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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 D� <br /> 2. Submit copies of ICC T hniciand/or Installer's certificate and all manufacturer training certificates for each <br /> person ins a ling or testing any component that is repaired or replace . nsure a copy of the ee ea and Safety <br /> Plan" is available on the jobsite as required by Title 8. p.-rthz4tF.4 <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 /> Ccro CG24aa46- *__ 4 ib jxse�t, TA?�J K (20 <br /> R f�+�a,•� ¢auLqY P. £. LSkJL r_T4u O�rfs�2 <br /> 1i C_uJ V M L GI L D — 2rOvo lXt,az LE.4WG 0CTWc-rA 2 <br /> 3� 'T Fs�r sy5 t=om QR4m pr-&- opPn� (usfi -r>,,:ao ito <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> qGI Lb —Z04V Lsrif- L,£ T>cryc,mcL_ <br /> 2 <br />