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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 [ I <br /> 2. Submit copies of ICC Service Technician Land/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 /> Dispenser 3/4 UDC - 91 Product Line Penetration repair- <br /> Remove dispenser 3/4 and remove brine from UDC. Prepare and reinforce 91 Product Line existing <br /> fiberglass penetration with Bravo SWAT repair epoxy. Perform manufacturer recommended test of <br /> UDC interstitial . Reinstall and startup dispenser. Perform any testing required by local agency. <br /> Existing (to be repaired) Bravo Penetration PN : F-22-LL-D <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> Bravo Epoxy Kit PN : EP10ORF <br /> EH230038 (revised 7-26-2016) 3 <br />