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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 [] NO [ ] <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, 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 />WORAUNIff1 I 1. INT.�� • tl 1 . —1 ! <br />Q <br />ilyfifErAvana M-6 <br />02 M10 <br />►' N 1 "Mom MINI! I 1 1111t! 1♦ III W11 • -[.tM <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />-I U t O t i l es Antll�.kt r a� �Oa1� ,cls p ICZ33JO 4C& 5 t brJ <br />rtop tied on amki c a -t <br />/.. a \ �. • a 1154. ' <br />fir 7 ! 1r <br />' o <br />3 <br />