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UST SYSTEM.'R-ETROFIT OR.RI=PAIR <br />(Submit n, num of3 sets of plans'& applications-asorigina,_. A be.retgined by EHD) <br />1. Site map enclosed? - YES { ] ' NO <br />.2. Submit copies. of ICC Service. Technician and/or Installer's certifice#e and all manufacturer training certificates for each <br />person installing or testing any component that is.repaired or replaced. Ensure a copy of !he.. "Site Health and Safety <br />Plan" is available on the jobsite as required by Title B. . <br />3. Detailed,description of.Work. to.be'completed: List components.tobe repairedor replaced and, attach a diagram drawn <br />to scale showing -location ofrepairs and/or.replacements: If, repairing a. component; describe iaow.this will �be.done:: (If <br />addba.piping; UDC's; or. other'UST 'equipment; ar.performing tank fop .upgrade,: use'the' UST Installation Application <br />pages 4-8 as riecessary-fnr a timely plan review :. <br />__-- d� .�� `®i �, lam. '� �. � �� ',� L.% � ' ► i�, <br />1 <br />