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UP SYSTEM RETROFIT OR REF^iR <br /> (Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) <br /> 1. Site map enclosed YES [] NO <br /> 2. Manufacturer's spec sheets attached for all equipment to be installe ES ] NO[] <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 Installation Application pages 4-8 ras necessary for a timely plan review): <br /> Q�PTe.•7Pn� all ons 9'/ T:11 Se-:1/ livcjre T. QvcAr -q4/1•d 0,w7mcd ICS7, <br /> Not C, d:re r•y CAfeT. <br /> 4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br /> top( l nl pne� . " PS-6 1-iv2-0V" Gvt sheet iiac.!!etJ <br /> 5. All equipment is State certified or approved.(7E—S-D NO [] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO[] <br /> b. Identify contractor performing decontamina io : <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 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 /> .AZ IA <br /> b. Piping Hauler: <br /> Name Phone ( ) <br /> Address City Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone ( ) <br /> Address City Zip <br /> EPA ID#(if transported to a permitted TSD facility) <br /> 8. Is the sampling firm an independent third party from the contractor? YES [] NO <br /> 9. Describe, in detail, how thesoil�and /or water sample(s) beneath the piping or dispenser will be obtained: <br /> 10. Handling of excavated oil (Contaminated Soil Hazardous Waste Hauler): <br /> Name Al 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 />