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SANJ O 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 EHD ) <br /> 1 . Site map enclosed ? YES k 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 , LIDC ' 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 /> cl - 4u. 'Iwl � r D%000 4kj 4rl &� la ) 59 ? T j l4k� <j <br /> 5.. 2 wf til � c d , RtLIIAcLlw Or& vo b Arj4E of 444injj awj r-Ato4& %4 . <br /> +�^yir 11 0 ? 4/ 1) Kc) 4coo ja4� 1 •.-. Q , rLA L, , rlSer Te, Yh Lt"D <br /> pty,...0 d�l � r � ��lrev � ..'1 . � re5vlr.,.-. . ..� r . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third - party approval ) : <br /> � rby0 % L Vr.4l u r144 4 (x ,4In6LL 1 I % , A144d W <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal ? YES [ ] NOA <br /> b . Identify contractor performing decontamination : <br /> Name Phone ( ) <br /> Address City Zip <br /> 3of6 <br />