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0 C L A L "� (4 F <br />VM 0 C- F h, -`i 1B t <br />Ir E -C 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 [ ] <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 LIST equipment, or performing tank top upgrade, use the LIST Installation Application <br />pages 4-8 as necessary for a timely plan review): <br />4-U L E V TL U Z E. S: T_f U s= 6� -r�-E V15 -F -6i42 1`2 <br />C, (z �4A A CC L S: 7 xTz--F <br />V P C. Q_ lk\) <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />E V I'?_ C M P 0 N 2 E rz � 't, IL C S2 1-1 V fi- re be-a_�VEz 203-E <br />U 5 t At t, -t- t -v- P OrPr, a- 'P>Q L ( 9 <br />0 <br />