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DocuSign Envelope ID:57852BDB-FD2B-4170-B5C8-435307C98954 <br /> SAN1 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 [XJ 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 /> -All existing piping to be removed and replaced <br /> -All existing UDC sumps to be removed and replaced <br /> -All existing fill/spill equipment located within the gasoline tank fill sumps to be removed and replaced <br /> -All existing gasoline tank turbine sumps and equipment within to be removed and replaced <br /> -Existing controller enclosure and alarm panel to be removed and replaced with new controller enclosure <br /> and 2 new alarm panels <br /> -Existing vapor processor to be removed and replaced with Arid Permeator <br /> -Existing vent risers to be removed and replaced <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> Bravo: Gilbarco: <br /> Containment Solutions: Double wall fiberglass vent transition sumps Encore 700S 1 house per side dispensers <br /> Double wall fiberglass containment_sumps and reducers Double wall fiberglass ump penetration fittings <br /> Double wall fiberglass underground dispenser containment sumps Healy: <br /> OPW: Dispenser deflection plates EVR Nozzles <br /> Muli-port lid assemblies Vac assist low permeation hoses <br /> Fill&vapor adapters&caps Emco Wheaton: Breakaway vales <br /> Pressure vacuum vent caps Composite manhole lids <br /> Extractor fittings Riverside: <br /> Composite manhole lids Omega: Concrete island forms <br /> Flame arresters flexible connectors <br /> Jack screw assembly kit Ball valves NOV: <br /> Product and vapor shear vales EZ-Fit fittings Double wall fiberglass piping and fittings <br /> Franklin Fueling: Veeder Root: Arid Technologies: <br /> Overfill prevention valve with 10-foot drop tubes Mini hydrostatic sensors Permeator Vapor Processor <br /> F.E.Petro 2 HP variable speed turbine pumps Pressure line leak detectors <br /> F.E.Petro check valve sensors Tank level Probes Total Meter Technologies: <br /> F.E.Petro siphon check valves Dual float probes Meter box for additive injection(AIS System) <br /> F.E.Petro Turbine&additive controllers Monitoring&adapter kits Additive controllers <br /> Vapor pressure sensor <br /> Morison: TLS-350R management system B.I.G. <br /> Rain cap vents Overfill alarm and acknowledgement switch Electrical controller enclosure <br /> 5. Decontamination Procedures: Cree: <br /> Canopy light fixtures <br /> a. Will piping be decontaminated prior to removal? YES DJ NO [] <br /> b. Identify contractor performing decontamination: <br /> Name Jones Covey Group Phone (888)972-7581 <br /> Address 9595 Lucas Ranch Rd City Rancho Cucamonga Zip 91730 <br /> 3 of 6 <br />