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L UST SYSTEM RETROFIT OR REPAIR <br /> t (Subunit minimum of 3 sets of pians&applications as originals wiff be retained by EHD) <br /> dEW <br /> L t. SM map enclosed? YESY NO[] <br /> 2. Submit copies of ICC Service Tedrrdcian and/or Installer's certiflcate 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 /> L 1PIie>"is available on the jobsite as required by Title 8. <br /> 3. De#aNed 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 /> gig piping, UDC's,or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary["a timely plan review): <br /> L exis titnael r d� Y SJ tie' -e11 <br /> _ r►� Stkn� an� PI�Wtp_1' i s r'�- P.p ir&.,._6.._6 YP.w► <br /> Iis Singe rule peyo We F!'K IJP R;Pl f%n Will 6e Joz)Je <br /> oTex- e piK 14CA-0 �v� J I�ea eilG'S <br /> Sac`or�R.G. Qin . t,,14►;r,I� W�'I� Rs r~ocgJar� c3Sr P _ <br /> _ _ re o �aoUe to l P'Pe. 7l�crc_ wall _tno eXcaUa born _ <br /> 01 Pi©iAll ..J i tl be po l l td ov 6 0-F- exi s HdQ Ceco�nLy4 <br /> SeQ*-%JACJ/ t ( fr4-U+n AlCe aro arA aS a cc,-debt h> <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing"rdlxuly approval): <br /> L ix)e! !err% 4�bts-nns co- S-lex _ piping C!_I12, <br /> UkS n (o- Ve.)(_ LeSt S'a;t <br /> L <br /> L. 2 <br />