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i <br /> I r ar� 0Environmental Health Department <br /> C 0 U N TY` -- <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 Pj 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 /> Install new above ground, surface mount Omega flex supply and return piping including new Western FRP <br /> transition sump (with new Veeder root VR420 sensor) to new day tank in generator room. <br /> Demo existing day tank after new is in operation <br /> 4 , list of equipment to be used (Attach manufacturer's specification sheets showing third -party approval) : <br /> Omega — <br /> Western FRA transition sump <br /> veeder root yr 420 sensor <br /> 5 . Decontamination Procedures : <br /> a, Will piping be decontaminated prior to removal? YES [ ] NO [ J <br /> b . Identify contractor performing decontamination : <br /> Name Costera envPhone 4t 15 ) 633-0112 <br /> Address 14 EI Vaquero City Rancho Santa Margarita <br /> _ Zip 92688 <br /> 3of6 <br />