Laserfiche WebLink
�, A N I O n (j I I I Environmental Health Department <br /> COU NTY -- <br /> M`u ��� S UI q RETROF T OR REPAIR <br /> (Submit minimum of 3 sets of plans & applications as originals will be retained by EHD ) <br /> 1 . Site map enclosed ? YES FVJ NOF'] <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 /> Site has Audio Visual for Overfills . We will be changing out 3 drop tubes and installing OPW 71 SO <br /> drop tubes with overfill prevention <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third-party approval ) : <br /> 71 SO OPW DROP TUBES <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removaj?._--= Y541 NOF] <br /> b . Identify contractor performing decontamination : <br /> Name --/ Phone (__) <br /> Add es / City Zip <br /> 3of6 <br />