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0 0 <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 YEI] NO [ ] <br />2. Manufacturer's spec sheets attached for all equipment to be installedYESI,NO [ ] <br />3. Description of work to be completed (Ifda ding 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 />4. Descript]on of equipment to <br />drawings/blueprints as necessary): <br />5. All equipment is State certified or approved. YESNO [ ] <br />6. Decontamination Procedures: ✓✓ <br />Will piping be decontaminated prior to removal? <br />b. entify contractor performing decontamination: <br />c. Describe hwthod to be used for decontamination: <br />YES[] NO[] <br />City Zip <br />d. Describe how rinsatbqnaterial will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and <br />Hauler Name <br />Storage & Disposal Facility: <br />7. a. Describe the method that will be utilized to"irge and/or inert the piping: <br />b. Piping Hauler: <br />Hauler Registration # (if hauled as <br />c. Piping Disposal Site: <br />K1___ <br />EPA ID# (if transported to a permitted TSU <br />Hauler Reg# <br />City Zip <br />Phone (_y <br />City Zip <br />_ Phone ( <br />City Zip <br />8. 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 dis Reser will be obtained: <br />10. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br />Name Hauler Registration # Phone <br />Address City <br />b) If soil is not to be hauled, describe what will be done with it: <br />2 <br />