Laserfiche WebLink
SA 0 A 0 U I N Environmental Health Department <br /> COUNTY <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 Installers 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 B. <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 /> Repairs for Violation date October 16, 2018 <br /> S-4 Vacuum sensor replaced on remote fill 10/2/18 <br /> S2 sensor failed test- Replaced Float Switch 10/18/18 corrected <br /> Vent Sump piping communication -add communication hose with test ports for secondary <br /> containment <br /> 4. List of equipment to be used(Attach manufacturers specification sheets showing third-party approval): <br /> Veeder-Root 330020-463 Vac Sensor <br /> Veeder-Root 330020-464 Float Sensor Switch <br /> Test ports -part number to be determined <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES NO <br /> b. Identify contractor performing decontamination: <br /> Name Phone <br /> Address city Zip <br /> 3 of 6 <br />