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UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed YES I j NO[I <br /> 2 Man s spec sheets attached for a0 equipment to be installed YES[I NO I I <br /> 3. Description of work to be completed(If Wring piping,UDC's,or other UST <br /> use the T! � or performing tank top upgrade, <br /> � ' n pa "�� __ n fnr a trtn plan review): <br /> CA <br /> 6 114. Desai of iPIQ to be usedg lueprints n_e <br /> j CS`iCbb <br /> 5. All equipment is State certified or approved. YES[j NO II <br /> 6. Decontamination procedures.. <br /> a-Wry piping be decontaminated prior to removal? YES[]. NO[] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Ad dn s PC hone( <br /> ZP <br /> Q Describe method to be used for decontamination: <br /> d. Describe how msate maiterWwill be stored onsrAe prior to manifesting o}fsge- <br /> e. Rkmfa Hauler and permiftd Treatment,Skrage&Disposal Faal <br /> Hauler Name <br /> Address Hauler Reg# <br /> Site <br /> City Tp <br /> Penmrtted <br /> a- Describe the method that will be utilized to <br /> Purge andlor inert the pipkrg: - <br /> b. Pipueg Hauler: <br /> Name <br /> Phone <br /> on 0(if hauled as hazardous) Cly <br /> c. ping Disposal Sde: <br /> Name <br /> qd � Phone <br /> l A W <br /> S. Is the sampling tum an independent third party from the contractor?YES[j NO[j <br /> 9• ,indetai,how Etre sora and/or water sampta(s)keneath the pining or dispenser will be obtained: <br /> 10. Handing of excavated sod(Contarnkrated'Sod Hazardous Waste Hauler) <br /> Name <br /> Hauler Regisbism g phone L� <br /> zip® <br /> b)If soil is not to be hauled,describe what will be done with it <br /> 2 <br />