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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[I NO[t� <br /> 2. Submit copies of ICC Service.Technician and/or Installer's certificate and all manufacturer <br /> training the"Sit Health Safety <br /> for each <br /> person installing or testing any component that is repaired or replaced. Ensure a copy <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 how rade, use the UST Installation will be <br /> done.ti(If <br /> din <br /> adpiping, UDC's, or other UST equipment, or performing tank top upg <br /> Appl <br /> pages 4-8 as necessary for a timeplan review): <br /> d �lAl Hyl : GAGE" <br /> I I1 � A4 . <br /> �g <br /> zi <br /> /St, 01`I' .. <br /> ` <br /> Y <br /> k w <br /> S L)m <br /> v <br /> P <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-parry approva "6) <br /> v - ^ <br /> 2 <br />