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RECEIVED <br />UST SYSTEM RETROFIT OR REPAIR OCT 2017 <br />(Submitof of plans & applications as originals will be 1 by <br />• • e:• NO HEALTHENVIRONMENTAL <br />2. AWNT <br />Submit fr : ofService Technician and/orinstaller'si,all manufacturer training i <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 Tifle 8. <br />3. Y f description owork•• becompleted.List componentsto berepaired or replaced andattach adiagram drawn <br />to scale showing location of repairs and/or replacements. If repairing a component, describe how this will be done. (if <br />addlog piping, or other UST equipment,or performingtank•r upgraUST de,Installationry r <br />r,;•: for plan review): <br />Test secondary to�deterrnlne location of leaks atentry boot fittings. Remoye and replap <br />EH230038 (revised 12-11-15) 3 <br />f •. i #.: .:f f. F y <br />