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SAN1 Q A Q U I N Environmental Health Department <br /> _._.. ._ _- C O U N T Y -_ . ,_._ <br /> T 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 ( ] 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 /> Violation Report 2/ 14/22 <br /> Replace 87 Southest Spill Container in Sump Like for Like <br /> Replace 4 staight Drop Tubes with Overfill Valves <br /> Run 3 . 0 test on newly repalce 87 leak detector if required <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval) : <br /> ( 1 ) OPW P761C- EVRDV Spill Container <br /> (4) OPW 71 SO Overfill Valve Drop Tube <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 />