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09/09/2009 WED 11:03 PAX 2094683433 SJC HHD »»» Stockton SeXV Sta Eq Cc ®004/008 <br /> \/ <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 K <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 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 /> L. �' <br /> tJ D N t tAa�P�L 7�► 'C 'F�.�o�- V RLA d) C9,4 <br /> TFt'1L. �A��t �- OIL. TAnIK-. <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> �c:;>t E,4(, TGA J� ca: -rte—%,tc_%rE c kL. <br /> �,4tVk -3p. VP_e_r�,g-_a. (,oetr tAope,.' r7!7g3So -208 ��asoiZ <br /> -Ad4o.__'CZ"%Acrc -nlf SDAC= Z50-NSMR <br /> yJ trH R \Jr__r� R--r M o DEt-"'79 0390 -qe)9 - <br /> 11kE V4P SGVE O1,1-- 'r-P_e4_ <br /> At-6o w re- prg2 . 9d of kdr -Tb A Ni12-P or <br /> Moow.. MopaL,* 847490 3cS' <br /> 2 <br />