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06/2512009 09:14 2099433003 APEC PAGE 02/04 <br /> Cogly)-rT out? idww ana ft.lel am& Woiy av*5 &vol <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 ? YESY NO[) <br /> 2. Submit copies of ICC Service Technician and/or Installers certificate and all manubmturer training ceffoates for eam <br /> person installing or testing any component that Is repaired or replaced. Ensure a copy of the`Stie 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 shovAng location of repairs and/or replacements. if repairing a component desaft how this will be done. (if <br /> addft piping, UDC's, or other UST equipment, or performing tank top upgrade, use tate UST installation <br /> pages 4-8 as necessary for a timely plan ): <br /> 0. <br /> on iQ 6P Me I YAW 15. Tw i� <br /> 17 . c %/ <br /> . u_ ki <br /> 4. Umt of eq*ment to be used 0AAch manufactUrOfts ions s thi <br /> A122�il <br /> 2 <br />