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SAN10 A Q U I N Environmental Health Department <br /> COUNTY <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 [ ] NOM <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 /> • Replace (3 ) existing Wayne Vista Dispensers with three (3) 3 + 0 Gilbarco Encore 700S Dispensers . <br /> • Install Bravo Conversion Frames . (required ) <br /> • Install piping and conduit for fuel , vapor and electrical lines . <br /> • Purge air out of dispensers , calibrate dispensers . <br /> • Complete weights and measures " Place into Service" procedures . Complete startup of new equipment . <br /> • Site will be keeping current Balance Vapor recovery system . <br /> • Configure and test all Veeder-Root sensors <br /> I IpgradP VPPdPr Root as nPPdPd and agrrariP man hnsPs <br /> • Complete Monitor Certification with local CUPA inspector. <br /> ('�aM lata fi ill Air ni iality testing_wlth IOCaI Air LilStroCt <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval) : <br /> Gilbarco Encore 700s <br /> Bravo Conversion Frame <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 P Zip <br /> 3of6 <br />