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MAY-20-2010 06:47 Service Station Systems 408 938 8888 P.02 <br /> 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? YESO NO Q <br /> 2. Submit copies of lCC 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 a. <br /> 3. Detalled 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 Crow this will be done. (If <br /> gdft piping, UDC's, or other UST equipment, or performing tank top upgrade, use the LIST Installation Application <br /> pages.4-8 as necessary for a timely plan review): <br /> installed a OPW 71 SO drop tube on 87 tank <br /> 4. Uist of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> OPW 7150 Overfill Prevention Valve <br /> 2 <br />