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Aug 15 13 06:09a Reliable Petroleum 20Q8458953 p2 <br /> (AIA C 'e-A NQS <br /> UST SYSTEM RETROFIT OR REPAIR REC"EIVED <br /> (Submit minimum of 3 sets of pans& applicators as originals will be retained by EHD) <br /> 1. Site map enclosed? YES i] NO AUG 15 2013 <br /> 2 Submit copies of ICC Service Technician andler Installer's certificate and all manufacturer trait rificates for each /�L <br /> person installing or testing any component that is repaired or replaced. Ensure a copy of the`St�jjjtj- itchSafetyNT <br /> Plan" is available on the jobsite as required by Title 8. <br /> 3. Detailed descrip-Jon of work to be completed Lst components to be repaired or replaced and attach a diagram drawn <br /> to scale showing location of repairs and/or replacements. If repairing a component, describe how this will be done. (If <br /> addiria piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Instafation Application <br /> pages 4-8 as,necessary far F F;^rely plan review): <br /> �,� � ^ fes. <br /> 4. List of equipmenz,to be used(Attach manufacturer's spedficaticn sheets showing third-party approval). <br /> 3 <br />