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W11 <br /> 1,1,-"-24./2 0 14 1 : 01 2095251004 THEUP_;STOPE "k GE IIS <br /> I <br /> RECEIVED <br /> I <br /> UST SY�TEM RETROFIT OR REPAID NOV 2 4 2014 <br /> (Submit minimum of 3 sets iof plans & applications as originals will be retained by EHD) <br /> ENVIRONMENTAL HEALTH <br /> 1- Site map enclosed? YES [I Na [) 0EPA-RTr>,/IEN';'- <br /> 2. Submit copies of ICC Service Technician and/or Installers certificate and all manufacturer training certtticates for each <br /> person installing or testing any compone'nt 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/ r replacements. If repairing a component, describe how this will be done. (if <br /> a din piping, UDC's, or other UST egpment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan!review): <br /> i <br /> i <br /> l <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> i <br /> i <br /> i <br /> I <br /> i <br /> 3 <br />