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E <br />RECOVED <br />1 209 <br />UST SYSTEM RETROFIT OR REPAIR SEP 9 <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) ENVIRONMENTAL HEALTH <br />PERMITISERIACE-5 <br />1. Site map enclosed? YES I I NO [I training certificates for each <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer <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 />and/?r replacements. If repairing a component, describe *w this will be done. (if <br />to scale showing location of repait 8T Installation Application <br />gddiM piping, UDC's, or other U!EK equipment, or performing tank top upgrade, use th <br />pages 4-8 as necessary for a time{ plan review): <br />4. List of equipment to be used <br />9 - 1 - . <br />[9-mmim-OIR -- <br />M <br />manufacturer's specification sheets <br />F-1-1230038 (revised 12-11-15) 3 <br />approval): <br />