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12-09-`08 09:29 FROM-WENDT CONSTR. 1-209-547-9312 T-539 P03/08 U-653 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals wlll be retained by END) <br /> 1. Site Wrap enclosed YES NO[] <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES NO() <br /> S. Desrript'on of work to be completed(1f addin piping, tjoc,% or other UST equipment,or performing tank top upgrade, <br /> us a UST Installation Ap lieed, +pages 4-8 as necessaa I or a timely pian review) <br /> i <br /> a. Description of eq+sipmentto be used(Attach dr"awingslblueprints as necessary): <br /> 5. All equipment is State certified or apprOved, YES(J NO[] <br /> 6. Decontamination Procedures: <br /> a.vlliil piping be decontaminated prior to removal? YES[) N®(, <br /> b. Identify contractor performing decontamination: Phone{_„ <br /> Name City Zip <br /> Address <br /> I c. Describe method to be used for decontamination: <br /> i <br /> d. Describe flow rinsate material will be stored onsite prior to manifesting offsite: <br /> i <br /> e. Rinsate Hauler and permitted Treatment,StoragePh®&Di` y:Disposal PacllitHauler <br /> Hauler Name City Zip <br /> J Address <br /> Permitted Disposal Sita <br /> 7, a. Describe the method that will be utilized to purge and/or inert the piping: <br /> b. Piping Hauler: Phone <br /> Name city Zip <br /> Address <br /> Hauler Registration (if hauled as hazardous} <br /> Q. Piping Disposal Site; Phone <br /> Name City Zip — <br /> Address <br /> i <br /> EPA IDO(if transported to a permitted TSD facility? <br /> i <br /> g, Is the sampling firm an independent third party from the contractor? YES[J NO <br /> i <br /> g. Describe,in detail,how the soil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 9 <br /> 10, Handling of excavated soil(Contaminated Soil Hazardous Waste Mauler): <br /> Name Hauler Registration# phone <br /> «--------- <br /> I City p, <br /> Address <br /> b)if soil is not to be hauled,describe what will be done with it: <br /> I <br />