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SA N J O A Q U I N Environmental Health Department <br /> COUNTY REECEIVED <br /> UST SYSTEM RETROFIT OR REPAIR (� C <br /> (Submit minimum of 3 sets of plans I£applications as originals will be retained by EHD) MAY 0] 2021 <br /> 1. Site map enclosed? YES[I NO(j ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <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 /> Remove (2) Gilbarco Advantage Dispensers. <br /> Replace with (2) Gilbarco Encore 7005 Series Dispensers with (2) Bravo Conversion Frames. <br /> Converting existing 89 Octane110,000 Gallon UST to 87 Octane. <br /> Manifold existing 89 product line to 87 product line above shear valve in the UDC. <br /> Program Veeder-Root to run the two 87 turbines to turn-on sequentially. <br /> Upgrade Software on Veeder-Root. <br /> Possible Cold Start. <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> (2) Gilbarco Encore 700S Series Dispensers <br /> (2) Bravo Conversion Frames <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Phone U <br /> Address City Zip <br /> 3 of Ei <br />