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0 • <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[I NO[I <br /> 2 Manufacturer's spec sheets attached for all equipment to be installed YES[j NO[j <br /> 3. Description of work to be completed(if adding 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 /> REt1r., -11 Rea/ C-r- _I1 2-7 4/d22 h-11.Cke.r Girv� <br /> 4. Description of equipment to be used(Attach drawingstblueprints as necessary): <br /> Lc ) <br /> 5. All equipment is State certified or approved. YES[j NO[I <br /> 6. Decontamination Procedures: <br /> a.VIII piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone( <br /> Address City Zp <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate materiat will be stored onsite prior to manifesting offsite: <br /> e. Rimsate Hauler and permitted Treatment,Storage&Disposal Facility. <br /> Hauler Name Phone�J Hauler Reg# <br /> Address city zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that wilt be utilized to purge and/or inert the piping: <br /> b. Piping Hauler. <br /> Name Phone <br /> Address . _ City Zip <br /> Hauler Registration It(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address City. Zip <br /> EPA ID#(if transported to a permitted TSD bcifdy) <br /> 8. Is the sampling firm an independent third party from the contractor?YES[j NO[j <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 sod(Contaminated•Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone( } <br /> Address City Zip <br /> b) If sod is not to be hauled,describe what will be done with it <br /> 2 <br />