Laserfiche WebLink
02/20/2008 WED 15:24 FAX 2094683433 SJC EHD --- Stockton Sery Sta Eq Co 0004/008 <br />r <br />T , <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 W/1' NO [ ] <br />2. Manufacturer's spec sheets,attached for all equipment to be Installed YES [ ] NO [ ] <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 />I A- <br />4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br />y'� CZ- C Ptt� K\STS... vc- Vi�C � aT`�.:�y-a�"'ie�► <br />V .1r? V <br />5. All equipment is State certified or approved. YES [ VO ( ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name_ _Phone(_�j <br />Address City Zip <br />c. Describe method to be used for deco lamination: <br />y <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name_ A Phone(_) Hauler Reg# <br />Address _ City Zip <br />Permitted Disposal Site <br />7. a. Describe the method that will be utili to purge and/or inert the piping: <br />b. Piping Hauler: <br />Name Phone (� <br />Address V City Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site. <br />Name, Phone (� <br />Address City Zip <br />EPA I®# (if transported to a permitted TSD facility) <br />e <br />8. Is the sampling firm an independent third party from the contractor? YES [ ] NO [ ] <br />9. Describe, in detail, how the soil and/orater sample(s) beneath the piping or dispenser will be obtained: <br />10. Handling of excavated soil (Claminated Soil Hazardous Waste Hauler): <br />Name_,_ _ _ Hauler Registration # -Phone(-- <br />Address- <br />hone(_Address mt City Zip <br />b) If soil is not to be hauled, describe what will be done with it: <br />2 <br />