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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[j NO <br /> 2. Sbmit-eopies of ICC Service Technician and(or.InstajIer:s certificate and all manufactprer7training_ge.rh icates 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'iltle 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 /> ad. ding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST installation Application <br /> pages 48 as necessary for a timely plan review): <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> lELFLILILncT4B-(n <br /> _.------ <br /> A <br /> kpm <br /> (`e�1,l./.':1 1 11 / , 11 ,f r+ �+ A;•, ' �:f . . <br /> , e.1. y <br /> ' I.r ! .'. 1.1 .. _/ I 11 ♦1 ..-' F V1 <br />