Laserfiche WebLink
04/0^12013 20'.08 (209)465-4988 Henderson Maintenance Co Page 111 <br /> RECE[V" <br /> UST SYSTEM RETROFIT OR REPAIR APR 0 2 2013 <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by E HEALTH 1RONMENTAL <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 /> ad 0n 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 /> A_ H <br /> S <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> ic- <br /> �.m. r+nu i of r`it Cr- VD Qr1D rlD\A/ f ref'rnn h�ca nallnn nri+h raSt iPnn Ild <br /> 2 <br />