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(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) SEP 2 5 201 <br />Site map enclosed? YES [ ] O [ ] IT <br />AL HEALTH <br />Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training c,i 6 _ff T <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 UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for a timely plan review): <br />SEP 2 5 201 <br />EALTH <br />DEPARTMENT <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />&2d <br />3 <br />