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1 U <br /> r <br /> % N L <br /> IST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as orlg€pais will be retained by EHD) <br /> 1. Site map enclosed? YES[] NO[] <br /> 2. Submit copies of ICC Service Teohniclan and/or Installer's certificate and all manufacturer tralrling 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 avallable on the jobslte as required by Title S. <br /> 3. Detailed description of work to be completed. List components to be repaired or replaced end attach a diagram drawn <br /> to scale showing location of repalm and/or replacements, If repairing a component,describe how this will be done. (if <br /> d� cling piping, UDC's, or other USS'equipment, or performing tank top upgrado,use the /1ST installation Application <br /> pages 4.8 as necessary for s timely plan review): <br /> Boot replacement is undetermined at this time,testing has teen done prior to actual scope of work. <br /> We did list the sealant as that may all thats needed. Diesel#2 STP sump. <br /> The UDCs#8#9110#1Ill 2 &##14 will be tested as per violation. This will be overdue <br /> -S-month test only,. o repairs <br /> J) 4Df <br /> 4. List of equipment to be used(Attach manufacturer's spaclfication sheets showing third-party approval): <br /> Diversified Bulkhead Bonder <br /> - m �J-4- <br /> �I <br /> F-F1230038(revised 12.11.15) 3 <br />