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Aug 25 08 09:16a Reliable Petroleum 209-845-8953 p.4 <br />0 0 <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 YES [ ] NO <br />2. Manufacturer's spec sheets attached for all equipment to be installedYES [ ] NOX <br />3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br />y.�e the UST Instal ation Application pages 4-8 s necessary for a timely plan review): <br />',t�a.nln� f PPf I &� 'n r[ ,�, L� sir ,,�.s - t L:a .I5« �' t Sc:/c_ Tom. � 'E� <br />4. Description of equipment to be used (Attach drawingslblueprints as necessary): <br />WA . <br />5. All equipment is State certified or approved. YES)( NO ( ] <br />6. Decontamination Procedures: <br />N1R' <br />a. Will piping be decontaminated prior to removal? YES [ ] NO(] <br />b. Identify contractor performing decontamination: <br />Name Phone( l <br />Address city Zip <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: Ae Aa <br />I- <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler NameN /19 Phone(_)Hauler Reg# <br />Address City <br />Zip <br />Permitted Disposal Site <br />7. a. Describe the meta that will be utilized to purge and/or inert the piping: <br />l/ <br />b. Piping Hauler,/ <br />N16 <br />Name Phone (� <br />Address ICity <br />Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />NIA Phone <br />Name �) <br />Address City <br />Zip <br />EPA ID# (if transported to a permitted TSD facility) <br />8. Is the sampling firm an independent third party from the contractor? YES [ J NO[] <br />IV/n <br />9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: A IA - <br />10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): A)/A . <br />Name Hauler Registration # Phone �) <br />Address City <br />Zip <br />b) If soil is not to be hauled, describe what will be done with it: N' /41 <br />K <br />