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UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of pians & 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 far 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 />MVJJM 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): Rdn� ��q{�� 4t � <br />>r <br />—. Remove elephant trunk "secondary flex" under the UDC on the 91 -product line <br />_• Remove the primary 91 product flex line <br />• Install new primary 91 product flex line <br />". Re -install elephant trunk and tighten clamps <br />.. • Test 91 product line <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />Q0 u <br />EH230038 (revised 7-28-2018) <br />k11 <br />AUG () 9 2017 <br />