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mac... <br /> l: <br /> UST SYSTEM RETROFIT OR REPAIR OCT 0 9 2014 I <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> ENVIRONMENTAL HEALTH <br /> 1. Site map erclosed? YES [] NO[ DEPARTMENT <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for each i <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. 1 <br /> 3. Detailed description of work to be completed. List components to be repaired or replaced and attach a diagram drawn j <br /> to scale showing location of repairs andlor 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 eview): 1 <br /> -- 7 <br /> I <br /> 1 <br /> i <br /> 4. List of equipment to be used(Attach man factur is specification sheets showing third-party approval): <br /> 2 CIZE�A <br /> I <br /> i <br /> I <br /> i <br /> I <br /> 3 <br /> I <br /> 9'd E9689V960Z Luneloatedelgeile2j e99:Z0t,1, 60;00 <br />