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USTSYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EH®) <br />1, Site map enclosed? YES j I NO nd all maEnsurenaufcopacturer training certificates for each <br />2. Submit copies Of ICC Service Technician and/or Installer's cor rertieficate a y of the 'Site Health and Safety <br />person installing or testing any component that is repaired placed. <br />Plan" is available on the jobsite as required by Title 8, components to be repaired or replaced and attach a diagram drawn <br />3. Detailed description of work to be completed, List corr <br />to scale showing location of repairs and/or replacements. if repairing a component, describe how this will be done. (if <br />gdgLina piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Applicaton <br />pages 4-8 as necessary for a timely plan review): <br />el V_ I-) <br />I <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval)* <br />2 <br />