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r! 7A <br /> rtment <br /> Do e <br /> Environmental Health Da <br /> SAN A UIN E } c « <br /> u.... . _ C_ 0 U N 'T <br /> ° w ii�i ��� 3� 1 �jT�`e �,. HEN l� i� <br /> UST SYSTEM RETROFIT ® R � P ; CC )A4 ,D,i � � E � 11 <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 /> Install Bravo conversion frames <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval) : <br /> (4) Gilbarco 700S <br /> ( 4 ) Bravo CONY- B2000 <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 /> f <br /> 0 <br />