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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 [ ] 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 />150-W jC <br />e�4-I' f V LLScv <br />f <br />�R (AL(Cpv C0 ,r P Toner ®5 > ps at <br />%,tUz_--) but, o 47atk 4 Z_ <br />Le <br /><-,F- C tj -C_ C? Vo ua� -4-6 1 L,"L V-, <br />J' v <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />bAo ID [01 f aAOVL�t f'Jr,- LA 0 L-7/ V-e,,r) I aj� L00A e <br />Flu �, I l D 0 A �—_J c <br />a <br />EH230038 (revised 12-11-15) 3 <br />