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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 YES NO[] <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YES X NO[] <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 tiTely plan review): <br /> R epairS doe t-00L3 `l 69 F0.i I ire s . Kew�o�c R�p(acc <br /> info e)ciSti✓L� SY` �2 9 iel4 <br /> 4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br /> See drCw,V�cs ' 6K *- TK2 — [ <br /> 5. All 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: N /n <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: N/A <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: NIA <br /> Hauler Name Phone(__j Hauler Reg# <br /> Address City Zip <br /> Permitted Disposal Site <br /> Q;p;nS dry vsi ^3 <br /> 7. a. Describe the method that will be utilized to purge and/or inert the piping: vacUUrn <br /> los'loVo.Cvjv-\ , f111 6,j o- r dv�-4 <br /> W;l 1pr T- <br /> b. Piping Hauler: <br /> Name e�5h�ce Ehv�ro,�r�er�tQl rviCe5 2r.-,C.-Phoneq4q �bO — 52,00 <br /> Address- 2-S 9 --TI T owv\e_ Ceo-kc< t0 c. City oot-,;1\ koL4clhZip 12-GI O <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: Q� 2 3 9' — 3 `� q 3 <br /> Name U S C C. o l o Pbone( <br /> Address O ox 58 City ec, VZip 0 3 003 <br /> EPA ID#(if transported to a permitted TSD facility) O O�� <br /> 8. Is the sampling firm an independent third party from the contractor? YES�(( NO[] [r C S <br /> Grp.,eckL�aVer�Er`.,,io,�v�t.til� 5or, ; e i _ r` <br /> 9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br /> QecoAtarn;V\C�te-d ko.r\d -c.,,ger will fie- Ose-d OJVarce. A cal"(-ea dept. The <br /> Ev.Vi(Oh. Soi Sary p1e� u,,i� 1^ S(ide (nwKMer will be u$ej f o Soil "L plc .n <br /> Kew Sleeves with w(G-es.5a4-ple(- wil( b° r,Qe�ontaw ;no—ted bc� .��orSur►�p�e �oco Fions <br /> 10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br /> Namel3el 1.'.ce Er j,ron . Se(viCC) X-%uler Registration # 2 g9 Phone q� <br /> Address Sq-f`I Tow r\e Ce-ntre O r. Zip 9L Co (o <br /> b) If soil is not to be hauled, describe what will be done with it: <br /> go So;t i5 ahs-;,; ;0-mero-�ej. EX�S �;,nc� U14L'S �! l�.b . FRP <br /> 5r.;-rti f,p e- is <-r� pea- �(0X0.1. Ex"3 t-; <br /> wilt b e- <<-—i s a ire-e o-:rs o-( & -a� . <br />