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Ll <br />C <br />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 [I <br />2 Manufacturer's spec sheets attached for as equipment to be installed YES [ l NO [ l <br />3. Description of work to be completed (If aqft piping, UDC's, or other UST equipment, or perfonnirg tank top upgrade, <br />use VVST Installation Application 4-8 as necessary for a timely plan review): <br />_ r •r i .. . <br />5- AN equipment i. State certified or approved. • <br />6. Decontamination Procedures: <br />a. Wig piping be decontaminated prior .. . O <br />b- Identily' contractor Perfoffning decontamination: <br />Name Phone( - <br />Address city —zip <br />Hauler Name Hauler Reg# <br />Address CRY zip— <br />ftrmitled Disposal Site <br />a. Descrbe the method that wilt be utilized to purge andfor inert the piping. <br />b. Piping Haub. <br />ewame Phone (� <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Stie: <br />IWme Phone (_ ) <br />Address CitV Zip <br />EPA 09 (f transported to a permitted TSD facility) <br />&. Is the sampling firm an independent third party from the contractor? yES [ 1 NO [ J <br />9. Describe, in detail, how the sal and/or water sample(s) bpneath the piping or dispenser will be <br />10. Handling of exmialed sol (Contam' 'Soil Hazardous Waste Haft): <br />Name Hauler Reffishadon # PhoneAddrew <br />Cily Tap <br />b) If so# is not to be hauled, describe what wig be done with it <br />