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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 /> 1. Site map enclosed YE NO [] <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YEAS -1ZO <br /> [] <br /> 3. Desc iption of work to be completed(If addpipping,-LIDC-'s rr-other-UST equiprnert, or performing tank top upgrade, <br /> TIP <br /> UL� ,lnstallation Application pages as necessary for a timely plan review <br /> ' 7 hum (mac tlst fa cc uJ 'j <br /> 1 t . <br /> 4. D P� equip ent o d`see � raI WL <br /> uei 1\Ian s ra <br /> Pr-t- i YS�" U ' <br /> 5. All equipment s State ce ified or approvedS NO; � �� ut�m <br /> 6. Dec ntmina ' nO <br /> a. Will piping be decontaminated prior to removal? YES(I 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 PhoneL_) 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. <br /> iping:b. Piping Hauler. <br /> Name Phone <br /> Address CityZip <br /> Hauler Registration#(d hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone L� <br /> Address City Zip <br /> EPA ID#(if transported to a permitted TSD faci5ty) <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: <br /> 10. Handling of excavated soil(Contaminated Soil Hazardous Waste Hauler): <br /> Name 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 />