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Mar. 11. 2014 2:05PM No. 3621 P. 3 <br /> HCAJEIVNED <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) MAR 1 1 2014 <br /> 1. Site map enclosed? YES bd NO[] ENVIRONMENTAL <br /> copies of ICC Service T HEALTH DEPARTMENT <br /> 2. Submit co <br /> p Technician and/or[nskaller'a cert�ficake 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 UST equipment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> Replace the existing siphon piping penetration in T-3 piping sump. <br /> Supply and install an additional piping and an additional electrical penetration fitting in T-3 piping sump. <br /> Replace the three existing steel annular space risers on T-1.T-2,and T-3(the three diesel tanks)with <br /> AO Smith fiberglass risers. <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> Diversified Repair penetration Fitting (Part #RBK 8-2 .5) <br /> Diversified repair penetration part#RBK 8.2.5&RBK 4-1.111 <br /> AO Smith 4"Fiberglass Pipe(Part#011040-191-4)&AO Smith 4"Bell X Male(Part#012940-191-4) <br /> Ata Smith Adhesive Kit(Part#02990-000-1) <br /> 3 <br />