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SANJOAQUINEnvironmental 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 [x] NO [] <br /> 2. Submit copies of ICC Service Technician and/or Ins/haa <br /> certific a and all manufacturer training <br /> certificates for each person installing or testing any compot is r aired or replaced. Ensure a copy of <br /> the"Site Health and Safety Plan" is available on the jobsitire by Title 8. <br /> 1-1 <br /> 3. Detailed des ' tion of work to be completed. List como be repaired or replaced and attach a <br /> diagram drawn t cale showing location of repairs and/orments. If repairing a component, describe <br /> how this will be do (If adding piping, UDC's, or otheruipment, or performing tank top upgrade, <br /> use the UST Installation plication pages 4-8 as necessaimely plan review): <br /> Diesel Turbine Sump: Remove p etration and install Bravo pen and re-test. Penetrations in sumps are bad. <br /> 4. List of equipment to be used (Attac manufacturer's specification sheets showing third-party approve <br /> -F-07-Retrofit-S <br /> -F-10-Retrofit-S <br /> -F-30-Retrofit-S <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 /> 3of6 <br />