COMPLIANCE INFO_2003-2009 - 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 '¢(,[ NO [ ] 2. Manufacturer's spec sheets attached for all equipment to be installedYES fA 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 pages 4-8 as necessary for timely plan review): • SKst'A-VL A. -t04 oC- IPuPI.9V St EVrL 7.zsp . 4. Description of equipment to be used (Attach drawings/blueprints as . LL t& r %/ - i/ a at% a— _ 7 n n Def A c a rt- r- SLacx Mcc 5. All equipment is State certified or approved. YES b4 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: r i A -T FE"" 4 F T -w o ,ss�ry): Jr s 6 L Q v t PvKG+--� - F-1 r r, 1 F YES[] NO[] Phone( 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 Permitted Disposal Site 7. a. Describe the method that will be utilized to purge and/or inert the piping: Zip Piping Hauler: Name Phone (� Address City Zip Hauler Registration # (if hauled as hazardous) c. Piping Disposal Site: Name Phone (� Address City Zip EPA ID# (if transported to a permitted TSD facility) 8. Is the sampling firm an independent third parry from the contractor? YES [ ] NO [] 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 #_ Address City b) If soil is not to be hauled, describe what will be done with it: 2 Phone (� Zip