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i <br /> SANO Q Q U I ' Y Environmental Health Department <br /> �. C. ? U i`J I Y <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 [I 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 /> Like for Like replacement of defective 794380-304 sensor within the additive STP sump ( L8 location ) , <br /> completed on 8/30/2023 . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third- party approval ) : <br /> Veeder- Root Sensor 794380 -304 , <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontamin. " ' "' "r '' " " ' ^ <br /> b . Identify contractor perforr <br /> Name Not Applicable <br /> Address . , :Ip <br /> 3of6i <br />