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UST SYSTEM RETROFIT OR REPAIR <br /> (Submit it minimum of 2 sets of plans&applications as originals will be retained by <br /> 9. Site map enclosed YES[ NO[ AUG 2 3 2016 <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 stalWon ication pages 4•-8 as necessary for a timely plan review): <br /> 4. Description of equ' nt tc3 be used Qkftch drawin lueprints as necessary): <br /> 5; All equipment is State certified or approved. YES 14 NO 1 <br /> C. Decontamination P <br /> a. Will piping be decontaminated prior to removal? YES[] NO f] <br /> b. Identify contractor performing decontamination: <br /> 1 <br /> Name Phone(____} <br /> Address city Ztp <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting o e: <br /> e. Pinsate Hauler and permitted Treatment,Storage&Disposal Facility.- <br /> Hauler <br /> ility:Mauler Name Phone() Hauler <br /> Add city p <br /> Permitted Disposal Site <br /> 7. a. Describe the method that will be utilized to purge andfor inert the piping: <br /> b.piping Hauler <br /> Name Phone <br /> City zip <br /> Hauler Regindration#(if hauled ashazardous)-----, <br /> c. Piping Disposal Site: <br /> Phone(.�...., <br /> Add City zip <br /> EPA i (if transported to a permitted TSD facility) <br /> B. Is the sampling firm an independent third party from the contractor? YES[] NO[] <br /> 9. Describe,in detail, how the soil and/or water sample(s)beneath the piping or dispenser will be <br /> obtained- <br /> . Handling of excavated soil(Contaminated Sail Hazardous Waste Mauler): <br /> Name Hauler Regh&Won g Phone I ) <br /> d p <br /> b)if sail is not to be hauled, describe what will be done with it: <br /> 2 <br />