Laserfiche WebLink
AN ' <br /> 't � (� ( Environmental Health Department <br /> O U N T Y - .- -. <br /> T° 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 [ ] NO [x] <br /> Z 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 /> Replace existing Dispensers Wth New Dispensers. <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval ) : <br /> (2) Gilbarco Encore 700S Dispensers <br /> (2) Bravo Conversion Frames <br /> (2) Bravo Deflector plates <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 /> f <br /> 3of6 <br />