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02/20/2008 WED 15: 24 FAX 2094683433 SJC EHD --- Stockton Sery Sta Ea Co I0004iuUtl <br /> 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(] NOo[Q_ <br /> 2. Manufacturer's spec sheets Attached for all equipment to be installed YES K NO[] <br /> 3. Description of work to be completed(If adding piping, UDC's,or other UST equipment,or performing lank top upgrade, <br /> use the UST Installation Application pages 4-8 as necessary for a timely plan review): <br /> 4. Description of equipment to be used(Attach drawings/blueprints as necessary): <br /> 5. All equipment is Stale certified or approved. YES tK NO[] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NON <br /> b. Identify contractor performing decontamination: <br /> Narne�E ��•-- r �' �,���...r Phon* ) 014 50 A <br /> Address Be P. City dais.•, Zip S ti.C7 <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsale material will be stored onsite prior tomanifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facilily: <br /> Hauler NameyC-.,t,r,,.�.•. /ice-rw..... Phone) _&L VLyi Hauler Reg# � <br /> Address 4City /Ja./fi r Zi <br /> Permitted Disposal Site. — <br /> 7. a. Describe the method that will be utilized to purge and/or inert the piping: <br /> b. Piping Nauler: — —� <br /> Name_- _Phone(_) <br /> Address_ City - Zip <br /> Hauler Registration#jifInauled as hazardous)_ ' <br /> c. Piping Disposal Site: <br /> Name.__. _ Phone(—) <br /> Address —may. City _Zip <br /> EPA ID#(it transported to a permitted TSD facility) <br /> 8. Is the sampling firm an independent third party from the contractor?YES[] NC.K <br /> 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— ,/ Clty Zip <br /> b)If soil is not to be hauled,describe what will be done with it: <br /> 2 <br />