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UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&appraations as originals well be retained by EHD) <br /> 1. Site map enclosed YES[I NO[I <br /> 2 Manufacturers spec sheets attached for all equipment to be installed YES[j NO[J <br /> 3. Description of work to be completed(If adconq piping,UDC's,or other UST equipment,or performing tank top upgrade, <br /> trams rthe UST f nstalla pa es 4-8 necessary for a ' plan review): <br /> 4. POscription of equipment to be used(Attach drawingstblueprints as ne ry) <br /> � J <br /> 5. aPF !Y ) fy)Lt f OC <br /> 6. Decontamination Procedures: <br /> a.VM piping be decontaminated prior to removal? YES[j NO[] <br /> b. Identify contractor performing decontamination: <br /> Name N Pie( <br /> Address city ZP <br /> c. Describe method to be used for decontamination: <br /> d. Describe how nnsate materW will be stored onsite pnDr to\X7 Resting offske. <br /> e. Rmwte Haubt and pennitled Treatment Storage&Disposal' <br /> Hander Name auler R <br /> Address <br /> Permitted DisposalSite <br /> 7. a. Describe the method that wilt be utilized to purge andlor inert the,poiri : <br /> b. Pring.Hauler: <br /> NaivePhone L <br /> Address ', 21p <br /> Hauler Registmillon#(if hauled as hazard <br /> c. Piping Disposal Site: <br /> Name - z P e L� <br /> Addre=ss may. Zip <br /> EPA (rf transported to a TSD far ty) <br /> S. Is the sampling firm an i ent third party from the contractor?YES[J NO[] <br /> �r <br /> 8. Describe,in detail,how the soil and/or water ssample(s)beneath the piping or des r well be obtained: <br /> 10. Handing of excavated sod(Contaminated-Sod Hauler): <br /> Name Hauler Regishation# Phone <br /> Address i Cttjr Zip <br /> b) If sod is not to be hauled,describe what will be done with it <br /> 2 <br />