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Oct 20 08 09 : 30a Elite Iv Contractors Inc 2094616342 P. 1 <br /> ?ft111L': <br /> (17-1 �� UST SYSTEM RETROFIT OR REPAIR <br /> {Submit minimum of 2 sets of plans&appfrcations as originals vAT be retained by EH[)) <br /> `1: Site map enclosed YES[] NO[] <br /> 2 Manufacturer's spec sheets attached for all equipment to be installed YES[I NO[j <br /> _ 3. Description of work to be completed(If addna piping,UDC's,or other UST ui <br /> use the UST Installation pn� or Reforming tank top upgrade,�1' I Application pages 4 8 as nem/s`a/ry for a timely plan} review}: <br /> ('�lt;llc�1•i f��,/ 4. Description of equipment to be used drawings/blueprints as necessary}: <br /> 5. All equipment is State certified or approved. YES[j NO[j <br /> 6. Decontamination Procedures: OCT 2 1208 <br /> a. Wil!piping be decontaminated prior to removal? YES I I NO[] <br /> b. Identify contractor performing decontamination: SAN JOAQ111N COUNTY <br /> Name <br /> Address Phone{�� ENVIRONMENTAL <br /> City i_ <br /> c- Desrsrbe method to be used for decontamination: <br /> d. Describe how nnsate mat_erialvall be stored ansae prior to mariffesfing oftsit` <br /> e. Rirtsate Hauler and permitted Treatment,Storage&Disposal Faalibf. <br /> Hader Name <br /> Address PhorteC---)_Hauler Reg# <br /> Permitted Disposal Site Citt' <br /> 7. a. Describe the method that will be utcTrzed to purge andlor inert the piPing: <br /> b. Piping Hauler. <br /> Name <br /> Phone LT,� <br /> Heiner Registration#(rfhauled as hazardous} City <br /> a Piping Disposal Site: <br /> Name <br /> Address Phone <br /> EPA IDll`(if transported to a pennitted TSD facility} City. Zp <br /> s. Is the sampling firm an independent third party from the contractor? YES[j NO[J <br /> 9. Desa7be,in detad,how the soil and/or water sampls(s)beneath the piping or disperser will be obtained: <br /> 10. Handling of excavated sod(Contaminated'Sorl Hazardous Waste Hauler): <br /> Name Hauler Registration 9 Phone( } <br /> Address Cly Zip <br /> b) If sod is not to be hauled,describe what will be done with it <br /> 2 <br />