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UST SYSTEM RE T ROFFi T VR 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 Te hnician and/or Instaiier's certificate and ail manufacturer training certificates for <br /> each person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health <br /> and Safety 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 <br /> drawn to scale showing location of repairs and/or replacements. If repairing a component, describe how this will <br /> be done (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br /> Installation Application pages 4-8 as necessary for a timely plan review): <br /> (-�t�tU�r m� Cx,r�rc)c 7'�,� 1�E'mc rr✓ C�crJCt'it� at"i Jzanih>!:�id G��akrrf <br /> � a <br /> a <br /> jjt 116am. �- �Spolkk U)/// aej Ck) a kms, dlAn fn <br /> 4" i I/ <br /> Ct ridf le io if <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> 4d - AA <br /> M4590 - _A0 4590 - Vee .l f ir?1�h i is rey <br /> 3 <br />