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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 f] NO 0 <br /> 2- Manufacturer's spec sheets attached for all equipment to be installed YES N NO[J <br /> 3. Description of work to be completed(If add!ng piping. UDC's, or other UST equipment, or performing tank top upgrade, <br /> the UST installation Appli tion pages 4-8 a necessary for timely plan revie ) <br /> �- I ►n i I� lit Ylcccl5-�CbL-LeLooftj <br /> L <br /> �oneere-t-�111 hc��e-robe. brouenut+4 - buClhe� rep�c�c��em- <br /> 4. ' scnption of equipment to be used(Attach drawingslblueprints as necessa <br /> ! u 9D~ r L _ less <br /> G6`Io shuitoF>= drop--►Ube. <br /> 5. All equipment is State certified or approved. YES IA NO[) <br /> 6. Decontamination Procedures: <br /> a. w0 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 materiat 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 /> b. Piping Hauler. <br /> Name Phone <br /> Address city Zip <br /> Hamer Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address city Zip <br /> - <br /> EPA ID#(if transported to a permitted TSD facility) <br /> a. 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 /> t 0. Handing 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 />