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02/19/2009 THU 12:52 FAX 2094683433 SJC EHD 12001 <br /> ********************* <br /> *** FAX TX REPORT *** <br /> ********************* <br /> TRANSMISSION OK <br /> JOB NO. 2270 <br /> DESTINATION ADDRESS 919165437048 <br /> PSWD/SUBADDRESS <br /> DESTINATION ID <br /> ST. TIME 02/19 12: 51 <br /> USAGE T 00' 29 <br /> PGS. 1 <br /> RESULT OK <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[] <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 Application pages 4-8 as necessary for a timely plan review): <br /> 4. Description of equipment to be used(Attach drawings/blueprints as s necessary): <br /> .1 <br /> 5. All equipment is State certified or approved. YES.X NO[] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] N014 <br /> b. Identify contractor performing decontamination: <br /> Name Phone( ) <br /> Address City Zip <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> t%J <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name ^ 01 "" 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 /> — t4/A <br /> b. Piping Hauler: <br /> Name JIJ A Phone( ) <br /> Address City Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: —. <br /> Name <br /> Phone( ) <br /> Address City Zip <br /> EPA ID#(if transported to a permitted TSD facility) <br />