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RECEIVED <br /> DEC 15 2015 <br /> ENVIRONMENTAL <br /> UST SYSTEM RETROFIT OR REPAIR HEALTH DEPARTMENT <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed? YES[] NO[] <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 /> 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 /> BAdIng piping, UDCs, 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 /> Unleaded 87-Slow Flow <br /> Replaced 87 leak detector <br /> 4. List of equipment to be used(Attach manufacturer's speeffication sheets showing third-party approval): <br /> 1. Vaporless 99VMI-2000 Leak Det ector <br /> 3 <br />