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SA N__�J0 A Q U IN 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 Z 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 NEW BRAVO DOUBLE <br /> WALL UDC. EXPOSE PIPING(PRODUCT,VAPOR,AND ELECTRICAL).BLOW ALL FUEL BACK INTO TANK BEFORE CUTTING <br /> LINES BACK FROM OLD UDC.REMOVE OLD UDC. PULL UP TO(3)SOIL SAMPLES FOR TESTING.INSTALL NEW UDC WITH <br /> ALL NEW PIPING PENETRATIONS(PRODUCT,VAPOR,AND ELECTRICAL).BACKFILL AND POUR NEW CONCRETE AROUND <br /> NEW UDC.REINSTALL DISPENSER.DEMO AND EXPOSE 91 STP SUMP AT LEAKING FITTING AND REPLACE FITTING WITH <br /> NEW BRAVO DOUBLE WALL FITTING PT No F-07-Retrofit-SD-AB,REPLACE REMOVED BACKFILL AND CONCRETE. <br /> Cut and break out concrete around 91 fill sump.Vacuum excavate to tank top Xerxes to remove and install new sump collar and sump <br /> top(see attached scope of work for work being performed by Xerxes).Perform all required inspections.Fill sump with brine.Back fill <br /> and replace concrete. <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 /> (2)BRAVO DOUBLE WALL ELECTRICAL PENETRATION <br /> ALL SMITH PRIMARY AND SECONDARY PIPING(2"RED THREAD PRIMARY,3"RED THREAD SECONDARY) <br /> 91 SUMP WORK,BRAVO DOUBLE WALL PENETRATION FITTING PT No F-07-Retrofit-SD-AB <br /> ZCL XERXES Flat-Sided,Two-Piece Double-Wall Containment Sump Uj J <br /> W <br /> 00 = F— <br /> No J W <br /> 5. Decontamination Procedures: NE"® c � L <br /> a. Will piping be decontaminated prior to removal? YES Z✓ NO C'4 z <br /> b. Identify contractor performing decontamination: L Q <br /> Name Phone ( ) Q Z W <br /> Address <br /> city BAKERSFIELD Zip _c <br /> 3of6 <br />