Laserfiche WebLink
SN J O A Q U N Environmental Health Department <br /> C O U N T Y-._.-r._.. <br /> UST SYSTEM RETROFIT OR REPAIR <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& <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 /> hour 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 /> Remove all float and chain devises <br /> Use Bravo plug kits and expoxy to seal <br /> Install stand alone sensors in UDC`s <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> 12) Brava 62K-P Plug Kits with EPIOORF Epoxy <br /> 8) 2)Veeder-Root 847990-001 Non-Discriminating Stand Alone Dispenser Pan Sensor <br /> 5. Decontamination Procedures: <br /> a. will piping be decontaminated prior to removal? YES [] NO[j <br /> b. Identify contractor performing decontamination: <br /> Name Phone[. <br /> Address City Zip <br /> 4W6 <br />