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• <br />L:] <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 [ ] NO [4 <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 />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 />�Itt(e- 'V-., e � e i-�'c,-4-7(1'43c0- S'c i t- <br />Gl -�ArI IC lGnV1 1,11 rAC S'pcc( -e ij e t_J <br />V a Q` 4eo,-, .�- -1 "I q 3 0 2, 0 S P h S)o r- <br />670 S -1 n ci S e S o s' S re , iS ( �2 cl 'e, l S -e- <br />& <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />1/� edr r - (roc, _ -7rl V 3610 - k/z ® Se_nl & <br />