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03/26/2009 THU 7-- 54 FAX 2094683433 SJC EHD 12004/008 <br /> LIST 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 /> 2. Submit copies of[CC 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 tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> o5e, FnkanCj <br /> Joto>cr <br /> LSD Uod)or -5LO&,j wxe-�er CA uen+ <br /> -71— gat ea tj D I i �-�V VCA-rt-V <br /> L <br /> _T 'Zu,^ Low uc4-,K, Clavi lae <br /> 0 (1k)OL)e 6rCUWj ivts ' <br /> rc'j- + Z>� <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approvaly <br /> cadbol"I <br /> CA. <br /> Ll <br /> U57- lkb-n�(2-5 <br /> 2 <br />