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SAN JOAQUIN <br />--COUNTY— <br />Environmental Health Department <br />RECEIVED <br />UST SYSTEM RETROFIT OR REPAIR JUN 1;� 2021 <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed? YES [ ] NO [x] ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />L 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 />Replacement of like for like direct berried 5 gallon 91 gasoline bucket. Cutting around and breaking the concrete. <br />Removing of exiting and installing new bucket to manufactures recommendations and testing it. <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />Phiktite fill bucket. 85100-1 <br />5. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO V] <br />b. Identify contractor performing decontamination: <br />Name Tank Tight Systems Inc Phone () 916 753 0177 <br />Address 8515 Waterman Rd CityElkgrove Zip 95624 <br />3of6 <br />