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RECEIVED <br /> UST SYSTEM RuROFIT OR REPAIR <br /> OrT Q- � 7O"7 <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1Site map enclosed? YES [] NO ENVIRONMENTAL HEALTH <br /> DENT <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 o copy of the "Site Health and Safety <br /> Plan" inavailable onthe joboibyoorequired byTitle 8. <br /> 3. Detailed description ofwork tobecompleted. List components buberepaired orreplaced and attach odiagram drawn <br /> boscale showing location ofrepairs and/or replacements. |frepairing ocomponent, describe how this will bedone. (if <br /> adding piping. UDC'o. or other UST equipment, or performing tank top upguada, use the UST Installation Application <br /> pages 4'800necessary for atimely plan review): <br /> Test all eiS|iM due to unsolicited cold St@[f <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> None <br />