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9255517888 Line :11 a.m. 04-07-2010 5/12 <br />%* o iJiGIYimr-iRVr'ii mcrW <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 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 Application pages 4-8 as necessary for a timely plan review): <br />REP Are SENSOR, (PIN 794380-323) ON L5-lT47 "Q1rC0 S.TD <br />4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br />VEEDER-ROOT SENSOR (794380-323) <br />5. All equipment is State certified or approved. YES S(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 City Zip <br />c.. Describe method to be used for decontamination: <br />d. Describe how drlsate 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 and/or inert the piping: <br />b. Piping Hauler: <br />Name Phone <br />Address City Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone L� <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 [] <br />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): <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 />