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SAN10 A Q U I N Environmental Health Department <br /> C O U N TY ---- - <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 [ ] NO [X] <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 one ( 1 ) Single Product Diesel Dispenser, <br /> Install Bravo Conversion Frame . <br /> Install one (1 ) Gilbarco Encore 700S Dispenser <br /> Reconnect piping and conduit for fuel , vapor and electrical lines . <br /> Purge air out of dispensers , calibrate dispensers , complete weights and measures . Place into Service procedures . <br /> Complete startup of new equipment. <br /> Complete Monitor Certification with local CUPA inspector <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third-party approval ) : <br /> Bravo Conversion Frame <br /> Gilbarco Envore 700s dispenser. <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 />