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Oct 23 09 06:14a Reliable Petroleum 2095-8953 p.5 <br /> 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 [] NO[q <br /> 2. Submit copies of ICC Service Technician andfor 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 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 /> adding 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 plan review): <br /> ,( yt, 1� I A_r-24,1 Sall A-11 bac <br /> ve Q , - C� <br /> by <br /> Q . <br /> -OY Y✓' lAn (A R l <br /> fe <br /> 4_ List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval). <br /> Q c) <br /> 2 <br />