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IRSYSTEMRETROFIT OR .REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed YE NO[I _ <br /> 2. Manufacturer's spec sheets attached for all equipment to be installed YESO[] <br /> tion of <br /> 3. Description work to be completed(If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> use the UST Installation Application pages 4-8 as necessary for a timely plan review): <br /> 4. Description of equment to be used(Attach rawings/blueprints as necessa <br /> 5. All equipment is State certified or approved. YES NO[ <br /> 6. Decontamination Procedures: <br /> rV <br /> a. Will piping be decontaminated prior to removal? YES[] NO <br /> b. identify contractor performing decontamination: <br /> Name ` Phone(_) <br /> Address <br /> City Zip <br /> c. Describe method to be used for decontamination: f <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage& Mng: <br /> Hauler Name -hone ler Reg# <br /> Permitted Disposal Site City <br /> 7. a. Describe the method that will be utilized to purge and/ob. Piping Hauler: <br /> NameAddress one 1 a <br /> HaulerRegistration#(if hauled as hazardous) City Zip-------- <br /> C. Piping Disposal Site: <br /> Name <br /> Address Phone <br /> EPA ID#(if transported to a permitted TSD ility) City zip________ <br /> 8. Is the sampling firm an independent third arty from the contractor? YES[j NO <br /> 9. Describe, in detail, how the soil and/or ater sample(s) beneath the piping or dispenser will be obtained: <br /> 10. Handling of excavated soil(Con minated Soil Hazardous Waste Hauler): <br /> Name <br /> Address Hauler Registration# <br /> Ci Phone L.__)_--_� <br /> zip <br /> b)If soil is not to be haute , describe what will be done with it: <br /> 2 <br />