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Petroleum Service <br />0 <br />.916-372-4873 <br />P-2 <br />• <br />UST SYSTEM RETROFIT OR REVE <br />(Submit minimum of 3 sets of plans & a l- PAIR <br />Site map enclvsed9 <br />Pi, catlons as originals will be retained by EHD) JA ;N � <br />1- <br />YES � ] No Pi, <br />2 2014 <br />2• Submit Capias of ICC Service Technician and/or Installer's Certificate and all�� <br />Person installing <br />or testing any component that is repaired or repia�d Ensure Ccfurer trainin cHEA Ly <br />Plan" is available on tihejobsite as required by Title e 9 � <br />3. Detailed description of work to be com feted, oPY of the "Site Heaith and a,e <br />to scale showing location of repairs and/vr replacements. ]f repairing a component <br />p List components ao be repaired or component, <br />de replaced r and attach a diagrambedo drawn <br />d n piping. UC3t✓'s, or other U51 equipment, or performing tank to u <br />Pages 4-8 as necessary for a timely describe how this +rrili be dpfTe- (1 f <br />Y plan review): P upgrade, use the UST Installation Application <br />-11 <br />MA <br />e <br />rr <br />4. List of ec-iprrent to be user ;A.t;ach manufacturer's s <br />(_ pacification sheets shaving third -party approval): <br />3 <br />