Laserfiche WebLink
UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans & applications as originals will be retained by END) <br /> 1 . Site map enclosed? YESk 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 /> e <br /> (A �t o w dTVV9 +Kyy -s 4V at&i-+-lac I v v1 <br /> ne-A ) o6 -V�0 P+kl"�- 5 <br /> 4 . List of equipment to be used (Attach manufacture's specification sheets showing third-party approval) : <br /> LA or C>1ve) �► � s <br /> 71 SO -410CB vapor-tight overfill valve <br /> 71 SOM412C vapor-tight overfill valve E85 <br /> EF1230030 (fo*ad 12. 11 - 15) 3 <br /> i <br /> i <br /> i <br /> i <br /> t <br />