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Dec 08, 10 02:12p Reliable PetroleumA 209-845-8953 p.14 <br /> i - r <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Submd 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 1('.0 Service Technician and/or Installer's certificate and all manufacturer training certificates for <br /> each person instal ng or testing any component that is repaired or replaced. Ensure a copy of the"Site Health <br /> and Safety Plan"is available on the jobsite as required by Title 8. <br /> 3_ Detailed descriptio i of work to be completed_ List components to be repaired or replaced and attach a diagram <br /> drawn to scale shc Ning location of repairs and/or replacements- If repairing a component, describe how this will <br /> be done. (If addi Ig piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br /> Installation Applica ion pages 4-8 as necessary for a timelyan review): <br /> S _ 3 0 bA- Y �Uj <br /> C- PLA CS6 0' <br /> PLO I)-16rLda 'S';�-2 <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party aRproval): <br /> U� E CZ 66-0'rd- <br /> Ua #39-3 3 <br /> 3 <br />