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SAN10 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 N NO [ I <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 /> T1 & T2 Siphon Line - Cut and disconnect the 2 " FRP primary pipe inside T1 STP Sump . <br /> Inspect for and remove any blockage in the line . Install new 2 " BxM adapter and reconnect <br /> reconnect Siphon line . Repair located inside sump ( not breaking ground ) <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third- party approval ) : <br /> NOV - 2 " BxM Adapter PN : 01 2020 - 1 91 - 4 <br /> ontamination Procedures : <br /> a. Wil p ' e decontaminated prior to removal ? YES [ ] NO [ ] <br /> b . Identify contractor ing decontamination : <br /> Name Phone ( ) <br /> Address City Zip <br /> 3of6 <br />