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Oct , 29 14 09: 03a E1 itIV Contactors 12094642 ` ,� ED <br /> UST SYSTEM RETROFIT OR REFS, ►IR OCT 2 9 20,114 <br /> (Submit minimum of 3 sets of plans&applications as originals will ,e retained b�EHI?)[� <br /> t�'`�,I+jLlr~��,;�-NTAL. HEALTH <br /> 1. Site map enclosed? YES[] N(hI L EPA`'I LENT <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all rra ufacturer training certificates for each <br /> person installing or testing any component that is repaired or replaced. Ensue a copy of the "Site Health and Safety <br /> Plan"Is available on the jobsite as required by Title B. <br /> 3. Detailed description of work to be completed. List components to be repaired o replaced and attach a diagram drawn <br /> to scale showing location of repairs and/or replacements. If repairing a compcn nt, describe how this will be done. (If <br /> adding piping, UDC's, or other UST equipment, or performing tank top upgrai+ , use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> 60-t e 17;,LJ d "A l hk) <br /> hlyl7 C • +r <br /> & 1 %t'P(lA1r�t C1 <br /> nK <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showinc third-party approval): <br /> i <br /> VW1 jg LD 26(v) _ <br /> ql octo <br /> 3 <br />