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UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans`&applications as originals will be retained by EHD) <br /> I. Site map enclosed? YES I I NO➢CI <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 S. <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 /> • � ar- bo I1- drnv,2 rvjan wa�j I o c>a.E-ed in �I�e,tuvbiYt�aurh� <br /> T 0 �t,,q—r✓w�9 y ' <br /> 111V_S_Z`� /y E 1/ .4N14114 4 /i/I <f 44 y 1 <br /> CC4y&1:9� cT ZGL <br /> /(A6&V//_1,L4/.06-ivTS <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> /veil-' �1 A r✓wr9 7yt/i 6-L C U 1-✓14 `i�0 �✓t <br /> D!CysL— <br /> w ! c/S <br /> 3 <br />