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SAN10 A Q U I N Environmental Health Department <br /> COU NTY — <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 R ] 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 /> During the SB989 test on 5-29- 10 the (3) secondary lines and 5 UDC's failed the test. We believe the secondary line failures are <br /> due to the test boots in the UDC s and sumps . We will replace the damaged test boot with the ICON replacment split boot for <br /> Environ pipe and retest the secondary lines and UDCs . If this does not resolve the UDC problems we will replace the UDC <br /> penetrations as needed with the ICON repair fittings listed below. <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval) : <br /> Test Boot Environ Flex - IC-ISRZOXZOA Split repair fitting <br /> Product Piping Environ Flex - IC- IRF8B2 . 0 Split flange repair fitting <br /> Vapor Piping Smith - ICdRF8B2 . 5 Split repair fitting <br /> Conduit 1 " or 3/4" - IC- IRF4B1 . 4 <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 />