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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 N 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 /> Tank 2 As-Built <br /> 12-07-18 JCG work order 9258734-Replaced Vaporless MLLD like for like PN: 99 LD-2000 <br /> 01-22-18 JCG work order 9607524- Replaced Vaporless MLLD with new Model PN: 99-LD2000E <br /> 04/07/18 JCG work order 11350862-Replaced Annular sensor like for like with Veeder Root PN: 794380-303 <br /> Tank 3 As-Built <br /> 12-21-18 JCG work order 9258734- Replaced Vaporless MLLD like for like PN: 99 LD-2000 <br /> 01-22-18 JCG work order 9607524- Replaced Vaporless MLLD with new model PN: 99-LD2000E <br /> Tank 4 As-Built <br /> 05-04-18 JCG work order 11549225- Replaced FE Petro leak Detector with Red Jacket LLD PN: FX1 D <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> Veeder Root annular reservoir sensor PN: 794380-303 <br /> Vaporless MLLD PN: 99 LD-2000 <br /> Vaporless MLLD PN: 99-LD2000E <br /> Red Jacket LLD PN: FX1 D <br /> EH230038(revised 7-26-2016) 3 <br />