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SAN1 O A Q U I N Environmental Health Department <br /> COUNTY <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br /> 1. Site map enclosed? YES [I NO b� <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training <br /> certificates for each person installing or testing any component that is repaired or replaced. Ensure a copy of <br /> the"Site Health and Safety Plan" is available on the jobsite as required by Title 8. <br /> 3. Detailed description of work to be completed. List components to be repaired or replaced and attach a <br /> diagram drawn to scale showing location of repairs and/or replacements. If repairing a component, describe <br /> how this will be done. (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 /> t <br /> t,U-(i Cl3"—Q" is GVAU civ t tins <br /> v�cdf. - - �. ; : I STP �to I �'�(( b B'1 ST'*o <br /> t-all <br /> t�TIJ 2t V Zi�t�, � ��L`�LI�Sr'i7T itL�O g7 ��� LICf �• l [f5t:� u��' is <br /> 4. List ofequipmentto be used (Attach manufacturer's specification shee-'tsI showing third-party approval): <br /> t-eVNAL out <br /> �1B <br /> ENv\ pEPP <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Phone U <br /> Address City Zip <br /> 3of6 <br />