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�j:Ser� G)df b� 13/10 c5B Pd� 2 an i <br /> UST SYSTEM RETROFIT OR REPAIR W e�cr� <br /> ` (Submit a"mum of 3 sets of plans&applimitions as or*Wls will be retained by EHD) <br /> 3, Site reap enclosed? YESY NQ I I ` <br /> ' 2. Submit copies of ICC Service TBdnidan erldlor lrrstaWs cerlifmate and all nrantrfarxurer training cerlificrtes for each � <br /> peraan taslAng or les"any component ttrat Is <br /> Pian"is available an the jobsite as required by'�Tine&�or replaced. Ensure a copy of the"Bile Health and Salary � <br /> 3. t?elaVed desr**on of Work 10 be=rgtelsd. List co+rrpaaerrts b be repaired or replaced and allach a diagram drawn <br /> r.. to scale shawhtg localim of repairs andlor mplecemerft It repaidng a conVonanl,descrthe how this will be done. (if <br /> pV%,UDC's.or other UST equipment,or perk ming tank top upgrede,use the UST installation Application <br /> pages 4-8 as necessary tot aiimely pin review): <br /> �.1 <br /> 6 <br /> is s.,, r,a3�i A".3te P" Pew Deo 4 W. <br /> - � !�• �� tae ANVe t.c3c.,o � <br /> y,cibPe : t� . i! 6e 1W ms's <br /> `" 5 ar�c3r <br /> jr,K, L4.1A wt roe RS rb4 tl2rd <br /> .._ <br /> .'L_Al}be t.J&It Plpe. Tket 1 ....._. i+a_ ertc_t}al~ic►r� c� csb <br /> ltd lr�o ,o ,;.,�1� k 1w11� oo t o& ash.. seca.r�r p��e -b <br /> dace enc? w_t zs a co ndui l in,—__ a• <br /> �.✓ ___-_-- II new �'�e c_. NCu?.CSN3�1p) – InStai1 P)9,<, bi- 4,, Veeki tog t; � -41 <br /> on WEAL- ! t aej rre-I-sL St-VonAr <br /> �� �erp,��r ► , iIs I1•St fhcn an1�1� �� late s}�'� r `� `' <br /> tea <br /> pr„nat ar \mVrchffm 046pa, 411, tmd JAL- cull FRP <br /> 4_ List of equipmenl lobe used~marwfachuees specihcallon streets showing third-party approval). <br /> Wes Urn ..<<g-S-teY. vtPirq _.._(I-'12, <br /> Wry r� to- rC Les �e r <br /> �,. nluRs Juvo3r .evil paM Iec. a61e 6a11 rlalVeS 2 <br /> Sr»dh /C -- — ZA Of {7rPr^ C Vein are <br /> •- �ax�rf �s I~ tuo k tT <br /> Wmew Ewt Ii j 1e2,k -4143YO-Zol <br /> Z <br /> 6- <br /> 6- <br />