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• <br /> 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 kf 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 /> lei s'fly'!3 5u,,L4a s�01idy <br /> V-�_, JCX 14,6t 35-2 4ALsc*- <br /> 5u- 011q76__e <br /> Ltilel 51,e SP,/n.S,V_ <br /> 4. Lis.of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> V q S7l�-1-13 sgot0 Sle,-vla✓ <br /> Llt.e� kov fi 2,00 <br /> 5/V fCV 2 E-0 <br /> 0 i•e s.el SIP S Otis e✓ <br /> _ Vze, it Ae/�- Z616 <br /> ,5 Al kD& q'F r- <br /> 2 <br />