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SANS] O A Q U IN Environmental Health Department <br /> — COUNTY— <br /> UST SYSTEM RETROFIT OR REPAIR SAN 2 3 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 HEALT" <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 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 <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 /> e the UST Installation Application pages 4-8 as necessary for a timely plan review): <br /> A 5 <br /> CPOQ <br /> bo) a5vc' <br /> yn <br /> 4 � <br /> A q <br /> V P O ►� V CC5 <br /> 4 v <br /> � r o <br /> Or Ak <br /> All <br /> crnnQ tie . <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showin third-party approval): <br /> W b r <br /> r All nAOT WAG . e daep /s <br /> e6 SelV 0i Z° N /K <br /> Ore 9 d o n d 9 U <br /> ©pw <br /> . 166 . 01wl M , Ihlof PA 6.0-15 <br /> o m <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NO [ ] <br /> b. Identify contractor performi g decontamination: <br /> Name Phone <br /> Address City e <br /> ,4z;�ik saris <br /> 30f6 I15� 1 <br />