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Monday, June 02, 2008 3:35 PM HMC- Henderson Maint Co(209)465-4988 p.02 <br /> 06/02/2009 MON 13: 29 PAX 2094 133 SJC ZHD 0002/002 <br /> US j SYSTEM RETROFIT OR REI-AIR <br /> (Submit minirnurn of 2 sets of plans& applications as originals will be retained by EHD) <br /> 1. Site reap enclosed Y5S [) NO[] <br /> 2, Manufacturer's spec sheets attached for all equipment to be installed YES[] NO[) <br /> 3. Description of work to be. completed (If adding piping, UOC'9, or other UST equipment,or performing tank top upgrade, <br /> use the UST installation Application pages 4-8 as necessary for a timely plan review): <br /> C_K<f=:t -/- 8 7 LLQ —-- <br /> 4. Description of equipment to be Used (Attach drawingslblueprints as necessary)! <br /> p�.�l--�!Tom. r:-�I-�y�yc�T. �_SaJ lOU 1��►'l.i �'LILL� �`i 4^,L��L10C e <br /> 5 All c?quipment is State certified or approved. YES [] NO [] <br /> 6. Decontamination Procedures: <br /> a wlU piping be decontan'rlriated prior to refnoval? YES [I NO(] <br /> b. Identify contractor performing decontaminatlon: <br /> Name Phone(_)_____ <br /> Address City <br /> c. Describe method to be used for decoritamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rlnsate 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 puree and/or inert the piping: <br /> b. Piping Hauler <br /> Name Phone (__)_ _ <br /> Address _^ _ _ _ _ Glty Zip <br /> Hauler t2egistration#(if hauted-as* hazardous) <br /> e. Piping Disposal Site: <br /> Name Phone <br /> Address _ , .. __City Zip <br /> EPA IDN(if transported to a permitted TSD facility) <br /> a. Is the sampling firm an independent third party from the contractor? YES[) NO [J <br /> 9. Describe. in detail,how the soil and/or water sampie(s)beneath the piping or disperiser will be obtained. <br /> 10. Harcling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone( <br /> Address__ _ _ City _ Zip <br /> b)It soil is riot to be hauled, describe what will be done with it: <br /> 2 <br />