Laserfiche WebLink
SANN 10 n Q I V I I N Environmental Health Department <br /> H ICI <br /> COU NIT YI <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 /> Install Bravo Retrofit entry kits at all product and electrical penetrations at <br /> UDC #1/2 -(6)— 2" Product Western Fiberglass Flex Pipe, (2) —2" Fiberglass Vapor <br /> Return Line, (1) — V Electrical <br /> UDC #5/6 •(6)— 2" Product Western Fiberglass Flex Pipe, (2) —2" Fiberglass Vapor <br /> Return Line, (1) — 1" Electrical <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> 12 - Bravo Retrofit P/N: RLX-2.5-01-U <br /> 4 - Bravo Retrofit P/N: RF-20-01-U <br /> 2 - Bravo Retrofit P/N: RF-10-01-U <br /> ontamination Procedures: <br /> a. Wil p e decontaminated prior to removal? YES [] NO [] <br /> b. Identify contractor ing decontamination: <br /> Name Phone �) <br /> Address City Zip <br /> 3of6 <br />