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0 <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 certificates for each <br /> person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health and Safety <br /> 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 diagram drawn <br /> to scale showing location of repairs and/or replacements. If repairing a component, describe how this will be done. (If <br /> adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review):SCOPE OF WORK <br /> COSTCO GASOLINE RECEIVED <br /> Costco Gasoline—Dispenser Replacement and <br /> Installation of Wireless Dispenser Sump and Vent Sensors ZQI6 <br /> 1630 East Hammer Lane, Stockton, California 95210 DEC 19 <br /> Costco Loc. No.038/Our Job No. 10199.19 <br /> • Remove the existing Gilbarco two-product dispensers. ENVIRONMENTAL <br /> AL H ALTH <br /> •Install new Gilbarco Encore 700S Series Model NG4 two-product dispensers on the existing islands. DEPA. <br /> •Install new(like for like) hoses, nozzles, and breakaway valves(or reuse existing). <br /> •Perform any and all purging, regulatory testing, and calibration on the newly-installed dispensers. <br /> •Extend the existing dedicated power for the Ethernet disconnect. <br /> (The Ethernet disconnect is to be completed under a separate permit.) <br /> •Disconnect and reconnect the power,data, CRIND, and controls. <br /> •Disconnect the existing Veeder-Root liquid sump sensors from the existing Belden cables within each dispenser containment sump. <br /> •Install new Veeder-Root MAG sump sensor(s) at each dispenser containment sump. <br /> •Install Veeder-Root TLS-RF wireless sensor transmitter(s)at each existing dispenser <br /> and install receiver(s) at the existing controller enclosure. <br /> •Connect each of the new dispenser sensors to the new transmitter and connect the new receiver(s) <br /> via TLS-RF consoles to the existing Veeder-Root TLS-35OR panel inside the controller enclosure. <br /> •Update the Veeder-Root TLS-350R panel with the new smart-sensor module(s)and software,and perform a cold start. <br /> •Remove the existing ISD pressure sensor from inside the existing dispenser sump nearest to the tanks <br /> and cap the connection as required. <br /> •Install one(1) new Veeder-Root 761190-201 vapor pressure sensor at the existing unleaded vent riser <br /> (including the 330020-715 installation kit and the 330020-716 enclosure kit). <br /> •Install new conduit(s) and cabling at the controller enclosure from the receivers to the TLS-RF console(s) and the TLS-350R panel. <br /> 4. List of equipment to be used. (Attach manufacturer's specification sheets showing third-party approval: <br /> •Veeder-Root TLS-RF Wireless 2 System. <br /> •Veeder-Root MAG sump sensor. <br /> EH230038(revised 7-26-2016) 3 <br />