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US ■ SYSTEM ■ mETf RFI f OR ■ IEPAI <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, 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 />Sawcut remove, and dispose, of concrete adjacent to the failed diesel <br />Excavate as required to expose SC, spoils to be stored onsite. Remove & <br />dispose SC, install <br />replacement like for <br />like OPW SC. <br />Perform <br />hydrostatic <br />test with Inspector <br />prior to backfill. <br />Backfill using <br />spoils <br />& install <br />new concrete to match existing with #4 rebar. <br />Replace the sensors in the 87, Die, & Red Die UST annulars, using <br />like for like Veeder-Root 420 sensors. <br />Perform final testing on all components and provide final reports to <br />Agency and Owner. <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />(1) OPW 1C-2100C-DEVR fill spill container <br />(3) Veeder-Root 794390-420 Interstitial Sensor <br />2 <br />