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UST" SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EH©) <br /> 1. Site map enclosed? YES[] NO[] <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 4-8 as necessary for a timely plan review): / <br /> ®�°a�/ �.t / �'?/tet /// . t7�cJ�: �` . /.lam ✓mar :R 't1��J+"s <br /> 149 <br /> a�-p.+e�r, e �'�,t� /Gf�j'�°, ee c� c a�.�c c. e,,;'114 Ale 4/' oe, Z 1 ,4 d9 <br /> f/Cl i.'.rM_J s�'e. � c—, ,�t?i-t � 1��� �? [ �s'�a��� t3� i&M ,OtA"'� <br /> jr !,`� ��°e.. e,!/" /.Zee r.5 d.ej pl.5 <br /> ...�T_ <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> / j <br /> e. I-W-11 X`5 Yam o,&, JZ--3'C <br /> �c�� .1y�/�-b+�" ,�:.5'��_��f�s`c'��Er• -it` f �'•� '.2�.�r�:�:i�s <br /> OXY <br /> 3 <br />