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Jul 25 13 05:22a Reliable PetrolPlim 2POR458953 p,5 <br /> RECEIVED <br /> JUL 2 5 2013 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3sets of plans&applications as originals wil. be retained by E EgALTH DEPARTMENTEAL <br /> I. Site map enclosed? YES[ NO <br /> 2. Submit copies of fCC Service Technician ano;cr Installer's certificate and all manufacturer training certificates for each <br /> person installing or testing 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 Titie 8. <br /> 3 Detailed description of work to be completed. List components to be repaired er replaced and attach a diagram drawn <br /> to scale showing location of repairs andfor replacements. If repairing a component; describe how this will be done. (if <br /> ad--;no piping, UOC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Appli <br /> pages 4-8 as necessary for a timely plan review): cation <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> L <br /> 3 <br />