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. . <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of3sets of plans&applications asoriginals will beretained byEHD) <br /> 1. Site map enclosed? YES[] NO�f <br /> 2. Submit copies ofICC Service Technician and/or Installer's certifioateand all manufacturer training certificates for each <br /> person installing mrtesting any component that iarepaired orreplaced. Ensure acopy ofthe "Site Health and Safety <br /> Plan"imavailable onthe]obmihaamrequired byTitle 8. <br /> 3' Detailed description ofwork bobmcompleted. List components 0oberepaired orreplaced and attach adiagram drawn <br /> toscale showing location ofrepairs and/or replacements. |frepairing ecomponent, describe how this will bedone. (|f <br /> adding piping, UDC'o. or other UST equipmant, or performing tank top upgrade. use the UST Installation Application <br /> pages 4-800necessary for otimely plan ruvew): <br /> ak 67 <br /> wi­e� Vf-cpix� Aq'=: &A/Y64"62 12;ZtM Obe_W** <br /> 4. List ofequipment tobeused(Attach manufacturers opeoifioubonsheets showing third-party appnova|): <br /> ff <br /> Em2annoo(revised 7ao-2o1o) 3 | <br />