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0 <br /> RECEIVEL <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) FEB 2 5 2015 <br /> 1. Site map enclosed? YES [] NO[v]� ENVIRONMENTAL <br /> HFWTW rlco4Q_nACK1T <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 /> Secondary cc)n f-4( o meet tes,j ( rict Ce e4 trs oeejes <br /> Seee) nC acq eon.-�nen mertf- pi*ncj Poc d leSel l,cleS1' <br /> P^oJu( 4- 1IV1e crt Ie, em bod.4 <br /> Secon &rq con+wnmen .� �; �, rct � r yes l ltS <br /> be o � �c1�e LCn- 00, te � ( <br /> �e- 1aCe� eomi (-\ecf-v,)(l 19oC+S. 0n ese1 ec_0 arj y,&-e � <br /> t�➢e S Se c o�n�a �y (��a��t C:-4 1 t h e- oe he-�-- c �-z S i rn Sig nn S <br /> S'C rczd e C Vtt�"S PS , C_L� i�c e-)4-s SQci mg - �yl Ne LJ <br /> 4. List of eqLhrment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> PcC Arc&S sell F rePa t <br /> 3 <br />