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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 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 /> �D <br /> 4. Description of(kuipmen$,to be used (Attach drawings/blueprints as necessary): <br /> 5. All equipment is State certified or approved. YES)q NO[] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone( ) <br /> Address City Zip <br /> c. Describe method to be used for decontamination: ;7 <br /> d. Describe how rinsate material will be stored onsite prior to manifesting off ' e: <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal F ity: <br /> Hauler Name Phone(_) H ler Reg# <br /> Address Ci Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge an or inert the piping: <br /> b. Piping Hauler: <br /> .Name Phone ( ) <br /> Address City Zip <br /> Hauler Registration#(if hauled ash ardous) <br /> c. Piping Disposal Site: <br /> Name Phone( ) <br /> Address City Zip <br /> EPA ID#(if transported to a ermitted TSD facility) <br /> 8. Is the sampling firm an ' dependent third party from the contractor? YES [] NO[] <br /> 9. Describe, in detail, w the soil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handling 2ex/cavated soil (Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone( ) <br /> Add res City Zip <br /> b) If oil is not to be hauled, describe what will be done with it: <br /> 2 <br />