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SAN 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 [ ] NO [ T <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 /> Scope of work to replace under dispenser containment ( UDC for three dispensers ( Dsl , Unleaded , Satelilte) <br /> Break concrete . Disable UDC leak monitoring ; disocnnect electrical and plumbing . Remove <br /> three exisiting (one diesel , one unleaded , one satellite) dispensers . <br /> Remove three failed old/worn UDC ' s (diesel , unleaded , dsl satellite ) <br /> Install three new UDC' s , install penetration fittings , flex connectors , and re- install piping . <br /> Install three new dispeners and anchor. <br /> Reconnect existing wiring , re-install existing hoses and nozzles . Re- install existing sensors . <br /> Start up and purge , and calibrate dispensers . Perform Line Tightness Test , <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third-party approval) : <br /> Bravo 8000 Singlewall UDC <br /> Bravo penetration fittings <br /> Franklin Fueling Flex connectors <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 /> 3 of 6 <br />