Laserfiche WebLink
AQ <br /> Environmental Health Department <br /> SAN jOUIN <br /> C 0 U f T"Y-- <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 ( NO [I <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 UST Installation Application pages 4-8 as necessary for a timely plan review): <br /> S7/^J 6 3��f EN V 120/N (o�E T©r2n1� <br /> I <br /> Co�l��l r7 L%N?R % F�T7r�GS &VI-r)4 -4WA yo 7� F-_L17-o <br /> i <br /> 1-r7//oGi S �N E il:�l 7-Z"/i1/6 S WIL-1- BC R 1_--M a V c A' <br /> %hfE Sti2FJ4c� OF THE �1 (3E2fG,gSS UPC ,4i✓D CoNiJUiTS <br /> liVl LL BE- S/�N flED g /-��}NZ� •4/h�D /1�E�it� /ZeAtA GC.MC-X <br /> X17-rjIV IAI 5'r/I <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> ;Z eACP $RA Vd RE-62-7-621- V �nrz�2� �i Trr dc's <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NOX <br /> b. Identify contractor performing decontamination: /V-0 .7-0 $C A6MOVF_1 . <br /> Name Phone (_) <br /> Address City Zip <br /> 3of6 <br />