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CQ NAeVi &L <br /> Lo cli C p �� b <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 [ ] NO [ ] <br /> i <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 sump. <br /> LWJ <br /> NnV 8 2019 <br /> ENVIRONMENTL I <br /> Li <br /> APART SENT"-j 10H <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval ) : <br /> F-17-SS-D-BLR-S•RND Split retrofit fittings <br /> i <br /> F-20-SS-D-BLR-SmRND Split retrofit fittings <br /> I <br /> EH230038 (revised 12-11 -15) 3 <br />