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.. ^ <br /> LIST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3sets of plana&applications as originals will be retained byEHD) <br /> 1. Site map enclosed? YES[] NOK <br /> "n^ <br /> 2. Submit copies ofICC Service Technician and/or Installers certificate and all manufacturer training certificates for each <br /> person installing ortesting any component that ierepaired orreplaced. Ensure acopy ofthe "Site Health and Safety <br /> Plan" ieavailable onthe jobaiteeorequired bvTitle 8. <br /> 3. Detailed description ofwork tobecompleted. List components bzberepaired orreplaced and attach ediagram drawn <br /> toscale showing location ufrepairs and/or replacements. |frepairing acomponent, describe how this will bedone. (|f <br /> adding pipinA. UDC'o. or other LIST equipment, or performing tank top upQmde, use the UST Installation Application <br /> pages 4-8eanecessary for etimely plan review): <br /> F xx r) <br /> z)tr Z014 <br /> ENVIRONM <br /> ' List— equipment_ __ used (Attach_ manufacturer's specification _sheets_6t ���,,.~-~-': <br /> ' ' ~ ''^"^-/�� <br /> IZOM&M 8611EBY ILS- 5Q board <br /> 2 <br />