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,/09/2009 WHO 11: 03 PAX `^94683433 SJC RHD --- Stockton Sezv S eq Cc ®004/008 <br /> r <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed? YES(] NO(jam --- <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 /> �V4iV I6 -j <24440AS OtiT DEea-r.•r! v€ <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> W� 4�e m0/"L)6, D � LEAK— rte TFe rr2 <br /> r�TJ{ VI r ► t2zooQ gut, -� -rEsr <br /> 2 <br />