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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 W 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 /> Tank 4- Break concrete around Tank 4 Fill Spill bucket , remove and replace spill bucket , pour <br /> back concrete , perform testing and inspection where required . PN : Phil -Tite 85100 - 1 <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third - party approval ) : <br /> Phiktite 85100 - 1 <br /> ination Procedures : <br /> a . Will piping ie4waLgjWinated prior to removal ? YES [ ] NO [ ] <br /> b . Identify contractor performin ation : <br /> Name ne �) <br /> Address City <br /> 3of6 <br />