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UST SYSTEM ■eE®R®FI. OR REPAIR <br /> (Submit minimum of 2 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed YEI] NO[] <br /> 2. Manufacturers spec sheets attached for all equipment to be installed YESKNO[] <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 U In ation Application pages 4-8 as necessary for a timely plan review): <br /> A i` s <br /> r <br /> 4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br /> 5. All equipment is State certified or approved. YE111, <br /> NO[j <br /> 6. Decontamination Procedures: Y✓ <br /> \entify <br /> decontaminated prior to removal? YES[] NO[] <br /> ctor performing decontamination: <br /> Phone( <br /> City Zip <br /> od to be used for decontamination: <br /> d. Describe how rinsataterial will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitte 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 utilizedto rge and/or inert the piping: <br /> b. Piping Hauler: <br /> Name Phone(_y <br /> Address City Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Phone <br /> Name U <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\dis <br /> NO[] <br /> 9. Describe,in detail, how the soil and/or water sample(s)beneath the pipiner will be obtained: <br /> 10. Handling of excavated soil(Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration# Phone <br /> Address City ip <br /> b)If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />