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06/27/2008 17:51 2093651543 TANKNOLOGY PAGE 02/02 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) <br /> � <br /> 1. Site map enclosed YESNO(] NO[l <br /> 2, Manufacturer's spec sheets attached for all equipment to be installed YES[] <br /> UDG's, or other UST equipment, or performing tank top�pgrade, <br /> g. Description of work to be completed(if ddin piping, plan review)- <br /> use a UST Installation Ap}�licatlon pages 4-8 as necessary for a timely p �� a i <br /> �. <br /> .:�...: Ulu. �•�" I <br /> ' 'on of equipment to be used(Attach drawingsibtueprints as necessary)' <br /> 4. D nptt q . <br /> a� .p V2,115 S�'2 <br /> !o L] <br /> roved. YES I <br /> s State certified or app <br /> S. All equipment iI <br /> I <br /> 6. Decontamination Procedures: <br /> YES[] NO[] <br /> a. Will piping be decontaminated prior to removal? phone(____ <br /> b. Identify contractor performing decontamination: City Zip <br /> Name l <br /> Address <br /> i <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior�to manifesting offsite; <br /> Phone(.) Hauler Reg# <br /> e. Kinsale Mauler and pe7 p� <br /> Storage&Disposal Fact <br /> rmitted Treatment, city <br /> Hauler Name <br /> Address <br /> Permitted Disposal Site I <br /> dlor inert the piping; <br /> 7. a. Describe the method that will be utilized to purge an <br /> I <br /> Phone(,,�� -----� <br /> b. Piping Hauler: Zip <br /> Name City <br /> Address <br /> Hauler Registration#(if hauled as ha2ardous) <br /> c. Piping Disposal Site: Phone(�.) <br /> Name City Zip`L- - <br /> Address <br /> EPA 1D#(if transported to a permitted TSD facility) <br /> Is the sampling firm an independent third party from the contractor? YES[] NO[] <br /> 8. <br /> 8. the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br /> Describe,in detail, how <br /> I <br /> I <br /> 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br /> Hauler Registration# Phone( )�� <br /> Name Cly Zip— <br /> Address— <br /> b) <br /> ipAddressb)If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />