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SAN ...JOAQUIN Environmental Health Department <br /> _.COUNTY......__.. <br /> U <br /> 0UNTY..1--­ <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 5] 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 repair <br /> air�l or replaced. Ensure a copy of <br /> the"Site Health and Safety Plan"is available on the jobsite as required by it <br /> .e 8 <br /> _y <br /> 3. Detailed description of work to be completed. List components to e repaired or replaced and attach a <br /> p c ts <br /> diagram drawn to scale showing location of repairs and/or replace nts. If repairing a component, describe <br /> J, <br /> 9 <br /> how this will be done. (If adding piping, UDC's, or otherUST ipment, or performing tank top upgrade, <br /> I for y p <br /> use the UST Installation Application pages 4-8 as necessary for 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 insp/t or. <br /> e <br /> Clean up construction debris. <br /> No primary pipe will be disc4ected. <br /> 4. List of equipment to be used(Atta#'manufacturer's specification sheets showing third-party approval): <br /> ICON Split Penetrations/ <br /> son <br /> r V saw <br /> N/A <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone 1L-_j <br /> Address CRY dip <br /> 3 of 6 <br />