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SAN J O A Q U I N Environ me a, rFft6 61 <br /> - COUNTY <br /> .IAN 19 A-3 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> NVRONMENTAL HEALTH <br /> (Submit minimum of 3 sets of plans & applications as originals will be ret"00-g§1DspVICES <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 /> Remove and replace existing manway covers and skirts , replaced existing fill and <br /> vapor spill bucket assemblies , drop tubes with overfill valves and tank bottom protectors <br /> Complete all required testing on spill buckets and overfill valves . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third-party approval ) : <br /> 40 " Fiberlite Multiport manways <br /> 61 salp - 1020 - EVR Fill swivel and 61 VSA- 1020 - EVR Vapor swivel <br /> 634TT - 7085 - EVR fill cap and 1711 T- 7085 - EVR Vapor cap <br /> 61 JSK-44CB - Jack Screw Kit <br /> OP - FSA , 400S face seal adaptor <br /> OPW - 71 SO -410C drop tubes <br /> OPW - 6111 - 1400 tank bottom protectos <br /> Nd f /I rpG/ (54 9115� <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 />