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SAN JOA Q U I N <br />COUNTY Environmental Health Department,, <br />- <br />,/. <br />UST SYSTEM RETROFIT OR REPAIR MAY 2 3 2023 <br />(Submit minimum of 3 sets of plans & applications as originals will be retained bTPWMHONA1ENTAAI 1-1;= \,� I I I <br />PERMIT/SERVIc;1 <br />1. Site map enclosed? YES 6c1 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 />REMOVE EXISTING DRESSER WAYNE OVATION DISPENSERS AND REPLACE WITH NEW <br />DRESSER WAYNE OVATION 2 DISPENSERS (LIKE FOR LIKE) WITH NEW HANGING HARDWARE, <br />REPLACE SUPREME TURBINE WITH NEW OF SAME MODEL, PULL ALL NEW DATA, <br />POWER, AND CAT6 CABLE TO ALL DISPENSERS, PERFORM ALL STARTUP, TESTING, <br />AND INSPECTION REQUIREMENTS, <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />DRESSER WAYNE OVATION 2 DISPENSERS <br />RED JACKET QUANTUM 20 2HP FIXED SPEED SUBMERGED TURBINE PUMP <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 a City Zip <br />3of6 <br />