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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 [ ] NOff <br />2. Manufacturer's spec sheets attached for all equipment to be installedYES [ ] NO <br />3. Description of work to be completed (if gdft 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 timely plan review): <br />Ll.. Description of equipment to be used (Attach drawings/blueprints as necessary): <br />5. All equipment is State certified or approved. YES a NO [ ] <br />T. Decontamination Procedures: <br />a. Nil piping •- decontaminated prior toremoval? <br />b. Identify contractor performing decontamination: <br />Address <br />c. Describe method to be used for decontamination: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name_ Phone( ) i <br />rr71••.. <br />7. a. Describe the method that will be utilized to purge and/or ip6rt the piping: <br />b. Piping Hauler. <br />Hauler Reg # (if hauled as <br />c. Piping Disposal Site: <br />M <br />Hauler Reg# <br />City Zip <br />Phone ( <br />Zip <br />Phone (__) <br />i Zip <br />TSD facility) <br />8. Is the sampling firm <br />.M--ndependent third party from the contractor? YES NO[] <br />9. Describe, in deofto,= <br />10. <br />of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Hauler RegistriMm # Phone (_) <br />City Zip <br />b) If soil is not to be hauled, describe what will be done with it <br />2 <br />