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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'M <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 />J lv) f 1 <br />(Cd o <br />C_n m n i i Ci n ce o +r 4, 0C\ (i SG t n <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />krad cCj O x d1 _ <br />I <br />r <br />r + F yd fr'+°'lr_y."'. i t a * FFi <br />