equipment to be used(A.114ch drawl igs/blueprints as necos8e►ry)' <br /> yhel-.71,I-F , +-_tl.-L&OLK4,r $,S1oU-i VM.I /AU-b y4-.�Q.20oe , <br /> 5. All e+gtiiprttent is State certified or approved. YFS() NO() <br /> S. Decontarnination ProcWtires; <br /> a Wli piping be oucontairlInale4 pity to Pefnt7vRiT YES(I NO(I <br /> b. Irientlfy contractor performing decontamtnallon: <br /> Name .. _. . —._Phone(..._.–)— __ _. <br /> Address City -Zip _ T <br /> c. t)escribe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored ensile prior to manifesl!ng offsite: <br /> e. Rtnsate Mauler and permitted Tleatmerit,Storage&Disposal Facility: <br /> Hauler Name Pnone(,____) Hauler Realk– <br /> Address <br /> Pelmitted Disposal Site <br /> 7. o. Doscrtbe the mettiod that will he utilized tv puree andior inerl the piping: <br /> I) Piping Hiuler: .- . <br /> Name Phone <br /> Address city„ zip <br /> Houfor t2egletration It(i anted-as haiardout) _ <br /> C. Piping Disposal Site: <br /> Name Phone(,____) <br /> Addrarm _ —.City- T,ip <br /> EPA lD#(if transported to a permitted TSO facility) <br /> a- is the sampling firm an incaperidant Third party from the contractor?YES O NO[ <br /> g. Desc4ibe.in detail, how the soi!and/or water sampio(s)beneath the piping or dispenser will be oblained. <br /> 10- 1-16noling of exravated soil (Contaminated Soil l4azardous Waste Hauler): <br /> Name _Hauler Registration# phone(_�) <br /> Addi96S_ - City _—. Lip <br /> ti)If soil ie not to be hauled,descrive what will be done with it: <br /> 2 <br />