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09/18/2006 09: 16 2094683433 EHD PAGE 03 <br /> LIST SYSTEM RETROFIT" OR REPAIR <br /> (Submit minimum of 2 sets of plans &applicat,ons as originals will be retained by EHD) <br /> 1. Slte map enclosed YES [] NOA'f <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES(] No <br /> 3, Description of work to be completed(If adgi!29 piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> e <br /> the UST Installation Application pages 4-8 as necessary for a timely plan review) <br /> I1S ��}T� lettio O'— B 1 4 $ CI amain. . r n s lit' o�rJorn S�7ta <br /> 4. De cription of equipment to be used(Attach drawings/blueprints as necessary): <br /> S. All equipment is State certified or approved. YES[XNO[j <br /> 6. Decontamination Procedures: /t,JA- <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name___ Phone(____j <br /> Address_ City Zip <br /> C. Describe method to be used for decontaminations <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 Phone( _Hauser Reg# <br /> Address_ city__ Zip <br /> Permitted Disposal Site. <br /> 7. a. Descnbe the method that will be utilized to purge and/or inert the piping: Pr+ <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 Lam. <br /> Address city 2,p <br /> EPA 10#(if transported to a permitted TSD facility) <br /> 8.P4 Is the sampling firm an independent third party from the contractor? YES [] NO[J <br /> 9.I1Ll A Describe, in detail, how the soil and/or water sample($) beneath the piping or dispenser will be obtained <br /> IO.NA' Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br /> NameHauler Registration# Phone(__} <br /> Address <br /> Zip___ <br /> b) If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />