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& 0 <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 64/ NO*0 <br /> 2. Submit copies of[CC 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 jobalte 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 end/or replacements. If repairing a component, describe how this will be done. (if <br /> Agd_ing 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 /> _znS&II Br4vo rxoW!L� 14 F'of, C <br /> J# <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> Z22 0 <br /> 2 <br /> Z0/Z0 39Vd 71IH >ionl­10 EZ6EE6ET99 ZV:ZT 600Z/LT/V0 <br />