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SANJ 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 N 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 /> - UDC # 14/ 15 : Install Bravo Retrofit entry kits inside UDC - ( 3 ) 3 " at products ( 1 ) 2 " at vapor . <br /> -T-4 87 Annular L- 10 : Break ground and replace 4 " FRP riser pipe including (2 ) 4 " BxM <br /> adapters . Replace/ install new 24 " manway . <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval ) : <br /> 3 - Bravo Retrofit P/N : RF-30-01 - U <br /> 1 - Bravo Retrofit P/N : RF- 20-01 - U <br /> TBD - NOV 4 " pipe P/N : 012040 -240-0 <br /> 2 - NOV 4" BxM P/N : 012940 - 1914 <br /> 1 - OPW 24 " Manway P/N : 6110 -24WT <br /> mination Procedures : <br /> a . Will piping inated prior to removal ? YES [ ] NO [ ] <br /> b . Identify contractor performing tion : <br /> Name ) <br /> Address City ip <br /> 3of6 <br />