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UST SYSTEM RETROFIT OR REPAIR A 6 2016 <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by H� <br />1 • Site map enclosed? YES [ ] NO [ ] C,vt: t.� •.�� <br />kit <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 />Saw out concrete perimeter of direct bury fills on Tanks 2 and 3. <br />Break out concrete and haul off for proper disposal. <br />Remove (2) existing Fill/Spill buckets from tanks 2 and 3 <br />Replace Existing (2) Emco Wheaton with OPW model# 1 SC -31532D on Tanks 2 and 3 <br />Replace existing Drop tubes on tanks 2 and 3 with OPW drop tubes model# 71 SO -420C <br />C1® � <br />Schedule Pre -bury inspection <br />Recieve approval for backfill and patch "'AH 13 2017 <br />ENVIRONMENTAL <br />.ENT <br />As -Built 3/6/17 <br />Replacement of existing 3" x 15" flex connector was determined unnecessary. Replaced one (1) 3" black iron union and one (1) 3" <br />black iron tee fitting on T-2 and T-3 diesel in lines. Tightened 3" flange at diesel out line. <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />*Diesel Tanks #2 and #3 have 15 gallon Emco Wheaton to be replaced with OPW model# 1 S_C_-_3.1532D <br />Diesel Tanks #2 and #3 drop tubes to be replaced with OPW model# 71 SO -420C <br />(1) Black iron 3" union, (1) black iron 3" tee AS -Built 3/6/17 <br />Install (1) Icon Split Penetration repair fitting model# IC-RFRIDIG3.5F in UDC 14-15 <br />Install (1) Icon Split Reducer boot model# ISR3.5X2,4 in UDC 14-15 <br />