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ADDENDUM - SR007567b RECEIVED <br /> UST SYSTEM RETROFIT OR REPAIR SSP 7 3 2016 11V I <br /> (Submit minimum of 3 sets of plans &applications as originals will be retainedp �ENTAL HEALTH <br /> SERVICES <br /> 1. Site map enclosed? YES NO �l <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 <br /> e the UST Inhow stallill be done. <br /> (if <br /> addin piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> on <br /> pages 4-8 as necessary for a timely plan review): <br /> f bra 1,1dC ('err r 1 '/� _�119 < 61, 0 }._ <br /> i � ( G ��F�0 1 L% ���e rvJ i�b�'i � (✓`'' � � l 11 1�1 --t-- <br /> 1 <br /> C <br /> LS <br /> f <br /> ADDENDUM <br /> _ SR0 :7�5676 <br /> Shell r'7700 MorelandOC212 _ <br /> Stockton, CA <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> 3 <br />