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02/20/2008 WED 15: 24 FAX 2094683433 SJC EHD Stockton Sery Sta Eq Co 0004/008 <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 P,-' <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES[ !O[] <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 Installation Application pages 4-8 as necessary for a 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[,Ko[] <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 decontaminatio <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 /> Addressf City Zip <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized I <br /> o purge and/or inert the piping: <br /> b. Piping Hauler: <br /> Name_. Phone( ) <br /> Address — City Zip <br /> Hauler Registration#(if hauled as ha ardous)_ !_ <br /> c, Piping Disposal Site: N <br /> Name Phone(_) <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[] r/� NO[] <br /> 9. escribe,in detail,how the soil andlor 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 />