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, t <br /> UST SYSTEMA 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[I NO[) <br /> 2. Submit copies of ICC ServiceTechnician and/orInstallees certificateandall 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 /> qAdlgg 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 /> Go � SIC C; �- (_ 1 <br /> J <br /> Sinn it Un+ 1 FNM2P (OU W61 fe0la(ei all ni ) CYY,5 <br /> ' 4kn kW.Qe 6 W(th act id` J cine 5 ii ckklft>rd Cal l <br /> Tf o :Q1 . IV)Sio_ f: 6NFS if. rc�&WffD ► c .L. (o s►nE oenelrc�+��ns� <br /> 6C 60"D isei AST TNiS M&Fce NEW 5 E IF to6ef, <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> tF LS <br /> r <br /> hay J_ 3l4" >°ICdyI ulTat rc l�n�cn �nsrct� + Pr <br /> �` <br /> 11 sumo hod `�t, elc ,ric1 ►oene «M�n c,n � J �SctJ `' f�lply ccs <br /> - <br /> - bbl CtQJ SUf1�t1 j�S 3 3l� e lcc�yicc>✓t �eanefirr.lhckt�S cin m5��� ��S�C1�J, <br /> r <br /> I <br /> r+ „ <br /> ;. { <br /> rexii. xt r # ,AI rr,yi ;y4 FSI ^+ e xxx xr <br /> x 41: if� kxs 1 x ^ xrr <br /> x.�, ! r x+ Y / t r r + 11 ♦-I x_ .s. xl.�t/r xi', x r 11 / x xt J + + x <br />