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(Submit minimum of 3 sets of plans & applications as originals will be retainedM"VjTVNMENTAL HEALTH <br />1, Site map enclosed? YES [ ] NO NPERMIT/SERVICES <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training <br />certificates for each person installing or testing any component that is repaired or replaced. Ensure a copy of <br />the "Site Health and Safety Plan" is available on the jobsite as required by Title 8. <br />3. Detailed description of work to be comple#ed. List components to be repaired or replaced and attach a <br />diagram drawn to scale showing location of repairs and/or replacements. If repairing a component, describe <br />how this will be done, (If addin piping, UDC's, or other UST equipment, or performing tank top upgrade, <br />use the UST {nstallation Application pages 4-8 as necessary for a timely plan review): <br />replace drop tubes in each tank with OPW 71 SO Drop Tubes <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />0 P 71S0 -410C <br />5. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />Name <br />Address <br />3of6 <br />YES [ ] NO [ ] <br />Phone L.__._) <br />City Zip <br />