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IECEIVED <br />FF -B 0 6 2017 <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />I T L LT <br />Site map enclosed? YES NO [ ] DEPARTMENT <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 />a L <br />g���g�� � �g.'°s"��i !�, iC�'^.4.�-► r.'t`�-�j� �+ ,i7-® �swc , �f� i't'7 �� � � � Vii"' <br />Gam=y�dJ�'� t� �`��11 �°-.✓�� �r� �� r�°Z � �'-�e�"�•�,� ✓°�°�.e�.,� —�'�' <br />EN <br />Em <br />1 <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />.�r t rl <br />EH230038 (revised 7-26-2016) 3 <br />Mar <br />