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Apr 04 02 12: 17p Elite Iv Contractors Inc 2094616342 p. 2 <br /> UST SYSTEM ®FIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals wig be retained by EHD) <br /> 1. Site map enclosed YES f I NO f] <br /> 2 Manufacturer's spec sheets attached for all equipment to be installed YES f I NO f I <br /> 3. Description of work to be completed(if addM piping.UDC's,or other UST equipment,or performing tank top upgrade, <br /> the UST,installation Application pages 4-8 as necessary for a timely plan review): <br /> J>:23._ •L.•,^ wi �� � %< .:ae'_ l t�i �a`i._. <br /> 4. Descpption of equipment to be used(Attach drawingstblueprints as necessary): <br /> -- - - _a.pa:r-U,�o I. h - �C)ac-g <br /> 5. AN equipment is State cerffied or approved. YES fI NO f) <br /> S. Decontamination Procedures: <br /> a.VM piping be decontaminated prior to removal? YES f I. NO[] <br /> b. ldenW contractor performing decontamination: <br /> Name Phone(--- <br /> Address <br /> hone(_Address City Zip <br /> c. Describe method to be used for decor. "on: <br /> d. Describe how rinsate maerbl wig be stored onsite prior to nmgesfing <br /> eRawate Ha and pennifted Treatment Storage' i FacW <br /> Haidw NameP ler R <br /> Address C4 r4p <br /> Pe D' Siite <br /> 7. a. Descrbe the method that will be utilized to purge andbr inert the piping: <br /> b.Piping Harter: <br /> Name Phone( <br /> Haciler Registration#(if hauled as hazardous) <br /> c. Piping Dhposal Site: <br /> Name phone i ) <br /> Address City. ztP <br /> EPA Its(rftransported to a permitted TSD facmw <br /> s. is the sampling firm an independent third party from the coritramW?YES[I NO f I <br /> 9. Desc rbe,in detail,how the soil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. 113ridling ofexcavated soil(Contaminated Soil Hazardous Waste Hauler): <br /> Name Haukr RegisbaBon 9 Phone{ ) <br /> Address City zip <br /> b)if sod is not to be hauled,describe what will be done with it <br /> 2 <br />