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Dec 05 2007 5: 31PM CRRBONTECH 9098643032 P. 5 <br /> 11/21/2007 WBD 14, 01 FAX 209,, $433 SJC END <br /> 2002/009 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit mfnimum of 2 sets of plans& applications as or,grnals will be retained by EHD) <br /> 1. Site map enclosed YESX NO() <br /> 2. Manufacturer's spec$heats attached for all equipment to be instaredYFS'K NO() <br /> 3, Description of work to be completed(If ad inq piping, UDC's, or other UST equipment,or performing tank top upgrade, <br /> use th UST Installation Application pages 4-9 as nec s ary fc�afimely pian review): <br /> CYL <br /> 4. Descript on of a uipmen to be used(A tach dhawfirIgsiblueprints as cessary} <br /> 5 All equipment is State certified or approved YES' NO(1 <br /> S. Decontamination Procedures: <br /> a.'Nil piping be decontaminated prior to removal? YESJQ NO[) <br /> b. Identity contractor p or dec to natiq <br /> Name 7C Phone( } <br /> Address <br /> City zip <br /> C. ribs method obe us dfor e ntami atiorr <br /> d. D ori a how rinsate rttaerial will be stor�orsfteior �manife�sting e; <br /> e. Rinsate Haul an pe mitts eatment, Sto & Disposal F chit <br /> Hauler Name Kane <br /> Address ler eg# <br /> Permitted <br /> is <br /> Site. CrtY Zip <br /> P��d LKi�+y K E�TJCnK --Iuw <br /> �p�'_ � k- Ai <br /> 7. a, De"a the me od hat MI be uti!V purge ard/qr inert,th iping: <br /> YA <br /> b. Piping ' uler <br /> Name Ph <br /> Address City Zi <br /> Hauler Registration #(if hawed as hazardous)_ p <br /> c. Piping DI's Site: <br /> Name <br /> Address w , p on <br /> EPA ID#(if transporled to a permitted TSD faci ity) Clty Zip <br /> 8 Is the sampling firm an independent third party from the contractor? YES <br /> NoI ) <br /> 9. 0 rime,in d tail, how he soil and/or w Aer sample s) be eath the pi Irk or d►sp ns be ob ed: <br /> J <br /> 1D Handlin I e, v ted so't�(Contaminated Soil azardous Waste Hauler}, <br /> Name Nauler f2egistration # �j - <br /> Address Pf�one t�r ) <br /> � City zip=-f5 <br /> b; If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />