Laserfiche WebLink
i N AM O U!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 j?( 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 besting any component that is repaired or replaced. Ensure a copy of <br /> the'Site Health and Safety Plar,'is available on the jobsits as required by Title 8. <br /> 3. Detailed description of work to be completed. List components to be repaired or replaced and aftach a <br /> diagram drawn to scale showing location of repairs and/or replacements. If repairing a component, describe <br /> how this wW be done. (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> use the UST Installation Appik#adon pages 48 as necessary for a timely plan review): <br /> See attached plans <br /> 4. List of equipment to be used (Attach manufacturer's specifi**m shuts showing third-party approval): <br /> See attached <br /> S. Decontandcwtion Proced im- <br /> a. Will piping be decontaminated prior to removal? YES NO[] <br /> b. Identify contractor performing decontamination: <br /> Name John B Winner Jr. Pie 650 588-3088 <br /> Address 1045 Airport Blvd. City S.San Francisco Zjp 94080 <br /> 3 of 6 <br />