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SA N J O A 4 U I N Environmental Health Department <br /> COUNT` <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 k] 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 /> • Drain diesel product line <br /> Remove dispenser MITI Island and make M on a palltit <br /> • Remove this section of pipe from the smith bulkhead fitting in a manor not to damage the penetration <br /> fiff <br /> mg Sand as needed to reserve entry fitting and remove pipe <br /> p rY 9 P P <br /> • Send pictures o ana <br /> • Dry fit new piece of pipe <br /> • Final sand and acetone <br /> Glue <br /> • Allow time to cure time <br /> Test <br /> • Permit inspections <br /> Put the disnensPr hack on island <br /> • Test line <br /> Leaare site <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> smith pipe <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 />