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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 /> 1 . Break Concrete & Replace 91 Direct- Bury Spill Container . <br /> 2 . Replace 91 drop tube . <br /> 4 . Obtain required CUPA inspections & testing . <br /> 5 . Restore all concrete disturbed for this work . <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval) : <br /> ( 1 ) OPW- 1 C - 3112D 5 - gallon DW spill container . <br /> ( 1 ) OPW-61 SALP - 1020 - EVR OPW 4 " swivel fill adapter <br /> ( 1 ) OPW- 634TT- 7085 - EVR OPW 4 " fill cap <br /> ( 1 ) OPW- 61 JSK-44CB Jack screw kit <br /> ( 1 ) OPW Face Seal Adapter <br /> ( 2 ) OPW 71 SO Drop Tube <br /> EH230038 (revised 7-26-2016) 3 <br />