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UST SYSTEM RETROFIT OR <br />Eew• : • •„ r <br />1. Site map enclosed YES [ ] NO [I <br />2. Manufacturer's spec sheets attached for all equipment to be installed YES [ j NO [ j <br />5. All equipment is State certified or approved. YES (I NO [] <br />,+1 Y • F . 157 r a <br />a. Will piping be decontaminated prior to removal? YES [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name Phone( ) <br />Address city —zip <br />i ar • •• •_ a1 76r, 1= I!• <br />e. Rinsate Hauler and permitted Treatment Storage & Disposal Facility: <br />Hauler Name oa. <br />Address city Zip <br />Permitted Disposal <br />7. a. Describe the method that will be utilized to purge andtor inert the piping: <br />b. Piping iNauler <br />Name Phone <br />Address City- zip <br />• 1 ihauledas hazardous). <br />c. • Disposal •. <br />Name Phone <br />+ • • i <br />EPA 1D# (if transported to a permitted TSD facility)_ <br />8. Is the sampling firm an independent third party from the contractor? YES f I NO[] <br />9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration <br />Address _Gity Zip_ <br />• •. r • •- ••'. •- a •• s.• <br />