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Apr 07 08 10:58a Sandra Barnhart 2098458586 P.5 <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 installedYES)(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 th UST instaJlationApplication pages 1 8 as neGessa forca tim ly plan review): <br /> 'X a in 6J 11 <br /> Ma <br /> %A-t>c',,s Pis weed-W - <br /> 4. Description of eq ipment to be used(Attach drawings/bIqeprints as necessary)* <br /> C�o�S OCLZ r tKi-f-, c1f,M± <br /> 5. All equipment is State certified or approved. YES Of NO <br /> S. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? .4- YES[] NO[] <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 /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name Phone() Hauler Reg#_ <br /> Address city Zip_ <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge andfor inert the piping: i A- <br /> b. Piping Hauler: <br /> Name Phone( <br /> Address city-- Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: 01A <br /> Name Phone <br /> Address —City_Zip_ <br /> EPA ID#(if transported to a permitted TSD facility) <br /> 8. Is the sampling firm an independent third party from the contractor? YES NO All-f <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): IV14- <br /> Name Hauler Registration# Phone <br /> Address city Zip_ <br /> b)If soil is not to be hauled,describe what will be done with it: <br /> 2 <br />