COMPLIANCE INFO_2006-2008 - Laserfiche WebLink

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UST SYSTEM RETROFIT OR REPAIR (Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) 1. Site map enclosed YES [ ] NON 2. Manufacturer's spec sheets attached for all equipment to be installed YES K NO[] 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use, the UST Installation Application ages 4-8 a necessary for a timely plan review): lot, j 331 0 -� �30 � CEC'�'tf�t1Cy - a, --t ym 4. Description of equipment to be used (Attach drw gss/blueprints as necessary): 141Z- 3t 6- C't 5. All equipment is State certified or approved. YES NO [ ] 6. Decontamination Procedures: a. Will piping be decontaminated prior to removal? b. Identify contractor performing decontamination: Name Address c. Describe method to be used for decontamination: YES[] NO[] lone(_) City Zip d. Describe how rinsate material will be stored onsite prior to manifesting offsite: e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name Phone( ) Hauler Reg# Address City Zip Permitted .Disposal Site 7. a. Describe the method that will be utilized to purge and/or inert the piping: b. Piping Hauler: Name Phone Address City Hauler Registration # (if hauled as hazardous) c. Piping Disposal Site: Name Address EPA ID# (if transported to a permitted TSD facility _ Phone City 8. Is the sampling firm an independent third party from the contractor? YES [ ] NO [ ] Zip Zip 9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): Name Hauler Registration # Phone ( ) Address City Zip b) If soil is not to be hauled, describe what will be done with it: 01