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UST SYSTEM RETR OFIT 0 R REPAIR <br />(Submit minimum of 3 set <br />1. She map enclosed? YES[—] NO r7,, <br />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 />adding piping, LIM'% or other UST equipment, or performing tank top upgrade, use the LIST Installation Application <br />pages 4-8 as necessary for a timely plan review). <br />replaced ICON penetration fittings in all dispensers: #11-2, #3-4, #5-6 and #7-8 <br />4, List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />ICON shallow pan fittings <br />