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Ap uuq SPooB <br /> SA N J O A Q U I N Environmental Health Department <br /> COUNTY--- <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 Dd 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) OPW10BHMP-5830 Double Poppet Shear Valves (4) OPW60VSP-100 Vapor Shear Valves <br /> (4) Bravo B8000 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 B855-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 N NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Elite IV Contractors Phone 2�61-6337 <br /> Address 2535 Wigwam Dr City Stockton Zip 95205 <br /> 3 of <br /> a <br />