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0 a RECEIVED <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of3sets ofplans Qapplications smoriginals will bmretained byEHC) JUN 1 8 2015 <br />1. Site map enclosed? YES [X NO[]ENVIRONMENTAL <br />HEALTH nFpAQTAfiFmT <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for each <br />person installing ortesting any component that iorepaired orreplaced. Ensure ocopy ofthe "Site Health and Safety <br />Plan" ioavailable onthe jobaitaeorequired byTitle 8. <br />3. Detailed description ofwork tobocompleted. List components toberepaired orreplaced and attach adiagram drawn <br />toscale showing location ofrepairs and/or replacements. |frepairing ecomponent, describe how this will bedone. (|f <br />adding piping. UOC'm. or other LIST equipment, or performing tank top upgnade, use the UST Installation Application <br />pages 4-8eonecessary for etimely plan review): <br />will excavate and reDair as necessary. Will work with Agency Inspector on repairs needed. <br />4. List of equipment to be used (Attach manufacturers specification sheets showing third -party approval): <br />3 <br />