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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 [ ] N <br />2. Submit copies of ICC Serviice. 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 B. <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 tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for a timely plan -review): <br />A� <br />r <br />4. List of- equipment. to be used (Attach manufacturer's specification sheets showing third -party approval): <br />3 LA <br />2 <br />