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SA NJ O A Q U I N Environmental Health Department <br /> C 0 U NTY <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 0 NO❑ <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 /> REMOVE(1)DISPENSER#5/6,SET ASIDE. CUT CONCRETE AROUND UDC#5/6 TO REPLACE WITH <br /> NEW BRAVO DOUBLE WALL UDC. EXPOSE PIPING(PRODUCT,VAPOR,AND ELECTRICAL).BLOW ALL FUEL BACK INTO <br /> TANK BEFORE CUTTING LINES BACK FROM OLD UDC.REMOVE OLD UDC. PULL UP TO(3)SOIL SAMPLES FOR TESTING. <br /> INSTALL NEW UDC WITH ALL NEW PIPING PENETRATIONS(PRODUCT,VAPOR,AND ELECTRICAL).BACKFILL AND POUR <br /> NEW CONCRETE AROUND NEW UDC. REINSTALL DISPENSER. INTERSTITIAL LIQUID TO BE USED IS <br /> BRAVO PROPYLENE GLYCOL. <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> (1)B8000 DOUBLE WALL BRAVO UDC 3+1 (BRINE FILLED) <br /> (6)SMITH BULKHEAD FITTINGS(2"PRIMARY X 3"SECONDARY) <br /> BRAVO DOUBLE WALL ELECTRICAL PENETRATION <br /> ALL SMITH PRIMARY AND SECONDARY PIPING(2"RED THREAD PRIMARY,3"RED THREAD SECONDARY) <br /> -,7 1111�ei__01_1' <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES NOF, <br /> /] <br /> Identify contractor performing decontamination: <br /> Name N/A Phone (� <br /> Address City Zip <br /> 30f5 <br />