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0 i <br />R 1z' C E 7L V E D <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) i A N 2 h Z018 <br />1. Site map enclosed? YES N NO [ ] ENVIRONMENTAL HEALTH <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training (P4k c16 eiWfail h <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 UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for a timely plan review): <br />1. Perform a Helium investigation to determine location of vapor leak. <br />2. Sawcut, remove and dispose of concrete in area of suspected leak. <br />3. Repair underground vent/vapor piping. <br />4. Obtain required CUPA inspections. <br />5. Restore all concrete disturbed for this work. <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />Red Thread II Fiberglass Pipe <br />EH230038 (revised 7-26-2016) <br />