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0 0 <br />I VVI 0 C- F X-1- —S I V <br />VIA P, r 6C A, <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 W NO ( I <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. (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 />sT_A-(, L E V TZ- IJP V_ S:y S T_F_ U!; R 0 0 <br />0 r -L ?0 L t S A SR_ 17C -b <br />(z W\ A Lb T- A_p_-F <br />F_ C> �_:!R c),q r jjostt <br />V �> (, <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />0 EVEL C() 0APOLLSLlzr, C(Zbe-,� 4- vfz-- 20,�� - E <br />u5t,-(c, -t-4p 4 Cfg4_eft - <br />2 <br />