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UST SYSTEM RETROFIT OR REPAIR <br />(Submit -minimum -of -3 -sets-of-plans -&-applicationsas-6dginals-will-be-retained-by-EHD) <br />1. Site map enclosed? YES [,3 NO [I <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 />goigg 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 />T-5 Premium Unleaded STP Sump - Remove and replace three (3) non -fiberglass penetrations with* Bravo SWAT <br />3/4" repair penetrations. <br />T-6 Auto Diesel STP Sump - Remove and replace one (1) non -fiberglass penetration with Bravo SWAT 3/4" <br />repair penetration. <br />DEC 0 7 2016 <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />Four (4) 3/4" Bravo SWAT repair penetrations for conduit (BR -F -07 -RETROFIT -S) <br />EH230038 (revised 7-26-2016) 3 <br />