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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 V] 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 />Remove and rept ac,e T1DC's for dat-P1 l i tP di anenaPra 1 and 2/-;. <br />Note: We don't expect an issue but are prepared to replace lines if necessary <br />to accompolish this. Satellite line 2 being the most likely. <br />114 3 12916 <br />_IC61TLJ nCP6RTV;.7KIT <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />Bravo B8000 Dispenser Sump <br />OPW 1OBFP Emergency Valve <br />OPW DPC-2150A Swivel Coupling <br />OPW DEB -4015A dbl Entry Boot <br />OPW TBA -0150 Test Boot <br />OPW EBF -0751 Conduit Entry Boot Fitting <br />OPW Flexworks C15A Piping (if Required) <br />Flex-ing FF15X18HMXM346 Swivel Connector <br />EH230038 (revised 12-11-15) 3 <br />