Laserfiche WebLink
RECEIVED <br />PA A,-. 0 4 2 14 <br />UST SYSTEM RETROFIT OR REPAIR ENVIRON TA <br />(submit minimum of 3 sets of plans & applications as originals will be retaine4R�Q FP, R MtENT <br />Dr' - <br />1. Site map encloseYES NO <br />2. Submit copies of ICC Service Technician and//r Installer's certificate and all manufacturer training <br />Person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Heal and Safety <br />Plan' Is available on the jobsite as required by Title a, cerbfi $� kr each <br />�� i <br />3. Detailed description of work to be completed_ List components to be repaired Or replaced and attach a d"1a i ram drawn <br />to scale showing location of repair; and/or replacements, If repairing a component, describe how this wii� t�a dome. {If <br />d�d� piping, U esse or other UST equipment, or performing tank top upgrade, use the UST Instaltatinnlen.,r..,.:on <br />pages 4�8 as necessary for a timely elan ra i—& . <br />3 <br />ZO/Z0 39Vd <br />1100d13793%107 <br />9L9LE£8887 GG•5Z VZOZ/bO/C0 <br />