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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)< NO[] <br /> 2. Manufacturer's spec sheets///s 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 tank top upgrade, <br /> use the UST Installation Appli tion pages 4-8 as necessary for a timely plan review): <br /> 0 911 . U 'LWc <br /> 4. Description ofequi ment to be sedgy tta drawings/blueprints as necessary): <br /> 5. All equipment is State certified or approved. YESX NO[] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YESNO[] <br /> b. Identify contractor perf ming decontamination: ' \ 607-_4�0 <br /> Name —Phone <br /> Address- - City. Q _Zip <br /> c. Describe method to be user[for decontamination: CA <br /> -1k;W <br /> d. Describe how rinsate material wia ll stored onsite prior to manifesting offsite: <br /> ��g\\nn tvoh <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Fa <br /> ali �Z <br /> Hauler Name SC.ieXiutic"�, �tt���r Phone 14k�'3 10 H ulerReg# <br /> Address S 5 Gsmm 1L *err City --kk , Zip 5 <br /> Permitted Disposal Site��,\e `iiy -2006 41; % �s-N;L Z5ss <br /> 1 <br /> 7. a. Describe the method that will be utilized to pura and fpr inert the piping: (� <br /> Q:PF.,i :5 V Anv <br /> 9\:4+�d� :N4ct., <br /> b. Piping Hauler: Cq5 1002_1{ilu <br /> Name hone <br /> Address t Z Nwt i oyGyv -' City tL59 Zip Z <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name y\&\ �W�� !^ �•"Ift Phone U <br /> Address to > IIIISRICity_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'W <br /> 9. Describin det5acil, hh�Ao�ws thecsoe\\land/ <br /> eCJ}wat s�ample°3(s�)beneath\thae i p\ipiS dbew r4 wibbtained: <br /> Z-0 <br /> 9.Q3 5 s <br /> , y <br /> 10. Handling f.excavated soil ( ontaminated Soil Hazardous Waste Hauler): <br /> Name Sc Ft�a.cv .�C`•\Sp�.<2c Hauler Registration # 3Z�j Z Phone 1( c� ) ]y�-30y0 <br /> ' Address City Zip <br /> Vc`� L\c. <br /> b) If soil is not to be auled, describe what <br /> w, be do a with it: A <br /> _ —Wit:--.--t. W - Ssl��{� �`\1^ Y``S C�ZC"' �P'Cv. :+v:, S<• <br /> r s, r <br /> �i.h\y S� s ca'� 5v4>S:.t�•e�\ �S':';`<. c�.:s9vsn� <br />