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Sep 13 10 11:31a BAGLEY ENT INC 2093675790 p.3 <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 enclosed? . YES V NO [ <br /> 2. Submit copies of ICC 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. (tf <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 /> pLq .�Cti DU13 ig& W A-ybXflc ,JQ_ &&A PROM A-A4 s15NSDAS <br /> 17t 4 1�) Oft + <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> S_i / 'fir st CQ Au SQ L.E ( Z) JC) <br /> ma& 69 <br /> L+A 1- 4.c <br /> 2 <br />