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May 12 09 12:40p Elite Iv Contractors Inc 2094616342 p.l <br />(? (DOSr � ' UST SYSTEM RETROFIT OR REPAIR MAY 12 2009 <br />�tU (Submit minimum of 3 sel , of plans & applications 3s originals will be retained bySF,ki Oq <br />QU"V r <br />EN'e/lr�t.J,VAR QUN7Y <br />V� 1. Sitc map enclosed? YDS [ ] NO [ ] HEALTH pL ENTAL <br />V PA21TM t8 <br />2. Submit copies, of ICC Scrvice Technician and/or installer's cortificate and all manufacturer training certificates F each <br />person installing or testing nny 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 repairing a component, describe how this will be done. (If <br />Addi� piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8rss necessary; for a timely plan review): /( j �i � /► <br />;(i(l.r/ ��`.k• il• 'r1!\��1 l.��l:' _x/11/GIGS _L112 <br />lir�-lL. ' <br />�-/,)��y �, L..L+I� T'��/ [..�i�ALJl•L.i. ��i��l% _ <br />)'t <br />4. �List,of equj ment to be used (Attach manufacturer's .- ecification shcots owing third -party approval): jYCf UC <br />�1 _ �, �L.e=:t 11> '�t L'c... °.C.i J �;� �'• _ r 1/- ! , ') 6, <br />H <br />T- <br />y� (% 57fi-r' 4W,-5, 6 ;/<_ .r -u k"a, r.'c �t.c _( <br />jzf <br />�"%_(_�i� %l/Y3 l�'C 7/ _) i --- - -- -- <br />a� t� <br />_ ✓J(;(�'(;� C � ti�_) � '� n;�.�•!4.�.�..r�1 � � ' � 1 � , ���'c� f UD GRJL,� y Z <br />�'7 ?'i' <br />L' <br />2 <br />