Laserfiche WebLink
Apr 04 02 12:19p Elite Iv Contractors Inc 2094,B16342 P.11 <br />LIST SYSTEM RETROFIT OR REPAIR <br />V <br />1. Site map enclosed YES I I NO [] <br />2 ManufbcWrer's spec sheets attached for all equipment to be installed YES j ] NO [ ] <br />3. Description of work to be-completed-fif performing tank top upgrade, <br />use the UST Installation Application pages 4-8 as necessag for a timely.plan review): <br />4. Description of equipment to be used (Attach drawings/blueprints, as <br />1_141115' <br />5. AN equipment is State certified or approved. YES [I NO[) <br />6. Decontamination Procedures: <br />a *10 piping be decontaminated prior to . removal? YES ti- No <br />b. Identify contractor performing decontamination: <br />Name Phone( <br />Address city <br />Zip <br />c. Describe method to be used for decontamination: <br />d. Describe how finsate material will be stored onsite prior to manifesting offsite: <br />e. Rhmts Hauler and perniffled Treatin6rit, Storage & Disposal Facility: <br />Hauler Name PhoneC--J:_Hauler Reg# <br />Address city <br />Zip_ <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge andfor inert the piping: <br />b. Piping Hauler <br />Name Phone( <br />Address City <br />Ap <br />kiWer'Registration # (if hauled as hazardous)__ <br />c. Piping Disposal Site: <br />Name Phone <br />Address -City, <br />zip <br />EPA [DO (if transported to a permitted TSD <br />- <br />a. Is the sampling firm an independent third party from the contractor'? YES NO [I <br />S. Describe, in detaff, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />10. Handling of excavated soff (Contaminated 'Soil Hazardous'Waste Hauler): <br />Name Hauler Reg" straCwn # Phone L <br />Address Ply- <br />Zap <br />b)If soil is not to be hauled, describe what will be done with it <br />2 <br />