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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. Sit map enclosed? YES[] NOS <br />2. Submit pies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for <br />each pers n installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health <br />and Safety n" is available on the jobsite as required by Title 8. <br />3. Detailed descr:ad <br />n of work to be completed. List components to be repaired or replaced and attach a diagram <br />drawn to scale ing location of repairs and/or replacements. If repairing a component, describe how this will <br />be done. (If dln!ping, UDC's, or other UST equipment, or performing tank fop upgrade, use the UST <br />Installation Apation ages 4-8 as necessary for a timely plan review): <br />�i <br />nfgOs ti r c q 4& J'and cos <br />/w,►94-nG ) /+?c/.ieG ",&9.!&7e <br />/ Lie, e4P4 C1114017 <br />4. List of equipment to be used (Attach manufacturer's specification sheets <br />third -party approval): <br />3 <br />NOT T rb V4 <br />