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JF <br />• <br />• <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 N NO [ ] <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for each <br />person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health and Safety <br />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 diagram drawn <br />to scale showing location of repairs and/or replacements. If repairing a component, describe how this will be done. (If <br />adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for a timely plan review): <br />Scope of Work: <br />Remove and replace the existing RUL and PUL direct -bury spill <br />containers that failed recent testing. <br />• Sawcut, remove and dispose of the concrete at each of two (2) <br />spill containers. <br />• Remove and dispose of the existing spill containers. <br />• Install all Source NA furnished OPW spill containers, swivel <br />adapters, caps, face seal adapters and jack screw kits. <br />• Obtain the required CUPA inspection prior to backfill. <br />• Backfill and restore all concrete removed for this work. <br />• Obtain all CUPA inspections and provide all CUPA and Air Quality <br />testing. <br />�d <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />(2) OPW-1 C-2100C-DEVR 5 -gallon spill <br />containers. <br />(2) OPW-61 SALP-1020-EVR OPW 4" swivel fill <br />adapters. <br />(2) OPW-634TT-7085-EVR OPW 4" fill caps. <br />(2) OPW-61 JSK-44CB Jack screw kit. <br />(2) FSA -400S OPW face seal adapters. <br />EH230038 (revised 7-26-2016) <br />