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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 [ ] NO <br />Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for <br />each person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health <br />and Safety 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,4eplaced and attach a diagram <br />drawn to scale showing location of repairs and/or replacements. If repairing a omponent, describe how this will <br />be done. (If adding piping, UDC's, or other UST equipment, or performi tank top upgrade, use the UST <br />Installation Application pages 4-8 as necessary for a timely plan review): <br />4. List of equipment to be uXed (Attach manufacturer's specification sheets showing third -party approval): <br />`�__ G QA V__ y IV -0 jk3\1(_ <br />