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08/11/2010 09:46 20994330 APEC PAGE 02/02 <br />Va/10(2010 TUB 15:49 FAA 20 433 STC END IZ002/002 <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EMD) <br />1. Site map enclosed? YES[) NO <br />,K <br />2. Submit copies of ]CC Service Technician and/or Installers certificate and all manufacturer training certificates for <br />each person installing of testing any component that is repaired or replaced. Ensure a copy of the "Site Health <br />and Safety Plan" Is available on the jobsite as required by Title 8. <br />3. <br />Detailed description of work to be completed, List components to be repaired or replaced and attach a diagram <br />drawn to scale showing location of repairs and/or replacements, If repairing a component, describe how this will <br />be done. (ifddding piping, UDGs, or other UST equipment, or performing tank top upgrade, use the UST <br />Installation Application pages 4-8 as necessery for a timeiv elan rpvlAwl, <br />n <br />of equipment to be used (Attach manufacturers specification sheets showing third-pari�r approval): <br />3 <br />