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5 A N J O 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 C✓ 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 B . <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 fill and vapor caps and adapters ( save for installation ) <br /> Remove ball floats and straight drop tube from existing tanks 1 , 2 , & 3 . <br /> Install new Defender OPV Drop Tube with overfill prevention at each tank and set overfill valve to 95% capacity <br /> Re - install fill and vapor caps and adapters <br /> Perform All required CARIB testing on installed components <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third- party approval ) : <br /> Defender OPV Overfill Prevention valve with 10' top tube and 10 ' bottom tube . CARB approved <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal ? YES [ ] N0 CV) <br /> b . Identify contractor- performing decontamination : <br /> i <br /> Name - - _ Phone ( ) <br /> Address -p KICA A <br /> Zip <br /> 3 of 6 <br />