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Jun 24 10 02:50p Reliable PetroleumA 209-845-8953 p.5 <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & appfications as originals will be retained by EHD) <br />1. Site map enclosed? YES [ j NO <br />2. Submit copies of !CC Service Technician and/or Installer's certificate and alt manufacturer trainingcertific ates far each <br />Person installing or testing any component that is repaired or replaced. Ensure a "Site Health and Safety <br />Plan" is avaiiabfe on the jobsite as required by Title 8. copy of the <br />3. Detailed description of work to be completed. List components to be repaired or replaced and attach a <br />to scale showing location of repairs and/or replacements. If repairing a component, describe how this will <br />ad_ dine piping, UDC's, er other UST equipment, or d,agram drawn <br />AL -- <br />Pages 4-8 as necessary fnr a f.,,,,.�.. _,__ performing tank toe unnrartc �...�_ ..,._ . done- (if <br />4. List <br />/of\equipment to be used (Attach manufacturer's specification sheets sh in third- a <br />—J 1 1 i�NDi ®1 n 1 %) /1 /") C-).-\ , n n i1 ,-I ")! g I� rtY approve!}: <br />2 <br />0 <br />