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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 addin 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 /> 4W Alf �g7sn <br /> 4. escription of a uipment to be used Attac 4rawings/blueprints as necessary): <br /> du OL <br /> 5. All equipm t is State certified or approved. YES [] NO[] <br /> 6. Decontamina ion Procedures: <br /> a. Will piping a decontaminated prior to removal? YES [] NO[] <br /> b. Identify con actor performing decontamination: <br /> Name Phone(_) <br /> Address City Zip <br /> c. Describe metho to be used for decontamination: <br /> d. Describe how rinsat material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and per fitted Treatment, Storage&Disposal Facility: <br /> Hauler Name Phone(_) Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will\butilized to purge and/or inert the piping: <br /> b. Piping Hauler: <br /> Name Phone( ) <br /> Address City Zip <br /> Hauler Registration#(if hauled aszardous) <br /> c. Piping Disposal Site: <br /> Name Phone( ) <br /> Address City Zip <br /> EPA ID#(if transported to a permitted TS facility) <br /> 8. Is the sampling firm an independent third pa from the or? YES [] NO[] <br /> 9. Describe, in detail, how the soil and/or water s ple(s) beneath the piping or dispenser will be obtained: <br /> 10. Handling of excavated soil (Contaminated Soil Haz rdous Waste Hauler): <br /> Name Haul r Registration# Phone ( ) <br /> Address City Zip <br /> b)If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />