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P <br />a ' <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 Installee..s. certificate and allmanufacturertraining 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 16bsite 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 />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />P _f - fcYT' "7qq 390 -42 U <br />