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UPSYSTEM RETROFIT OR RERIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) <br /> 1 Site map enclosed YES NO)r <br /> A <br /> 2, Manufacturer's spec sheets attached for all equipment to be installed YES P, NO <br /> 3. Description of work to be completed(if g!j"in piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> use the UST Installation Application pa es 4-8 as,n g essary for a timely IanC review): <br /> COV- T(V�v Urti, AU <br /> Aj D 12 Ir SA 14�)0,J C Ke <br /> 4. Description of equipment to be used (Attach drawin /blue Tints as necessary): <br /> �C <br /> 02W Q," DV9_ 5C)i 11 (TVC <br /> 5. All equipment is State certified or approved. YEW NO <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone <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 Zi <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 /> Name Phone <br /> Address city— Zip <br /> Hauler Registration#(if hauled as hazardous <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address _City Zi <br /> EPA 1D#(if transported to a permitted TSD facility <br /> 8. Is the sampling firm an independent third party from the contractor.? YES NO <br /> 9. Describe, in detail, how the soil and/or water sample(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 />