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0 <br /> RECENED <br /> UST SYSTEM RETROFIT OR REPAIR FEB 0 12017 <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1 Site map enclosed? YES NO ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> 2. Submit copies of ICC Service Technician and/or Installers certificate and all manufacturer training certificates for 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 LIST equipment, or performing tank top upgrade, use the LIST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> Remove existing Gilbarco Advantage dispensers.Install 4 new Gilbarco Encore 700 Dispensers,Install updated <br /> Veader-root ISD software.Cold start system,program and testa sensors. <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> (4)CONY-132000 Bravo Conversion Frames <br /> (4)Gilbarco Encore 700 Dispensers <br /> (1)Veeder-Root Firmware <br /> EH230038(revised 12-11-15) 3 <br />