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Jan 08 09 12:41p Reliable Petroleum 209-845-8953 p.5 <br /> 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[] NO'W <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES[ NO j ) <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 Installatior}Applic-a pages 4-8 as necessary for timely plan review) <br /> 4. Description of equipment to be used (Attach drawings/blueprints as necessary). <br /> 5. All equipment is State certified or approved. YES [] NO <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address Phone(--_) <br /> 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 /> b. Piping Hauler: <br /> Name Phone ( ) <br /> Address City Zip <br /> Hauler Registration #(if hauled as hazardous) <br /> c. Piping Disposal Site.- <br /> Name <br /> ite:Name Phone(_ ) <br /> Address City Zip <br /> EPA ID#(if transported to a permitted TSO facility) <br /> B. Is the sampling firm an independent third party from the contractor? YES [] NO[] � <br /> 9. Describe, in detail, how the soil and/or water sample(s) beneath the <br /> piping or dispenser will be obtained: � <br /> 10. Handling of excavated soil(Contaminated Soil Hazardous Waste Hauler)- �11,4�— <br /> Name Hauler Registration # � " (' Phone(_� <br /> Address City Zip <br /> b) If soil is not to be hauled,de5GALl364W;&will be done with it: <br /> 2 <br />