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RECEIVED <br /> UST SYSTEM RETROFIT OR REPAIR DEC 2 2 2016 <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed? YES j( NO [] ENVIRONMENTAL <br /> ii HEALTH <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training cPe i icateEforr each <br /> person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health and Safety <br /> 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 diagram drawn <br /> to scale showing location of repairs and/or replacements. If repairing a component, describe how this will be done. (If <br /> adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> Remove and Replace (E) wall mounted Waste Oil Drain Table and Drip Tray in <br /> Maintenance Garage. (N) Drip Tray to extend Beneathe (E) Filter Crusher. <br /> Install (N) Drain Piping and Fittings. Install (N) Electric Ball Valve on <br /> Drain Piping That closes-with the V/R High Level Sensor set @ 90% High level <br /> in the 1,000 gallon UST. <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> ValWorx Electric Actuated Stainless Steel Ball Valve 2", 120VAC Qty. 1 <br /> Veeder Root 794380-208 Sensor Qty.1 <br /> Veeder Root 794390-420 Sensor Qt. 1 <br /> EH230038(revised 7-26-2016) 3 <br />