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1�5517888 <br />Line 1 10-55:32 09-09-2013 4/12 <br />.... ...... _.­._­.­­ ------ <br />UST_ SYSTEM RETROFIT OR REPAIR - <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />I Site map enclosed? YES [I NO. f� <br />2. Submit copies of ICC Service Technician and/or installers 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 />jd_AijnA piping, UDC's, or other UST equipment, or performing tank top upgrade, use the LIST Installation Application <br />pages 4-8 as necessary for a timely plan review). <br />Replace miro sensori `t. in 97 F!4_ sump. <br />4. List of equipment to be used (Attach manufacturers specification sheets showing third -party approval): <br />V45pookW—j PlUaLo Sensor 794380-3,qq <br />3 <br />