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UST SYSTEM RETROFIT OR REPAIR <br /> t �"I (Submit minimum of 2 sets of plans&applications as originals Win be retained by EHD) ����� <br /> Aa .Sq"%nclosed YES[j NO[j t <br /> atj� sheets attached for as equornent to be instalied YES[j NOENVIR <br /> PE, y11 work to be ed-(lfadn �DC—s;oFather lSTequipmeni,or Yerforrn tank top upgrade, <br /> use the UST 1 ApppCation pages 4-8 as fora review). <br /> 4. Description of equipment draWng biue irbts as /W <br /> 5. An equipment is State cerNied or approved. YES F j NO H <br /> 5. Deconiaminatkrn Prebcedures: <br /> a.VVdt piping be decontaminated prior to removal? YES[j NO F j ,�0/ . <br /> b. Identify�perforz*lg decmnWBkmbm 6K �r <br /> Name ph0lltec---) <br /> Address CRY zip <br /> c. Describe method to be used for demitalrnitbatiOn: <br /> d.Describe tow rinsa le material will be stored ortsde prior to marnTmbtg o <br /> e.tete Hauser and perms ted TreaUnent St<uage&Disposal Fad: Hauler Reg# <br /> Hailer Name , city Address <br /> Permed 01sposai Site <br /> 7. a.Describe the method Shad wig be utilized to purge and[Or inert the Pip : <br /> b.Piping Hauler <br /> Nam" City 24) <br /> phot�---) <br /> Address <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: Phone( ) <br /> Name <br /> Address zip <br /> EPA (if farted to a Perms TSD hICEW <br /> 8. is the sampling firm an independent bird partly from Ste cordrae;jor7 YES F j NO[] <br /> 9. Describe,in decal.tow the sail andtor water samples)beneath the piping or disperim will be obtained: <br /> 10. Har ftV of ebmavated s*(Contamirale4'Soil Hazardous Waste tom: <br /> Hades Ramon# Phone <br /> Address <br /> zip— <br /> b)tf sod is not to be h puled,describe what will be dors with it <br /> 2 <br />