Laserfiche WebLink
e <br />cyct, 02 01:48p Elite Iv Contractors Inc 209461G342 p.2 <br />UY/'L6/ ZVutS (xl Y: LO ee.ti .v�•.v •••••• '•"— <br />UST SYSTEM E 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 ( ] NON <br />2. Manufacturer's spec sheets attached for all equipment to be installed YESN 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 necessa t for a timely plan review)ALILL co / VI(w�i` lr J pip <br />y <br />„� , a ; ..� •.,: i ' ; � � , <¢ � f'� � c ' lig Ric", <br />t T %I'rl i't 2' '� Xr ; ` i -� tl 1c r1 ' Pirutcc r �� ityi.11V 11r U.:� J� Poo cti CC, (K(tq, `� (e -Q f� lctCC� <br />tis i�frc c @ fit, t ,� �C f�'l ( p t tx . �i�Y� :� tr} , c��fcs4L r iii X �` <br />Description of equipme t to be used Attach drawings/blueprints as necessary):CC1 i,t rc , .ti <br />1' v(U'J PIP! s , t, t7Yifti <br />,3., fz�c,ic e,.4t�i""crF' - �, 1 ` �.r •. 1 i S � ' - 1 " ' S <br />5. All equipment is State certified or <br />6. <br />Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identil <br />Name <br />Addre <br />NO (I <br />YES(] No [( <br />c. Describe method to be used for decontamination- <br />d. Describe how rinsate material will be s>ored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and. permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone() Hauier Reg# <br />Address City Zip <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge andlor inert the piping: <br />b. Piping Hauier ' <br />Name �1 ` ( �I ) 'L� 1,i( 'L�! i i C bE {�l W F 0 _rl <br />one (— <br />Address City <br />Hauler Registration # (if hauled as hazardous) <br />Zio <br />c. Piping Disposal Site: 1-1 „ <br />Name_ ' tt t�( iCi�.��,-) C� 1 UM Lei ►1C' Phone (_) <br />Address City zip <br />TEPA ID# (if transported to a permitted TSD facility) <br />%8. \ is the sampling firm an independent third party from the contractor? YESV NO ( } <br />9. j Describe, in detail, how the soil andfor water sample(s) beneath the piping or dispenser will be obtained: <br />til. Handling of excavated soil (Contaminated Soil Hazardous Waste Wainer): <br />Name Hauler Registration # Phone (_) <br />(1� Address City Zip <br />b) If soil is not to be hauled, describe what will be done with it: <br />2 <br />