Laserfiche WebLink
UST SYSTEM RETROFIT OR REPAIR <br />l�; LAI <br />IF171t =t1t, At� M =1.; 11L 1M im I <br />1. Site map enclosed YES[] NOU <br />2. li�anufacturer's spec sheets attached for all equipment to be instaffedYES [ ] NO F4 <br />3. Description of work to be completed Of ad&A piping, UDC's, or other LIST equipment, or performing tank top upgrade, <br />use the UST Installation Application pages 4-8 as necessary for a timely plan review): <br />Repair leak in sump pipingsfor-Zasbline hj=s I and 2. <br />a. Will piping be decontaminated. prior to removat? TES[I NO[] <br />b. Identify contractor performing decontamination: <br />Name Phonef <br />Address city —Zip <br />d. Describe how rinsate material wilf be stored onsite, prior to manifesting offsite: <br />e. Rinsate Hauler and pennitted Treatment, Storage &,Disposal Facitity: <br />Hauler Name phone( I Hauter Reg#_ <br />Address city Zip <br />Permitted Disposal Site <br />b. Piping Hauler <br />Name Phone <br />Address City_ Zip <br />Hauler Regis bation # (if hauled as hazardous)_ <br />c. Piping Disposal Site: <br />Name Phone <br />Address —City Zip_ <br />EPA lD# (if transported to a permitted TSD tactility) <br />8. Is the sampling firm an independent third party from, the contractor? YES [ ] NO[] <br />aa; 07MITM I <br />10. Handling of excavated soil (Contaminated, Soil Hazardous Waste Hauler): <br />Name Hauler Regisb2tion # Phone <br />Address city Zip_ <br />b) If soil is not to be hauled, describe what wifl be done with it: <br />9 <br />