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q IIS lq <br />A-Oe—vtci mt <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, UDCs, 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 />Remove dispensers <br />Saw cut & break out concrete at island UDCs <br />Pioina - take soil sample <br />Set 4 new Fiberglass UDCs - Install pipe entry fittings <br />Plumb Fiberglass product & vapor piping into 4 -UDC <br />Pressure test lines with EHD present <br />Make final plumbing <br />Precision line test each line product line with ERD present <br />Investigating repairs to be made to the 87 STP sump & to the transition sump. <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />See attached equipment schedule <br />Transition sump parts to be used: to be determined <br />87 STP sump parts to be used: to be determined <br />112018 <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />EH230038 (revised 12-11-15) <br />