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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? YESX 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 UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for a timely plan review): <br />Sin0j,e �� S6ej Dip <br />If, Lb <br />In dvex Sopolq PoYm0 roor'% In 6101nit 6aseime_Alt, 1r%663(1 Mew <br />8n 6e-nea U,% p+ m na `d n J of +r o s in <br />r00l'+r1 L-, <br />pco4l ScCC42kCV C_0-n6')1nW%ew t <br />o- I?jmes arJipl'14. <br />Ins"H Oct.,; <br />We - s nso-f- e Viceckr rooL: PN-* -fq <br />384 2406iaL- <br />lm,J <br />po.r,6 o6- (N) <br />Stice� w elp ( Darn se <br />as 6 dekitoit -a <br />lcaK <br />a� I`Ye- edr�ie� ©DP��'►'�l. R�laCe �� "�iar.a-o��- A+�bo►+ �+,vitc%. <br />err s <br />i *z �isconnec� �t"!14, a�N)/'OA-04" <br />VtCjef Raab TLS -36O LAnk <br />i lLor,n S $ bem <br />Si itck. <br />Jac <br />�0 2+�di h�?n <br />oar �►v) ��'dk Sti�So�'. <br />4. List of equipment to be used (Attach manuf <br />1)ceJur roo Ir - 4 380 - Z<a <br />S. Fi <br />sc(n 40 6(a& s ked d oIna <br />sheets showing third -party approval): <br />c l ea vdve Cao z <br />2 <br />