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UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minirfsum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed? YE80 NOM <br /> 2, Submit copies of[CC 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 end:attach a.diagram drawn <br /> to scale showing location of repairs and/or replacements. If repairing a component, describe how this will be done. (1f <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 /> replace direct bury fill bucket on 87 tank;excavation required <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third party approval): <br /> Phil-tite 85101-V <br /> �lUG Rh 201 <br /> ALTH <br /> S <br /> 2 <br />