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EIVED <br /> CE <br /> o l <br /> lt <br /> "4 Uv� <br /> UST SYSTEM RETROFIT OR REPAIR <br /> ENNIftyAg"�ans&applications as originals;will be retained by EHD} <br /> 1 site,ancjo..g�P PARTM�f NO -ir-ALSH <br /> ,0NI,fil�-FU\-L I t- <br /> ENVIR '-" - I <br /> 2. Submit cops es of ICC Service Technician and/or Installers certificate and all manufacturer tralning ;V&6JNnre�' h <br /> person installing or testing any component that Is repaired or replaced. Ensure a copy of the"Site Health and Safety <br /> Plan"Is avallable 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 h a diagram drawn <br /> to scale showing location of repairs and/or replacements. If repairing a component,demscri this will be done. (if <br /> adft piping, UDCs,or other UST equipment or performing tank top upgrade, use the S Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> EMIace all(JIB wdsting dispensers,change tank 3 unleaded to diesel,trench,in II pitpi!22from tank 3 <br /> to JbI front(3)dism"mers <br /> UDC's with SMith Fit@rQ[iW 12Upg. <br /> eAkeuQi <br /> -TILC Li� <br /> Ae 8nLQLCA .L/jv-P— <br /> AJ 'P L I <br /> 7 e;i Lj a <br /> 121E 3,0 5: 46-4� el�zxz' <br /> 4. List of equipment to be Lwisedmanufacturer's speellication <br /> heWets showing third-party approval): <br /> Smith 3"fib erglass red t=polip:and associated elbows a pHng$. <br /> Smith 4"fiber lass red ft�ad secondaix giDina with associated".couplings,and termination fittings. <br /> r IY72— <br /> jz-qd 19101) <br /> 3 <br />