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UST SYSTEM RETROFIT OR'RERAIR <br /> (Submit minimum of 3 sets of plans*&applicatiohs as originals wilPbe retained byEHD) <br /> 1. Sftemapenclosed? YES[] NO <br /> 2: Submibegples of IGG.::3erviee e far�.�gd(gr.lnstall r's•certlflGate.and all manyfacturer,;tralning,9e!orates inr, ac0, <br /> person installing or testing artYcomponent 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 shbwl6b location of repairs and/or replacements. If repairing a component, describe how this will be done. (If <br /> Ad In .plping, 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 /> CX) (1W1 ) <br /> F# <br /> 4. List of equipment to be used(Attach manufacturees specification sheets showing third-party approval): <br /> y <br /> 1 , <br /> • <br /> u�i1'/lly 6' Y • tl I xi kl ll'OY# 1 , x ' vv(yA.{'I:'i.(1111 '" 1111 u l� It..11l , y5f',u1 n 1.1 xt <br /> 11 1 P <br /> 1 I 1 <br /> • • I x,Il.,1 I 11 , <br />