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To: Elena Manzo Page 9 of 13 2018-09-05 16:47:04(GMT) 17076380484 From: Nucleus Pump Services <br /> SJ 0 A Q U 1 N Environmental Health Department <br /> {0 k_ N 'Y <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'/ 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 /> Convert existing 89 unleaded US'T to Diesel product. Replace 4x.dispensers (2x with Diesel). <br /> Separate Diesel vent risers.Cap off vapor line in STP sump. Cap off unused diesel piping <br /> in 3+0 dispensers.New Diesel line leak detector.New dispensers will have Bravo conversion <br /> frames. <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> See attached cut sheets. <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone�) <br /> Address City Zip <br /> 3 of 6 <br />