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Jan 16 13 03:07p Reliable PetroleumA 209-845-8953 p.5 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (St Dmit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclose YES[] NO,[t' <br /> 2. Submit copies of CC Service Technician and/or Installer's certificate and all manufacturer training certificates for each <br /> person installing r testing any component that is repaired or replaced. Ensure a copy of the "Site Health and Safety <br /> Plan"is available n the jobsite as required by Title 8. <br /> 3. Detailed descripti in of work to be completed. List components to be repaired or replaced and attach a diagram drawn <br /> to scale showing cation of repairs andlor replacements. If repairing a component, describe how this will be done. (If <br /> adding piping, U 's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as neci ssary for a timely plan review): <br /> C' cs a t [5 i3 <br /> t� <br /> VN <br /> SS(A r <br /> 4. List of equipment tc be used (Attach manuiacturer's specification sheets showing third-party approval) <br /> rryKJV�C( i <br /> I <br /> 3 <br />