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*SYSTEM <br />RETROFIT <br />(Submit minimum of 3 sets of pians & applications as originals will be retained by EHD) <br />1. Site map enclosed? YESQ< 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 />K ® t <br />x <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />-0 � �1 S' <br />9 <br />f� <br />R <br />i3 <br />9 <br />f� <br />R <br />3 <br />