Laserfiche WebLink
SA N . J 0 A Q U IN Environmental Health Department <br /> - - - C O U N T Y --__ _._ _. <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 4-8 as necessary for a timely plan review ) : <br /> Replace three (3 ) existing Wayne Vista dispensers with two (2 ) 3 + 1 Gilbarco Encore 700s dispensers . Install Bravo conversion <br /> frames . Cap , seal , and cover unused UDC with Bravo box . <br /> Reconnect piping and electrical ines . Purge air out of dispensers , calibrate dispensers , compete weights <br /> and measures " Place into Service" procedures . Upgrade Veeder- Root, if needed . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval ) : <br /> Gilbarco Encore 700s 3 + 1 Dispensers ( ENC700SNL1 -2) <br /> Bravo Conversion Frames (CU -380CA) <br /> VST Whip Hose (VSTAP-EVR-012) <br /> VST Reattachable Coaxial EVR Breakaway (VSTA-EVR-SBKA) <br /> VST 8' Platinum Coaxial EVR Hose With Venturi (VDVP - EVR-096 ) <br /> VST Coaxial EVR G2 Balance Nozzle Black (VST-EVR- NB13K-2 ) <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 /> j 3of6 <br /> i <br />