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SANJ O A Q U I N Environmental Health Department <br /> COU NTY -- <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 N <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 /> Conversion of the Diesel tank to E85 . Replacement of the sensors , droptube , adapters , Caps <br /> LLD , and turbine . Replacement of the Dispensers with conv sion frames . Replacement <br /> of the tank monitor. <br /> tank trTtQrstifial serer y3G <br /> 9)q qt MV3 sunsaf h23 <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval) : <br /> OPW: 71SOM �412C , 634TT-7085 - EVR , 1711T-7085- EVR , 61SALP4A , 61 VSA- MA <br /> dent v1tjf i c, <br /> Husky : 5885 <br /> FePetro : STPRAG1504L2 , 403169901 <br /> SLY" 'i - t <br /> Gilbarco : ENC700 <br /> 1'� II � I PII ) O <1 1) (8 <br /> Veeder- Root : TLS -350 , 08463974071 79 80.3323 , 794380-430 <br /> �iCG1V� CU <br /> 5 . Decontamination Procedures : N/A <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 /> 3of6 <br />