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a w <br /> UST SYSTEM RETROFIT OR REPAIR JUL 2 3 2012 <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained bj EKD)' "iGdT <br /> 1. Site map enclosed? YESX 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. tf 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 U::: <br /> la. n Application <br /> pages 4-8 as necessary for a timely plan review): <br /> Ste ( i wade s� a o�uriSv I r i <br /> r toso an c e-bo "n 69 e' a <br /> 1 11e;f"6> - t &-ekorn bo en Z on �lxn 1-WS1 W 1t-A. <br /> 1+� 'ecor�arll t�in� ' .n ip;nq tnsilad/t X60 <br /> 60LSI, on cul a) N l,ea k T root W:7943M-26A <br /> Mil Q6 ItnW di t 1 <br /> (nS�►�{ isSt10 W� t n bGf'5'��� �?nI�S i>` � ��', <br /> LM1 S can cc mak. PW -41432042A. IA6WI 0 0,7421 ent- 6071h <br /> Ins& One agnesahcr Vn ole on COO.P. _ taat enera 6K doors <br /> 1n i e Iinrre> S a , -0iso 0jleak ser oirsP. Ptd."310467) <br /> on WCraw doors at Irf in . Jr5 (l OIca lea rias so t o_ <br /> (F) V'en t is M ! eow-L;A rebxn s . I ns l a I I (1) e,e� veru' <br /> cTn v+Ve g`ef-a 6r kA^ coo . <br /> 4. List of equipment to be used(Attach manufacturer' specification sheets showing third-party approval): <br /> \Ane - foot (�atc s X94 O�Zo i' ( 3 <br /> yice�r rao inl�'rsti ba Sensors� p 2 ; -494,310-420 j-eSL.-Cl <br /> 6C.640 black s i r;inar ;SOPPIq JrJ M&ION {�Ut <br /> ait VZ(� <br /> F-.rervend t - 1` r;go,r, Bras. FSU Z�44%F IUZ <br /> p 12- — t ISiQ f�no�� robes ;0r' z paSe �n kS on <br /> food S c4no e og- w6 k. 7BaSe -1 ankV QrC hDo St, �(69J <br /> 6 aCC&M Jatc pro6e inAs (1'A-b6A_ . <br /> qf 23 J12 - +s�o� Utz : lis alb t,o �2) �J Veee&T root X4390-420 <br /> ligv.� V-r\sor-s ;n (E) 6,e LbALS can Codd . L ecag'- (0) W5s a 96'P <br /> l qu;j I Lo a lar T�esc 9-�&rS <br /> 6e ins09' }Nnk rZ66 sMce �e 6ase (finks ;)Ir- 60 <br /> Fr � <br />