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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 V 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 jobsile 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 9s, or other UST equipment, or performing lank lop upgrade, use the UST Installation Application <br /> pages 4 . 8 as necessary for a timely plan review ): <br /> REPLACE (4) OVATION DRESSER WAYNE DISPENSERS WITH (4) NEW OVA7ION -2 DISPENSERS AND VST HANGING HARDWARE, <br /> CONVERT HEALY ASSIST SYSTEM VR-202 TO BALANCE SYSTEMS VR-204 <br /> 4 , Lis ( of equipment to be used (Attach manufacturer's specification sheets showing (hind-party approval ) <br /> DRESSER WAYNE OVATION TWO 8-12 DISPENSERS (3+0) <br /> DRESSER WAYNE OVATION TWO B-23 DISPENSERS (3+ 1 ) <br /> VST EVR HOSE WITH VENTURI <br /> VST G2 BALANCE EVR NOZZLES WITH SRM, BLACK <br /> HUSKY PRESSURE-ACTIVATED DIESEL NOZZLE, GREEN <br /> VST REATTACHABLE BALANCE BREAKWAY <br /> VST VST EVER BALANCE WHIP HOSE <br /> DPW MULTI-PLANE SWIVEL <br /> VEEDERwROOT SOFTWARE UPGRADE KIT <br /> r7sAvv �/V / �i�C.Y f�JCfllSr /Q <br /> 2 <br />