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UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained byEHD) <br /> 1. Site map enclosed? YES[I NO[j <br /> 2. Submit copies of-{CC 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 /> c ANCIr 6, grin nieYf 0,511 MU,10 ib oxtgirc-L1 ff5tQjl-.'etf Czi 6c W)F,-,.,-J <br /> e 1 l Iniac: <br /> .rV�s�.�ntkd_� tU. bucl[et_ Q!(a1tL�:�Ta -nom v <br /> t nlnrr 1 1 F <br /> 6 4 bu o� <br /> e 5d\i rx� <br /> b X ' nrrnenfi the r X[ �inu ornhr'S flit Iilll che,rrrtrl 1r� u �csi MA <br /> fMOT wilh. c mo Int5 <br /> 1 Z ` <br /> ploinbinqi fW <br /> `� o k <br /> SeiS <br /> carr�s �rsrr, +-ha [e tre�I tt-rl �1nx �t ��� 2 dt�rin <br /> r 0i`;fl n5ex� xt5hnd will fWA Zr1 oct Rem o4ha , excel 21 nt- <br /> 11�(%1ol a�� IfNa1I neu) �Mt- CAD J <br /> N�[E" 1)n tanys ovqrdn 5k,llr(t wm c,GLj ljjqo a (a11 ,d1C5VM3tr n lumbin <br /> �l o � <br /> I Slurcl <br /> (u ll f� cr�vra) rxi5+t�:mnac4•-ycalY� �2 � troll nn� he, rernrlur13 <br /> 4. List of equipment to be used(Attach manufacturers specification sheets showing third-party approval <br /> INCL-IP 9-Wilm VA.pa OL , Y/3PctP, <br /> l+) t ' 2 t�L - DFV 7-hc►lkn �t —' P111 k^t 104'®ip _ <br /> 1 <br /> /,•11 Al ill t r <br /> I ,NI I , �Ia -wN II � ��rc�.x�ll'yr •1• 11 err , , , , .SAS S'+'Y�l" . r, xl <br /> ,•,.. . . .. . . . J , .. � �7V.Ft'I rl .•{. . . ,. . A ,. X41�,. �'41^T.� .N.r.•. . . <br />