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RECEIVI-,�_'. <br />CA <br />UST SYSTEM RETROFIT OR REPAIR MAY 0 3 2�0 <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD)ENVR01\JMENT,, <br />H EA JIH D F RA RTI <br />1. Site map enclosed? YES [] 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 />Test secondary to determine location of leaks at entW boot fiffings. Rt -move and <br />replace entry boot as needed on #1/2 and #5/6 <br />Diversified products being replaced with Incon products, see below part numbers along with cut sheets <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />IRF TCI -S1.4 <br />ISR 3.5X4.2A <br />IRF TC14.5 <br />SIKAFLEX-1A <br />FASTFUSE <br />EH230038 (revised 12-11-15) 3 <br />