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J <br /> ( Environmental Health Department <br /> C O U N TY - . _... _ <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 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 /> Remove & Replace Existing 87 Tank Overspill Container <br /> Remove Existing Straight Drop Tubes on the 87/91 & Diesel Tanks & <br /> Install (3) New Overfill Drop Tubes <br /> Remove & Replace # 11 / 12 Shear Valve <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval) : <br /> ( 1 ) 85100 / PhikTite Overspill Container <br /> ( 3) 708591902 / EBW Defend erOverfill Drop Tubes <br /> ( 1 ) 10BHMP-5830 / OPW Shear Valve <br /> I <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal? YES ( ] NO ( j <br /> b . Identify contractor performing decontamination : <br /> Name Phone (_) <br /> Address City Zip <br /> 3of6 <br />