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13 1 1.25a JP Petroleum Service <br />0 <br />916-372-4873 p.4 <br />I- <br />ECEIVE <br />UST SYSTEM RETROFIT OR REPAIR �i " 2 6 2013 <br />(Submit minimum of 3 sets of plans & applications as originals will be retained bHDiR®NENTldl <br />ucnoru ncono-reer_Kir <br />1. Site reap enclosed? YES[] ND`K <br />2 <br />3. <br />Submit copies of IGC Service Technician and/or Installer's certificate and all manufacturer training certricates 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 />Detailed description of work to be completed. List components to be repaired or replaced and attach a diagram brawn <br />to scale shoving 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 tate UST Installation Application <br />pages 4-8 as necessary for a timely plan review): ` <br />F7t+i <br />A, ✓t m G ��'� ?J Ct <br />A -U Cf - <br />I2 <br />I2iALr <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />j�rcl z f j-7 <br />tb <br />3 <br />