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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? YESA 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 /> adding 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 /> ��. k/ Gcuf 4n I Gm4AV4o /aGL wqe.nw7 i `idS Li+f/t/Z <br /> y0 erFG ioo G;W-S S.0%?liG S�a��. :LL Aacil�%f un� <br /> .Orcy /u6Gf a ;/ qnY /Ja� ,o LH a%�'S//Dut i.f f<i•-�vJ <br /> llG4LSGf rza✓vecv eaZ_Zey , Ta CGI ;/L4' a.j /ac.a/err <br /> 4. List of equipment to be used (Attach manufacturer's specification/sheets showing third-party approval): <br /> _�L—�/� er FG 'IOO �.�.tinc✓ty L�e,/J <br /> f <br /> AOIorrif0.-7 <br /> mer✓i.Se•+ /.Jrgf Cie jzjc, //il�.r <br /> r � <br /> 3 <br />