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REGEI V EL <br /> UST SYSTEM RETROFIT OR REPAIR DEC 0 9 2015 <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) �ypp�� <br /> 1. Site map enclosed? YES[] NO EWFI NVIR�tVMEN .L <br /> IR f1CDP DTgq T <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 a 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 /> Installation of EVR equipment on 100 octane( Rancing Fuel) under ground storage tank <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> 1. OPW 1C.2100C-DEVR 5-Gallon Fill Bucket 1.OPW 61SALP-1020 EVR Fill Adapter <br /> 1.OPW 1 C-2100C-PEVR 5-Gallon Vapor Bucket 1.OPW 61 VSA-1020 EVR Vapor Adapter <br /> 1.OPW 71 S0-4106-EVR Overfill Drop-Tube 1.OPW 61JSK-44CB <br /> 2.OPW FSA-400-S Face Seal Adapters <br /> 3 <br />