Laserfiche WebLink
SANU I 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 [ j 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 ]obsite 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 LIIS�/T Installation Application pages 4-8 as necessary for a timely plan review): <br /> c Maj. <br /> 4, List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> I <br /> i <br /> 5 . Decontamination Procedures: <br /> a . Will piping be decontaminated prior to removal? YES U NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name 6t0M+C. eefto- i Phone ( 07 ) 46 <br /> Address �� . p 05he t7reHue City _ �zHe _ Zip <br /> i <br /> 3of6 <br />