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SEP -6-2006 10:25A FROM:D&SDRAG-IINE SVC 2098268699 :4683433 P.3 <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 [A +o LoC� a.k. <br />2. Manufacturer's spec sheets attached for all equipment to be installed YES K 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 />Z ,1.0 _ Ana:p I*- i'6. c1�ntllnni <br />4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br />5. All equipment is State certified or approved. YES bq NO [ ] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [k] NO[] <br />b. Identify contractor performing decontamination: <br />Address <br />c. Describe method to be used for decontamination: <br />"Cr ipIB %r.5c. <br />City <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />cum s <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name rS�Cxrw o . Phone(_ �) Hauler Reg# <br />Address 2100 N I 1 city ; _ Zip, b7O Z�"Z <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge and/or inert the piping: <br />b. Piping H uler: ' <br />Name 2J &jh6qa=i62L Phone ( Z.ol j Lg <br />Address's P 6Y ' Cit zip Zip "558 <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Pho <br />Address -Po ov ��LD4� City w •1 a UK. Zlp 9n 3i3 I <br />EPA ID# (if transported to a permitted TSD facility) <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 sampie(s) beneath the piping or dispenser will be obtained: <br />10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # Phone ( j <br />Address City Zip <br />b) If soil is not to be hauled, describe what will be done with it: <br />6 <br />