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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 [yj� <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for <br />each person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health <br />and Safety 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 <br />drawn to scale showing location of repairs and/or replacements. If repairing a component, describe how this will <br />be done. (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br />Installation Application/pages 4-8 )as necessary for a timely plan review): <br />U G Cc G Q /A, O <br />V e_ F x I S � �N � L - -T, ��!/ 1t� f r h' Stlyln l kcdu G <br />c�,v <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />l� /' et�Lac f— i L'A�%Q l� a G ��, e1��ac e%fNf ieWvice/� <br />ke, Y -ed C"V ok/l fywal /&Z' <br />3 <br />