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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 P <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 UST Installation plication pages 4-8 as necessary for a timely plan review): <br /> 4. Description of equipment to be used(Attach drawings/blueprints as necessary): <br /> 5. All equipment is State certified or approved. YES D' NO(] <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone ) <br /> Address Ci Zip <br /> c. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manife ing offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disal 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 top e and/or inert the piping: <br /> b. Piping Hauler: <br /> Name Phone(_) <br /> Address City Zip _ <br /> Hauler Registration#(if haul e as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone L_) <br /> Address City Zip <br /> EPA la(if trans to a permitted TSD facility) <br /> 8. Is the sampling an independent third party from the contractor? YES[] NO[] <br /> 9, Describe,in etail, how the soil and/or water sample(s)beneath the piping or dispenser will be obtained: <br /> ;10./ZHaing of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br /> Hauler Registration# Phone City Zip <br /> b)If soil is not to be hauled,describe what will be done with it: s <br /> 2 <br />