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Work Order: 2255439 <br /> U ST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum f 2 sets of plans&applications as originals will be retained by Eh ID) <br /> r Site map enclosed YES R NO[J <br /> 2 ManuFacturer's spec sheets attached For all equipment to be installed YES I] NO[) <br /> 3 Description of work to be comp) ted(€f adding piping.UDC's,or other UST equipment,or performing tan. :. . <br /> use the UST Installation Applica ion pages 4-8 as necessary for a timely pian review). <br /> k� v 8 M sir+- S£1Jft t —._—.... . <br /> 4. DesFrjption of equipment to be L 3ed(Attach drawingslblueprints as necessary). <br /> AL <br /> 5. All equipment is State certified o approved. YES[] NO[] <br /> 6 Decontamination Procedures: <br /> a. Will piping be decontaminat d prior to removal? YES t] NO[] <br /> b. Identify contractor performin decontamination' <br /> Name Phone(_] _—..-. <br /> Address city—Zip <br /> Zip <br /> c. Describe method to be used for decontamination <br /> d. Describe how rinsate mated M will be stored onsite pnor to manifesting offsite: <br /> e. Rinsate Hauler and permit ed Treatment,Storage$Disposal Fac:lity: <br /> Hauler Name Phone(_ Hauler Reg# <br /> Address City Zip_—_ <br /> Permitted Disposal Site <br /> 7. a. Describe the method that wi I be utilized to purge and)or inert the piping: <br /> b. Piping Hauler. — <br /> Name Phone ----- <br /> Address city Zip... ...-__... <br /> Hauler Registration#(if hauled as hazardous) <br /> Piping Disposal Site, <br /> Name Phone i_ ? <br /> Address City Zi; <br /> EPA IDIS(if transported to a permitted TSD facility) <br /> B. Is the sampling firm an inde endent third party from the contractor?YES[] NO[] <br /> g. Describe,in detail,how the i 1,ojS andlor water sample(s)beneath the piping or dispenser will be obtain, <br /> 10 Handling of excavated sat(Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phoney L� <br /> Address City Zip__ <br /> b)If soil is not to be hauled,describe what will be done with it: <br /> 2 <br /> Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 <br />