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17 <br />Ll <br />minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />Site map enclos�d? YES [ ] NO <br />Submit copies f ICC Service Technician and/or installer's certificate and all manufacturer training certificates for each <br />person instailin or testing any component that is repaired or replaced. Ensure a copy of the "Site Health and Safety <br />Plan" is availabl on the jobsite as required by Title 8. <br />Detailed description of work to be completed. List components to be repaired or replaced and attach a diagram drawn <br />to scale showin 3 location of repairs and/or replacements. If repairing a component, describe how this will be done. (If <br />adding piping, I JDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as n(cessary for a timely plan review): <br />4-4 RS OAS <br />1901 u EL ODRPD'.t. <br />S;TOCKTON CP <br />;2/22/2016 12.29 PM <br />SUMP LEAK TES' <br />UDC 3-4 <br />TEST STARTED <br />12a ai� <br />,,ST STArR70 <br />12/22/'2016 <br />BEGIN ..EVE_ <br />6.3247 Ih' <br />END TT:Mr <br />12.29 PM <br />END DATE <br />12/22/Z316 <br />;7ND 'LEVE;- <br />6.5245 iN <br />LEAK THRESHOLD <br />0.102 IN <br />TcST RESULT <br />'2ASSED <br />List of equipme6t to be used (Attach manufacturer's specification sheets showing third -party approval): <br />zJr, <br />r i <br />1 <br />