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Nov 06 07 12:05p Elite Iv Contractors Inc 2094616342 p.l <br />UST SYSTEM RETROFIT REPAIR <br />(Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) <br />U.2 1. Site trap enclosed YES I] NO [ I �i jC��� 1U ---1- <br />2 <br />Manufacturer's spec sheets attached for all equipment to be installed YES [ NO [ <br />3. Description of work to be completed (If adding piping. UUC's, or other UST equipment, or performing at n tap upgrade, �l <br />c^t.:k1 i:nM K:r Id <br />ix the USTTlinsiaflation pglication pages 4$ as necessary for timely :plan iea�e�... <br />/\lI'�o RLO <br />o. Ars equipment is gate cenmea or approvea. Yt5 I I NU II <br />6. Decontamination Procedures: <br />a. Weil piping be decontaminated prior to removal? YES [ ] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name Phone(_) <br />Address City —zip <br />e. Rinsate Hauler and persni€ted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone(,_,,,",} Haub 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 Haub <br />Name Phone L <br />Address . City Zip <br />Hinter Registration 0 (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone { } <br />Address City. ZIP. <br />EPA 1D# (if transported to a permitted TSD facility) <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 sod (Cordaminated'Soil Hazardous Waste H <br />Name Haider Registration # Phone (. ) <br />Address City zip <br />- <br />b) If sod is not to be hauled, describe what will be done with it <br />C <br />