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May 19 08 03:01p RELIABLE PETROLEUM SERVIC 2098458953 P.5 <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 [] NO X <br /> 2. Manufacturers spec sheets attached for all equipment to be installed YESKNO[] <br /> 3. Description of work to be completed (If adding piping, UDC's, or other LIST equipment, or performing tank top upgrade, <br /> use the UST 1pstallation Application pages 4-8 as necessary for a timety plan review): <br /> - l-3 V N'3-- �hLAI bi Zkle-12270 M K:2 ±Lt't4 LI)Lt� Ed <br /> 4�11 <br /> 4. Descn'ption of equipment to be used (Attach drawings1blu9prints as necessary): <br /> Eek :SLCJ—V­i��— EY:1\1 <br /> 5. All equipment is State certified or approved. YES 0 NO <br /> 6. Decontamination Procedures: pi/4 <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name PhoneC___j <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. Describe the method that will be utilized to purge and/or inert the piping: 44- <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 IDN(if transported to a permitted TSD facility) <br /> 8. Is the sampling firm an independent third party from the contractor? YES NO (] /V/4 <br /> 9. Describe, in detail,how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: /11/4 <br /> 10- Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): A//+ <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 />