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UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & app wmions as originals will be retained by EHD) <br />1 Site map enclosed? YES/ NO [ I <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for <br />each person installing or testing any component that is repaired or replaced Ensure a copy of the "Site Health <br />and Safety 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 <br />drawn to scale showing location of repairs and/or replacements If repairing a component, describe how this will <br />be done. (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br />Installation Application pages 4-8 as necessary for a timely plan review) <br />VL46;01� Sf-9- 4. I>D" �'1�t✓%S <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />r�1EbSE sz-j-r S-Mpw *,b m4wS 4 <br />3 <br />