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May 08 07 09: 47a Elite Contractors Inc 2094616342 P. 1 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be ret y EHD) <br /> 1. Site map enclosed YES[] NOK <br /> 2. Manufacturers spec sheets attached for all equipment to be installed YES[] NO[J <br /> 3. Description of work to be completed(If adding piping. UDC's, or other UST equipment, or performing tank top up{grade, <br /> use the T Ins Ration Applicatio pa 8 as n ry for a timely plan ew): tr.,/ fi il/ <br /> ,12 <br /> 4. Description of equipment to I>e (Attach drawingsfblueprints as nese�ry): <br /> �r�used� /C �,Cy <br /> 5. All equipment is State certified or approved. YES l NO[] ,.,,�X.r✓ CX,� ��LW� p <br /> 6. Decontamination Procedures: / ' <br /> a. Will piping be decontaminated prior to removal? YES[] QVO <br /> b. ldentifycontractorperforming decontamination: <br /> Name Phone(_ <br /> Address City �P <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 Phoneme_) Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge andfor inert the piping: <br /> b. Piping Hauler- <br /> Nam <br /> aulerName Phone <br /> Address CityZD <br /> Hauler Registration f1(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address City ZiP <br /> EPA ID#(rf transported to a permitted TSD facirdy) <br /> 8_ Is the sampling firm an independent third party from the contractor?YES[J NO[J <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 sol(Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration 8 Phone C___)_ <br /> Address City Zip <br /> b) if soil is not to be hauled, describe what will be done with it <br /> 2 <br />