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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 W NO I] <br /> 2. Submit copies of ICC Service Technician and/or Installers 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 /> ad in 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 pian review): <br /> REPLACE AND INSTALL NEW FIBRELITE MANWAY FRAMES, MANLIDS, FILL AND VAPOR LIDS, <br /> SKIRTS AND TOP HAT ASSEMBLIES. REMOVE AND REPLACE FILL AND VAPOR BUCKETS WITH <br /> ASSOCIATED SWIVEL, FACE SEAL ADAPTORS, CAPS AND NIPPLES. INSTALL NEW OPW <br /> 71SO-410C OVERFILL VALVES WITH NEW DROP TUBES AND OPW-6111-1400 TANK BOTTOM PROTECTORS. <br /> cal-7 s z-iK-F u-mw ser-rAM P-e' O P6P 4PC <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> FIBRELITE LIDS AND MANWAYS WITH SKIRTS <br /> OPW TANK BOTTOM PROTECTORS <br /> OPW FILL AND VAPOR SPILL BUCKETS P71 1-EVRDV/P71 1 EVRPL <br /> OPW OVERFILL VALVES 71 SO-410C <br /> JACK SCREW SETS 61 JSK-44CP <br />