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RECEIVED <br /> h;IAY" 2 7 2014 <br /> UST SYSTEM RETROFIT OR REPAIR ENVIRONMENTAL <br /> (Submit minimum of 3 sets of plans&applications as originals will be retain d by ]-H DEPARTMENT <br /> 1. Site map enclosed? YES[] No N9 <br /> 2. Submit copies of ICC Service Technician andlor 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 9. <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 replacements. If repairing a component,describe how this will be done. (tf <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 /> "L&v1 <br /> 4. List of equipment to be used(Attach <br /> manufacturer's specification sheets showing third-parry approval) <br /> S 1� �� �'1 SC) 3 -1 <br /> 3 <br /> 9'd Z96896860Z uaneloaied algelle?l e6t7 90 b b LZ AIRA <br />