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J Q lr J o A Q U 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 /> 9. Site map enclosed? YES bd NO[] j <br /> 2. Submit copies of ICC Service Technician and/or installer's 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 8. <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 /> Remove existing defective penetration in the diesel STP sump. <br /> Install new penetration and test plug. <br /> Perform water tightness test. <br /> Final inspection with county inspector. E D <br /> � . <br /> Clean up construction debris. <br /> 01 2018 <br /> No primary pipe will be disconnected. AUG <br /> ALT <br /> DEPARTMENT <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party rtYapproval : <br /> , <br /> ICON Split Penetrations <br /> t <br /> ISR 3 .5 X 2.4A; ISR 4.8 X 1.9 X 1.4; ISR M4.8 X 2.0 LP i <br /> IRF XL3.5; IRF XXL8.8 X 6.8 X 4.6; IRF XXL8.8 X 6.8 X 4.6 j <br /> I <br /> i <br /> N/A 5. Decontamination Procedures: i <br /> a. Will piping be decontaminated prior to removal? YES[] NO[) <br /> b. Identify contractor performing decontamination: i <br /> Name Phone( <br /> Address City Zip <br /> 3016 <br /> I <br /> 1 <br /> l <br />