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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. 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): y l <br /> fA_c 3;�e 01 t`r b1^.v,. r 4 I... <br /> 4. DeFpption of equipment to be used(Attach drawingslblueprints as necessary): <br /> 5. All 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 413 <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. Rinsatie Hauler`and pennitt ed 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 and/or inert the piping: <br /> b. Piping Hauler. <br /> Name phone( 1 <br /> Address . <br /> City Zip <br /> Hanle r Reagistration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address City Zi P_ <br /> EPA lD#(if transported to a permitted TSD facility) <br /> S. Is the sampling firm an independent third party from the contractor?YES[] NO[I <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(Contaminated-Soil Hazardous Wbste Haider): <br /> Name Hauler Reeeg"IsbaGon# Phone <br /> Address City Zip <br /> b) If sod is not to be hauled,describe what will be done with it <br /> 2 <br />