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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. Sde map enclosed YES[I NO[I <br /> 2 Manufacturer's spec sheets attached for all equipment to be installed YES'k NO(j <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 pag`4-8 s necessary for a timely plan review): <br /> �J y <br /> 4. ?�� rc 1e � ��� <br /> ption of egwpment to tta mgs/bluepnn necessary : <br /> J <br /> 5. All equipment is State certified or approved. YES NO[j <br /> 6. Decontamination Procedures: <br /> a. Wib piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name PhoneL_j <br /> Address CfiY Zip <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manffesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility <br /> Hauler Name Phone( 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. Piping Hauler: <br /> Name Phone�) <br /> Address City ZP <br /> 1-6661 Registration tf(rf hauled as hazardous) <br /> c. Piping Disposal Sile: <br /> Name Phone 1( <br /> Address City_ zip <br /> EPA til?#(d transported to a permitted TSD facility) <br /> 6. Is the sampling firm an independent third party from the contractor YES[I 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 sod(Cmitaminated'Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone( ) <br /> Address City Zap <br /> b) If sod is not to be hauled, describe what will be done with it <br /> 2 <br />