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Oct 19 07 O1 27p El it Iv Contractors Inc 2094616342 P. 1 <br /> 1 9 2007 UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) <br /> I HULTH <br /> 1. Sift lilii l40%— <br /> W 0 E' Es H NO[) <br /> 2. Manufacturer's spec sheets attached for ad equipment to be installed YES[] NO[] <br /> 3. Description of work to be completed(if agft piping.UDC's,or other UST equipment or performing tank top upgrade, <br /> use the M, Installation Applicati n pages 4-8 as ecessary for a timely)plan review <br /> 4. DeLnp�fiof�eku"JpTme7n�16 b4Ws d r mg <br /> u <br /> U,p is as necims:irwr <br /> J29 <br /> 5. Ali equipment is ed or appro%Ted. I NO fj Atlee <br /> 6. Decontamination Procedures: <br /> a.Will piping be decontaminated prior to removal? YES[I No[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone <br /> Address city —zip <br /> c- Describe method to be used for decontamination: <br /> d. Descnbe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rimsate Hauler and perm fted Treatment Storage&Disposal Facility. <br /> Hauler Name— honeL--)—Hauler Reg#_ <br /> Address Ci!y zip <br /> PermittedDis;posal Site <br /> 7. a. Describe the method that will be utilized to purge and/or inert the piping: <br /> b. Piping Hauler: <br /> Name Phone <br /> Address . C___J_ <br /> City Zip <br /> kauiiiiir Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address —Cft <br /> EPA ID#(Af transported to a permitted TSD <br /> a. Is the sampling firm an independent third party from the contractor?YES NO <br /> 9. 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,SoU Hazardous Waste Hauler): <br /> Name Hauler Registration it Phone <br /> Address <br /> City ZIP <br /> — <br /> b)If sort is not to be hauled,deserd)e what will be done with it <br /> 2 <br />