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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? YES [] NO$ <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for <br /> each person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health <br /> and Safety 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 <br /> drawn to scale showing location of repairs and/or replacements. If repairing a component, describe how this will <br /> be done. (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br /> Installation Application pages 4-8 as necessary for a timely plan review): <br /> Ila The n_-aQ esT Qc- 8g jVayE (etv-ct-e_U1'% uj-,O k t Qe� ) TW C) <br /> LXC=N G-E t tJ+� i1 e��ex Rock 4S Sl�$o (0 O V PoC u u K se�.l 5or� it �..O <br /> GZ�EQI orae -lam w rah ve.ecjer-Poor q 51 *0-t Uo %JOs,C cx)t-t <br /> S�eo�SGrS . v l e_ w i _C_e.S-C Z6� Ge_4.J S0r-S p "&-4r- Avs..►� <br /> -L'i4arK y Q C L Ok- *�,e ries U-FS Vie U-W C AL t For AILJ daJ <br /> feu act geP�rs kre,aLl_ teAa, <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> _C-2) eC OT FA512'b0 —10O IA CUur-.5e►jsc -s <br /> 3 <br />