COMPLIANCE INFO_2005-2008 - Laserfiche WebLink

Home Browse Search

-S U SYSTEM RETROFIT OR RE IR (Submit minimum of 2 sets of plans & applications as originals will be retaij� jj�1j'I,i_,�- 1. Site map enclosed YES [] NO JUL 0 200 2. Manufacturer's spec sheets attached for all equipment to be installed YES [] NO,1.- ENVIRONMEIV-#H',-Al.TN 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, o ( ,�,op upgrade, use the UST I stallation Application pages 4-8 as necessary for a timely plan review): ® g= 4. Description of equipment to be used (Attach drawings/blueprints as necessary): '0 �.r 5. All equipment is State certified or approved. YE O [] 6. Decontamination Procedures: a. Will piping be decontaminated prior to removal? YES [] NO [] b. Identify contractor performing decontamination: Name Phone(_) Address City Zip c. Describe method to be used for decontamination: d. Describe how rinsate material will be stored onsite prior to manifesting offsite: e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name Phone( ) Hauler Reg# Address City Zip Permitted Disposal Site 7. a. Describe the method that will be utilized to purge and/or inert the piping: b. Piping Hauler: Name Phone ( ) Address City Zip Hauler Registration# (if hauled as hazardous) c. Piping Disposal Site: Name Phone ( ) Address City Zip EPA ID#(if transported to a permitted TSD facility) 8. Is the sampling firm an independent third party from the contractor? YES [] NO [) 9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): Name Hauler Registration # Phone ( ) Address City Zip b) If soil is not to be hauled, describe what will be done with it: 2