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SA ..,J 0 A Q U I Environmental Health Department <br /> COUNTY <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans& applications as origpnals ME be retained by EHD) <br /> 1, Site map enclosed? YES [4 NO [1 <br /> 2, Submit copies of Its Service Technician anchor Installer's certificate and all manufacturer training <br /> oertiflcates for each person Installing or testing any component that is repaired or replaced. Ensure a copy of <br /> the "Site Health and Safety;Tart" Is available on the jobsite as rewired 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 /> haw this will be done, (if adding piping, UD 's, or other LIST equipment, or performing tank tap upgrade, <br /> use the UST Installation Application pages 4-8 as necessary for a timely plan review); <br /> As-Built 1110112024 <br /> RepWced VR vacuum sensor (INN; 330020-463)using VP spare parks kit(F�#�857 80-100)located inside <br /> the Sic-diesel Transition sump. Like-fnr--like replacement, <br /> As-Built 0411812025 <br /> Reylaced leak detector(PN. 99 LD-2000) located at T3 Diesel STP sump. Like-for-like replacement. <br /> 'This plan submission is intended to resolve permit submission required on Violation Notice dated 61 0125, <br /> 4. List of equipment to be used (Attach Manufacturer's speciricatlon shoots showing third-party approval); <br /> Veeder-Root- VR Vacuum Sensor(PN: 330020-463) using VR spare parts kit(PN:857280-100) <br /> Vaporless- Leak detector(PR. 89 LD-2000) <br /> S.—Desontarnination Procedures: <br /> a. Will 1plpin-g-M-deeoptapj&ted prior to removal? YE [I NO [1 <br /> b. Identify contractor performing-dscahrlarr inr 60n: <br /> Dame ne ) <br /> Address city <br /> 016 <br />