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9255517888 Line 11:f Ia.m. 06-01-2016 51,11 <br /> UST SYSTEM RETROFIT OR REPAIR JUN 0 1 2016 <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> In"'*0ra l,`. <br /> 1. Site map enclosed? YES NO[] `L `-' `"— , <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 B. <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 /> PENETRATION FITTING REPLACEMENT AND SB989 RETEST OF UDC#5-6. <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> ICON SPLIT REPAIR FITTINGS IRF 461AM,IFR 8B2.5M AND IRF1062.5 <br /> 2 <br />