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NOV, 19. 2015 10:26AM N0. 1292 P. 3 <br /> RECEIVED <br /> NOV 19 2015 <br /> UST SYSTEM RETROFIT OR REPAIR ENVIRONMENTAL <br /> (Submit minirnurn of 3 sets of plans&applications as originals will be retained by EHl)) NFAI TU n[MADTAACIUT <br /> 1. Site map enclosed? Y* NO(I <br /> 2. Submit copies of ICC Service Tachnioien andlor Instalier's certificdtte and all manufacturer ttaining certificates for each <br /> person installing-or testing any*cor'nponent that is repaired-or replaced. Ensure a copy of,the`Site Health and Safety <br /> Plan'is available on the jobs'Ite 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 andlor replaeemonts, if repair'mg a component,desvibe how this will be done. (If <br /> adding plping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST'installation Application <br /> pages4.8 as necessary for a timely pian review): <br /> 4. List of equipment lobe used(Attach manufacturer's specification sheets showing third-party approval): <br /> I,^1 sP�L� ems; -t►. - � ''S 'D��_ <br />