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U3/22/2012 05:17 0000000000 <br />• PAGE 03/30 <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of3 se of plans & applications as originals will be retained by EHD) <br />1. site map enclosed? YES [7 NO <br />[] <br />2. Submit copies of JCC 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- <br />3. Detailed descrlptlon 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. (If <br />adding 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): / q <br /><�•?��. s�,�-�� ��� �Gr�. X7r- l �r fj/� Gid/ /��r /� /20 �v J� <br />S� s4rl.HC,-rc� ctna/ Lo/I!/GF­7 1 <br />!�"` 0 N'G � ry ./S r O '=r r r i F �Y! � )('i S 'Y ! .''k �/ G 1• ?r+�l� f <br />rfY /Zp � S'TCrt <br />lr Il✓G U/r II �/ /5 C7I 1�I571 )Mf til Olr?Q! <br />NJ V lJlu Cr �1(j I r/1 <br />G 5a� li r <br />lrlS {� <br />/�.tL! r.1 !' n ry u C� cJ �.� C/S/rn^e Gi <br />L�rADG S L ✓GLS` <br />1 <br />J <br />r r r <br />4, List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval); <br />I�F <br />3 <br />