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R <br /> +' <br /> Up SYSTEM RETROFIT C* REAR <br /> (Submit minimum of 2 sets of plans&applications as oniglinals will be retained by EHD) <br /> 1. Site map enclosed YES[] NO <br /> 2. Manufacturer's spec sheets ed for all equipment to be installed YES O(] <br /> 3. Description of work to be completed(If AgSlM piping, U `s, or other UST equipment or performing tank top upgrade, <br /> use the UST Installation Application pages as necessary for a ti n revi ): <br /> 4. Description of equipment to be used(Attach drawings/blueprints as ne ry): <br /> 5. All equipment is State certified or approved. YES[] O[] <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 Trp <br /> c. Describe method to be used fordecontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting oftsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Phone( Hauler R <br /> Address city Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utikzed to purge and/or inert the p[ <br /> b. Piping Haug: <br /> Name Phone(� <br /> Address City Zip <br /> Hauler is #(if hauled as hazard ) <br /> c. Piping Disposal Site: <br /> Name Phone(_) <br /> Address cityZip <br /> EPA! (if transported to a permitted TSD facility} <br /> 8. Is the sampling firm an Independent third party from the or?YES[] NO[] <br /> 9. Describe, in detail,how the soil andfor water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handling of excavated soil( inat "1 Hazardous Waste Haulery <br /> Name Hauler Reglstratl4*i# Phone <br /> AddressCity Zip <br /> b)If soil is not to be hauled,describe what will be done with it I' <br /> 2 <br />