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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 [ ] NO [4 <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 Add Direct bury Vapor bucket . Replacement of the sensors , droptube , <br /> adapters , Caps , LLD , and turbine . Replacement of the Dispensers with conversion frames . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval ) : <br /> OPW: 71 SOM412C , 634TT-7085 - EVR , 1711 T-7085- EVR , 61 SALP-MA , 61 VSA- MA , 1 C-2200P <br /> Husky : 5885 <br /> FePetro : STPRAG150-VL2 , 403169901 <br /> Gilbarco : ENC700 <br /> Veeder-Root : TLS -350 , 08463974071 794380 -3231 794380-430 <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 />