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%X/ % GAJ <br /> l � 1 <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 [ ] 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 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 /> addingpiping , 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 /> Remove INCON products, replace with Diversified products <br /> ra { <br /> Y ' <l <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> Split repair boot SR-FB-5 .9X4.9 <br /> Split Inserts SR-IZ <br /> Diversified Bulkhead Fill CWDBF IkWIVIL <br /> EH230038 (revised 12-11 -15) 3 <br />