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41 <br />I'll OP" <br />LIST 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 />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 />Ag "in piping, UDC's, or other UST equipment or performing tank top upgrade, use the LIST Installation Application <br />pages 4-8 as necessary for a timely plan review) <br />4 List of equipment to be used (Attach manufacturers specification sheets showing third -party approval) <br />0 <br />�i <br />