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0 . . 0 <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 2 sets of plans & applications as originals ►arill be retained by END) <br />1. Site map enclosed YES[] NOH. <br />2 Manufacturer's spec sheets attached for all equipment to be instafled YES* NO�tl1-) J L <br />o n veec�L( coo � <br />3. Description of work to be completed (If addmg piping. UDC's, or other UST equipment, or performing tank top upgrade, <br />use the UST installation Application payers 4-8 as necessary fora timely plan review): <br />4. Description of equipment to Pe used (Attach drawingstblueprints as necessary): <br />C'�P11—ICIf' __kF <br />5. All equipment is State certified or approved. YES NO [] <br />6. Decontamination Procedures: <br />a. VM piping be decontaminated prior to removal? YES [ ] NO[] <br />b. Identify contractor performing decontamination: <br />Name Phone) <br />Address City �p <br />c. Describe method to be used for decontamination: <br />d. Describe how rumate material will be stored onsite prior to manifesting offsite: <br />e. ate Hauler and permitted Treatment, Stmage & Disposal Facriity: <br />Hauler Name Phon__ <br />e(. 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. <br />tiiz&r Registration # (rf hauled as hazardous) Crty <br />c. Piping Disposal Site: <br />Name Phone <br />Address City Zip <br />EPA W# (f transported to a permitted TSD facility) <br />S. Is the sampling firm an independent third party from the contractor? YES [ ] NO [ ] <br />9. Describe, in detall, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />10. Handling of excavated soil (Confaminated-Sorl Hazardous Waste Haider). <br />Name Hauler Registration # Phone <br />Address city Zip <br />b) If soli is not to be hauled, describe what will be done with it <br />