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May. 29. 2007 9:55AM No, 0491 P. 2 <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 installed YESV NO [] <br /> 3. Description of work to be completed (If addhig 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 /> d <br /> 4. Description of equipment to be used(Attach drawings/blueprints as necessary): <br /> 5. All equipment is State certified or approved. YES NO[] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES] NO[] <br /> b. Identify contractor pert ing decontamination- <br /> Name <br /> ecor amination: <br /> Name 1C Phone� �0 <br /> Address City c <br /> c. Describe method to be u ed for deconta in ion: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> 411-4 , <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name Phone( ) Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the methooYTtwill be utilized to purge and/or inert the piping: <br /> b. Piping Hauler: <br /> Name Phone <br /> Address City Zip <br /> Hauler Reglstrat' n#(if hauled as hazardous) <br /> c. Piping Disposal 'te: <br /> Name Phone C__) <br /> Address City Zip <br /> EPA ID#(if transported to a rmilted TSD facility) <br /> 8. Is the sampling firm an independ nt third party from the contractor? YES [] NO[] <br /> 9. Describe,in detail,how the soil an for water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handling of excavated soil(Co aminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone(� <br /> Address City Zip <br /> b)If soil is not to be hauled, escribe what will be done with it: <br /> 2 <br />