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Mar 28 08 10:02a Sandra Barnhart 2098458586 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 /> I, Site map enclosed YES [] NO W <br /> 2. Manufacturer's spec sheets attached for all equipment to be installedYESIA 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 /> usepe UST Instliallation Ap lication pages 4-8 as necessary for a timely plan review}: 1 <br /> ;i 1 L L 2L' Q, ^ �Yl -Ct1 y/ f'i-6,d t ct <br /> 4. De�sc�ipti�e#fequipment llL used ,drawr5 tP e/V) Ls1necessary): <br /> �'" -ik 6 -7c96 y18 <br /> 5. All equipment is State certified or approved. YES D1 NO[j <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? /V :- YES[] NO[] <br /> b. Identify contractor performing decontamination: <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 /> b. Piping Hauler: <br /> Name Phone( <br /> Address CityZip <br /> Hauler Registration# (if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address City Zip <br /> EPA JD#(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 the soil and/or water sample(s) beneath the piping or dispenser will be obtained: ./V/i�, <br /> 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone L__j <br /> Address City Zip <br /> b) If soil is not to be hauled,describe what will be done with it: <br /> 2 <br />