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3 3 0 0 V1 N-1 eft L o o Ilk <br />, <br />51-0 Citto�4 UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed? YES 14 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 />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 />, tilSTA-L,L EVrZ. U('C.RA-bC SiST-Em 0SIn16� T-WFl— VEft• R 0 0 T_ <br />1/A-9ort_ 'P® r✓ r s14ErL . N 0 _1�S b - <br />• {P E cz I= o rz K- /'� C 0 C 1� - S T'A-rL- T " 0 F 7C If S T(►a- C` <br />V t✓fr;D�,-2 - 200 "i �'t 1 -F-()rzr-C. C,/ AC=T <br />V PC, rz "tz - <br />C o ►4 V Eco T t- N V�_ XIS T—L 'L C� g `(-rA-"e_ <br />• IZC- IL TPr EXc S `1 - �^ L -L) W tb4 A- 1_L Fin/ <br />1j L n C) P &o r _&--s V INt 1 9 - L <br />• fZ ,.c s E_ T- i:-� E* ( S r1 g C, 8 9 'P L P 1- 4 7 A -UL A_),X,) F R o P Ea c <br />S P e s iF— C- 2r -c S A-1- U 'Frc ( ao rL t o rr c C "C r, W L -1-14- <br />2E.� <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />• E Vr?__ C0VAPo►L.twTS FEL E*ELo -Ti-11- GRbSrz # VQ_ - 201 - E <br />A -Por- PC C,c sHt5�a - <br />Vb- Zcc0 km(,C1) <br />2 <br />