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Jan 24 11 09:11a Reliable PetroleumA 209-845-8953 p.5 <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 j NO,, <br /> 2. Submit copies of IC C Service Technician and/or Installer's certificate and all manufacturer training certificates for <br /> each person install g or testing any component that is repaired or replaced. Ensure a copy of the "Site Health <br /> and Safety Plan" is avaflable on the jobsite as required by Title 8. <br /> 3_ Detailed descripdon of work to be completed. List components to be repaired or replaced and attach a diagram <br /> drawn to scale sholving location of repairs and/or replacements. If repairing a component, describe how this will <br /> be done. (If add4Lq piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br /> Installat" Applica ons pages 4-8 as necessary for a timely plan review): 1 <br /> 4. List of equipment tc be used (A ch manufacturer's specification sheets showing third-party approval): <br /> e <br /> 3 <br />