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SAN JOAQUIN Environme , Lft M 'Oart eni <br />---COUNTY---- X11,{ O 4) i',,i! <br />UST SYSTEM RETROFIT OR REPAIR , , ,,l ,'. <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by �kiD) <br />1. Site map enclosed? YES [ij� 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 />N1zW lb L,- Line Lec, k. 41? bmlb< (,wll be 2" Pack <br />feu) sA&V13e,r5 CLI, �a�e <br />BrA"C) cc✓1UCJ•S;G/1 Fr'o yle.S'. <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />!P e --. 5 r' jS jV) P 10, ns � �C/�t,.CS�S 9 " S (an k Vee -1 <br />LPS �C 1026C. lfrr C.bg4CjCV1eQ OrOr/l� <br />5. Decontaminationrocedures <br />a. Will piping be de ntami ted prior to removal? YES [ ] NO [ ] <br />b. Identify contractor Pqrjdming decontamination.- <br />Name <br />econtamination: <br />Name _ <br />Address <br />3of6 <br />Phone (� <br />City Zip <br />