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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,[,]' NO [] <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES [] NO [] <br /> 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> use the UST Installation Applicationpages 4-8 as necessary for a timely plan review): <br /> 0- <br /> VP&1ZA F4LW-rt%J(L '>TTSE .- fri✓tt Z:da✓AT'XUC*JC- w%rp- NG.uI /NJGOIJ <br /> --- -- <br /> 4. Description of equipment to be used (Alta h drawings/blueprints as necessary): <br /> _ISP- �Si�IYNLEF-+�/►AJGE.�1� =--------—-- — -- - <br /> 5. All equipment is State certified or approved. YES ]'NO [] <br /> 6. Decontamination Procedures: N I Ik <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. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name_ Phone(—_) 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 /> -------------- <br /> b. Piping Hauler: <br /> Name_ ---_ —_ Phone <br /> Address_— _ _ _ _ City—__--_-- Zip <br /> -- __-- <br /> Hauler Registration#(if hauled as hazardous)—_— __ _ -- _—_ <br /> c. Piping Disposal Site: <br /> Name_— -- Phone <br /> Address- — ----- <br /> ---------------City----------Zip- - <br /> ---- -- <br /> EPA ID#(if transported to a permitted TSD facility)--_____ <br /> 8. Is the sampling firm an independent third party from the contractor? YES[] NO[] <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 -- <br /> Address ------City-—-------—--- —Zip - <br /> b) If soil is not to be hauled,describe what will be done with it: <br /> 2 <br />