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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 [I NO)( <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer the Heath and certificates r each <br /> person installing or testing any component that is repaired or replaced. Ensure a copy y <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 /> adclinct 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 /> Remaye shear valve top and attampt tolEpair Replace ah ar valve if needed <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> JORMTP-5E5j7 SHEAR TOP REPLACEMENT DOUBLE POPPET OPW Male too 1-1/2' (For shear valve <br /> 10BHMP-5830). <br /> 1OBHMP-5830: SHEAR VALVE OPW Male to 1-1/2' Double Poppet, Pressure Combination Mount. <br /> (Replacement top use 10RMTP-5851) <br /> 2 <br />