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:1 92 5551 7888 Main Fax GETTLER RYAN INC 3:18 p.m. 10-16-2007 6/10 UST SYSTEM RETROFIT OR REPAIR (Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) 1. Site map enclosed YES [] NO V 2. Manufacturer's spec sheets attached for all equipment to be installed YES [yf NO [] 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application pages 4-8 as necessary for a timely plan review): RE-121 ACE A POS11ION SENSITIVE SENSOR(PIN 794380-123)IN IMF 89 STIR SI IMP 4. Description of equipment to be used(Attach drawings/blueprints as necessary): VEEDER-ROOT POSITION SENSITIVE PANISUMP SENSOR(794380-323) 5. All equipment is State certified or approved. YES V NO [] 6. Decontamination Procedures: a. Will piping be decontaminated prior to removal? YES [] NO [] b. Identify contractor performing decontamination: Name Phone( ) Address City Zip c. Describe method to be used for decontamination: d. Describe how rinsate material will be stored onsite prior to manifesting offsite: e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name Phone( ) Hauler Reg# Address City Zip Permitted Disposal Site 7. a. Describe the method that will be utilized to purge and/or inert the piping: b. Piping Hauler: Name Phone( ) Address City Zip Hauler Registration #(if hauled as hazardous) c. Piping Disposal Site: Name Phone( ) Address City Zip EPA ID#(if transported to a permitted TSD facility) 8. Is the sampling firm an independent third party from the contractor? YES [] NO [] 9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: 10. Handling of excavated soil(Contaminated Soil Hazardous Waste Hauler): Name Hauler Registration# Phone( ) Address City Zip b) If soil is not to be hauled, describe what will be done with it: 2