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r 1.. 0 0 <br />LIST SYSTEM RETROFIT OR REPAIR <br />1, Site map enclosed? YES X NO [ I <br />2. Submit copies of ICC Service Technician and/or Installers 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 />g4diM piping, \D »< 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 />A" I <br />EC) <br />Mon <br />r - I "11J11'V,L <br />,x"1.i;, <br />4. List £>» »»«obe used (Attach manufacturer's specification sheets showing third -party approval): <br />UI <br />kAer Rani *7_T4320 -'-(0R oted&I 10:)&J <br />