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08/18x'2010 09:22 2099433003 APEC PAGE 01/01 <br /> 08/18/2010 WED 9:02 PAX 2094r 33 SSC $efl ®001/001 <br /> 7700 bWhe k/-� S7L. S7 <br /> ��X 7��T 3y33 UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of pians&applications as originals will be retained by EHD) <br /> 4. Site map enclosed? YES[] NO/jq <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)obsite as required by Title S. <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 wilt <br /> be done. (If ,ming 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 /> Ra ucinQ L- 125 it 3/`l 1gVu& l&-r 6evise) c tit did Ap f <br /> o VNA0 I A ICA�'w► . <br /> Re�ICar t ng 4 f-Vaf would n/ot <br /> sk i-- dawvA du,rtr►U Fuel Adanm , <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval),, <br /> s®l <br /> L- A Sev\cnr 7Gl13 20 - 30H - <br /> 82 ReAC,4-LA -7 - p <br /> 3 <br />