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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 Nl_� <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 snowing 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 /> � 5 e, ' W s'4 u: 4 LAO jft <br /> t�y X <br /> 10 C' a F 6"1 c6Q•l"UAo A BC.ACk- tvC-_ -r © r <br /> L� <br /> Q t e u5ilfrnA) s Wi te- <br /> �,s�-c��, �s-�►w�1Z +.i.3- T�+�s l��+ate ���t,;r�.crc�3rt-ry'� 1'�'ttn1T�� <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> 1 G4-z P G <br /> u DIPS-�* 2►d 7C d <br /> 2 <br />