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Aug ,16 12 12:33p Reliable PetroleurnA 209-845-8953 p,16 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Sub it minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed.. YES[I No <br /> 2. Submit copies of IC C Service Technician and/or Installer's certificate and all manufacturer training certificates for each <br /> person installing or sting any component that is repaired or replaced. Ensure a copy of the"Site Health and Safety <br /> Plan"is available or the jobsfte as required by Title 8. <br /> 3. Detailed descriptior of work to be completed. List components to be repaired or replaced and attach a diagram drawn <br /> to scale showing lo( tion of repairs and/or replacements. If repairing a component, describe how this win be done. (if <br /> adding piping, UDC , or other UST equipment, or pbrfbrming tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necesL ry for a timely plan review}: <br /> cl PL L <br /> -VSAA <br /> J44 9k--t415aP=±U& <br /> 4. List of equipment to 1**used(Attach manufacturer's specification sheets showing third-party approval): <br /> L lL I-) <br /> -7� <br /> '#ci r~�3—2z <br /> 3 <br />