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/ ♦141. Y 1 it • 1 i iM.. Y ♦ .iY iIY ` <br /> 1 <br /> 1 <br /> Y <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[] 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 /> cAcN �) An ns- <br /> 'P�- �t. a an <br /> K, I ) <br /> 3ajcMcn <br /> Aakll uw 8'� :6d Ibm e, <br /> l ; Two e w 1 Q <br /> uS� adh ff)i W j r-U -LC 8 b ua)bn-�pe L • dna <br /> n,wt� 0 NU:5fted 5, X 2 k_1 bat (_�n lci�)K)P ) :5(nfl , <br /> 1 <br /> 7) <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> 5ereg da6ca D102 ) i be WaS`)6ccl Th lead o bo ` 0(A \ 1 <br /> -v(AC1' <br /> Ack,�e i to kf 5)C, x1 < 0 V tin- y1) �i (�AIQZ) <br /> DNUI circa Lx 22 tcb_b_o& U � J i X�� <br /> 2 5iee _ LCcx lw)A� @ mia- A 1@03c- Int -6 <br /> 3 <br />