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RECEIVEI <br /> UST SYSTEM RETROFIT OR REPAIR f�1 NOV 18 pg2015 q <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained byENVIRONMENTAL <br /> NFAITW nC0AOTAWkM <br /> 1. Site map enclosed? YES[] NO[] <br /> 2. Submit copies of ICC 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 description 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): <br /> Brake-out concrete and repair the existing man-way lid on the 87-Unleaded fill sump-raising metal sump <br /> ring. <br /> Install new reducer boots, band clamps, inner sump lids and sump gaskets on the 87-Unleaded <br /> gt-Premium,and Diesel fill sumps <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> 7. Franklin Fueling WFR-1013 reduoding boots with clamps.4(87)Unleaded Sump 2-(91)Premuim Sump 1-Disesl Sump <br /> 3, Western Fiberglass Type B gaskets kit-cauking, hold downs,nuts, and screws -all three sumps <br /> 3 Western Fiberglass Custom Lids Part#TAL 33CU-alt three sumps <br /> 1 Western Fiberglass Custom fit Sump Shield Part#TAL-MTP Unleaded Sump <br /> 1 Western Fiberglass Retrofit Kit Riser Reduoder Type B Part#TA9985.Unleaded Sump <br /> 3 <br />