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UPSYSTEM RETROFIT OR RAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by ED) <br /> 1. Site map enclosed YES[I NOW <br /> 2. Manufacturers spec sheets attached for all equipment to be installed YEN'NO <br /> 3. Description of work to be completed(If g4din g piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> MT <br /> th UST InstIll! p1 on as=n <br /> 0 <br /> SSIM a ti I plan review <br /> RMUM ON . <br /> 4. Descrip' n f equipmen0 used(Attach dra <br /> VN s/blueprints as necessary). <br /> 5. All equipment is Statf-nertified 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: A <br /> Name Phone <br /> Address city Zip <br /> C. Describe method to be used for decontamination: <br /> A I A <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Phone( Hauler Reg#_ <br /> Address city Zi <br /> Permitted Disposal Site7. <br /> Describe the method that will be utilized to purge and/or inert the piping: <br /> b- Piping Hauler: <br /> Name Phone <br /> Address city Zip <br /> Hauler Registration#(if hauled ashazardous <br /> c. Piping Disposal Site: <br /> Name Phone <br /> Address ---city-Zip- <br /> EPA lD#(if transported to a permitted TSD facility)_ <br /> 8. 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 Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone <br /> Address city_zip_ <br /> b) If soil is not to be hauled,describe at will be done with it: <br /> 2 <br />