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r <br /> 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[] NO[] <br /> 3. scription of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> us the UST Installation Application pages 4-8 as necessary for a timely plan review): <br /> 4. Descripti of equipment to be used(Attach drawings/blueprints as necessary): <br /> 5. All equipment i State certified or approved. YES[] NO[] <br /> 6. Decontamination rocedures: <br /> a. Will piping be d ontaminated prior to removal? YES[] NO [] <br /> b. Identify contracto erforming decontamination: <br /> Name Phone( <br /> Address City Zip <br /> c. Describe method to be ed for decontamination: <br /> d. Describe how rinsate material ill be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treat ent, Storage&Disposal Facility: <br /> Hauler Name Phone( ) Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to pur and/or inert the piping: <br /> b. Piping Hauler: <br /> Name Phone U <br /> Address City Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone(� <br /> AddressCity Zip <br /> EPA ID#(if transported to a permitted TSD facility) <br /> 8. Is the sampling firm an independent third party from the contractor?\piping <br /> NO [] <br /> 9. Describe, in detail, how the soil and/or water sample(s) beneath the dispenser will be obtained: <br /> 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone(� <br /> Address City Zip <br /> b) If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />