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SANJ 0 A Q U I N Environmental Health Department <br /> COUNTY --- � jr;-:-q7Li <br /> ,> r <br /> \ 3 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans & applications as originals will be retained by EHI 6Ar <br /> 1 . Site map enclosed ? YESW NO [ ] Eft \11Py0pgp1l [vaT�, l_ f-ic �, LTI � <br /> � 1 <br /> LI \ It1El I � . ) LI \ `.,J � � L � <br /> 2 . Submit copies of ICC 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 /> 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 a timely plan review) : <br /> ****See Attached Scope of Work**** <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third-party approval) : <br /> ****NONE**** <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal ? YESTJ NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name Adams Services , Inc . Phone3( 10 ) 5234430 <br /> Address 406 E . Alondra Blvd , City Garden , CA Zip 90248 <br /> 3of6 <br />