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J <br />491 <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 [ ] NOS` <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 />r <br />g`7 --�a Y\ Ckn nW_(ci(' S(?�tCe LJ <br />y?eAEC - E7e,4 ---IrLlZ0 <Crl1 oc% CXtS4 int St?Y1 Sc) <br />I ceLj -ieC►YL�� take ala C ;1 t Ct01 . <br />S-eryWC. .Trl5--AIlyiet',3 SerlS (' % lou` ec 1Y2C1 trn <br />GtVVVAGL( A C (L (e CA V1 CnV-1E'_C-+ e-)(- 1���IM2 Lamr1c] <br />V1C t c �r1e c S v1 S ire y S rte vt <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />K <br />