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�', 0-7 <br /> SAN-J O A n V I N Environmenta <br /> COUNTY <br /> PffCMED <br /> UST SYSTEM RETROFIT OR REPAIR JAN 0 8 2018 <br /> (Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br /> 1. Site map enclosed? YES [] NO [] ENVIRONMENTAL HEALTH <br /> DEPARTMENT <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]obsite 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 /> WE- i_>7z-o POS C --V i of S--r0z_ befLCCiz7;?-' �>LA-� <br /> Tz> 'r _ �E . —M ENS til t?_C <br /> ,>fS PENS tvTz­ E!.TKR-S 11-t4('_\N Q i 1 L7 D Tz t}-r hl <br /> `rb T14-,E� u INC-S . <br /> 4. List of equipment to be used (Attach man,,ufarcturer's specification sheets showing third-party approval): <br /> -7 eo7m v F 9p4-k -P <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [] NO [] kf f 04 <br /> b. Identify contractor performing decontamination: M JA <br /> Name Phone (� <br /> Address City Zip <br /> 3 of 6 <br />