Laserfiche WebLink
SAN10 A Q 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 M NO [ ] <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 /> SCOPE OF WORK <br /> • REMOVE EXISTING FUEL DISPENSERS . <br /> • INSTALL SIX ( 6 ) WAYNE OVATIONS ( 3 + 0 ) , AND (2) <br /> WAYNE OVATIONS ( 1 + 0 ) FUEL DISPENSERS WITH <br /> FACTORY INSTALLED BALANCE FLOW METER . <br /> • INSTALL NEW HANGING HARDWARE SETS FOR <br /> DIESEL AND GASOLINE . � I� [ h 2OZO <br /> • INSTALL NEW BRAVO CONVERSION FRAME AT ALL - <br /> FUEL DISPENSERS . <br /> • UPGRADE EXISTING VEEDER ROOT SOFTWARE TO <br /> VERSION 1 . 05 WITH COLD START, ENVIRONMENTAL HEALTH <br /> • PERFORM FULL MONITORING CERTIFICATION . DFPARTpI/+ ENT <br /> • PERFORM SYSTEM START- UP TO ENSURE PROPER <br /> OPERATION . <br /> I <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval ) : <br /> EQUIPMENT SCHEDULE <br /> FITEM # DESCRIPTION MANUFACTURER MODEL # QUANTITY <br /> 1 3+0 FUEL DISPENSER W/ BALANCE VR FLOW METER WAYNE WA-B12/3-OVATION2 6 <br /> 2 1 +0 FUEL DISPENSER WAYNE WA- R11 / 1 -OVATION2 2 <br /> 3 3/4 AUTO SHUT OFF NOZZLE LEADED - GREEN OPW OP- 11B-0100 4 <br /> 4 3/4 VI F MULTI -PLANE SNIVEL MxF HUSKY HU-350 4 <br /> 5 3/4 x 3/4 RECONNECTABLE SAFE-T-BREAK HUSKY HU -3360 4 <br /> 6 3/4 x 1 ' FLEX-ON HARDWALL HOSE MxMS - GREEN FRANKLIN FUELING SYSTEMS FX-FLG3/4- 012- MXMS 4 <br /> 7 3/4 x 8' FLEX -ON HARDWALL HOSE MxMS - GREEN FRANKLIN FUELING SYSTEMS FX-FLG3/4-096-MXMS 4 <br /> 8 EVR BALANCE NOZZLE ENVIRO-LOC G2 (NEW) VAPOR SYSTEM TECHNOLOGIES VS-VST- EVR -NBBK-2 12 <br /> 9 EVR BALANCE 8' VENTURI HOSE VAPOR SYSTEM TECHNOLOGIES VS-VDV-EVR-096 12 <br /> 10 EVR BALANCE 1 ' WHIP HOSE VAPOR SYSTEM TECHNOLOGIES VS-VSTA- EVR-SBKA 12 <br /> 11 EVR REATTACHABLE BALANCE SAFETY BREAKAVVAY VAPOR SYSTEM TECHNOLOGIES VS-VSTA- EVR-SBKA 12 <br /> 12 SOFTWARE UPGRADE VEEDER ROOT VRI -331500-358 1 <br /> 13 UNIVERSAL CONVERSION FRAME FOR CALIFORNIA BRAVO BR -CU -250-CA 8 <br /> 5 . Decontamination Procedures : N /A <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 />