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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? YE NO j] <br /> 2. Submit copies of ICC Service Technician_and Installer's certificate and all manufacturer training certificates for <br /> each-person-installing-or-testing-any-componentthat 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 addin other LIST equipment, or performing tank top upgrade, use the UST <br /> Installation Application pages 4-8 as necessary for a timely plan review): <br /> a <br /> �f �hC I+>19�11 /tif e� r oho <br /> 4 <br /> 5nate) <br /> 11 . /r j{ <br /> OVd ` lad <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> 4rt _ - jat <br /> 9[)5 Ye e c � 11 , i�r �ago" <br /> - - 3. . _.. <br />