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06/06/2013 11:01 (209)465-4988 Henderson Maintenance Cc Page 1/1 <br /> RECEIVED <br /> JUN 0 6 2013 -JJJ <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by ERVIRONMENTAL <br /> EALTH DEPARTMENT <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 /> addin piping, LIDC'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 /> 1-7-a7 PplacpMpnt <br /> SR006? 60 <br /> �p�Np�M A�nu1a� <br /> 87 cemeC'� <br /> SensOC septa <br /> Ce - lam - 2A1-3 <br /> Valero - Stockton <br /> 713 N El Dorado St <br /> Stockton, CA 95202 <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> 7943 ) 301 SENSOR Dual Point Hydrostatic for Brine annular,Veede.r-Root <br /> 2 <br />