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May 19 10 09:37a Reliable PetroleuM6 209 45-8953 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 [I NO [e <br />2.'/Submft Copies Of ICC Service Technician andtor 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 showing location Of repairs and/or replacements. If repag a component, describe how this will be done. (If <br />9 "din Piping, UDCs, or other LIST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for a timely Plan review): <br />0a <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />----------- <br />2 <br />