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L � <br /> +a17 <br /> EN !`3 i <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans &applications as originals will be retained by EHD) <br /> 7. Site map enclosed? YES(] NO D, <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 /> 7 3 Ply `- 3v� -F. L. <br /> oil <br /> d �em of-e, a h CCl A,op/aee_ 6r-..i VV C-�W Flo,4- <br /> ��rrla✓� qnd �t�/a[ie ,C3ello�s fo <br /> i vc ke <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> ✓l� -79u3 � � - 0� <br /> Inna,n L5.. 3 <br /> ra��lr� USG ( oaf <br /> C �1P — ry) I <br /> DUO <br /> i <br /> 1 <br /> 1 <br /> (4 <br /> P <br /> EH230038(revised 12-11-15) 3 <br />