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cr <br /> SAN ) O A Q U I N EnvironmRECt <br /> DVED <br /> L 01J r.i I Y <br /> Nook o 5 2021 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> ( Submit minimum of 3 sets of plans & applications as originals will be reta&"bftENTAL HEALTH <br /> 1 . Site map enclosed ? YES (✓ NO [ ] 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 fill and vapor caps and adapters ( save for installation ) <br /> Remove ball floats and straight drop tube from existing tanks 1 , 2 & 3 <br /> Install new Defender Drop Tube with overfill prevention at each tank and set overfill valve to 95% capacity <br /> Re - install fill and vapor caps and adapters <br /> Perform All required CARB testing on installed components <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third - party approval ) : <br /> Defender Overfill Prevention valve with 10 ' top tube and 10 ' bottom tube . CARIB approved <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal ? YES [ I NOg <br /> b . Identify pontractor performing decontamination : <br /> Nome Phone <br /> dress KI A @ftZip <br /> MVVM01L 164 16F 0 <br /> 3of6 <br />