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RECoEIVED <br /> a <br /> 2017 <br /> N 0" n 10 <br /> UST SYSTEM RETROFIT OR REPAIR qj, 7-017 <br /> fWt4@W"pplIcatIons as originals will be retained by EH6� <br /> 1. Site map enclosed? r)F-Pk%-WEN'T NO[] ENVjR0NM,�rj^pL HE AUSH <br /> g <br /> gWENT <br /> 2. bmit co les of ICC Service Technician andfor Installer's certificate and all manufacturer training I as for each <br /> co 8 <br /> pe <br /> a n installing or testing any component that Is repaired or replaced. Ensure a copybf the'Site Health and Safety <br /> o <br /> Planavailable <br /> lan avallable on the jobsite as required by Title <br /> 3. Detaital <br /> led cription of work to be completed. List components to be repaired or replaced and attach a diagram drawn <br /> to scale a ng location of repairs ancVor replacements. If repairing a component,describe.how,this will be done. (if <br /> pip <br /> addW piping, C's,or other UST equipment, or pedortning tank top upgrade, use the UST Installation Application <br /> peg"4-8 as necessary for a timely plan review): <br /> Replace all(6)existing dispensers, change tank 3 unleaded to diesel,trench,Install piping from tank 3 <br /> to the ffgnl(3)dispense UD 's vAth Smith FlbeEglass pi <br /> A <br /> Z_ <br /> hI A Jel- <br /> Am cL L L LIN s u�& <br /> e) Aj P—L jok, Q('L I L L Ur4' <br /> 19 xc4uA. r-�r A a.-- <br /> C LZU '&21 "1 1A 71�j <br /> C <br /> 4. List of equlpmente used(Attach manufacturees specification sheets showill'thlrd-party approval): <br /> Smith 3"fiber lass red thread pipe and associated elbows and couplings. <br /> Smith 4"Aberalass red thread secondary Piping with associated elbows,couplings,and rmInation fittings. <br /> tiW <br /> 11000 busd Auh k)&z2j&. <br /> 6E9Z,.L-) .4 a <br /> 3 <br />