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06128:2011 06:24 (209)465-4988 HRAC-Henderson Nlaint Co Page 2!3 <br /> 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[I NOX <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}obsite 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/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 pian review): <br /> 17• Adjust Diesel line hold pressure <br /> 18&45: Replaces gaskets and secure rings. <br /> L - 7 87 /,Vt nt Jc-A2 SEniSa2 t7F_ c1-;'�/+E . <br /> MENS SROQ6So0fplacement <br /> po p`da L Sen <br /> 612812 <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> Gaakets-Pomeco P31 J-G <br /> V1bF_2i�c��- bvk1 F1We, r 14qM�esf v 2 Sevsc/2 <br /> `7443ew- 303 <br /> 2 <br />