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04/29/2015 07:49 209-465-4988 HMC PAGE 01/03 <br /> UST SYSTEM RETROFIT OR REPAIR RECEIVED <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD)APR 2 9 2015 <br /> 1. Site map enclosed? YES[] NOX L <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer tram' <br /> N <br /> I <br /> ' T <br /> person installing or testing any component that is repaired or replaced. Ensure a copy of the" e 661t an Wa <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 /> gg!±M piping, UDC's, or other UST equipment, or performing tank top upgrade, use the LIST Installation Applidation <br /> pages 4-8 as necessary for a timely plan review): <br /> EePla:&37_ffl_huaW(dirgrl buiy)due to -- ---- <br /> 000 (\40 <br /> A <br /> vAb <br /> ,Z(3- <br /> N66. <br /> to <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> 1Q_2100 DEVl3 Rt Direct BuU 1%5 gallan. <br /> 110 <br />