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SAN O A Q U i N Environmental. Health Department <br /> k. <br /> COUNTY �� , � " � n, AV <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 NON <br /> B <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 /> se the UST Installation Application pages 4-8 as necessary for a timely plan review) : <br /> W�Zeq op" ostl H X96 �+ af\ L f C 6t r CAJ <br /> 0C, � h shcd gL <br /> Zig C r��t.ai '� � > n rIse <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval) : <br /> CK) ik:cA alM cqL 61f " 5" <br /> f <br /> E <br /> F <br /> 5. Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal? YES NO <br /> b . Identify contractor performing decontamination : <br /> Name Phone (� <br /> Address City Zip <br /> 3 of 6 <br /> i <br /> i <br /> P' <br />