Laserfiche WebLink
Jan. 6, 2011 3:43PM RUMMY CONSTRUCTION No,35u P. 1/1 <br />2/30,/20i0 THU 11:56 FAX 209461 13 SSC HHD C 1'001/001 <br />r <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 seta of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed? YES [ ] NOg_ <br />2_ Submit mpies of ICC Service Technician and/or Installer's certiftcate and all manufacturer training certificates for <br />each person installing or tesftng any component that is repaired or replaced_ Ensure a copy of the 'Site Health <br />and Safety plan' is available on the yobsit:e as required by Title 8. <br />3. Detailed description of work to be completed. List components to be repaired or replaced and attach a diagrarn <br />drawn to scala showing location of repairs and/or replacements. If repairing a component, describe Flaw this will <br />be done. of acct piping. Was, or odd UST equipment, or perfbnTJnq tank top upgrade, use the UST <br />Installation Application pages 4-8 as necessary for a timety plan review). <br />wuW 0- btil 5 54- -FKWYl '10S- VS <br />4ift <br />,,& -�t � §emy 4D VeeAff �zk <br />-11n� yy) U�r ct— gee 6uc - C k,, fy- als� <br />4. Ust of equipment to be used (Atm marwfaetur&s specification sheets showing third -pasty approval): <br />z c.�G� i�ecaz� o� -f� a -e>qjew <br />3 <br />