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UST SYSTEM RETROFIT OR REPAIR MAY Ob 2016 <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHO) <br />1. Site map enclosed? YES (j NO (j <br />tl C•!4 [?r,,, —..�4t V'e't .`.t: <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 />ad . piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br />r <br />4. List of equlpment to be used (Attach manufacturer's specification sheets showing third party approval); <br />J -s . L [ 6-,�,Vk _GOt1j Ii2�i, rJ tsLr�ye )-,4 `Spy <br />3 <br />