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19255517888 Main Fax 0 GETTLER RYAN INC 0 •52:14 a.m. 01-15-2008 5110 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 Ni 2. Manufacturer's spec sheets attached for all equipment to be installed YES P(NO [ j 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): REPLACE .ft! },aa(7943sQ-324------------- -- 4. Description of equipment to be used (Attach drawings/blueprints as necessary): a jPt1 sENsoRff2-1NL-gQ211--__—_—________ POSITION SENSMVE SENSOR (794380-323) 5. All equipment is State certified or approved. YES [lY)'NO [ ] Decontamination Procedures: a. Will piping be decontaminated prior to removal? YES [ ] NO[] b. Identify contractor performing decontamination: Name----- -- w _�_------ 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_— �_------___�_ �___—____—___—___--____ —_ 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