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v <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans& applications as originals will be retained by EHD) <br /> Site map enclosed? YES NO [j <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 /> E> <br /> k <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 /> CIL <br /> 65P/11-4 r <br /> 771 <br /> nhe <br /> i�& j ti d 77 <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> AM <br /> (9 9 Alz 'x <br /> (� <br /> 3 <br />