Laserfiche WebLink
UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by END) <br /> i. Site map enclosed YES[] NO[) <br /> 2. Manufacturer's spec sheets attached for al!equipment to be installed YES[] NO[) <br /> 3. Description of work to be completed(!f adding piping, UDC's, or other UST equipment, or Performing tank top upgrade, <br /> the UST Installation Application pages 4-8 as necessary for a ti ely plan review):cat f _ . <br /> �, j -i'z,� tri r"�l ' �� > ;G7 c j <br /> =W clY t, l ti 3/ i�e e <br /> «. ° c���c� �r nct o�`t vif+1 � r r•151 <br /> t~ r1c i J�1� cf Y S�. cc c y1 <br /> 4. escri on of equi ment to be used (Acta drawinc slblueprints necessLry). <br /> - 3 C Pts_' _ <br /> -i+5 r' r <br /> 5. All egifipment is State certified or approved. YES[] NO f b r�cl��� �U,.� /�, _ �`'jc` rrt71C � <br /> /lr lCl C c'i 1-0.(e ll f r 4f V'ikv( j i-�(-v m p).e 4ee4 <br /> 6. Decontamination Procedures: [ 'i Ciy cj bl� ''e Lj& e �p bc'S <br /> a. Will piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination.- <br /> Name <br /> econtamination:Name Phone(_, <br /> Address City Zip <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e_ Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name PhoneC ) Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge and/or inert the piping.- <br /> b. <br /> iping:b. Piping Hauler <br /> Name Phone <br /> Address <br /> Hauler Registration#{if hauled as hazardous) City Zip <br /> c. Piping Disposal Site.- <br /> Name <br /> ite:Name Phone(__j <br /> Address City Zip <br /> EPA ID#Cif transported to a permitted TSD facilrty) <br /> 8. Is the sampling firm an independent third party from the contractor? YES(] NO[) <br /> 9. Descnbe, 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 <br /> CityZip <br /> b) If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />