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SA N ; .J O n Q I I N Environmental Health Department <br /> '' OUNH `�1u <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 [ ] <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 /> Removal of existing TLS-350 monitoring panel and INCON ISD . Install the TLS450 with Veeder Root ISD . <br /> Plumb in VR flow meters , VR pressure sensors <br /> Installing Bravo Retrofit level kits . <br /> STP <br /> Installing Mag Sump Sensor in all l IDC's & si impg (( 87, (41 P. Diesel) , <br /> These will be placed at the lowest point of the sump, nearest to the product line. <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval) : <br /> Veeder Root TLS-450 <br /> Bravo retrofit level cups <br /> Veeder Root Mag Sump Sensor #0857080- 111 <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 />