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Nov 26 2007 4: 44PM CRRBONTECH 9098643032 p. 2 <br /> 11/21/2007 RED 14101 FAX 2094683433 SJC END <br /> ®002/009 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minlmum of 2 sets of plans 8.applicall as originals will be retained by EHD <br /> 1. Site map enclosed YES[J Np)ll <br /> 2. Manufacturer's spec sheets attached for all equipment to be installedYES;( NO(J <br /> 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, <br /> use the UST Installation Application pages 4-8 as necessary for a timely planview); � performing tank top upgrade, <br /> 1? rV u N V <br /> u rive V� tP ivsl C7 <br /> 4, Description of equipment to be used (Attach drawings/bluetre El-Y C Ili 4A 41print as necessary} <br /> CD M 17 P r � U t <br /> y- <br /> 5. All equipment is State certified or approved, YES NO if <br /> 6. Decontamination Procedures: <br /> a.Will piping be decontaminated prior to removal? <br /> b. Identify contctor performin deconta }{��at� YES NO <br /> m (J <br /> Nae / <br /> Address <br /> Phone <br /> City I�1tL� Zip at _ [ <br /> o. Describe method to be used for decontmi a�ior� <br /> f u r G <br /> ,,,,n <br /> €i <br /> I Describe how rinsate mall will be st or donsi erl to manifesting offsite: <br /> r� y <br /> e. Rinsate Hauler and perrvitted Treatment, forage&Disposal Facility: <br /> Hauler Name Phone( t <br /> Address Hauler Reg# <br /> Permitted Disposal Site C'tY Zip <br /> 7. a. Describe the nril th9j will be util' ed to purge andlor inert the piping. <br /> �P E �r�r�27`� D w�f-H i7�cs6c� <br /> b. Piping Haul r: <br /> Name (I�f� l/l <br /> Address Phone <br /> Hauler Registration #(if h led as hazardous) Cit yXf 'f Zip <br /> C. Piping 17isoosal Site: <br /> Name C AP- L Ul�'dn/ l LLQ <br /> Address �0 t4-" Phone(66) <br /> EPA ID4(If transport d to o permitted TSD facility) City Zip 6 <br /> 8. Is the sampling fir an independent third party from the contractor? YES X- NO <br /> 9. Describe, in de il, how the soil and/or water sam e s beneath [J <br /> f� ( ) lNe pipin or <br /> n er will be obtained: <br /> 1D. Handling I excavated soil (Cont <br /> Nalre amSo' �ti <br /> azardous' aste Hauler) <br /> ' t inated auler Registration# ZGJ9 7 Phone <br /> Addr s _ � �. ) <br /> city Zip <br /> b f soil is not to be hauled, describe what will be done with it <br /> 2 <br />