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E <br />UST SYSTEM RETROFIT OR REM <br />(Submit minimum of 2 sets of plans & aPprmaWns as originals win be retained by Efil)) <br />1 Site map enclosed YES f Nl� <br />2- Manufacturer's Spec sheets attached for an equipment to be installed YES Poo f I <br />3- Description Of work to be completed (if adft_q piping. UDCs, or other UST eqLqxnert or performing tank top upgrade, <br />the UST IAPp' <br />�ation es 4a as qpcessaq for a <br />ft* plan review): <br />4 ' 4 <br />9= <br />MUNW1013 1 11 <br />N� <br />5- All equipment is State cerffied or approved. yES NO <br />f DecOntmmmabon Procedures: <br />a- VM APIng be decontaminated prior to removap <br />b- ldenfffYcOnt♦rpwbmangde=7WWnagon: <br />Name <br />Add hone(-� <br />city zip <br />c- Dewbe meffW tD be used for &=ftr,*�: <br />d. Descr&e how rhmaL, material Will be stored onsite prior to manffe_qfng offs& -- <br />e, Rkmte HaUW and pennifted Treatment SWrage & Disposal FacW <br />Hauler Name <br />Address 5 .;—Hauler Reg# <br />P LI-mWed <br />7., a- Deswbe the method that will be ul!ilized to purge andfor inert the piping. <br />b- "P09 Hauler- --------- <br />tion #(f auled �as <br />Phone C <br />— zip <br />Phone ( <br />to ...... � zip-� <br />8. Is the samprmg firm an Independent third party f <br />rom the contr <br />ac,Dr? YES <br />I NO [I <br />9. De=be. in detall, how the son andjor water sampL.0) L�eneath the piping or dispenser win be obtakled: <br />10. Handing of excavated $04 (Confaminated-Son Ha• zardous Wagle Haulery <br />Mme Hauler Regisb*iou <br />Phone <br />• <br />b) If 309 is not to be hauled, describe what will be done with it <br />