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Work Order. 2254987 <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(f NO[J <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES[J NO[J <br /> 3. Description of work to becompleted(If a din piping,UDC's,or other UST equipment,or performing tank top upgrade, <br /> use the UST Installation Application pages 4-8 as necessary for a timely plan review): <br /> �ilma :e FYld Le&IG [LLe4,4W S(L.LK J/2ve-3S-&'e- /►Zt.C/ TGsa-fE 0Z <br /> 4. Description of equipment to be used(Atlach drawingsrblueprints as necessary): <br /> �n,o[ d F Y 1y Lh a Js,'.�s.fw ., Y/ � S 0 1 <br /> 5. All equipment is State certified or approved. YESONO 11 _ <br /> 6. Decontamination Procedures: // <br /> a. Will piping be decontaminated prior to removal? YES(] NO[] <br /> b. Identify contractor performing decontamination: <br /> 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. Rlnsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name PhoneL--) Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> T a. Describe the method that will be utilized to purge and/or inert the piping: <br /> b. Piping Hauler. <br /> Name Phone L_J <br /> Address City_ Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone L� <br /> Address CityZip <br /> EPA ID#(if transported to a permitted TSD facility) <br /> 8. Is the sampling firm an independent third party from the contractor? YES[J NO[1 <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 L-J <br /> Address city Zip <br /> b)If soil is not to be hauled,describe what will be done with it: <br /> 2 <br /> Tanktology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 <br />