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OU I F." nvironmesntal Hoffaltli IAF �`trgrf:tpiC i : f <br /> C . . CI_ 1N -ll. . . - <br /> 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 <br /> certificates for each person installing or testing any component that is repaired or replaced . Ensure a copy of <br /> the " Site Health and Safety 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 <br /> diagram drawn to scale showing location of repairs and/or replacements . If repairing a component, describe <br /> how this will be done . ( If adding piping , UDC ' s , or other UST equipment, or performing tank top upgrade , <br /> use the UST Installation Application pages 4-8 as necessary for a timely plan review) : <br /> 91 Slow Full - Replace Leak Detector Non - like for like <br /> Run 3 . 0 test - Pass <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third-party approval ) : <br /> 1 ) ( 1 ) VMI 99LD2000 <br /> 5 . D`ecb. ntamination Pro dures : <br /> a Oill piping be decon minated pri r to r oval ? ES NO [ <br /> b" Identify cont actor performing de ontami tion : <br /> Name ` s Phe ( <br /> Address _ City Zi <br /> 3 of 6 <br />