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Der, 15 14 01 : 57p Elite Iv Contractors Inc 2094616342 P.6 <br /> RECEIVED <br /> UST SYSTEM RETROFIT OR REPAIR <br /> Submit minimum of 3 gets of ans&applications as ` 2014 <br /> ( I� originals will be retained by EHD) <br /> 1. Site map enclosed? YES [] No ENVIRONMENTAL HEALTH <br /> 2. Submit copies of ICC Service Technician and/or Installers certificate and all manufacturer training certMeates 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 he repaired or replaced and attach a diagram drawn <br /> to scale showing location or repairs andfor replacements. tf repairing a component describe how this will be done. (If <br /> adift piping, UDC's, or other UST equipment, or performing tank lop upgrade, use the UST Installation Application <br /> pages 4qq-8 as necessary for a timely plan review): <br /> _ `ll .; : ��' C'.fl./ 'i%i r (t C �` ''� >Z,�.) i7i'•'lr � a' It ��Y'l.1 <br /> - <br /> a- List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval) <br /> �' K <br /> 35t3'71/-01 <br />