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UPSYSTEM RETROFIT OR REMIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed YES [] NOK <br /> 2. Manufacturers spec sheets attached for all equipment to be installed YES P NO <br /> 3. Description of work to be completed(if pdding,piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> use the UST Installation Apion es Iti 4-8,1!nressary for a timely an review): <br /> pca pa <br /> C U <br /> ta-, 1164- <br /> a now t' j c Ke <br /> 4. Description of equipment to be used(Attach drawins/blue ripts as necessary): <br /> bcve spi 11 Cc <br /> V <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(____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 oftite: <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name Phone -Hauler <br /> Address city Zip <br /> Permittj 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 Zip_ <br /> EPA ID#(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 Ci tV Zi <br /> b) If soil is not to be hauled, describe what will be done with it: <br />