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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? YESk 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 /> ReAare_ t✓}CiS�r,c�T (i►•t qjrJl��U Sy 41in <br /> 6,bnk Su-nD and PUWtP raorr, . F-4isbnl �`T'k 6 6e re.noyc <br /> is side SII Aei(Ale p1`pC , Qew A"ain W; 1i b2 J04e Lobo <br /> em-) plpE wiil[ 6e ipalW <br /> t 0 <br /> c1 rein am1bQe W� l Ppe. 71erc w Ii no eKe-avaiiion . <br /> I ; . will v I �� 006 0<9 e r s ' �ec64aL <br /> SeccaNaar wi 11 rer'QP;n iA ace anj ac,k as a Cov-loll bD <br /> ro II nc, POIRC bno �_. <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> )��e5�fn _ � bcSct S Ca� S-jeXpiQi�� I-11zw&eJ—) <br /> 2 <br />