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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 [) NOX <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, <br /> describe <br /> e the UST Installation will be <br /> donApple. <br /> (ln <br /> adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br /> pages 4-8 as necessary for a timely plan review): <br /> geplacioa SUSPECT part to determine cause. �FF ATTACHED Memoraodurn for Reco[d, <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> Smart Sensor Module. <br /> Potential replacement parts, <br /> Power supply <br /> Printer <br /> Probe Module <br /> Output Relay Module <br /> 2 <br />