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UST SYSTEM RETROFIT OR REPAIR L_(r--kVQV J Y <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <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$. <br /> 3. Detailed description of work to be completed. List components to be repaired or replaced and attach a diagram drawn <br /> to scale showing location of repairs and/or replacements. If repairing a component, describe how this will be done. (If <br /> adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-$as necessary for a timely plan review): �Oau <br /> 01 uA ik I <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> V IY)Z -l-�� CV- �C n I e' ti(1 �� �a&r�o �t <br /> &ailf I ttl� P l t�l� �O <br /> 3 <br />