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4 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1 site map enclosed? YES[j NO JW <br /> 2 Submit copies of ICC Serves 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. Enure a copy of the"Site Health and Safety <br /> Plan"is available on the jobsite as required by Tide 8. <br /> 3. Detailed description of work to be completed. List components to be repairer or repkiced and attach a diagram drawn <br /> to scale showing location of repairs and/or replaosments. 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 /> / K <br /> s <br /> I <br /> ® F S <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing thirdparty a <br /> "­% E s &—/DA <br /> 9-C � p <br /> 2 <br />