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SAW , ( J OAQ U I N Envu' anmoaW 14saith Dapovbnmnt <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 f4" 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 Ads? 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 /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval) : <br /> if <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal? YES [g ' NO [ ] <br /> b , identify contractor performing decontamination: <br /> Name sfe r.�-t�.n�► s., ��.� Phone 561 q7qt <br /> Address , 3114 Or.��( city Say Zip T5403 <br /> 3of6 <br />