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UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed? YES D4 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 />A ovS 0ls ,s+' -S `/z 'A,; , /�G� V)z . /2i.-7,,06 A -t-/)fy�TiL4TI6-1 (i TV '4 <br />� TALL Nfk &_4tlo F, �,�GL�SS` �' �' ,r►Anua Fr rT►�ti&S . p,2,- TF-s"r <br />&Ielc ;Te,". =o , -Tf'F 41,L LA26' Cv STN <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval) <br />r _e - (Ly r (Lo Fr T - S rL,g t /, -Vuf-0 �j y«j:9L, _ T- <br />10 <br />ria A97120 FIT 5 FL4 rAoc-0 % k <br />y - ►' - LCA r-6-rrC it -r - -.5 f14rAyy,L WD 2- y;8 26 L,4s , <br />3 Z -Ttt -T- B® e -Ts <br />