Laserfiche WebLink
\4 <br /> �J\ 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 [I <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES[] NO [] <br /> 3_ Description of work to be completed(If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> the US Ins allati n plication ges_4-8 necessary for a timely ply eview): <br /> � - e Gic uric // <br /> 4. Description of equipment to be used Attach dra ings/blueprints as n n �"s`s off' <br /> 44 1 <br /> �U t1l 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 Phone( <br /> Address City Zip <br /> c. Describe method to be used for decontamination.- <br /> d. <br /> econtamination: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_j Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utiftzed to purge and/or inert the piping.- <br /> b. <br /> iping: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 L� <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 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 />