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0;/15/2002 02:43 2093397651 LMH MTC SHOP PAGE 04/05 <br /> R E Co El <br /> UST SYSTEM RETROFI�,OR REPAIR OCT 3 1. 2017 <br /> (Submit minimum of 3 sets of plans&applications as originals wilt be retained NbA <br /> V <br /> E D <br /> IONMENTAL HEALTH <br /> 1 Site map enclosed? YES[] NO[] DEPARTMENT <br /> Z Submit copies of ICG 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 lank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> S3 no vac in fault, replaced Veeder-Root 463 sens <br /> ,br like for like. <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval); <br /> (1) Veeder-Root 330020-463 <br /> EM230038(revised 12.11,15) 3 <br />