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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 [ ] 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 /> Install ( 1 ) Single Product DSL Gilbarco 700s Encore dispensers with Bravo conversion frames <br /> at 11 / 120 <br /> Updated to include : <br /> Replace OPW direct bury bucket and drop tube on DSL . <br /> Break concrete . Replace like for like direct bury bucket and drop tube . Test with inspector. Pour concrete . <br /> Test with inspector again if required . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third-party approval) : <br /> Gilbarco Encore 700 <br /> Bravo Conversion frame <br /> OPW 71 SO drop tube <br /> OPW 2100 direct bury bucket <br /> j EH230038 (revised 12- 11 - 15) 3 <br /> i <br /> r <br />