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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 e <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 /> e P I a c e S - I 9'7 P ,;oct u c+ Vic w_t rt1\ <br /> 0330© z_,0 -x(.03 VA 69 033c462-e) r �� <br /> tape- S '3 G I p (-6jetc4 y&tugm see nSor <br /> \U 0 ( - Voe)+ eaG4- n U n't <br /> �-� c t►� lef�-4 to t <br /> 6tLto 414 V1 (-4-c <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> ee j e-f - &c -t- 0 3 3 0 6 Z.c) - L4&3 \'CL-C a LA. Y A S-e n S C c- <br /> e C - (�&4 t) 3 01 6) v - 4� 4 \[C_Gt,tLl t-VA �-e tl S'o<­ � � ���(< 1t <br /> 2 <br />