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06/21/2010 14:18 559688116 FRANZEN HILL PAGE 03107 <br /> From:209 957 3972 Page:Off Date:&10/2010 10:37:20 AM <br /> UST SYSTEM RETROFIT OP. REPAIR <br /> (Suhrrtit minimum of 3 sets of pf®n5&applications as orfgirrals wilt be retained by EHD) <br /> 1. Site neap enolosed? YES e) NO[] <br /> .2. Submit copies Of PCC Service TeOniclan and/or instaiiees oerilEfiosts and all rn8nUr1cbxw training corbflcates for eaCh <br /> per-"h rnotaihng or tesdng any rA that 1s repaired or replaced. Ensure b copy of ®Sid Health and SefaZy <br /> Ptah is avallable on the jobslte as required by 7-rge 3, ,� <br /> 3. Detailed description of worts t©be completed. t,lst oornponents to be re rid or ra <br /> to scale shaving IOCDUOn of repairs and/or I and attach a diaaMM drawn <br /> 90109 plpl^g. UDCs,or other UST equipment, or �erfthcrmingta^kg a u �damodbe hot this will ba dote. (if <br /> pages 4.8 assn for a UMMY plan revs aw). Pgmds, use tMe UST htatagation Appticetion <br /> � i <br /> V IL <br /> 4, List of equipment to be used rnenufacturar s speCiSceflon shits shvwin9 third-party approval): <br /> 2 <br /> This fax was received by GFI FAXmaker fax server. For more information,visit:http.-Ihyww.gfi.com <br />