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DocuSign Envelope ID: 2F173BE3-D39C 47D3-A9g3-65B9F76377E9 <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 /> 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 /> Work to be completed : <br /> - Contractor to remove existing HEALY CAS Tank. Existing Concrete Pad to remain for re-use <br /> - Remove above ground 1 " pipe connection between HEALY and VENTS <br /> Contractor to Excovoto Vent Riser Area to Expose Existing Vent Piping <br /> - Contractor to install ARID Permeator Unit on Existing Concrete Pad and reconnect new Piping . <br /> - Install new compression fitting at existing vent Transition sump <br /> - Install new vapor return line from existing vent transition sump to existing tank 1 turbine sump <br /> - install pipe and conduit repair penetrations at tank 1 turbine sump <br /> install pipe secondary repair termination boots at vapor lines In tank # 1 turbine sump <br /> Perform Hydrostatic sump test on i ank #1 1 ur ine sump <br /> SEE PtANS FOR ADDITIONAL SCOPE! <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third-party approval ) : <br /> See Attached Plans for sito specific Equipment list. <br /> 5 . Decontamination Procedures : Not Applicable <br /> a . Will piping be decontaminated prior to removal ? YES [ j NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name Phone ( ) <br /> Address City Zip <br /> 3of6 <br />