COMPLIANCE INFO_2001-2009 - Laserfiche WebLink

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UST SYSTEM RETROFIT OR REPAIR (Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) 1. Site map enclosed YE NO [ ] 2. Manufacturer's spec sheets attached for all equipment to be installedYES,*NO [ ] 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): 24.nk4L, &1ci 5d +v%n De�SVFo,- u: tkn Ncw Vea,,4 94.(_k 4. Description of equipment to be used (Attach drawings/blueprints as necessary): S=11F & mss, 5. All equipment is State certified or approved. YES"[], NO [ ] N 6. Decontamination Procedures: a. Will piping be decontaminated prior to removal? YES[] NO[] b. Identify contractor performing decontamination: Name Phone(_) Address City Zip N 7 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 � k Piping Hauler: Name Hauler Registration # (if hauled as City, Phone (-� Zip c. Piping Disposal Site: Name Phone (� N Address City Zip EPA ID# (if transported to a permitted TSD facility) Is the sampling firm an independent third party from the contractor? YES [ ] NO [] 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 #,!�_ Address City b) If soil is not to be hauled, describe what will be done with it: 2 Phone C__) Zip