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UST SYSTEM RETROFIT OR REPAIR SEP 14 2U16 <br /> (Submit minimum of 3 sets of plans &applications as originals will be retained by EHD) rfn�r�AbL <br /> 1. Site map enclosed? YES[] NO[1 d <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 87-Unleaded fill sump-raising <br /> Install new reducer boots,band clamps,inner sump lids and sump gaskets on the 87- <br /> r <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> 7.Franklin Fueling WTR-101 reducing boots with clamp.4-(87)Unleaded sump 2-(91)Premium sump 1-Diesel sump <br /> 3.Western Fiberglass lyoe/b gaskets kit-cauking,hold downs,nuts,and screws-all three sumps. <br /> 3.Western Fiberglass custom lids parl#0W420CT-58B33PT-all three sumps <br /> 1.Western Fiberglass custom fit sump shield part#TAL-MTP.Unleaded sumps <br /> 1.Western Fibs less Retrofit kit Riser Reducer Type B Part#TA9985.Unleaded sump <br /> EH230038(revised 12-11-15) 3 <br />