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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 [ ] <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for each <br />e_5 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 />Ie` g4 -"A Se,S ov s .,11A 4 -e-- <br />i2.-Cio I0 <br />I es�e <br />U <br />t�s-el <br />Rm , Neat, . <br />i I IJi_c[Le+ - L ke- 4 r L /&e, <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />aw <br />QPW) 1-210D—L.,J�L- I (VZ1-- i OILVZ�) S,2 III <br />Cl - <br />2 <br />