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AJ O A Q U I N 0nvironmental Health Department COUNtTY UST SYSTEM RETROFIT OR REPAIR (Submit minimum of 3 sots of plans &applicalions as originals will be retained by EHD) 1, Site map enclosed? YES I 1 No[n 2. Suhmit copies of ICC Service Technician and)or Installer's certificate and all manufacturer training certificates for each person inslailing or testing any componenl that is repaired a replaced. Ensure a copy of the"Sile Health and Safety Plan" is available an the jobsite as required by Tille 8. 3. Detailed description of work to be completed, List components to be repaired or replaced and attach a diagram drawn to scale showing lacalian of repairs andlor replacements, If repairing a component, describe how Ihis will be done. (If adding piping. UDC's, or other UST equipment, or performing lank top upgrade, use the UST Instalta#ion Applicalion pages 4-9 as necessary for a timely plan review): Remove fuel from lank. Expose and remove manway (break out and remove Vx& concrete around sump, remove piping, electrical, sump, and pea gravel, shore-up excavation)_ Prepare tank for safe entry (clean, vacuum, and defume). Enter lank, inspect and repair if possible_ dose Tank. Test Tank. Re-install piping,electrical. removed tank fop. Test Tank. After approval from EHD put tank back. Into service Revised 1712024: At the time of tank entry we will perform art inspection,and if possible la rep alr,repalrs will be made See attached scope of work from Containment Salut ion sl O and Bagley 4. List of equipment to be used (Al lach manufacturer's specification sheets shaving Ihird-party approval), No equipment needed_ Containment Solutionsr+NOV, the tank company, will clean tank bottom, Inspect, and repair if possible_ 5, oeeontaminattan Procedures: a. Will piping be deccnlaminated prior to removal? YES NO [ U. Identify conlractar performing deconlamination: Name Phone (` Address City Zip 3616