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SAN10 A Q U I N Environmental Health Department <br /> COUNTY <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans & applications as originals will be retained by END ) <br /> 1 . Site map enclosed? YES N 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 /> •. <br /> Ljl <br /> JUL 15 2020 <br /> EN VIRGNMENTAt H0 El Fj� <br /> DEPARTMENT <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval ) : <br /> 5ee <br /> 5 . Decontamination Procedures : 10 rq lc.ce4 . <br /> a. Will piping be decontaminated prior to removal? YES Nf; NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name G 4K�B �c (`ra !' �uw► Phone (gUi ) 4C2, 101(a <br /> Address �J7 Z (o � � B ac., e Ave City 7 I "e Zip <br /> 3 of G <br /> I <br />