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11 <br />1�1 <br />UST SYSTEM RETROFff OR RrEPAR <br />$ubmit minimum of 3 sets of -plans & applications as originals will be retained by EHD) <br />Sic map or,aoi ed? YES NO I <br />Submit copiesY ICC S rvice Technician and/or installer's certificate and all manufacturer training Ceftif*'CateS for each <br />L <br />testing person inst flin or test ng any component that is repaired or replaced. Ensure a copy of the "Site Health and :safety <br />Ple.i" is, availaice on the jobsite as required by Title 8. <br />Det,10ed descrijI xion OT work io be completed. List components to be repaired or replaced and attach a diagrarn �Irawn <br />to scale shovdr�q location of repairs and/or replacements. If repairing a colliponent, describe how this will be done. (if <br />LAogin piping. ADC's, or other UST equipment, or performing tank top upgrade, Use the UST Installation Applin.ation <br />pages 4-8 as n?cessary for a timely plan review), <br />-4, List of, equip; ne0i to be used (Attach manufacturer's specification sheets showing third -party approval): <br />IL <br />2 <br />90/60 39Vd ADO-10NANVI EVST99660Z 90:TT 010Z/V0/T0 <br />'7 <br />7 7 A! <br />-4, List of, equip; ne0i to be used (Attach manufacturer's specification sheets showing third -party approval): <br />IL <br />2 <br />90/60 39Vd ADO-10NANVI EVST99660Z 90:TT 010Z/V0/T0 <br />