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Jan .22 14 08;37a <br />JP PetraleumService <br />0 <br />91642-4873 p.2 <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of pians & applications as originals will be retained by EHD) JAN .2 2 2114 <br />1. Site map enclosed? YES ] NO ENV"O" <br />ENTAi. iH� H <br />2. Submit copies of ICG Service Technician and/or Installer's certificate and all manufacturer training cpkwwr � � <br />person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health and are l <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, a <br />to scale showing location of repairs and/or replacements. If repairing a component, describe haw this will be done. (if <br />adding piping, UDC's, or other UST equipment, or perfcrming tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for a timely plan review): <br />=-L` d. r 7 r rte _ r s .iliz A-�f c Cyl ._ t J If I ll Gi/ _1� 6 ►ice - <br />,-A- L moi Ifs A,�,] � 4 <br />d 1 <br />4. List of equipment to be used (Attach manufacturer's specification sheets shoring third -party approval): <br />3 <br />