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From:ER VINE 209 541 1694 03/05/2015 12:48 #056 P.003/006 <br /> , t / <br /> UST SYSTEM RETROFIT OR REPAIR MAR 0 5 2015 <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained bx F, Fri <br /> 1. Site map enclosed? YES [j NO[� <br /> av�no���r41�V�'n A-ee�;tT <br /> 2. Submit copies of ICC 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 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 showing location of repairs and/or replacements. If 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 /> b,)F 7114 c-, TCA30 CZ) we�.� �_Oc�t-S, <br /> 1 L S <br /> _Jyl W(tz j f A c-, r S i cam- 'Cb iia-c 4s l <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> c Lo��t - 4 c G S t[ s�`tC� sw <br /> 2. Vs�oS_- � -Poor y© a0— 4L uyrrn SE1SAi2 <br /> 3 <br />