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09/09/2009 WED 11: 03 FAX 209 '3433 SJC EHD --- Stockton Sere Sta F- CV 71004/008 <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 <br /> 2. Submit copies of ICC Service Technician and/or Installer's ceicale 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 Tiee 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 ba done. (If <br /> adding piping, UDC's, or other UST equipment, or performing tank tap upgrade, use the UST Installation Application <br /> pages 4•8 as necessary for a timely plan review): <br /> Fg-z -rH HJR` til_ ``�/j> Viz20$ <br /> V <br /> 4. List of equipment to be used(Attach manufacturers specification sheets showing third-party approval); <br /> —r <br /> r.lttta AA,- <br /> —'P <br /> u S <br /> vJ Ma�29q,?9n -4103 <br /> 5 - Y ►-�o0 51�� ''S 3rd <br /> z <br />