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Seip,30a02 04:10p Elite Iv Contractors Inc 209461 42 p.3 <br />Q1003/005 <br />04/26/2008 FRI 9,28 FAX 2094 33 SJC HHD <br />is <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 2 sets of plans & applications as originals wig be retained by END) <br />1. Site map enclosed YES i ] NO"N\ <br />2. Manufacturer's spec sheets attached for all equipment to be installedYES'K NO [ ] <br />3. Description of work to be completed (if ad, ding piping, UQC's, or other UST equipment. or performing tank top upgrade, <br />use the UST installation Application pages 48 as necessafy for a timely plan review): ( % l_t <br />vie': tl { �: ttC 1 `LV <br />r/1, p,,,y�,ya�,> Ir' . ` �. {,. �, \ {n`! •, <br />CL, E 1 !_T :Vc G `: M1` �(1�1.%���t' C't ` 1 �,111tJ✓ 3" Pi �}l.irl' �i.���%� <br />ftC (CfrLCC U• �!qj it10kkiE:Q-`�fl <br />Description of equipme t to be used (Attach drawings/blueprints as necessary):CO PfXrCciPr_ <br />`L) LL. P t_ -G2 <br />5. All equipment is State certified or approved. YESK NO [ ) <br />6. Decontamination Procedures: , <br />a. Will piping be decontaminated prior to removal? YES [ ) NO [ <br />b. Identify contractor perforr ng decontamination: Phone(, <br />Name 1. L. °�. " <br />Address " )'i / s �r C ^�YY� 1`1. City . L <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and Permitted Treatment, Storage & Disposal Facility: Hauler Reg#_ <br />Hauler Name 1 lrc Phone{) g <br />Address City Zip <br />Permitted Disposal Site <br />a. Describe the method that will be utilized to purge and/or inert the piping: <br />b. Piping Hauter'tai } I C AFl ") one ( C %X ti%J X01 Lair <br />Name city Zip <br />Address <br />Hauler Registration !# (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name_ �C t(( r C'�t C J C,1 �-� J iC' _- Phone (_) <br />Address City Zip <br />EPA IDO (if transported to a permitted TSD facility) <br />8. Is the sampling firm an independent third party from the contractor? YESK NO [ ] <br />9. t Describe, in detail, how the soil and/orwater sample(s) beneath the piping or dispenser will be obtained: <br />10. Handling of excavated soil (Contaminated Soli Hazardous Waste Hauler): <br />Name Hauler Registration # Phone ( ] <br />(\� Address City Zip <br />b) If soil is not to be hauled, describe what will be done with it: <br />