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Dec 05 11 05:31 p Reliable PetroleumA 209-845-8953 p.5 <br />. <br />1� 0 is <br />UST SYSTEM RETROFIT OR REPAIR <br />(Subm 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 IC Service Technician and/or Installer's certificate and all manufacturer training certificates for each <br />person installing or t sting 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 f work to be completed. List components to be repaired or replaced and attach a diagram drawn <br />to scale showing loc tion of repairs and/or replacements. If repairing a component, describe how this will be done. (if <br />adding piping, UDC' , or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necess ry for a timely plan review): <br />( v 9y3�a-3aa �J u�c 9�ia <br />s o- <br />4. List of equipment to b � Bused (Attach manufacturer's specification sheets showing third -party approval): <br />'Jeer �c c (moi` Jtnso f -7q t -380 —, Po? <br />3 <br />