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v <br />y <br />MALA414 ,, 1 V4 .e IN . , <br />(Submit minimum of 2 sets of plans & applications as originals will be retained by END) <br />1. Site map enclosed YES [ j NO [] <br />2 Manufacturers spec sheets attached for all equipment to be installed YES [ j NO [ j <br />3. Description of work to be completed (if a piping. UDC's, or other UST equipment, or performing tank top upgrade, <br />use th"ST l5nstatlation Application es 4-8 as necessary fora timely plan review): . /) ; . , , A <br />�XW—I I/1,0WW75 A�-WarAIRM1 AAM7Gr!JWR_*1r0 <br />- � ori � ` � <br />6. Decontamination Procedures: <br />a. Wig piping be decontaminated prior to removal? YES [ ] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name Phone(. <br />Address City Zip <br />r •. <br />e. Rimmte Hauler, and permitted Treatment Storage & Disposal Fatality: <br />Hauler Name Hauler Reg# <br />Address Ctty rip <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge and/or inert the piping: <br />b. Piping Haub: <br />Name Phone <br />Address . <br />C ty Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone <br />Address City Zip <br />EPA IM (if transported to a permitted TSD fades) <br />8. Is the sampling firm an independent third party from the contractor? YES [I NO [ ] <br />9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser wiq be obtained: <br />10. Handling of excavated soil (Coniaminated'Sog Hazardous Waste Hauler): <br />Name Hauler Registratim fi Phone <br />Address City Zip <br />b) If so# is not to be hauled, descrbe what will be done with it <br />