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UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum <br /> of 2 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed YES[yam NO[] / <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES() NO WK <br /> 3. Description of work to be completed (It adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> use the UST � <br /> Installation ApplicaU pages 4.8 as necessary for a time pl revi w): <br /> a� tin � G.�t<. <br /> 4. Description of equipment to be used(Attach drawings/blueprints as necessary): <br /> VAT LD Ta.r�ei <br /> 5. All equipment is State certified or approved. YES R 0[] <br /> 5. Decontamination Procedures: <br /> a. Will pipin a decontaminated prior to removal? YES[] NO[] <br /> b. Identify con ctor performing decontamination: <br /> Name Phone() <br /> Address City Zip <br /> c. Describe method to a used for decontamination: <br /> d. Describe how rinsate mated will be stored onsite prior to manifestiFoAftsite:e. Rinsate Hauler and permitted Treatnt, Storage &Disposal FaciHauler Name Phone() eg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> ?. a. Describe the method that will be utilized to purge dlor inert piping: <br /> b. Piping Hauler <br /> Name Phone (_) <br /> Address City Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone() <br /> Address city Zip <br /> EPA ID#(if transported to a permitted 7 facility) <br /> S. Is the sampling firm an independent ird party from the contractor? YES[] NO[] <br /> 9. Describe, in detail, how the soil d/or water sample(s) beneath the piping or di enser will be obtained: <br /> 10. Handling of excavate oil (Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# P ne (� <br /> Address City Zip <br /> b) If soil is not be hauled, describe what will be done with it: <br /> 2 <br /> L9199 39tid -nIH >19r1H9 £Z5££6£L99 b£ :LL 399Z/LZIb9 <br />