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--- <br /> UST SYSTEM.STEM RIG:.E 6'`OFF RE1'"A® <br /> (Submit minimum of 3 sets of pians&applications as originals will be retained by EHD). <br /> 1: Site map enclosed? YES[j NO[] <br /> - 2. =Submit copies-of ICC Service.Technician and/or.lnstailer's cert1 icate,and all-manufscturer_tra ring carkif 'a s_for each <br /> per8on'1nstai'ling or testing any component that Is repaired or replaced. Ensure a copy of the°Site Health and Safety ' <br /> Pian".Is..avallable.on the'jobsite..as.required byTlfle 8. <br /> 3. Detailed description of workfo.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 /> pgdIng piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 asnecessaryfor-a timely plan review): <br /> ,F) <br /> NO KU 160b R1'3 Zy�c <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> i <br /> tl <br /> 1 ' " <br /> i- <br /> ak d'-4 tl#�4. '� MW-m�4tl ♦ 'ti. ;�:Y)" 4�t <br />