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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 B. <br /> & 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. (it <br /> adding piping, UDC's, or other LIST equipment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a dmely plan review): <br /> s ka ra L/0 C'/0,4 eeO C <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval)' <br /> /V/re, A_.-Ac:;e mod 1s <br /> TT/90 39VJ 71IH monl-10 EZ5EE6ET99 90:TT 6002/VT/00 <br />