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UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by END) <br />map enclosed? YES[] NO I <br />2. Submit copies of ICC Service Technician andtor Installees certificate and all manuftwWrer training certificates for each <br />person installing or t6sting any component that is repaired br replaced. Ensure a copy of the wSite Health and Safety <br />Plarf is available on the jobsite as required 1* Title 8. <br />3. De%lled description of work to be completed. . List components to be repaired or replaced and attach a diagr <br />i rarn drawn <br />to scale showing � location of repairs andlor replacements. If repairing •a component, describe how� this will bb�dbne..- (if <br />a4dibg piping, UDC's'. ' or other LIST -equipment, or perforrning tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for a timely plan'review): <br />ENVIRONMENTAL HEALTH <br />4. List of equipment. to be used (Attach manufacturer's specification sheets showing third -party approval): <br />a <br />'1490'-001 Alk <br />................ <br />