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SANJ O A Q U I N Environmental Health Department <br /> - - COUNTY - - <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 [A 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 /> Remove existing dispensers and install new Gilbarco Encore 700s dispensers . Upgrade TLS-350 software <br /> to newest version . See attached plans for detailed parts list . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval) : <br /> N0. EOUIPM ENT DESCRIPTION MANUFACTURER PARTNUMBER <br /> tO NEW 601LBARCO EHCO RE 7005 DISPENSER 3 . 0 OILBIR CO ENCORE MOOS 3+0 <br /> O IIEW OILBARCO EIICORE700S DISPENSER 3 + 1 OILBARCO Ell CORE 70053+ 1 <br /> ONEW EVR NOZZLE VST VST-EVR- NBBK-2 <br /> O NEW BREAKAWAY VST VSTNEVR-SBKA <br /> O NEW 1Y COAXIAL HOSE VST VSTA-EVR-012 <br /> eO NEW 9COAXIALHOSE VST VDVEVR-090 <br /> 7O NEW 12' DIESELWHIP HOSE CONTINENTAL $52-327.12421200 <br /> ONEW DIESELBREAKAWAY HUSKY OD3360 <br /> O HEW 81 DIESELHOSE CONTINENTAL 032327,12400809 <br /> 10 NEW DIESELNOZZLE OPW IIA010O _ <br /> 11 NEW % APOR FLOW METER DSD) VEEDER .ROOT 332374002 <br /> 12 EXISTING VAPOR PRESSURE SENSOR (ISD) VEEOER-ROOT "1940,001 <br /> 13 NEW TLS-M SOFTWARE UPGRADE VEEOER-ROOT 130.00 <br /> W <br /> NEW ISD SOFTWARE UPORADE VEEDER•ROOT 100 <br /> 15 NEW DISPERSER ADAPTER FRAME BRAVO CONV-82000 <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 />