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Jun. 26. 2014 11:13AM <br />RECEIVED <br />UST SYSTEM RETROFIT OR REPAIR JUN 2 6 M14 <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />Site map enclosed? YESX NO[] ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for each <br />person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health and Safety <br />Plan' is available on the jobsite as required by Title 8, V <br />3. Detailed description of work to be completed. List components to be repaired or replaced and attach a diagram drawn <br />to scale showing location of repairs and/or replacements. If repairing a component, describe how this will be done. (Ir <br />94 "in piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST installation Application <br />pages 4-8 as necessary for a timely plan review): <br />M U0two C.Cm Dry f` i n. c \-K CU . <br />U �_V `S <br />v <br />a <br />0 <br />✓- 0 ,yj.p <br />List of equipment to be used (Attach manufacturer's specification sheets <br />]showing <br />'third -party approval): <br />0, Or <br />riLL 'SL -,Sr <br />v S/-16 r L4W_AF Ito <br />3 <br />q) <br />