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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 /> 7, site map enclosed? YES[I NO D1,, <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates each <br /> person Installing or testing any component that is repaired or replaced. Ensure a copy of the"Site Health d safety <br /> Plan'is available on the Jobsits as required by Tille 8. <br /> 3. Detailed description of work to be completed. List components to be repaired or replaced and attach diagram drawn <br /> to scale showing location of repairs and/or replacements. If repairing a component,describe how a will be dome. (Ii <br /> B ix piping,UDC's,or other VST equipment,or performing tank top upgrade, use the UST taltation Application <br /> pages 48 as necessary for a timely purr review): e <br /> 14 <br /> ~. Remove elephant trunk"secondary flex"and the UDC on the 91-product line . °. <br /> • Remove the primary 91 product flex line <br /> r. Install new primary 91 product flex line <br /> "-. Re-install elephant trunk and tighte lampsixz�%aEIVED <br /> _. Test 91 product line <br /> NOV 14 2017 <br /> ENVIRONMENTAL HEALTH <br /> 4. Ust of equipment to be us (Attech manufacturer's specification sheets showing third-party approval): <br /> � tt t°l `ae t�t�.�•e ' s <br /> AUG 0 9 2417 <br /> EK230039(revised 7-M2028) 3 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />