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0*04/2013 20:35 (209)485-4988 Henderson Maintenance C-- Page 2 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1. Slee map encloses? YES j] NO), <br /> 2. Submit copies of ICC SaWA Technician andtor lnstaller''s cerljficate and all manufacturer training certificates for each <br /> person installing or testing any component that is repaired or replaced. Ensure a copy of the'She Health and Safety <br /> Plan'is available on the jobsite as required by Title 8, <br /> 3. Detailed description of work to be completed. Ust'oomponents to be repaired or replaced and attach a diagram drawn <br /> to scale showing location of repairs and/or replacenNu7ts• If repairing a component,describe how this will be done (if <br /> addi�r g piping, [!DC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Appt-tcation <br /> pages 4-8 as necessary for a timely pian review): <br /> ggQja Ed4d7 c'Jn(•Jular gtf+u•A sensor atL-4. - — <br /> ADD: 91 &87 slave MLLD replace or repair as needed. <br /> 1$a� <br /> 5242 <br /> N�vMCap\to\P`'e. <br /> 6421 `ace <br /> ep <br /> AO 013 �SNE <br /> s�aMeM <br /> 9A' <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-pasty approval): <br /> �.,.Mg7 N'OR.AnnufaLsnas 7 51 to 9'EIDE GLA S TANK ()Mn Fami,,,s�VLegr.Root <br /> i � <br /> UPTO 2 as needed: 99-LD2000: LEAK DETECTOR,Vaporless, LD2000 <br /> 2 <br />