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11 <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 [ ] NO [I <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 />use the UST Installation AppNgation pages+A as pecessary fgfia timely plan review):_ <br />4. Description of equipment; to be used <br />5. All equipment is State certified or approved. YES [ ] NO [] <br />6. Decontamination Procedures: <br />as necessary): <br />a. Will piping be decontaminated prior to removal? YES [ ] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name Phone( <br />Address City - rp <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting ollsite: <br />e. Rimsate Hauler and pwmHW Treatment Storage & Disposal Facility: <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 and/or inert the piping: <br />b. Piping Hauler. <br />Name Phone U <br />Address City Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone (_) <br />Address City Zip <br />EPA ID# (if transported to a permitted TSD faciity) <br />Is the sampling firm an independent third party from the contractor? YES [ ] NO[] <br />Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />10. Handing of excavated sorb (Contaminated'Soil Hazardous Waste Hauler): <br />Name Hauler Reg" g Phone (.. } <br />Address City Zip <br />b) If soil is not to be hauled, describe what will be done with it: <br />