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jaw& Aduk". <br /> qB so RECEIVED <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans 2- 7 2 013 <br /> &applications as originals will be retained by EHD)` <br /> 1. Site map enclosed? YES[I NO[] ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> 2. Submit copies of ICC Service Technician and/or Installers 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 B. <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 LIST equipment, Or Performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> - <br /> 4. List of equipment to be used(Attach manufacturers specification sheets showing third-party approval): <br /> V ea6 Tog- X q 0 t.-,k <br /> U4e0(eR_ <br /> lag, <br /> 3 <br />