COMPLIANCE INFO_2008-2016 - Laserfiche WebLink

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URSYSTEM RETROFIT OR REAR (Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) 1. Site map enclosed YES [] NO [ ] 2. Manufacturer's spec sheets attached for all equipment to be installed YES [ ] NO [ ] 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application pages 4-8 as necessary for a timely plan review).: I c, C. -e (��., e. �-c. 1 / � G i k 1 6, e A Cid^ -O( l 'T,"C.. -, " � l 6 , - 0 �w Ali,c V,.c 4 r I?e,) j i !_f_ 't-«..... K� C l "., k i - k t/-, -, , ike r v t _ c�.r -'t}' S �/ � i i Ac - 4. Description of equipment to be used (Attach drawigs/bluprints as necessary): op LJ F, I f P, VQ V [ P.ve& M" e 5. All equipment is State certified or approved. YES lq--,�O [ ] 6. Decontamination Procedures: a. Will piping be decontaminated prior to removal? b. Identify contractor performing decontamination: Name Address c. Describe method to be used for decontamination: YES[] NO[] Phone( ) _ City Zip d. Describe how rinsate material will be stored onsite prior to manifesting offsite: e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name Phone( ) Hauler Reg# Address City Permitted Disposal Site 7. a. Describe the method that will be utilized to purge and/or inert the piping: b. Piping Hauler: Name Address Hauler Registration # (if hauled as hazardous c. Piping Disposal Site: Name Address EPA ID# (if transported to a permitted TSD faci Phone City _ Phone City 8. Is the sampling firm an independent third party from the contractor? YES [ ] NO [] Zip Zip Zip 9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: 10 Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): Name Hauler Registration # Address City b) If soil is not to be hauled, describe what will be done with it: 2 Phone Zip