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UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of pians&applications as originals will'be retained by EHD).' <br /> _ 1. _Site map enclosed? ___ YES[] _ _- NO[] <br /> 2: Submit copies of ICC Service.''Technician and/or Installer's certificate and all manufacturer training certificates for each <br /> personanstalling:,or•:testing.any component-that-is repaired or-replaced. Ensure a copy of the`Site Health and-Safety <br /> Plan".is..available.on the Jobsitb.a&required by Tide 8. <br /> 3. Detailed description of work td be completed. List components to be repaired or replaced and attach a diagram drawn <br /> to scale showing 9ocation of repairs and/or replacements. If repairing a component,describe how this will be done: (If, <br /> adding piping, UDC's, or othe�UST equipment,or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> Yk <br /> 4. List of equipment to be used(Attach mangfacturer's specification sheets showing third-party approval): F <br /> r <br /> a. <br /> _ 3 <br /> 1 4 <br /> x <br />