Laserfiche WebLink
hw: , '' •. <br /> SAN J0AQUIN Environme N�DPart eni <br /> --- COUNTY---- 0I.1 [) 6 r.;,i/ <br /> UST SYSTEM RETROFIT OR REPAIR FNWONM':'`I I'Al I•1`:/ LTH <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by <br /> 1. Site map enclosed? YES[" NO[] <br /> 2. Submit copies of ICC Service Technician and/or Installers 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): I f1 I <br /> CO✓tVe6`�'� eKi,!9 l[i 32 G&!a(�Pa4 o d UST -to N ese <br /> &p[eve- U UJl R ieSc()_ Se-CCACcAke, ASL <br /> ye►n - d`ic;eI . Co.0 I� F� VGL00 ' line ;a 9-TP cukytn . <br /> cr uLA/C&� die ' o ,AiA;, in sW <br /> New p�� Llne Lecl 4-6r e Ca.QS 1AA( be- 211 F/sCk <br /> Site( Par 39C 16,200 o bcu) D,sp•e,nse,rs cu �a�e <br /> grave) Cc.1 e.S. <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> �PC P�L�5 f'.r in (nlP/6,✓ S, _Ly\df dr_9 ,? f�tan <br /> l "0 3�C 10?GC• PcGr GLq,1010"eC1 eipl J, <br /> 5. Decontaminationrocedures- <br /> a. Will piping be de ntaml ed prior to removal? YES[] NO[] <br /> b. Identify contractor ming decontamination: <br /> Name Phone(� <br /> Address City Zip <br /> 3of6 <br />