Laserfiche WebLink
0 • <br /> SAN10 A Q U I N Environmental Health Department <br /> C C U1NTY <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> I Site map enclosed? YES[] NO liQ <br /> z. Suhmit copies of ICC Service Technician and/or Installer's certificate and a!l 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 B. <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 /> 92CVve W& b �r`r► �� 34 <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> -rLew. <br /> j C&Va <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> 5. Deconta on Procedures: <br /> a. Will piping be inated prior to removal? '[ NO)( <br /> b. Identify contecon <br /> ractor perfor tamination <br /> Name Phone L__) <br /> Address City Zip <br /> 3of6 <br />