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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 eholosed? YES[] NO M <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 /> Pian"is available on the]obslte as required by Title B. <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 /> addin 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 /> 0 CIL Id !9. <br /> a T TZ�1 \ �. <br /> rN <br /> 1 <br /> 4. List!of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> 1 - z222 kas.vtw <br /> y . r - �_ , <br /> 2 <br />