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SA J OA U I Eny+ ironmentaI Health Department <br /> .COUNTY — <br /> UST SYSTEM RETROFIT OR EPAIF <br /> {Submit minimum of 3 sets of plans &applications as originals will be refined by EFID} <br /> 1, bite map enclosed? YES [I NO [ ] <br /> 2. Subrnll copies of ICC Service Technician andlor Installers certificate and all manufacturer training <br /> Certificates for each person installing or testing any component Ihat 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_ Irist components to be repaired or replaced and attach a <br /> diagram drawn to scale showing location of repairs andlor replacements. if rewiring a component, describe <br /> how this will be done_ (if adding piping, UDD'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 /> Transition Surnp Supply & Return Line Fittings to be Replaced. <br /> 4_ Lfst of equtpmank to be used (Atlarh manufacturer's specification sheets showing third-party approval): <br /> 1 ) ISR 1 .4 x 1 .25A Icon Split Repair Fitting <br /> 2) IBF 1 .25 x 1 .0A Icon Split Repair Fitting <br /> 3) 1 RF I OBS L Plug Icon Split Repair Snap Lock Flange Fitting Kit <br /> 4) IAC Fastfuse Icon Split Fitting Repair Bonding Solvent <br /> ) IAC Sikaflex Sikaflex Fitting Gasket Sealant <br /> 5. Decontamination Procedures: <br /> a. Will piping be decontaminated priorto removal? YES [] NO 0 <br /> b. Identify contractor performing decontamination: <br /> Narne Rhone <br /> Address city Zip — <br /> :iofG <br />