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SAN JOAQUIN <br />C O U N T Y---- <br />SR0083601 10/19/21 Amendment for QS 144 <br />Environmental Health Department <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 />diaaram drawn to scale showing location of repairs and/or replacements. If repairinq a component, describe <br />how this will be done. (It adding piping, LIM's, or other us I equipment, or perfor <br />use the UST Installation Application pages 4-8 as necessary for a timely plan review): <br />Remove (3) Existing Straight grade Gilbarco Advantage Dispensers <br />Replace with (3) Gilbarco Encore 700S Series Blender Dispensers. <br />Installing (3) Bravo Conversion Frames. <br />Converting existing 89 Octane/10,000 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. Updating Software on Veeder-Root. <br />Possible Cold -Start. <br />AMENDMENT: Installing deflector plates in each UDC. (3) <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval) <br />(3) Gilbarco Encore 700S Series Blender Dispensers <br />(3) Bravo Conversion Frames <br />«) 'P)rwto �urers�rl I�'ledvr'�fa�S CF-31380-�6 <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 />3 of <br />