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I ' <br /> 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 N 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, <br /> describe <br /> how this will be done. (If adding piping , UDC 's , or other UST equipment, or performing tank 4opupgr, i!, �1 <br /> use the UST Installation Application pages 4-8 as necessary for a timely plan review) . , j � II II ( I <br /> SCOPE OF WORK <br /> • REMOVE EXISTING FUEL DISPENSERS . JN 1), 20 ? 1 <br /> • INSTALL NINE ( 9 ) WAYNE OVATION ( 3 + 0 ) , AND TWO <br /> (2) WAYNE OVATION ( 1 + 0) FUEL DISPENSERS WITH <br /> FACTORY INSTALLED BALANCE FLOW METER . <br /> • INSTALL NEW HANGING HARDWARE SETS FOR <br /> DIESEL AND GASOLINE . <br /> • INSTALL NEW BRAVO CONVERSION FRAME AT ALL <br /> FUEL DISPENSERS . <br /> UPGRADE EXISTING VEEDER ROOT SOFTWARE TO <br /> VERSION 1 . 05 WITH COLD START. <br /> • PERFORM FULL MONITORING CERTIFICATION . <br /> • PERFORM SYSTEM START- UP TO ENSURE PROPER <br /> OPERATION . <br /> • INSTALL NEW BRAVO UDC RETROFIT PLATES AT ALL <br /> FUEL DISPENSERS . <br /> • CONVERT EXISTING 89 MID-GRADE UST TO 87 <br /> UNLEADED UST. <br /> • 87 UST'S WILL BE MANIFOLDED AT FUEL DISPENSERS , <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval) : <br /> EQUIPMENT SCHEDULE <br /> ITEM F DESCRIPTIDN MANUFACTURER MODEL N QUANTITY <br /> 1 3+0 FUEL DISPENSER VI/ BALANCE VR FLOW NEPER WAYNE 14IA-812/3-OVATION2 9 <br /> 2 1 +0 FUEL DISPENSER W/ BALANCE VR FLOW NEPER WAYNE VIA-1111 /1 -OVATION2 2 <br /> 3 3/4 AUTO SHUT OFF NOZZLE LEADED - GREEN OPW OP- 118 -0100 4 <br /> 4 3/4 VI F MULTI-PLANE SWIVEL MXF HUSKY HU-350 4 <br /> 5 3/4 x 3/4 RECONNECTA13LE SAFE-T-BREAK HUSKY HU-3360 4 <br /> 6 3/4 x 1 ' FLEX-ON HARDVIALL HOSE MxMS - GREEN FRANKLIN FUELING SYSTEMS FX-FLG3/4-012-MXMS 4 _ <br /> 7 3/4 x 8' FLEX- ON HARD1'IALL HOSE MxMS - GREEN FRANKLIN FUELING SYSTEMS FX-FLG3/4-096-MXMS 4 <br /> 8 EVR BALANCE NOZZLE ENVIRO-LOC G2 (NEW) VAPOR SYSTEM TECHNOLOGIES VS-VST-EVR-IIBBK-2 18 <br /> 9 EVR BALANCE 8' VENTURI HOSE VAPOR SYSTEM TECHNOLOGIES VS-VDV-EVR-096 18 <br /> 10 EVR BALANCE 1 ' WHIP HOSE VAPOR SYSTEM TECHNOLOGIES VS-VSTA-EVR-SBKA 18 <br /> 11 EVR REATTACHABLE BALANCE SAFETY 13REAKAVIAY VAPOR SYSTEM TECHNOLOGIES VS-VSTA-EVR-SBKA 18 <br /> 12 SOFR'IARE UPGRADE VEEDER ROOT VRI -331500-358 I <br /> 13 UNIVERSAL CONVERSION FRAME FOR CALIFORNIA BRAVO BR-CU-250-CA 11 <br /> 5. Decontamination Procedures : N /A <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 />