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Work Order: 2255433 • • <br /> ST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sate at plans&applications as originals will be retained by EHD) <br /> r. Site map enclosed YES(] NO[] <br /> 2 Manufacturer's spec sheets atter hed for all equipment to be installed YES I I NO f] <br /> 3. Description of work to be comp) ted(If adding piping.UDC's,or other UST equipment,or performing Ian <br /> use the ST Installation Applica ion pages 4-8 as necessary for a timely plan review): <br /> USM <br /> Ac MA-rm.- <br /> 4, <br /> AlM.a. Description of equipment io be d(Attach drawingslblueprkits as necessary): <br /> 'ff f— 75 o sr.✓leg <br /> 5. All equipment is State certified o approved. YES I) NO[I <br /> & Decontamination Procedures: <br /> a.Will piping be decontaminatE d prior to removal? YES[] NO[] <br /> b. Identify contractor performiril decontamination: <br /> Name phoneL__J <br /> Address Oily Zia <br /> c. Describe method to be used or decontamination: <br /> d. Describe how rinsate materu I will be stored onshe prior to manifesting offsite: _ <br /> e. Rinsate Hauler and permitt id Treatment,Storage 8 Disposal Facility-* <br /> Hauler Name Phone( I Hauler Reg71 <br /> Address Diry <br /> Permitted <br /> 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 /> How ler Registration N of—hat led as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address Clry tp. -- <br /> EPA IDk(if transported to a p a rmilted TSD fscility) <br /> a Is the sampling firm an inde pi indent third party from the contractor? YES[I NO[] <br /> 9. Describe.in dooi1.how the sc it andfor water samples)beneath the piping or dispenser will be obtains <br /> 0. Handling of excavated soil(C maminated Soil Hazardous Waste Hauler). _ <br /> Name Hauler Registration rR Phone <br /> Address City Zia– "— <br /> zIP_..— <br /> b)If sal is not to be hauled,d tribe what will be done with if <br /> Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 <br />