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mut V4/nb <br /> 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 NO() <br /> 3. Description of work to be completed (If adding piping, UDC's, or other UST equipment,or performing tank top upgrade, <br /> us t�e UST Installation Application pages 4-8 as necessary for a timely plan 1e�wA);8,� <br /> l0 OL 1 1 <br /> 4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br /> S. All equipment is State certified or approved, YES() NO [] <br /> 6. Decontamination Procedures: NO <br /> a.SII piping be decontaminated prior to removal? YES[) [) <br /> b. Identify contractor performing decontamination: Phone(„_) <br /> Name City Zlp <br /> Address <br /> c. Describe method to be used for decontamination: <br /> d. Describe how nnsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storageo Phe(iDisposal Facility: Hauler Reg# <br /> Hauler Name yCity Zip___ <br /> Address <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge and/or inert the piping; <br /> b. Piping Hauler: Phone <br /> Name City Zip-------- <br /> Address <br /> Hauler Registration#(if hauled as hazardous) <br /> C. Piping Disposal Site: Phone <br /> Name City Zip <br /> Address <br /> EPA ID#(if transported to a permitted TSD facility) <br /> 6. Is the sampling firm an independent third party from the contractor? YES[) NO [] <br /> g, Describe, in detail,how the soil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> 10. Handling of excavated soil(Contaminated Soil Hauler Hauler): <br /> Reg stration# Phone <br /> Name City Zip__ <br /> Address <br /> b)If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />