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0 0 <br />UST 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? YESX NO [ ] <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 />I WVUX Ex(6r&6 Ptf 11.) V5r n 'dWn-1-14Y t01 5eC_ <br />i74t.L '�i ���U(3A2�o �NCy �do�g U*VJi�Ofiy�(9424ffu 1 v ) <br />n/S GL 10,69 ,5 � V <br />-Y IC INJw_.�i .A aA. -r r7.roAo 0122 ,/ew.. <br />List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />dot 33 V&mr Cy. <br />d3,�o CO�w - Sze�d <br />