Laserfiche WebLink
r <br /> 4J A <br /> J11 Av <br /> SA N ] DAO` ' ( � r Y</AAA 7 Environmental Health Department <br /> c� t <br /> C 0 U N T Y._____ <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 [ ] 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 /> Located pipe leak 3" outside sump <br /> Cut fractured 2" primary pipe outside tank sump . Install new section primary and secondary pipe. <br /> Air test primary and secondary pipe with EHD present <br /> Water test sump <br /> Perform precision line test <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval) : <br /> Smith Pipe Red Thread Primary Pipe PT#011020-069-1 <br /> Smith Pipe PT#011030-069-1 <br /> Smith Pipe Sleeve Coupling <br /> Smith Piping Sleeve Coupling 3" SC Sleeve <br /> Franklin Fueling Flexible Entry Boots FEB-300 <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 />