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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 /> I Site map enclosed? YES [I NO DSC <br /> 2. Submit copies of ICC Service Technician andtor 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 repaited or replaced and attach a diagram drawn <br /> to scale showing location of repairs and/or replacements. It repairing a component, describe how this will be done, (N <br /> Widina pong, UDC's, or other UST equipment, or performing tank too upgrade, use the UST Installation Appk"W <br /> pages 4-8 as necessary for a timely pian review): <br /> lD <br /> 3 vtnl/1 Jfi9 dryer/ Iib j¢ory �;'��S lGz <br /> c� 7— T;H f Ts T J k 1 -"'r9E30j�) <br /> 2� <br /> 72 k Call, sr-,44`1- 0o, S b <br /> .5 O � r w ri-+Lt. CiyJ SE it-y}-Q 4 <br /> 4. List of equipment to be used(Attach manufachuefs spedflcetion sheets showing third-party approval) <br /> 3 <br />