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ANJ O A U I N Environmental Health Department <br /> _ COUNTY , _ .. . = IV <br /> RECE ED <br /> UST SYSTEM RETROFIT OR REPAIR APR 2 22021 <br /> (Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br /> 1 . Site map enclosed? YES [ ] NO [ ] ENVIRONMENTAL HEALTH <br /> DEPARTMENT <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 (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 running the two 87 turbines to turn-on sequentially. Updating 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 /> (3) Gilbarco Encore 700S Series Blender Dispensers <br /> (3) 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 /> 3 of 6 <br />