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Jun 23 14 04:35a Reliable Petrolpum 2DO8458953 p.21 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&applications as originals will be retained by EHD) <br /> 1. Site map enclosed? YES f] No j ' <br /> 2. Subm t copies of ICC Service Technician and/or 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 Title 8. <br /> 3. Detailed description of work to be completed List components to be repaired or replaced and attach a diagram drawn <br /> to scale shcwing location of repairs andlor replacements. If repairing a component. describe how this*1 be done. (If <br /> adding piping, UDC's, or other UST equipment, or performing tank top upg.,ade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan revieru). <br /> srr a.► <br /> JUN 2 3 2014 <br /> TH <br /> ENVIROC®ARIMENT <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval)- <br /> 3 <br /> �l <br />