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Environ <br /> SANRECEm �t <br /> J AUIN <br /> cOurlTY - SEP1 2 9 2021 <br /> LIST SYSTEM RETROFIT OR REPAIR ENTAL HEALTH <br /> (Submit minimum of 3 sets of plans & applications as originals will be regNyjWRTMENT <br /> E <br /> b� NTAL <br /> 1 . Site map enclosed ? YES [ ] 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 existing 87 , 91 & Diesel straight drop tubes . <br /> Install (3) new EBW Overfill Drop Tubes for 87 , 91 & Diesel . <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval) : <br /> Equipment: <br /> (3) EBW Overfill drop tube- Part # 708592902 <br /> 5. Decontamination Procedures : <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 />