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t <br /> I <br /> SAN loj O H Q U I N Environmental Health Department <br /> — COUNTY <br /> - - <br /> NAME TITLE PHONE #, <br /> ADDRESS <br /> SIGNATURE DATE <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 [ I NO [ ] <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates <br /> for each person installing or testing any component that is repaired or replaced . Ensure a copy of the " Site <br /> 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 diagram <br /> drawn to scale showing location of repairs and/or replacements . If repairing a component , describe how this <br /> will be done . (if adding piping, UDC's, or other UST equipment, or performing tank top upgrade , use the UST <br /> Installation Application pages 4 -8 as necessary for a timely plan review) : <br /> Replace 91 grade drop tube due to shutting off at 91 % Installed new Franklin Fueling� <br /> Defender series drop tube . Make calculations to shut off at 95% <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval) : <br /> Franklin Fueling series drop tube <br /> 30f7 JAI � Q � 1� � � <br />