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Jan 14 11 10:02a Reliable Petroleu 204 -845-8953 p.14 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> (Subrr it minimum of 3 sets of plans&aPpfications as originals will be retained;by EHE)) <br /> 1. Site map enclose ? YES[] NO[V� <br /> 2. Submit I" <br /> copies C Service Technicrasn an&Or Insla�r's and all manufacturer training certifrgtes for <br /> each person ins, ling or testing any component that is repaired or . Ensure a copy of the-site Health <br /> and Safety Plan i avertable on the j as requ{red try Tf 8. <br /> 3. Detailed ciescripti of work to be completed. List components to be repaired or replaced and attach a diagram <br /> drawn to scale sh 'ng location of repairs and/or ants. If miring a component, describe how this will <br /> be done. (If ad piping, UiDC's, or ofher UST equipment, or performing tank top upgrade, use the LIST <br /> Installation Appy" tion pages 4-8 as necessary for a timely plan review): <br /> cum. <br /> i <br /> I <br /> 4, list of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> I <br /> 3 <br />