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r I RECEIVED <br /> DEC 112015 <br /> UST SYSTE RETROFIT OR REPAIR ENVIRONMENTAL <br /> (submit minimum of 3 sets of plan R applications as originals will beretained byRMTH f)FPARTMFNT <br /> I <br /> 1. Site map enclosed? YES NO <br /> 2. Submit copies of ICC Service Techniblan and/or nstaller's certificate and all manufacturer training.certificates foreech <br /> person installing or testing any component tha�i repaired or replaced. Ensure s copy of the°Site Health and Safety <br /> Plan"is available on the jobsite as required by i e B. <br /> 3. Detaileddescriptionof work to be completed. i t components to be repaired or replaced and attach..a,diagram drawn <br /> to scale showing location of repairs and/or caplet mens, If repairing a component,describe how this:will be done. (if <br /> addino piping, UDC's, or other UST equipment;, r performing.tanktop upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan reviavi): <br /> t <br /> ove and Replace old penetration fitting in Vap lank for bulk fueling rack.it will be a like for like replacementin Icon fittings. TNrS tm JS i'ffg v5T Sb <br /> ��Wdn 5�t� /a-(}AUkk� t�TVN� of �djt Ti,�6 ¢irtW6 � GEfif� p�� <br /> Wf 14jllL /� Lax i s P�6 JG- G nGd �Nc SuLA�o� s r f r <br /> f���o R- �iry l7Tf�✓� W I"r1-I � � �J.nIOL , ly�� Fa^- L/JL <br /> U i4f ' <br /> i <br /> i <br /> 4. List of equipment to be used(Attach manufacturer specifibatignsheels showing third-party approval): <br /> ICON <br /> i <br /> 2 <br /> it <br />