Laserfiche WebLink
w � <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 [] NO [I <br />2 Manufacturer's spec sheets attached for all equipment to be installed YES [ ] NO [ ] <br />3. <br />3 <br />5. Ad equipment is State certified or approved. YES [] NO [] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name Phone(_ <br />Address City Zip <br />c. Describe method to be used for decont.amint. <br />d. Describe how rinsale materiat will be stored onsile prior to manifesting offsite -- <br />e. Rin wte Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone( Hauler Reg# <br />Address City zip <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge andlgr inert the piping: <br />b. Piping Hauler. <br />Name Phone �) <br />Address City Zip <br />Hauter Registration # Cd hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone U . <br />Address City Zip <br />EPA 1D# (d transported to a permitted TSD fa " ) <br />8. Is the sampling firm an independent third party from the contractor? YES [ ] NO[] <br />9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />10. Handing of excavated soil- (Contam' ,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 />