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10/28/15 03:44PM BZ Service Station Maintenance 916-572-1050 p.03 <br />A <br />UST SYSTEM RETROFIT OR REPAIR OCT 2 8 2015 <br />(Submit rninimum of 3 sets of plans & applications as originals will be retained by EHO) <br />1, Site map enclosed? YE NO I <br />2. Submit copies of JCC 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 "Sito: Health and Safety <br />Plan" is available on Ole jobsite as required by Title 8, <br />3, Detailed description of work to be completed. List components to W repaired or replaced and attach a diagram drawn <br />to scale showing location of repairs and/or replao.ements. If repairing a component, describe how this will bP done, (if <br />PAding piping. UDC's, or other UST equipment, 61, performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for a timely plan review),. <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval), <br />3 <br />