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UST SYSTEM RETROFIT OR REPAIR <br />2 (Submit minimum of 3 sets of plans & applications as originals will be retained by EHD).JUN 0 ZU17 <br />1. Site map enclosed? YES [] NO [1 <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training _.0.dfl,64164ah <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 />Remove existing Gilbarco Advantage dispensers, Install 4 new Gilbarco Encore 700 <br />dispensers. <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br />(4) CONV-B2000 Bravo Conversion Frames <br />(4) Gilbarco Encore 700 Dispensers <br />EH230038 (revised 12-11-15) 3