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I � , 0� x;j 0C <br />ok i f) 0 9,5j <br />jdCjj4L4Vq::f� LJOST SYSTEM RETRURT OR REPARM <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />1°fn <br />1 _ Site map enclosed? YES I. i NO-[ <br />2. Submit copies of LCC.Service-T_echniciao andLorJnstailers certificate and all manufacturer training certificates for <br />each -person- installing- or:-testing-an-y-.cornponent-,t,hat 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 />)Cjl Kit f t,(1_r1� <br />A <br />- ")i,{ W) :}boa i ),I VP <br />r � � , � (1 ri � f ` ��rs spe��atlon sh�s shiiv i ird- a approval <br />C4_ Lit o en u e ttach ma u a g p ) <br />fY1 C 1 a 1 (Y1 � 1 n � n�.i -�- �C P cn i V i i <br />T -d <br />i i l V <br />A oCl,,���.t� <br />Z -1:1E9 T 9tl60z T sjogoequo0 AI a4 T T 3 dt'+ : Z T 01 Be 400 <br />2 <br />