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04/2912011 16:18 9163731173 WALTONENGINEERING PAGE 02/02 <br />SR0062oo4 - 04-22-11 <br />UST SYSTEM RETROFIT OR REPAID <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed? YES [:g NO (I <br />Technician and/or Installer's certificate and all manufacturer training certificates for each <br />2. Submit copies of ICC Service <br />that is repaired or replaced. Ensure a copy of the `Site Health and Safety <br />person installing or testing any component <br />Pian" is available on the jobsite as required by Title B. <br />3. Retailed 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 r6pairing a component, tche USTribe Installation this <br />i will bep one. i (If <br />da "Ina. piping, UDC's, or other UST equipment, or performini tank top upgrade, <br />pages 4-8 as necessary for a timely plan review): <br />Demo and excavate concrete at likely underground leak are as indicated <br />on 'Bali= Investigation Report, dated 04-01-11, stockpiling spoils onsite. <br />Make necessary repairs to underground 91 product secondary piping. <br />Schedule inspection with county Inspector and perform pressure tasting of <br />91 product secondary. Backfill and restore all concrete to match existing <br />using #4 rebar as required. Perform final BB989 test of 91 product <br />secondary with reports to County agency and owner. <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />Smith Fiberglass Piping - Red Thread IIA, <br />2 <br />