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RECEIVED <br /> 4 <br /> LIST SYSTEM RETROFIT OR REPAIR <br /> ENV OM""ArP10,At�9pians&applications as originals will be retained by EHD) -H <br /> 1 site map enclo7kff A RTM MIM NO U <br /> ENV1R0Nj,fii-j,,jTJ1L t i' 11 <br /> 2. Submit copies of ICC Service Technician and/or installer's certificate and all manufacturer training 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 andloureplacements. 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 /> Replace all(6)e)dsUnR dispensers,change tank 3 unleaded to diesel,french,install piping from tank 3 <br /> to the front(3)dispens%eUDC's with Smith FiberlassDioina. <br /> 4. List of equipment to be used(Attachan facturer` pe cation sheets showing third-party approval): <br /> . u associated <br /> ss ws a st <br /> Smith 3"fiber thread p and ated el ws and cou [in s. <br /> cl a C*Z�,scoupplrllngs, and termination fittings. <br /> ja� <br /> el <br /> Smith 4"fiberglass red threa secondary plping�wlt7h as ciated elbows <br /> d:#&72 <br /> /7,n,, A% <br /> 3 <br />