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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. Site map enclosed? YESX NO j <br /> 2. Submit copies of]CC Service Technician and/or Installer's certificate and all manufacturer training certificates for each <br /> person installing or testing any component that is repaired or replaced. Ensure a copy of the"Site Health and Safety <br /> Plan"is available on the jobske as required by Tale 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 showing location of repairs and/or replacements. ff repairing a component,describe how this will be done. (If <br /> adding piping, 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 /> /J-7 <br /> h <br /> Vf.U: 045L,226 /4/6,�I-(te lt•� 3x t�w�r'c?/- 1 G'd,J — <br /> rte"• ,�1�t�. Y r�lrr- l Sr���� �. <br /> r <br /> !1't()—qVQ Iti Utx, <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> 6AJ 0 x'7.` '; Z/&V7- COYO <br /> 2 <br />