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12/30/2008 12:56 9163731173 WALTON ENG PAGE 02 <br /> 0 0 <br /> (39 <br /> 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[) <br /> 2. Manufacturer's spec sheets attached for all equipment to be installedYES[] 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 pplication pages 48 as necessary for a timely pian <br /> 4. Description of equipment to be used (Attach drawings/blueprints as necessary): <br /> S. All equipment is State certified or approved. YES[] NO[] <br /> 6. Decontamination Procedures: <br /> a. WRIT 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 rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Nam® Phoner 1 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 <br /> City Zip <br /> Hauler Registration#(if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Phone( <br /> Name <br /> Address City Zip <br /> EPA IDA(if transported to a permitted TSD facility) <br /> 8. Is the sampling firm an independent third party from the contractor? YES[] NO[I <br /> 9. 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.9 Phone <br /> Ad dross City, zip <br /> b)If soil is not to be hauled, describe what will be done with it: <br /> 2 <br />