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SANJ O A Q U I N Environmental Health Department <br /> - - - C O U N TY -- <br /> LIST 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 [) 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 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 /> use the UST Installation Application pages 4-8 as necessary for a timely plan review) : <br /> - Convert ( E ) 201000g 87 slave UST to E85 product . <br /> - Eliminate (4) middle dispensers and UDCs . <br /> - Remove ( E) manifold piping between 87 tanks . Perform soil sampling . <br /> - Replace (8 ) remaining dispensers with Gilbarco Encore 700S dispensers on conversion frames <br /> - Run new 3"x2 " fiberglass E85 product piping to (2 ) dispensers . <br /> - Install E85 compatible components in tank sumps , annular, and UDCs as necessary . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval ) : <br /> See Material List on plans . <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal ? YES [ T� NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name Dillard Environmental Services Phone ( 925 ) 634-6850 <br /> Address PO Box 579 City Byron Zip 94514 <br /> 3of6 <br />