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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 /> 1. Site map enclosed? YES [I NO <br /> 2. Submit copies of ICC Service Technician and/or Installers 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 /> ren (ce ea, iia , e(�so� ©u g q +at& 4_0 <br /> V L. Lj <br /> 'AUG 2 5 201! <br /> IIFPARTAAFNT <br /> 4. List of equipment to be used (Attach manufacturers specification sheets showing third-party approval): <br /> mR -* 33 a &o _ Lf to 3 6vo&L SVJ_S2v J <br /> EH230038(revised 7-26-2016) 3 <br />