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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 <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 /> Q-xy9^a4 F P_ e I (fl sgL� u D e A-. ARMS v rzEm ws sem. ,Ti?: <br /> fLO448L,€591D�_ 3'ySTFM APJa (to4x)b CA-.wry SFy562 , jgSMC 14 <br /> At-TO RE�P�A IF4 NDC S£NSDAL cIWOTA- 9"1L4c,,iry ctnr06TrxV0 <br /> f/vu>z moasT�� s+JL SYSsFM C_KEC44" mx nw SYs +s Ss <br /> sti.1G 0C1Lf4AL, (yycowi t pvo) <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> U.1.r17vSP-5A1-- t`x4D- :y SumP 5g"Sb1e P/N ( TP -aL_s <br /> SNe-D. - r�nNk &IMJ =Utj3j & SY51%^5 <br /> 3 <br />