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UST SYSTEM -RETROFIT OR REPAIR <br />(Submit minimum of 2 sets of plans & applications as originals will be retained by END) <br />1. Site map enclosed YES NO <br />Z Manufacturer's spec sheets attached for all equipment to be installed YES[ I NO <br />3. Description of work to be completed-(If79qqtg-,'A '. . of - er-UST--equipment- or performing tank top upgrade, <br />use the UST Installation Application pages 4-8 as necessary for a Timely plan review). <br />5. All equipment is State certified or approved. YES [] NO Q <br />6- Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES[] NO[] <br />b. Identify contrador performing decontamination: <br />Name Phone( <br />Address city Zip <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsate materW will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name PhoneC_J Hauler Reg#_ <br />Address City 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- Zip <br />Hauler Registration 0 (if hauled as hazardous <br />c. Piping Disposal Site: <br />Name Phone <br />EPA lD# Cd transported to a permitted TSD facMW)_ <br />B. 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 wig be obtained: <br />10. Handling of -excavated, soil - (Confaminated'SoN Hazardous Waste Hau".- <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 />I -5A- <br />8 -Cl ajbC9T8-jr60a OUI SJ040eJ4U00 AI 84T13 dLD:To 20 06 unr <br />