Laserfiche WebLink
SANJ O A Q U I N Environmental Health Department <br /> — <br /> C 0 U NI ' 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 M 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 /> See Attached Scope of Work <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third- party approval) : <br /> ( 3 ) OPW FibreTite Multi - Port Retrofit Kit ( 87 , 89 , 91 ) <br /> ( 3 ) 61 SALP- 1020 EVR OPW 4 " swivel fill adapters <br /> ( 3 ) 634TT- 7085- EVR OPW 4 " fill caps <br /> ( 3 ) 61 VSA- 1020 EVR OPW Swivel Vapor adapters <br /> ( 3 ) 1711 T- 7085 - EVR OPW 4 " Vapor caps <br /> ( 6 ) FSA- 400S OPW face seal adapters <br /> ( 3 ) OPW Overfill Drop Tube <br /> 5 . Decontamination Procedures : N/A <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 />