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UST SYSTEM RETROFIT R 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 /> Remove 87191 spill container replace with new <br /> Remove 87 / 91 drop tubes <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval ): <br /> 2) OPW 1C-2100C-DEVR '.. <br /> 2) 7180 Overfill Prevention Valvs <br /> �) C)N 6u ( O ( d6plar Ur ISAI_ � L)30 - L v12- <br /> EH230038 (revised 12-11 -15) 3 <br />