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(Submit minimum of 2 sets of plans & applications as originals will be retained by END) <br />1. Site map enclosed YESX NO [ ] <br />2. Manufacturer's spec sheets attached for all equipment to be installedYES 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): <br />JM+altin4 Hezly G1, --2n ,Air Je.E2rz+pr- unit b'Vee.dee-- IZoat 1512 5er%5&cs . <br />4. Description of equipment to be used (Attach drawings/blueprints asneces <br />RA-21Vc_QS (4t"A&I') _ WJly vacuJrr% =uwap C JrPI0Y? <br />5. All equipment is State certified or approved. YESX NO [ ] <br />6. Decontamination Procedures: W/4", <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 />WSM <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e <br />Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Phone() Hauler Reg# <br />Address City <br />Permitted Disposal Site <br />WA, 7. a. Describe the method that will be utilized to purge and/or inert the piping: t-A!A <br />b. Piping Hauler: <br />Name Phone (� <br />Address CityZip <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 />Nf �. 8. Is the sampling firm an independent third party from the contractor? YES [ ] NO [ ] <br />�la 9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # Phone <br />Address City Zip <br />b) If soil is not to be hauled, describe what will be done with it: <br />010 <br />