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Dec 07 10 01:48p Reliable Petrol e A 209-845-8953 p.10 <br />1. Site map <br />• • y, 11 <br />.� <br />minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />YES [l NO [V <br />2. Submit copies of C Service Technician angor Instafler's certificate and all manufacturer training certificates for <br />each person in sta ling or testing any component that is repaired or replaced. Ensure a copy of the "Site Health <br />and Safety Plan" . available on the jobsite as required by Title 8. <br />3- Detailed descriptk n of work to be completed. List components to be repaired or replaced and attach a diagram <br />drawn to Seale s wing location of repairs andfor replacements. If repairing a component, describe how this will <br />be done. (If add M piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br />Installation Applica tion,pages. 4-8 as necessary for a timely plan review): <br />4. <br />V MHW <br />010— L�Mj UA� J-je_f C.{ <br />q L`l� 2DZ�c� D �h e 8 t nK,-, <br />List of equipment to <br />VIMMT <br />be used (Attach manufacturer's specification sheets showing third -party approval): <br />gc'CDZCo LA <br />3 <br />