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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? 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 />nsia,c l V_eedCK4Zoof isQ <br />n d& si+es maxis-nny-e er_t-_oofi SLS irvttf) ISu _cb�+vyam <br />aM heslft Grp l d <br />i n5jAl i CLPor flow nx; er af- I Lez ej I t x <br />R_CM0v !2j "l>e tadrec bL Senwr at di��en <br />I�Sfi tI <br />VV 1+h V - Awt Visors -( r ayrhye shut- clou.:n <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />► _y�ede� 1200+ 33oitoo-ooq- 5EM Sew Eohax)cemexv u,,:lE <br />q- - V eeder- P -Dot _ 33oo,20_ 5315 Biu lice V si YaTvr Flow Sensor - <br />I 12 -ex dip° re auired <br />