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qST SYSTEM RETROFIT O <br /> k R REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EMD) <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 /> 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 /> t v <br /> iA 6 <br /> c.q ptnd. Annobf_af)w--------------- <br /> r <br /> fcd <br /> I <br /> 4. list of equipment to be used(Attach manufacturers <br /> specification sheets showing third-party approval): <br /> - ]94- �o <br /> 3 <br />