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Dec 0710 02:43p Reliable Petrolel imA 2nQ-845-8953 p.5 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Subrr it minimum of 3 sets of plans&appticafions as originals will be retained by EHD) <br /> 1. Site map enclosed? YES[] NOV <br /> 2. Submit copies of CC Service Technician andlor instailees certificate and all manufacturer training certificates for <br /> each person instz ling or testing any component that is repaired or replaced_ Ensure a copy of the "Site Health <br /> and Safety Plan"i available on the jobsite as required by Title 8. <br /> 3_ Detailed descripti n of work to be completed_ List components to be repaired or replaced and attach a diagram <br /> drawn to scale sh iwing location of repairs and/or replacements- If repairing a component, describe how this will <br /> be done. (If ad n piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br /> Installation Application pages 4-8 as necessary for a timely plan review).- <br /> �1 2a,_b. <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval;: <br /> 3 <br />