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'NN <br /> 4%k bev5T <br /> RS <br /> wM14�e...a.ri.t+ ..^s...us�'au<a:e..a.."®...... _..tw.v�"o'- .___•_ aS.m.®�a.a�+s _i•: ;awa}�. <br /> 12123/2014 17:06 20S BAGLU ENMRPR S PAGE 02/02 <br /> _R <br /> Er-EIVED 0* 00'IVEC <br /> "IzL; <br /> DEC 2 3 2014 <br /> UST SYSTEM RETROFIT OR REPAIR DEC 02' 2014 <br /> ENVI RO N M Ef(§j6Aa&Cmkj4w 3 sets of plans&applications as originals will be retained by W&RO <br /> OERARI <br /> 4, Site map enc osed YES[] NO DEPARTMENT <br /> 2. Submit copies of IGC Service Technician and/or Installer's certificate and all manufacturer training certificates for <br /> each person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Wealth <br /> and Safety Plan"is available on the jobske 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 <br /> drawn to scale showing location of repairs and/or replacements. If repairing a component, describe how this velli <br /> be done. (if adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br /> Installation Application pages 4-8 as,necessary for a timely plan review): <br /> sco a of Work- Ye laCe wain damn ed motor a.n utlt witb new like item <br /> Restart/cold start veeder rOOt system <br /> 4, List of equipment to be used(,Attach manufacturers specification sheets showing third-party approval). <br /> Ga.Bboy motor pact= number F37351 <br />