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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 /> 1. Site map enclosed? YES[] NO[] <br /> 2. Submit copies oLICC Service Techmcian_and/or Installer's cerfficaie 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_thejobsite 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 addino_piping,_UDC's, or other_UST_equipment,_or performing tank top upgrade, use the UST <br /> Installation Application pages 4-8 as necessaryfor a timely plan review): <br /> _ . <br /> le IOU <br /> Lb <br /> IVLLA <br /> i <br /> it o <br /> d� <br /> 4. List of equipment to be used(Attach manufacturers specification sheets showing third-party approval): <br /> zCJft� 79gQ�-1169 <br /> yah 3 <br />