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Oct 01. 02 09:51a Elite Iv Contractors Inc 2094616342 p.4 <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 (] NdNf <br />2. Manufacturer's spec sheets attached for all <br />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 neoessa for a time 1 plan review): r' <br />1N1; (o(Ycv 1 rt .')Y, - i ,•. t� l; :i� ci' .if ,' ' - q/iC' '? '&i ' `, rck-b ii{ <br />1. 2f :E �''i '( .! i' 4 E 2�� ti f '? " `c t' ' Tf( �t('i) �'iII�L) ttL(��x!r <br />it fY1Grt; <br />t%v (cf��(t r Vii✓ d�c�t �itOS tZe�� N Cf�ft'o - CuOtcw U tt ? t1l nem 3 Pi P0 cn ccs rKtrL(' f� R lctct',�_� <br />Description of equipme�[ to be used (Attach drawings/blueprints as neeessary)m f}{itrc�.: l�C tL it\Y; a:(n� ; IiT`�tt;i� f 2'/X <br />nr 1g11 Y ,.ii..0 �� • P l � i i� i' s ( :t .'4 `Y'( -Yi", t 1�t 11 YA <br />l- 1 j- _ <br />LL - <br />5. All equipment is State certified or approved. YES M NO[] <br />f:11 <br />Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identil <br />Name <br />Addre <br />YES [ ] NO1)� <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 perrmitted Treatment. Storage & Disposal Facility: <br />Hauler Name V /% Phone( Hauler Reg# <br />Address ICity Zip <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge and/or inert the piping: <br />b. Piping Hauler `Y� f(I F -C��t Ok <br />Name `l� 1 R t..� LIV'j: V\1 R I.� .TLS C, i P one ti. J �f \ �,p <br />Address City Zip `: [ C6 <br />Hauler Registration # (if hauled as hazardous)_ <br />c. Piping Disposal Site: <br />Phone (_) <br />r Zip <br />EPA ID# (if transported to a permitted <br />Is f sampling firm an independent third party from the contractor? YES NO [ ] <br />Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # <br />Address City <br />b) If soil is not to be hauled, describe what will be done with it: <br />Phone (,___) <br />Zip <br />