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SAN JOAQUIN <br />Environmental Health Department <br />COUNTY <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & applications as ori ginais will be retained by EHD) <br />1. Site map enclosed? YE=S DI NO [] <br />. Submit copies of ICC Service Technician andfor Installer's certificate and all manufacturer training <br />Certificates for each person installing or testing any oonnponent 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 a. <br />3. Detailed descriplion of work to be completed. List components to be repaired or replaced and attach a <br />diagram drawn to scale showing location of repairs andfor 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 purr review): <br />-Replace the flex connector at T1 - Diesel STP S uinp and T - Diesel STP Sump. <br />4, list of equipment to be used (Attach manufacturer's specification sheets showing third -party approval), <br />Franklin FueIirig F F EZ 1 2X18MXM <br />---Decontamination Procedures: <br />a. Will piping b}e-deoaniaminated prior to removal? YES [ ] NO[] <br />b. Identity contractor performing de ntaulEnation; <br />Narne---------- Pi e } <br />Address city ip <br />3ofo <br />