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11/08/2010 17:40 5307499892 MIDVALLEY CONSULTING PAGE 04 <br /> t <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed? YES[] NO X <br /> 2. Submit copies of ICC Service Technician andlor Installer's certificate and all manufacturer training certificates for <br /> each person installing or besting any component that is repaired or replaced_ Ensure a copy of the 'Site Health <br /> and Safety 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 <br /> drawn to scale showing k calkin of repairs and/or replacements. If repairing a component, describe how this will <br /> be done. (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br /> Installation Application pages 4-8 as necessary for a timely plan review): <br /> - <br /> 1�i0 <br /> _ l J a J/1 ST? S vn„ Ail g cc ft- <br /> D lt_ Yrk2111vr l s%a o �Slr�� 1 i.S {'1 e ' �amq , <br /> 70/36'2 J O <br /> ZJi � 2�p ace `L✓,fybtiu/ sfrsfrL, <br /> � f <br /> a List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval) <br /> 3 <br />