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lse �23� cog <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of pians&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)obsite 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 /> n 6 6r/re-mour <br /> i s uP 11 Reid ble IJeu) w "Je- <br /> Of <br /> "i bye lldz ' <br /> Swonar <br /> ifr= td W CA Ld i 1 t RS ro4q o r) C L-a&- <br /> lie 081 PtW-. 7km wilt �o e�ca�taan <br /> 01 i11 011 e� 00L ac- j �eCon, br <br /> 1S <br /> cC4::1njer "ill fCYV91n in dace nod ack aS a coy-j <br /> tJet.�: — bye at {�s a �rrn� r ° ' re-ks� serond2►� , <br /> r� t <br /> W 3cc&-c�r r it jesb d'-w1 a�2k a,� F?�P Un� r <br /> lf►ar d ar r n pipice w4s' Aad JoAlf Cial4 FISP <br /> 4. List of equipment to be used(Attach man uf turer's specification sheets showing third-party <br /> ttapproval): <br /> cl-I�Z"d;aer- <br /> WrS L.e5t ;+ <br /> Nay: Jarna r 'fv pe rE lor,"le- LOU l JalVeS 2 <br /> fjwv. 3 <br /> rl H-,xaJ 9A FAC " i n k ma <br /> 4" r12rw IrA MP <br /> rr , I .L- ba <br /> V <br />