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UST SYSTEM RETROFIT OR REPAIR RECEIVEC <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) SEP 2 S 2015 <br />1. Site map enclosed? YES [ ] NO [ ] ENViRONMENTAv <br />1 "77 <br />ori—r.rrin _lTsa ,,- <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for eacFi <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): <br />L 2 - Dispenser #3/4 UDC - Remove dispenser from island. Remove existing Blueline interior UDC <br />entry fittings. Install new Diversified Products repair boots. Test , return dispenser to island. <br />S1 & S2 - Replace defective Veeder-Root Vac sensors on Unleaded Vapor secondary and Unleaded <br />and Product line secondary. <br />Make necessary repairs to Unleaded product line in tank sump due to small seepage. <br />Parts to be determined. <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />2 - each Diversified Products UMSZ BLM-3.6 Split Repair Kit for Blue lines ( Product penetrations ). <br />1 - each Diversified Products UMSZ BLS -1.1 Split Repair Kit for Blue lines ( Vapor Penetration ). <br />2 - each Veeder-Root 330020-463 Replacement Vac Sensor <br />