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• <br />11 <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 2 sets of plans & applications as originals will be retained by END) <br />1. Site map enclosed YES [ ] NO [] <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 t4apkpp upgrade, <br />the PT tnstatlatior2 Appl�ation pales 4-8 ne ary for a t mely�plan re w). �E✓ <br />4. Description of <br />�� q4�certa <br />5. IA•lt e. -VL, rpment is to ' ed or apps <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 --zip <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: <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 L,) <br />Address city Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone (_> <br />Address City. Zip <br />EPA ID# (if transported to a permitted TSD facility).. <br />8. Is the sampling firm an independent third party from the contractor? YES [ ] NO [ j <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 (Confaminated'Soil Hazardous Waste Hauler): <br />Name Hauler Registration # Phone <br />Address City Zip <br />b) If sod is not to be hauled, describe what will be done with it: <br />