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6 . <br />09/26/2008 FRI 16:47 FAX 2094683433 SJC EHD 0003/007 <br />' t . <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed YESX NO [ ] <br />2. Manufacturer's spec sheets attached for all equipment to be installed YES NO[] <br />3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br />use the UST Installation application pages 4-8 as necessary for a timely plan review): <br />r1n n k A Thr \ le M 0 -k/\ <br />4. Description of equipmen o be used (Attach drawings/blueprints as necessary): <br />5. All equipment is State certified or approved. YE A NO [ ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name C61 Phone(_) <br />Address City Zip <br />c. Describe metho to be used for decontamination: <br />61 <br />d. Describe how rin to material will be stored onsite prior to manifesting offsite: <br />e. Rinsate ermitted Treatment, Storage & Disposal Facility: <br />Hauler NPhone( ) Hauler Reg# <br />Address City <br />jDisposa <br />Zip <br />Permittee <br />7. a. Describehat will be utilized to purge and/or inert the piping: <br />b. Piping Hauler: <br />Name Phone( ) <br />Address City <br />Zip <br />Hauler Registration 161if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone (_) <br />Address City <br />Zip <br />EPA ID# (if transport! o a permitted TSD facility) <br />8. Is the sampling firm a ndependent third party from the contractor? YES [ ] NO[] <br />9. Describe, in detail, h the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />10. Handling of excavate oil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # Phone { <br />) <br />Address City <br />Zip <br />b) If soil is not to be auled, describe what will be done with it: <br />61 <br />