COMPLIANCE INFO_2004-2009 - Laserfiche WebLink

Home Browse Search

r UST SYSTEM RETROFIT OR REPAIR (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) 1. Site map.enclosed YES K NO [] 2. Manufacturer's spec sheets attached for all equipment to be installedYES[] NO [] I�4(A 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application pages 4-8 as necessary for a timely plan review): R E 9 4 L 2 a(= •i-N-I- 9-4- S 1-P S v vN P k" 9 1 Fr c t 7 U im 0 4. Description of equipment to be used (Attach drawings/blueprints as necessary): I t P IZ E S)N Pr of p W q---T;K r, lM A-T e-rz t A--c S 5. All equipment is State certified or approved. YES(] NO [] M 14 6. Decontamination Procedures: a. Will piping be decontaminated prior to removal? YES [] NO [] b. Identify contractor performing decontamination: Name Phone( Address City Zip c. Describe method to be used for decontamination: d. Describe how rinsate material will be stored onsite prior to manifesting offsite: e. Rinsate Hauler and permitted Treatment, Storage& Disposal Facility: Hauler Name Phone ) Hauler Reg# Address City Zip Permitted Disposal Site 7. a. Describe the method that will be utilized to purge rt b. Piping Hauler: Name Phone(� Address City Zip Hauler Registration#(if hauled as hazardous) c. Piping Disposal Site: Name Phone(� Address City Zip EPA ID#(if transported to a permitted TSD facility) 8. Is the sampling firm an independent third party from the contractor? YES[] NO[] 9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): Name Hauler Registration# Phone(� Address City Zip b) If soil is not to be hauled, describe what will be done with it: 2 I