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SAN JOAQUIN F ear e � �m <br /> Environmental Health Department <br /> W. COUNTY .. ._ _ - „ <br /> Fkb 0 3 2020 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) J I AL HEALTH <br /> { . Site map enclosed? YES j ] NO ( ] � L ` ; 'f A/IENT <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 Pian" is available on the jobsite as required by Title B . <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 /> A �� lAcCl'v' 55WC 0E 2 � Malt, In 5 $ 51W 1 SPt LL SUS <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval) : <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal ? YES [ ] NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name Phone (�) <br /> Address City Zip <br /> 3of6 <br />