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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? 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. 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 /> ice II s. wade S}nQ asoppi �n <br /> (s4W ) and be6Y, i,�, basom' <br /> eQe3Ear 1 �1 �f'ekr�Tn� geneld, '� ( ,Ira 2) on1 IJj\„a �- fdIt�k_ <br /> (0 ) se-corAarlcon 6ainec} DiDinCl— �MnS'66/1 LOX, <br /> ot1�Si e on byiI�r,.g, Wi �lJ) Ieak genSor (ilk-)g- rods, W: 14437'1—Zo67) <br /> 1k .- T <br /> install IW o W) -n kssb bh Qe� If, (E 65?- <br /> Anlcs OA r0D& �Ve_J r root, PW 394390-42g). 1rnq9l1 (0) oo��air�en� 6cren <br /> inSiae One pgnesa{� Vy o L)le on 1-00 9-'., cads c ener2 ( Floors <br /> 1nSiae arm 06n4linwett {wo 0,3) leak sens6S OR PN'-"380-z0?) <br /> on a6sr kloors at tow P6A. Ltr ven6 Sb tka t <br /> (1= VCYIL is ro1,� wre4�rn �p� (�s�II CrJ) vend <br /> ern cage ge^e-3 � k� n a COO <br /> 4. List of equipmentlo be used(Attach manufact er's specification sheets showing third-party approval): <br /> \Jeerer root (�al� s 4380-Zoe' ( 3 <br /> Vicekr roo 6 in krstob a Seen 2 a -4g43`i0--420 <br /> Eck 4o black pr;mar S�ff Iq XJ rctcX' <br /> FRP �n vert Cs,Y, t1, Re�7hr�'d� 1T� <br /> Amer c _ orr.&,y) Qras. F16 2-44 <br /> 2 <br />