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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 [A 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 /> • Provide, install five drip pans <br /> •Saw cut, demo, remove and replace 91 fill/spill &vapor bucket, place <br /> concrete, and retest. Saw cut, demo, remove four 12"tank annular <br /> manways and replace with four 18" Manway, relocate junction boxes to <br /> allow access to wiring and install 3 new Veeder Root 409 tank sensors <br /> • Obtain UST Repair permit from San Joaquin County COPA <br /> 4 1 ist of equipment to ha impel (Attarh mangyifarttirer'e ep prifinatinn chap-t,;ghnwing thir -pnrtVaprn nva1)' <br /> Encore Deflector Plates Veeder Root 409 tank annular sensor, &QPw Edge Dot,h1e Spoil Bucket#1c-3112D <br /> see attached Bravo cut sheet <br /> see attached Veeder Root 409 cut sheet <br /> see attached OPW Edge Spill Bucket cut sheet <br /> etv <br /> EH230038(revised 7-26-2016) 3 <br />