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SAN10 A Q U I N Environmental Health Department <br /> COU N �rY <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 [ ] 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 /> Replacing Premium ( 91 ) LLD from Vaporless to RedJacket 116 -056 -5 <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval ) : <br /> As above . <br /> 5 . Decontamination Procedures : N /A <br /> a . Will piping contaminated prior to remo ? S [ ] NO [ ] <br /> Identify ntract performing decontamin ion : <br /> Name Phone ( ) <br /> Addr ss z City Zip <br /> 3 of 6 <br />