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UI Environmental Health Departmojit. <br /> C C) lEa� f` s l y <br /> UST SYSTEM RETROFIT OR REPAIR <br /> ( Submit minimum of 3 sets of plans & applications as originals will be retained by END) <br /> 1 . Site map enclosed ? YES N 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 /> Convert exsiting 12 , 000 gallon ( 87) siphon tank to Diesel <br /> Remove and replace Transition sump <br /> Remove and replace UDC ' s and dispensers <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval) : <br /> (4 ) Gilbarco Encore 700 3 + 1 dispensers ( 16) Franklin Fueling Flex Connectors <br /> ( 12 ) OPW1013HMP - 5830 Double Poppet Shear Valves (4 ) OPW60VSP - 100 Vapor Shear Valves <br /> (4) Bravo 88000 Single Wall Dispenser UDC' s (22) Bravo F-32S-T- F Flat Wall w/ tester for 3'X2 ' FRP Pipe <br /> (5 ) Bravo F-07S-0- D- F Electrical Sump Penetration Fittings ( 1 ) Bravo 400ML (40) EP- 100 Expoxy Kits <br /> ( 1 ) Bravo 13855-S60-01 32" Transition Sump ( 1 ) Bravo M1 PC42- 12 Manway Cover w/ Skirt <br /> ( 1 ) VMI 99LD2000 Leak Detector ( 1 ) Veeder- Root Software <br /> Smith Fiberglass Pipe & Fittings : Please see attched list <br /> 5 . Decontamination' Procedures : <br /> a . Will piping be decontaminated prior to removal ? YES M NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name Elite IV Contractors Phone ( 209 61 -6337 <br /> Address 2535 Wigwam Dr City Stockton Zip 95205 <br /> 3of6 <br />