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SANJ O A Q U I N Environmental Health Department <br /> - <br /> COUNTY - <br /> UST <br /> OUNTY - <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 Dd 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 /> Tank 1 ( 87 ) . Remove existing drop tube and replace with OPW Overfill Prevention drop <br /> tube , like for like , PN : OPW 71 S &420C . Perform any Inspection/ Testing as required <br /> by Local Agency . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third- party approval ) : <br /> OPW Overfill Prevention Drop Tube PN : X1 SO420C . <br /> ontamination Procedures : <br /> a . Wil p e decontaminated prior to removal ? YES [ ] NO [ ] <br /> b . Identify contracto ing decontamination : <br /> Name Phone �) <br /> Address City Zip <br /> 3of6 <br />