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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{] N0 <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 availableon thejobsite..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 perforrhing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> �OIU e� est 141 r_T dtrec� X11 "�x1� s L <br /> -oc ib" <br /> on <br /> c1� 1 laculu{$ f <br /> (16KA516f) nrdte <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showingthird-party approval): <br /> U 1 <br /> ' l C 216UC; 0E b 5-bgI160 <br /> ,1 f <br /> A <br /> f <br /> WI <br /> ,_ A} IMh is / 11 1 6 f ¢ A 11 �1,. .. t • �f r, 1 1 if <br />