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Mpr 27 08 09:00a Sandra Barnhart <br />2098458586 p.2 <br />0 <br />LIST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 2 sets of plans & applications as originals will be retained by GHD) <br />1. Site map enclosed YES D( NO ( I <br />2. Manufacturer's spec sheets attached for all equipment to be installedYES N' NO I I <br />3. Description of work to be completed (if adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br />se the UST Installation Application pVes 4-8 as necessary for a timely plan review, <br />i "IA iX I ri " I t'CaA C. fic /.)., I I -dily04- T�it ,. C" '19 L 2 <br />D,,Caooyr-6A <br />ol&e VINT I <br />a r -Y. -j- we-li-,.0a,mA <br />FL-tn C44oi-ta-L —eke *,t Ale- <br />A�tirm�i,'A pik�5 0-9-i - fjtrX" C�A�eck� VA ­A�P 3459e-fdn P-W–aWa—ptb(le.' <br />4. Descriptionofequipment tonetused�ApchdramdngsUueprirtsasneoessar� <br />j( <br />6) <br />FIA I ii, n vm-r. qqZ/�jov),o 91 .54- 0 S/,9 3 91? 30r-,9,0 1-?eJ,7 <br />MA 'WINA"', <br />-r i - U aw-j <br />or approved. YES 61 NO[) <br />S. Decontamination Procedures: NIR <br />a. Wig piping be decontaminated prior to removal? YES 11 NO[] <br />b. Identify contractor performing decontamination: <br />Name Phone( <br />Address city zip <br />o. Describe method to be used for decontamination: <br />d. Describe how rinsate material viii be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility. <br />Hauler Name Phone( I Hauler Reg# <br />Address city Zip_ <br />Permitted Disposal Site <br />7. a. Describe the method that vA!l be utilized to purge andfor Inert the piping: Nj- <br />b. Piping Hauler <br />Name Phone <br />Address City_ Zip <br />Hauler Registration # (if hauled as hazardous) <br />a. Piping Disposal Site: <br />Name Phone <br />Address ----Pity_ Zip_ <br />EPA ID# (if transported to a permitted TSD facil <br />8. Is the sampling firm an independent third party from the contractor? YES NO [] )V/)+ <br />9. Describe, in detail, how the soil and/os water sample(s) beneath the piping or dispenser will be obtained: A114 <br />10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): A//A- <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 />K <br />