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UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans &applications as originals will be retained <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 /> person installing or tes{ g any component that is repaired or replaced. Ensure a copy of the "Site Health and Safety <br /> Plan"is available on the bsite as required by Title 8. <br /> 3. Detailed description of wor�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 othar UST equipment, or performing tank top upgrade,,use the UST installation Application <br /> pages 4-8 as necessary for a t ely plan review): <br /> Je rZ ,�c <br /> ✓ qy3 ,n <br /> iC e <br /> In <br /> UY&,�L dil <br /> 0 gemov-e, and \�e-ejalaee, 6Y-4 VV CW Floo <br /> 40 :9. 3 - 6 <br /> 4. List of equipment to be used(Attach ma ufacturer's specification sh is showing third-party approval): <br /> EH230038(revised 12-11-15) 3 <br />