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4REGP.\,fl-- D <br /> UST SYSTEM RETROFIT OR REPAIR <br /> A J <br /> (Submit minimum of 3 sets of plans&applications as original$will be ret&WV*, H <br /> 1. Site map enclosed? YES NOW <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 LIST equipment, or performing tank top upgrade, use the LIST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> Remove existing Gilbarco dispensers, Install new Bravo conversion frames and 4 new Wayne <br /> dispensers model B12 <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> Wayne 3+0 Dispensers(4) <br /> Bravo Conversion Frames(4) <br /> EH230038(revised 12-11-15) 3 <br />