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• <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) N <br />1. Site map enclosed? YES [ ] NO pQ z, Qkp�rtavEs <br />V2. 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 />'OLJ W�S�YE. <br />cm co 3*cl f3t.Ge-49trAG %SPS istizS ,) <br />61 AJ STS Two Cad <br />R,Tw T u/444 rr1 Ta G1(-QA4z c o <br />'g,Ls�cJ i cy G 3 -t• o �S^`' S ��� � s -t�CL � �. R��'�Ov Ct; 7^w o <br />(A U C. to <br />��(t�STi�L� �ts�. << t� GtI•QA�.Go �.t��, Ivo S N L f <br />�vu� NPs noISPesUZ. <br />e_.� (N S cA t rt ST A70 o rt �k P� G t v s � c. � 1. S. 0. onI <br />Cr. A,(z. ,g. EXE, Cvnyf- �n2��R v C, • <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />SEE AT`` A C, 4 ED U s T- - Oaf QV TiA w f,- L -.r B r, jp 510o a. <br />Q s ('90-7. <br />V, <br />