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SAN10 A Q U I NEnvironmental Health Department <br /> COUNTY ---- RECEIVE ® <br /> UST SYSTEM RETROFIT OR REPAIR JUN . 2 3 2021 <br /> (Submit minimum of 3 sets of plans & applications as originals will be retained by EHD ) <br /> 1 . Site map enclosed ? YES [x] NO [ ] ENVIRONMENTAL HEALTH <br /> DEPARTMENT <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 , LIDC ' 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 /> Lock Out/Tag Out the power to the monitoring system . <br /> Remove the existing Veeder- Root probe and OPD drop tube. <br /> Install 4" diesel float kit and re-install the in tank probe . <br /> Install OPD drop tube . <br /> Certify the probe and OPD drop tube . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval) : <br /> OPW Dual Point Vapor-Tight 4" x 15' EVR . Emco Wheaton A1100-EVR-056 <br /> Mag Probe Install Kit Diesel 4" Float 5' Cable . Veeder-Root 849600-001 <br /> 5 , Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal ? YES [ ] NO [x] <br /> b . Identify contractor performing decontamination : <br /> Name NA Phone ( ) <br /> Address City Zip <br /> 3of6 <br />