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UST SYSTEM RETROFIT OR REPAIR O1- <br /> (Submit minimum of3sets oyplans&applications oo originalswiUbanabainadbyEHO) <br /> &��i ���TH <br /> [���\/\����������. . .' � ^_' ,~ <br /> 1. �� map enclosed? YES [l NO [� �����T����T <br /> 2. Submit copiesof |CC8mmiomTeohn\cionand/or |OmtaUerncertifiuotoandeUmmnufocturertrain|ngoertificab»mforeech <br /> person installing ortesting any component that |orepaired orreplaced. Ensure acopy ofthe "Site Health and Safety <br /> Fqen^ ioavailable onthe jobcitaeg required by Title 8. <br /> 3. Detailed description ofwork hobecompleted. List components hoberepaired orreplaced and attach odiagram drawn <br /> toscale showing location ofrepairs and/or replacements. |frepairing acomponent, describe how this will bedone. (|f <br /> adding piping. UOC'o, or other LIST equipnnant, or performing bynh top upgnade, use the LIST Installation Application <br /> pages 4'8aanecessary for mtimely plan n*vevv : <br /> 87 Product replace Phil Tiba Spill bucket. Test spill back and complete paperwork. <br /> 87 Product Replaced mechanical leak detector. Test and completed paperwork. ' <br /> r <br /> �� yz <br /> L� L <br /> 4. List of equipment to be used (Attach manufacturers specification sheets showing third-party approval): <br /> Phil llbaSpill B ohmt <br /> VepodaaoLeak Detector <br /> � <br />