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'RECEIVED <br />�8Y �� YOi� <br />UST S����TEU� ����T��|�FIT o��� ��EP��I�� MAY " � ^,.^ <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by E'-MVIRONMENTAL HEALTH <br />1 Site map enclosed? YES[} NO[) PERMIT/SERVICES <br />2 Submit copies of]CC Service Technician and/or Installers certificate and all manufacturer training certificates for each <br />person installing or testing any component that is repaired or replaced. Ensure o copy of the "Site Health and Safety <br />Plan- isavailable onthe jobsitoesrequired byTitle 8 <br />J Detailed description ofwork !obecompleted. List components tnberepaired orreplaced and attach a diagram drawn <br />to scale showing location ofrepairs and/or replacements. If repairing aoomponent. describe hovvthis will be done.(|f <br />adding piping, UDC'» orother UST equipment,urpe�onn/ngtank top upgrade. use the UST Installation Application <br />pages 4'Daonecessary for atimely plan roviaw)� <br />4. List cfequipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />3 <br />