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UST SYSTEM RETROFIT OR R H11R <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed? YES [ ] NO [I <br />2. Submit copies of ICC Service Technician mris repaired orrreplaced. Ensure aificate and all facturer trainincopy of the Site Health and Safety <br />certificates for each <br />person installing or testing any component that <br />Plan" is available on the jobsite as required by Title 8. <br />be <br />red or replaced and attach a diagram <br />wn <br />3. Detailed description at woof repak to irs and/ored. List components replacements. If repair ng a component, describe how this will be done. (If <br />to scale showing location p use the UST Installation Application <br />addingpiping, UDC's, or other UST equipment, or performing tank top upgrade, <br />nacres 4-8 as necessary for a timely plan review): <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />r1( Q. N ) <br />2 <br />