Laserfiche WebLink
SAN . f A Q I I I N Environmental Health Department <br /> C0UNTY ._ . . .. _ I <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 [ ] 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 41nt8 as necessary for a timely plan review): <br /> * Remove existing Diesel Wayne dispenser & replace with Wayne Ovation dispenser. <br /> * Remove existing damaged Wayne Satellite dispenser & replace with " like for like " <br /> Wayne Satellite dispenser. <br /> * Both dispensers with Bravo conversion frame . <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval) : <br /> ( 1 ) Wayne Ovation Hi- Flo Dispenser Model # H22/2220D3 <br /> ( 1 ) Wayne Satellite " Like for Like" dispenser. Model # 3/G7037 <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 (� <br /> Address City Zip <br /> 3of6 <br />