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0 0 <br />LIST SYSTEM RETROFIT OR REPAIR RECEIVED <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EMD) . APR 0 3 2015 <br />1. Site map enclosed? YES® NO[—L] ENVIRONMENTAL <br />2, Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training NWWdM4WWK1T <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 84 <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 LIST Installation Application <br />pages 4-8 as necessary fora timely plan review): <br />replace turbine relay on tank #1 (87) <br />replace turbine relay on tank #2 (91) if needed <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />Red Jacket Relay 079425-1 <br />