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JOAOUIN Environmental Health Department <br /> SAN <br /> COUNTY— <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 N04*0�, <br /> 2. Submit copies of [CC 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 /> ' <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 goft piping, UDCs,!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 /> lki S1 c 1L 7 <br /> sp �vUcA� <br /> Lo <br /> sy4y,z OVL W, <br /> 4. List of equipment to be used(Attach manufacturees specification sheets showing third-party approval): <br /> 141 Ace _70 <br /> 10,-) <br /> S2 <br /> I V .111= D <br /> SIP 08 2017 <br /> EHHR5NMffN7,Ar ML LTH <br /> DEPLETMENT- <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES NOX <br /> i <br /> b. Identify contract Worming decontamination: <br /> Name N <br /> Phone <br /> Address <br /> City Zip <br /> 3 of 6 <br />