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;rr9 a3. 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[] <br /> 2. Submit copies of ICC Service Technician and/or Installers certificate and all manufacturer training certificates for <br /> each person installing or testing 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 location 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 /> In tallaticn Application pages 4-8 as necessary for a timely plan review): <br /> d<� <br /> tj, ko rA will -4Z, <br /> I a / 3 1/ <br /> 1 <br /> �U�cy <br /> (5/0 1U S an til M /0-I?z4J xt6Codj,oil c�/�A o �dt� <br /> 1-01a f, C � � ( � 95� Sh �. <br /> X0 11 V <br /> 7/02 10ee�4. List of a uipment to be used(Attach manufacturers specification sheets showing third-party approval): <br /> i -6d IZAAWal &A44-b- 79U396-zid 9 <br /> -4" ✓1�&� <br /> a <br /> "did . u �n <br /> DPS olkl <br /> P/10 50 &Z 71,SO t"W PACUCAAzL. 11al(�G c� lti <br /> 'O w 415 rac& tit 6140 &Z S/< <br /> 001 <br /> ' - 7900Vis--GAJ/ G `vim J� a cmow le��rrta�, <br />