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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 /> t. Site map enclosed YES[I NO [I <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 upgrade, <br /> use the UST Instal tion Applicatio�pages�4$as necessary fo�time plan review): <br /> �� <br /> 7 / ' <br /> i <br /> 4. Description of equipment o be used(Attach drawings/blueprints as neces ary)' YV'G�/t C �f�f frac <br /> / NI " , a h('lI ? V � R yS 763 Gas" r�r�uf�hm Kai <br /> Vw c �(I 9a(,.' - - i '�a�o�;r ;i owl ���a3z jo-l2rt^at <br /> >. aPP V° T `�] i- S Il Y-N Se n-W i f14t)r-6a o <br /> 5. All equipment is St a ce ed drat ro ed. S Nd � <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. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name PhoneL_) Hauler Reg# <br /> Address Cit zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge and/or inert the piping: <br /> b. Piping Hauler: <br /> Name Phone <br /> Address City Zip <br /> Hauler Registration#(d hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone(� <br /> Address City Zip <br /> EPA ID#(if transported to a permitted TSD facirdy) <br /> B. 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 /> to- 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 />