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SAN10 A Q U I N Environmental Health Department <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 x <br /> NO [] <br /> 2. Submit copies of ICC ServiceTechnician 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 /> 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 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 atimely plan review): <br /> V A- h�• 1 / 2 a".Af� nn '' <br /> +0 I ' ] 2 ( o j <br /> o vbv` d V4 V S U P C <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> C V D C-_ G � <br /> co",o VA-,V <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminateA"prior -.emoval? YE NO [] <br /> b. Identify contractor performing decontaminAti <br /> Name Phone(_) <br /> Address City Zip <br /> 3of6 <br />