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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 enclosed? YES[] NO[j <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- as neces <br /> sary for a tim an review): <br /> A <br /> - - "' w <br /> 4. List of=equipment:to be used(Attach manufacturer's specific ion sheets.showin third-party approval): <br /> V, <br /> 2 <br /> �`Q,4'� <br />