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Apr 04 02 12:19p Elite IV Contractors Inc 2094616342 P.11 <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 2 sets of plans & applkations as originals will be retained by EHD) <br />1. Site map enclosed YES I I NO [] <br />2 Manufacturer's spec sheets attached fbr all equipment to be installed YES I I NO [ I <br />3. Desaipdonofwork tobe-co.mpieed-fff-gg!±� �,' �,ff w-6kST-equipment- or performing tank top upgrade, <br />use the UST Installation Application pages 4-8 as necessary for a timely plan review): <br />4. <br />5- Ad equipment is State certified or approved. YES [I NO [) <br />17 177T <br />a. Will piping be decontarninated prior to removal'? YES NO [] <br />b. Identify contractor performing decontamination: <br />Name Phone( I--. <br />Address city —zip <br />45-TaF =**, <br />nrj7t,7j?=-,i =,tzjj(4 <br />z. ffinsate Hauler and permitted Treatrn6nt, 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: <br />8. <br />9. <br />10. <br />b. Piping Hauler. <br />Name Phone <br />Address City _.Zip <br />kitiliir Registration# (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone I <br />Address <br />Zap <br />EPAIM (d transported to a permitted TSD bcw)— <br />Is the sampling firm an independent third party from the contractor? YES NO <br />Describe, in detaff, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />HandEng of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauller Reffistratiko # Phone( <br />Address City— zip <br />b) If soil is not to be hauled, describe what will be done with it <br />2 <br />