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SANSAN I o A Q I I N Environmental Health Department <br /> COUNTY ? i LCEIVC <br /> UST SYSTEM RETROFIT OR REPAIR <br /> Submit minimum of 3 sets of plans & applications as originals will be retained b �EHD O 7 2021 <br /> ( p pp � g Y )<. <br /> 1 . Site map enclosed ? YES [ ] NO [ ] ENVIRONMENTAL HEALTH <br /> PERMIT/ SERVICES <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 ( 2 ) Gilbarco Advantage Dispensers . <br /> Replace with ( 2 ) Gilbarco Encore 700S Series Dispensers with Bravo Conversion Frames . <br /> Converting Healy to VST . <br /> Converting existing 89 Octane/ 10 , 000 Gallon UST to 87 Octane . <br /> Manifold existing 89 product line to 87 product line above shear valve in the UDC . <br /> Program Veeder- Root to run the two 87 turbines to turn - on sequentially . <br /> Upgrade Software on Veeder- Root . <br /> Possible Cold Start , <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third - party approval) : <br /> (2 ) Gilbarco Encore 700S Dispensers <br /> (2 ) Bravo Conversion Frames <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 />