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AUGRECENE'l Dj__ <br />1 a 2010 <br />ENllilR(1KHt�t�� UST SYSTEM RETROFIT �� <br />��Re�'ETIENT � HEA1 <br />OR REPAIR <br />Submi minimum of 3 sets of pians &applications as <br />originals will be retained by EHD) <br />CES <br />1. Site map enclosed? YES <br />Non <br />2. Submit copies of ICC Service Technician andfor 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 description or work to be completed. List components to be repaired or replaced and attach a diagram drawn <br />to scale showing local ion of repairs and/or replacements. If repairing a component, describe how this will be done. (If <br />addino piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessa for a timely plan review): <br />t <br />4. List of equipment to besed (Attach manufacturer's specification sheets showing third -party approval): <br />i1i ON 41, _ i <br />2 <br />