Laserfiche WebLink
UST SYSTEM RETROFIT OR REPAIR <br />AV, <br />1. Site map enclosed YES[] NOT4 <br />'liviR,�411§ <br />M-17 =1 �WUZ;I�H <br />5. All equipment is State certified or approved- YESU NO <br />S. Decontamination Procedures: <br />a. VIIII piping be decontaminated prior to removal? TES[] N <br />b. Identify contractor performing decontamination: <br />Name P•ne( <br />Address city <br />--.-;6p <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsale material will be stored onsite prior to ma�4ng oftite. <br />a. Pineate Hauler and permitted Treatment, Storage & U* posal Facility: <br />Hauler Name Phol Hauler Reg#_ <br />Address <br />Zip_ <br />Permitted Disposal Site <br />I Y\ <br />7. a. Describe the method that will be utilized andfor inert the piping: <br />b. Piping Hauler. <br />Name Phone <br />Address City_ <br />Zip <br />Hauler Regletration # (N he rdous) <br />c. Piping Disposal Site: <br />77 <br />Name Phone <br />Address -city_ <br />Zi <br />EPA lD# (if transporte�r permitted TSD facility)_ <br />8. Is the sampling firm ay( independent third party from the contractor? YES NO[] <br />9. Describe, in detaiow the soil and/or water sample(s) beneath the piping or dispenser will be <br />obtained: <br />10. H5andfing soil (Contaminated Soil Hazardous Waste Hauler): <br />ex <br />/ <br />Name Hauler Reglatration # Phone <br />re <br />Add city_ <br />Zip_ <br />b soil is not to be hauled, describe what will be done with it <br />K <br />