Laserfiche WebLink
C1 <br />Ll <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 [I NO [I <br />2 Manufacturer's spec sheets attached for all equipment to be installed YES [ j NO [ ] <br />3. Description of work to be completed (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br />useAe UST Installation Application pages 4-8 as necessary for a timely plan review): <br />4. Description of equipment to be used (Attach drawingstblueprints as necessary): <br />l.i V Lf. -I<- (L -4f, L. r -j K v `7L <br />5. AU equipment is State certified or approved. YES [] NO [] <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name Phone( -- <br />Address City Tip <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsae material will be stored onsite prier to mane%sting offsite: <br />e. Rinsatea Hauler and permitted Treatment, Storage & Disposal Facird : <br />Hauler Name Phone(_) Hauler Reg# <br />Address City zip <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge andlor inert the piping: <br />b. Piping Hauler. <br />Name phone <br />Address . City Zip <br />Hauler Registration # (f hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone ( <br />Address City. rp <br />EPA ID# (if transported to a permitted TSD facifidy) <br />S. Is the sampling firm an independent third party from the contractor? YES [ j NO [ ] <br />9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />10. Handing of excavated sot (Contaminate d'Soii Hazardous Waste Hauler): <br />Name Hauler Reeg"i bvtIon # Phone <br />Address City zip <br />b) if soil is not to be hauled, describe what will be done with it <br />2 <br />