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• 0 <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />DEC (5 2014 <br />1. Site map enclosed? YES NO [ ] ENVIRONMENTAL HEALi-H <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training cuert$caies fd94Th <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, 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 />,- <br />SA A)o A ZO A -e- 5 ti � � rt <br />BACIIE �Podn� ;EHAFXZ' is <br />Lu�'lI Re lee p"o ur- ±H AT W /9 S PART 0-1' 48&- <br />We- <br />y& -Eve- wL I( Re—move' AAL P19/z-rS Ff1G&,, j3cc`c._DRe14 <br />B4c,tRoo--_ , <br />-L(/• i l I -X Ael"_M9 w (/ T S%/4A/ A Z a. At., Se -r, c <br />1 G .4 <br />ly d 1 C14 G L Esti t/�/1 o.yn,.en l� ec. C.f 61 ])gPi4A ioi.o n r <br />7-P 1-c 1-'�! o T S222,1,,0 — hZeAAP_ <br />e) TY9746 Will NG 10,404it.— 7t. 1rMa-r 3s,- <br />10 <br />List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />D_ti S 244 sti /J " ��Q ��2 �S /� •t..i' �/L <br />