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' iST SYSTEM ETROw1T OR'REPAIR: <br />(Submit minirnum of 3 sets of plaits applications as originals will>be retained by EHD): <br />1. Site map enclosed? YES [ ] NOfl <br />2. Submit copies of ICC ServicTeehniclan and/or -Installer's certificate aid ali m nufa to r fir ILlraA certif peie fir ch __ . ,., <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 jobsite..as.required by Title 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 shbwing location of repairs and/or replacements. If repairing a component, describe how this will be done. <br />pd_ ding piping, UDC`s, or of er UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for timely plan review): <br />QQ a i <br />�un�rx �1�'i c P (tel <br />N,� h serve ,fc r. mau- r\ wr6_ 2 I- <br />4. List of equipment to be used (Attach manufacturer's spedlflcation sheets showing third -party approval): <br />V <br />t <br />+� cAw_e a�+i + �� ti �*1� + .g�� <br />t <br />.. r ♦" + '� t Y 1 .p <br />