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tff .A a ° - e t . •.4 sr ; '�. + ♦. $ M - . 'ti "a♦ 1 �. i'♦h->f f a <br /> s <br /> LIST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed? YES[] NO[] <br /> 2. Submit copies of ICC Service Technician and/or Installe?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 availableon 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 /> JA <br /> cU 3 1 i <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> Ale ) ONO-U) <br /> L kmK <br /> 3 <br />