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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 f, NO[j <br /> 2 Manufacturer's spec sheets attached for all equipment to be installed YES[] NO[] <br /> 3. Description of work t be completed(If adding piping, UDC's,or other UST equipment, or performing tank top upgrade, <br /> use the UST Instpila'.0 �licatign�pages 4-8 4s necessary for a timely plan review): <br /> 4. Description of�quipment to be used(AttatFh`r�wings/blueprints as necessary): <br /> 5. All equipment is State certified or approved. YES[j NO[] <br /> 6. Decontamination Procedures: <br /> a. Wig piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address PhoneL) <br /> City Zip <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate materiat will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facilldf. <br /> Hauler Name Phort°LJ Hauler Reg# <br /> Address <br /> Permitted Disposal Site Cly <br /> 7. a. Describe the method that will be utirized to purge and/or inert the piping: <br /> b. Piping Hauler. <br /> Name <br /> ,qddmss Phone <br /> Heater Registration#(if hauled as hazardous) City Zp <br /> e. Piping Disposal Site: <br /> Name <br /> Address Phone <br /> EPA ID#(if transported to aCity Zip <br /> permitted TSD facility) <br /> 8. is the sampling firm an independent third party from the contractor? YES[] NO j] <br /> 9. Describe,in detail,how the soil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handing of excavated sol(Contaminated'Sol Hazardous Waste Hauler): <br /> Name <br /> Address Hauler Registration# Phone( } <br /> City Zip <br /> b) If sol is not to be hauled, describe what will be done with it <br /> 2 <br />