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fft <br /> jot <br /> 0A 0 <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 [ I 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 existing 2"x3/4" entry fittings, replace with Bravo split Fiberglass fittings in the 91 / diesel sumps. <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval ) : <br /> 17-17-8&13-BLR-S-RND Split retrofit fittings <br /> F-20-SS-D-BLR-&RND Split retrofit fittings <br /> PIE i i <br /> r ' I V ! . - , <br /> ?A P PA. R T INIT <br /> EH230038 (revised 12-11 -15) 3 <br /> K <br />