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Envi Ii4fQe artment <br /> SANJOAQUIN p <br /> --- COUNTY - - <br /> UST SYSTEM RETROFIT OR REPAIk <br /> (Submit minimum of 3 sets of plans & applications as originals will be retaii((� ' <br /> 1 . Site map enclosed ? YES NO [ ] <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 /> rTQ m4 lace ox o /� ) �. I b��� 3 + o d r sa � e71 64.1 % Wn <br /> ` 3) ?ee !> S 0.j war tie" 0Ie . c>1 fl > � p� j cl atAci •-f o ,re/� � e <br /> /yS +4p 4 t4et. j Vee 41 �dil� C ,� ftp / ` <br /> � fl7 � ZlLti �` i (lS ( f C. tt{ i S h Cf43ic - 9 L3 `t,, sols W ; LA V i\ <br /> I <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing thlyd-party approval ) : <br /> Ve .? <br /> C4 ) � �e � 3zr IN tV1 � t � � eti, � � ra 131Z1322t > 3 <br /> TP, FU e+, Itj k1 h V . �I eh, KtVp 2 <br /> i <br /> i <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal ? YES [ ] NOX <br /> b. Identify contractor performing decontamination : <br /> Name Phone (__) <br /> Address City Zip <br /> 3of6 <br />