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Vis- <br /> fr <br /> UST SYSTEM RETROFIT OR REP <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 man ' . 1Wi1t4ihr 6 erti#6at� 446 1W <br /> person installing or testing any component that is repaired or replaced . Ensure copy of the +, ! jj"jptgorid Safety <br /> Plan" is available on the ] obsite 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 dear diesel overspill container <br /> Replace clear diesel overfill drop tube <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval ): <br /> OPW 1C-2100-DVR <br /> OPW FSA400 04 Face seal adaptor <br /> OPW 61JSK-4410 Jack Screw kit <br /> OPW 7150-410C vapor tight overfill valve <br /> EH230038 (revised 12-11 -15) 3 <br />