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Nn Q ` ) I N Environmen a ea epartment <br /> C O U N T Y --. . .-. NiAtY 0 6 ZOZZ <br /> UST SYSTEM T FIT OR REPAIR ENVIRONMENTAL HEALTH <br /> (Submit minimum of 3 sets of plans & applications as originals will be retained IDERARTMENT <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 , LIDC '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 /> SCOPE OF WORK : <br /> Replace existing Gilbarco Advantage dispensers / Upgrade Veeder-Root Software <br /> Install Wayne Ovation dispensers ! Veeder Root cold start will be required <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval ): <br /> 6) Bravo Universal Conversion frames <br /> 6) Bravo - Ovation Deflector Plates <br /> 1 ) Veeder- Root 331500-353 Software <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 /> i <br /> i <br />